Predictors for Clinical Outcomes After Accelerated Partial Breast Intensity-Modulated Radiotherapy

Reeder, R.; Carter, Dennis L.; Howell, Kathryn; Henkenberns, P.; Tallhamer, Michael; Johnson, Timothy K.; Kercher, Jane M.; Widner, Jodi; Kaske, Terese I.; Paul, Devchand; Sedlacek, Scot; Leonard, Charles E.

doi:10.1016/j.ijrobp.2008.06.1917

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…The lack of relationship between PTV and pain contrasts our prior report [37]. However, the current analysis corroborates the statistically significant relationship between the volume of the chest wall receiving >35 Gy and patient-reported pain as previously discussed (results not shown).…”

Section: Resultssupporting

confidence: 91%

“…This report is an update to previous publications [34–37] and represents the largest cohort and longest follow-up of APBIMRT reported to date. Four-year results continue to demonstrate excellent local control, survival, cosmetic results, and toxicity profile and support the continued use and study of this technique.…”

Section: Discussionmentioning

confidence: 84%

“…Various techniques for APBI delivery have been explored over the past decade, including interstitial (multi-catheter) brachytherapy [10–15], single-entry brachytherapy using intracavitary devices such as MammoSite [16–20], external beam radiotherapy (EBRT) utilizing photons [21–37] or protons [38, 39], and intraoperative radiotherapy (IORT) delivered as a single fraction at the time of definitive surgery [40–43]. EBRT, specifically EBRT utilizing 3-dimensional conformal planning (3D-CRT), has gained popularity due to its noninvasive nature, decreased procedural trauma to the breast, ease of adoption for most radiation treatment facilities, and its suitability for most cases (in terms of tumor location and breast volume) [8, 9, 44].…”

Section: Introductionmentioning

confidence: 99%

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Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT)

Lei

Leonard

Howell

et al. 2013

Breast Cancer Res Treat

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This prospective Phase II single-arm study gathered data on the use of intensity-modulated radiotherapy (IMRT) to deliver accelerated partial breast irradiation (APBI). Four-year efficacy, cosmesis, and toxicity results are presented. Between February 2004 and September 2007, 136 consecutive patients with Stage 0/I breast cancer and negative margins ≥0.2 cm were treated on protocol. Patients received 38.5 Gy in 10 equal fractions delivered twice daily. Breast pain and cosmesis were rated by patient, and cosmesis was additionally evaluated by physician per Radiation Therapy Oncology Group (RTOG) criteria. The National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v3.0) was used to grade toxicities. 136 patients (140 breasts) with median follow-up of 53.1 months (range, 8.9–83.2) were evaluated. Population characteristics included median age of 61.9 years and Tis (13.6 %), T1a (18.6 %), T1b (36.4 %), and T1c (31.4 %). Kaplan–Meier estimates at 4 years: ipsilateral breast tumor recurrence 0.7 %; contralateral breast failure 0 %; distant failure 0.9 %; overall survival 96.8 %; and cancer-specific survival 100 %. At last follow-up, patients and physicians rated cosmesis as excellent/good in 88.2 and 90.5 %, respectively; patients rated breast pain as none/mild in 97.0 %. Other observations included edema (1.4 %), telangiectasia (3.6 %), five cases of grade 1 radiation recall (3.6 %), and two cases of rib fractures (1.4 %). This analysis represents the largest cohort and longest follow-up of APBI utilizing IMRT reported to date. Four-year results continue to demonstrate excellent local control, survival, cosmetic results, and toxicity profile.

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Section: Resultssupporting

confidence: 91%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT)

Lei

Leonard

Howell

et al. 2013

Breast Cancer Res Treat

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“…29,36,37 However, other clinical series of APBI delivered with 3D-CRT or IMRT reported acceptable cosmetic outcomes. 9,[38][39][40][41][42][43][44][45] These conflicting studies raise the hypothesis that subtle variations in planning techniques and/or dose constraints may substantially modify the therapeutic ratio of EBRT-based APBI. [46][47][48] In light of ongoing research, particularly the National Surgical Adjuvant Breast and Bowel Project B-39/RTOG 0413 trial, 5 which has yet to report cosmetic outcomes for patients treated with 3D-CRT APBI, the task force opted not to make a specific recommendation either for or against the use of EBRT-based APBI at this time.…”

Section: Comment On External Beam Apbimentioning

confidence: 99%

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Correa

Harris

Leonardi

et al. 2017

Practical Radiation Oncology

516

342

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“…EB-APBI is non-invasive and offers the advantages of decreased procedural trauma to the breast and relative ease of adoption for most radiation treatment facilities, thus potentially expanding the accessibility of APBI to more patients with prior augmentation mammoplasty. The precision required to optimize dose homogeneity and customize implant-sparing is particularly amenable to manipulation with IMRT (23–25, 31). This updated and expanded data series corroborates and strengthens our previous report that breast-conserving therapy including APBI in general, and EB-APBI in particular, is a viable treatment option for patients with prior breast augmentation.…”

Section: Discussionmentioning

confidence: 99%

External Beam Accelerated Partial Breast Irradiation Yields Favorable Outcomes in Patients with Prior Breast Augmentation

et al. 2014

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Purpose: To report outcomes in breast cancer patients with prior breast augmentation treated with external beam accelerated partial breast irradiation (EB-APBI) utilizing intensity-modulated radiotherapy or 3-dimensional conformal radiotherapy, both with IGRT.Materials and Methods: Sixteen stage 0/1 breast cancer patients with previous elective bilateral augmentation were treated post-lumpectomy on institutional EB-APBI trials (01185132 and 01185145 on clinicaltrials.gov). Patients received 38.5 Gy in 10 fractions over five consecutive days. Breast/chest wall pain and cosmesis were rated by patient; cosmesis was additionally evaluated by physician per RTOG criteria.Results: The median follow-up from accelerated partial breast irradiation (APBI) completion was 23.9 months (range, 1.2–58.6). Little to no change in cosmesis or pain from baseline was reported. Cosmetic outcomes at last follow-up were judged by patients as excellent/good in 81.2% (13/16), and by physicians as excellent/good in 93.8% (15/16). Ten patients (62.5%) reported no breast/chest wall pain, five (31.2%) reported mild pain, and one (6.2%) reported moderate pain. All patients remain disease free at last follow-up. The median ipsilateral breast, planning target volume (PTV), and implant volumes were 614, 57, and 333 cm3. The median ratios of PTV/ipsilateral breast volume (implant excluded) and PTV/total volume (implant included) were 9 and 6%.Conclusion: These 16 breast cancer cases with prior bilateral augmentation treated with EB-APBI demonstrate favorable clinical outcomes. Further exploration of EB-APBI as a treatment option for this patient population is warranted.

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Predictors for Clinical Outcomes After Accelerated Partial Breast Intensity-Modulated Radiotherapy

Cited by 11 publications

References 30 publications

Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT)

Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT)

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

External Beam Accelerated Partial Breast Irradiation Yields Favorable Outcomes in Patients with Prior Breast Augmentation

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