Predictive parameters in hypofractionated whole-breast 3D conformal radiotherapy according to the Ontario Canadian trial

Lazzari, Grazia; Terlizzi, A.; Scarpati, Giuseppina Della Vittoria; Perri, Francesco; Chiara, Vincenzo De; Turi, Barbara; Silvano, Giovanni

doi:10.2147/ott.s127833

Cited by 14 publications

(9 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly as with the CF schedule, high BMI, an increasing PTV volume with a cut off value as small as 500 cm 3 32 , 35 , 42 , and excessive radiation dose in the target volume ( i.e . V107–110 %) contribute to increased acute skin toxicity.…”

Section: Resultsmentioning

confidence: 99%

“…V107–110 %) contribute to increased acute skin toxicity. 17 , 42 When CF was compared to HF, the CF schedule was a predictive factor for increased ≥ G2 toxicity. 17 , 32 , 35 One study reported no differences in acute skin toxicity when HF was compared to CF in similar groups of largebreasted women (volume > 1.500 cm 3 ), BMI > 30, or breast separation > 25 cm.…”

Section: Resultsmentioning

confidence: 99%

“… 7 , 12 , 22 , 24 , 26 , 34 , 37 Clinical reports are confirming the long-term safety and feasibility of moderately hypofractionated schedules also in women with large breasts. 11 , 17 , 32 , 36 , 38 , 42 , 80 , 81 Most of the investigators attributed higher toxicity rates in BC radiotherapy to dose inhomogeneity and a higher percentage of hot spots, irrespective of breast volume. 7 , 12 , 17 , 31 V105–107 % of the prescribed dose (PD) was significantly related to increased desquamation, dermatitis, oedema, and pain 12 ; and V105 % PD 82 , 83 or V110 % PD 83 to long-term breast pain.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Ratoša

Jenko

Oblak

2018

Radiology and Oncology

View full text Add to dashboard Cite

BackgroundBreast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size.ConclusionsInhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Ratoša

Jenko

Oblak

2018

Radiology and Oncology

View full text Add to dashboard Cite

show abstract

“…This differs from a study of dosimetric parameters predictive for toxicity by Lazzari et al, which allowed doses of >110% hot spots using a regimen with a higher total dose (4256 cGy in 16 fractions). 17 Another study of predictors of toxicity during hypofractionation suggested that breast volume does predict for higher toxicity. 18 However, our study shows that, compared with patients treated with conventional radiation therapy, there is less toxicity with hypofractionation for patients with large breasts.…”

Section: Discussionmentioning

confidence: 99%

The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

Butler-Xu

Marietta

Zahra

et al. 2019

Advances in Radiation Oncology

View full text Add to dashboard Cite

Purpose Hypofractionated radiation therapy (HFRT) remains underused, despite multiple randomized trials showing the equivalence of HFRT to conventional fractionated radiation therapy (CFRT). We sought to retrospectively review the relationship between breast volume and toxicity for HFRT versus CFRT. Methods and materials Data from 114 patients who received a diagnosis of early stage breast cancer and were treated with lumpectomy and whole breast radiation alone were reviewed. Breast cancer laterality, stage, grade, estrogen/progesterone receptor and human epidermal growth factor receptor 2 status, and systemic therapy use were recorded. Length of follow-up was calculated using the last day of radiation treatment and the date of the most recent follow-up. Results The median follow-up was 42 months. A total of 83 patients were treated with HFRT and 31 with CFRT. Rates of grade ≥2 skin toxicity were significantly higher in patients undergoing CFRT compared with HFRT (76% vs 28%; P < .0001). In a subset of patients with breast volume ≥1000 cm 3 , grade ≥2 skin toxicity trended higher for CFRT patients (73% vs 38%; P = .057). For posterior separation >25 cm, the percentage of patients with grade 2 skin toxicity was 43% for HFRT versus 57% for CFRT ( P = .67). The volume of breast tissue receiving >105% of the total prescription dose, including boost, was not significantly different for HFRT versus CFRT ( P = .70). Conclusions Use of HFRT resulted in lower acute skin toxicity rates compared with CFRT. Large breast size (volume ≥1000 cm 3 ) was associated with lower acute grade 2 toxicity with the use of HFRT despite achieving similar dosimetry compared with CFRT.

show abstract

“…Age, surgery, stage, tumour grades and molecular subtypes, systemic therapy, and duration of follow-up matched the patients of the study groups as closely as possible. The control group included patients which were previously excluded by hypofractionation due to unfavourable dosimetry as described before [9] . Results were compared and analyzed to assess as a primary endpoint the outcome in local relapse free survival (LRFS) as a function of histological grade and molecular subtypes according to the fractionation arm.…”

Section: Methodsmentioning

confidence: 99%

Tumor grade and molecular subtypes on local control in breast cancer radiotherapy: Does fractionation really matter? A retrospective control study group

Lazzari

Terlizzi

Leo

et al. 2019

Clinical and Translational Radiation Oncology

View full text Add to dashboard Cite

The aim of this current study was to assess whether the tumour grade and molecular subtypes have influenced local control in the whole breast hypofractionated radiotherapy (HRT) over standard radiotherapy (SRT) in early breast node negative cancer patients by a retrospective control group study.Data of 215 patients treated with hypofractionated radiotherapy at our institution from 2008 to 2011 were prospectively collected and then compared with 215 pts treated with SRT in a control group study. The local relapse free survival (LRFS) in both arms was compared on the basis of variables defined by tumour grade (Nottingham Grading System), and Molecular subtypes. Kaplan-Meier method was applied to estimate the LRFS in both groups. Chi-squared and univariate Cox proportional hazards model were conducted for all variables in both groups to assess the impact on local control. Statistical significance was assumed at P < .05. Statistical significant variables at univariate analysis were then included in multivariate Cox proportional hazards model. The median follow up duration was 9.5 years (7–13 yrs); the Kaplan Meyer 8 year LRFS did not reach any statistical significant difference between the two groups (P = . 836). At univariate Cox analysis tumour grade 3 was significantly related to local relapse only in the SRT group (P = .041) while, among molecular subtypes, no differences were found for all groups; for Her2 + noL no difference was found (P = .233). Multivariate analysis confirmed Her2 non-luminal subtype as an independent variable for local relapse regardless the fractionation arm (P = .045). Breast cancer subtypes show a different radiosensitivity, which is independent by fractionation.

show abstract

Predictive parameters in hypofractionated whole-breast 3D conformal radiotherapy according to the Ontario Canadian trial

Cited by 14 publications

References 36 publications

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

Tumor grade and molecular subtypes on local control in breast cancer radiotherapy: Does fractionation really matter? A retrospective control study group

Contact Info

Product

Resources

About