Partial breast irradiation for early breast cancer

Hickey, Brigid E; Lehman, Margot; Francis, Daniel; See, Adrienne M

doi:10.1002/14651858.cd007077.pub3

Cited by 44 publications

(39 citation statements)

References 95 publications

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“…Some studies have reported that breast cancer patients who received APBI report satisfaction with treatment [58] and good cosmetic outcomes [5,22,59], while other studies reported unacceptable cosmetic outcomes following APBI [60,61]. In a systematic review of published and unpublished trials, PBI/APBI was associated with lower likelihood of acute, but not late, skin toxicity compared with WBRT, although cosmetic outcome and local recurrence-free survival appeared to be worse with PBI/APBI in the studies reviewed [15]. …”

Section: Discussionmentioning

confidence: 99%

“…However, a number of systematic reviews reported a lack of evidence about short-term RT side effects and their impact on changes in quality of life (QOL) [11–14]. One review of randomized clinical trials comparing PBI/APBI and conventional or hypo-fractionated WBRT found that no studies reported on the relative effects of PBI/APBI and WBRT on quality of life [15]. …”

Section: Introductionmentioning

confidence: 99%

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Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

Pérez

Schootman

Hall

et al. 2017

Breast Cancer Res Treat

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Purpose Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type. Methods We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤ 3.0 cm and lymph-node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 “not at all” to 5 “all the time”) and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors. Results Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up. Conclusions Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

Pérez

Schootman

Hall

et al. 2017

Breast Cancer Res Treat

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“…The results of these clinical trials demonstrated diverging outcomes related to local recurrence rates, while establishing comparable similar survival outcomes for APBI and WBI . A systematic review and a meta‐analysis assessed the effectiveness and outcomes of APBI compared to WBI in early‐stage breast cancer, confirming that APBI was associated with a small but statistically significant increase in local recurrence rates …”

Section: Discussionmentioning

confidence: 77%

“…The authors found that local recurrences and new primary ipsilateral tumors were more common with APBI, without differences in survival. Due to the limitations of the included data, the authors did not make any definite conclusions about the safety and efficacy of APBI …”

Section: Clinical Evidence For Apbimentioning

confidence: 99%

“…APBI compared to WBI in early-stage breast cancer, confirming that APBI was associated with a small but statistically significant increase in local recurrence rates. 13,14 Available data clearly demonstrates the importance of patient selection for APBI. The TARGIT-A 19 and ELIOT trials 7 using intraoperative radiotherapy APBI with low-energy photons and electrons respectively, obtained local relapse rates that were statistically significant higher after APBI, likely because of the inclusion of a number of patients with high-risk breast cancer features.…”

Section: Niquesmentioning

confidence: 99%

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Accelerated partial breast irradiation: Current status with a focus on clinical practice

et al. 2019

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Accelerated partial breast irradiation (APBI), a radiation technique in which only the tumor bed is treated, has now become an acceptable radiation modality for selected early‐stage breast cancer patients. Compared to conventional whole breast irradiation (WBI), APBI has some benefits with regard to the reduced total irradiated breast volume and the shorter treatment time. The role of APBI, which can be delivered using diverse techniques, has been evaluated in several prospective randomized phase III trials. These clinical trials demonstrate diverging outcomes relating to local recurrence, while establishing comparable effect in terms of survival between APBI with WBI. The aim of this study was to review the current status of APBI with a focus on clinical practice.

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Hypofractionated Nodal Irradiation for Breast Cancer

2019

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Hypofractionation for breast cancer radiotherapy is attracting considerable attention. 1 Compared with conventional therapy, hypofractionation delivers a full course of treatment in fewer sessions, which may improve patient convenience and reduce treatment costs. There is a growing trend to extend the therapy's indication to regional nodal irradiation (RNI). The question is whether this is wise. We assessed meta-analyses of breast cancer radiotherapy and have found cause for caution in extending the use of hypofractionation to RNI until data from prospective clinical trials become available. Data needed to improve decision making for extending hypofractionation use may include short-and longterm data on the repercussions of this therapy for lung and heart function and noncancer morbidity/mortality.As a historical background, we considered earlier randomized clinical trials (RCTs) that compared adjuvant radiotherapy vs no radiotherapy after surgery. A meta-analysis reviewed 41 trials and pooled a population of 20 310 patients with a 20-year follow-up. 2 Even though fractionation was not the explicit focus of these trials, it was a known issue. Several salient points bearing on the choice of a fractionation schedule became apparent in the meta-analysis: (1) radiation provides a large reduction in recurrences and breast cancer mortality but at the cost of excess noncancer mortality, resulting in only a small improvement in overall survival (OS) 2 ; (2) radiation in trials prior to the 1970s and in small trials was found to be detrimental to OS; (3) an OS benefit was observed in more recent trials with longer follow-up, attributable to modern radiation techniques that avoid late lethal toxicity; (4) improved OS in postmastectomy trials was almost entirely due to trials using a "safe fractionation" of 1.8 to 2.5 Gy per fraction at 5 times per week (dose intensity of 9.0-13.3 Gy per week) for a total dose of 45 to 54 Gy; (5) all breast-conserving surgery, adjuvant radiation trials applied the same "safe fractionation" method; (6) the boost dose ranged from 0 to 30 Gy; and (7) non-breast cancer mortality increased significantly in postmastectomy trials with inadequate or excessive dose and in trials with inappropriate target volume.More recently, fractionation schedules have been the explicit focus of later RCTs. These trials were reviewed in a Cochrane systematic review that pooled 8228 women from 9 studies. 3 The pooled mean follow-up was 8.8 years. Most experimental schedules were in the range of safe fractionation: 42.

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Partial breast irradiation for early breast cancer

Cited by 44 publications

References 95 publications

Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

Accelerated partial breast irradiation: Current status with a focus on clinical practice

Hypofractionated Nodal Irradiation for Breast Cancer

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