Redefining radiotherapy for early-stage breast cancer with single dose ablative treatment: a study protocol

Charaghvandi, R.; Asselen, Bram van; Philippens, M.; Verkooijen, Helena M.; Gils, Carla H. van; Diest, Paul J. van; Pijnappel, Ruud M.; Hobbelink, Monique G.G.; Witkamp, Arjen J.; Dalen, Thijs van; Wall, Elsken van der; Heijst, T. C. van; Koelemij, R.; Vulpen, Marco van; Bongard, H. J. G. D. van den

doi:10.1186/s12885-017-3144-5

Cited by 35 publications

(26 citation statements)

References 47 publications

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“…At Utrecht University Medical Center, Utrecht, The Netherlands, a study on the feasibility of preoperative single dose ablative radiotherapy in the supine position has recently been completed (≥50 years of age with cT 1-2(max 3.0cm) N 0 non-lobular carcinoma), delivering 20 Gy to the tumor and 15 Gy to the clinical target volume. Details on these studies have been previously published [13] , [15] , [16] , [24] .…”

Section: Methodsmentioning

confidence: 99%

“…The maximum amount of segments in the treatment planning software was set at 100. Dose prescription, coverage requirements and organ at risk (OAR) constraints were utilized as currently employed in the Dutch study for single dose APBI in the supine position [15] . The rationale for this possibly ablative treatment approach, prescribed dose and development of the organs at risk constraints have been previously described [15] .…”

Section: Methodsmentioning

confidence: 99%

“…Dose prescription, coverage requirements and organ at risk (OAR) constraints were utilized as currently employed in the Dutch study for single dose APBI in the supine position [15] . The rationale for this possibly ablative treatment approach, prescribed dose and development of the organs at risk constraints have been previously described [15] . An integrated boost was utilized, with 20 Gy delivered to the GTV and 15 Gy delivered to the CTV, since this is also the intended prescription dose for future MRI-linac treatments.…”

Section: Methodsmentioning

confidence: 99%

“…Adequate coverage was defined as at least 99% of the PTV GTV/CTV receiving at least 95% of the prescribed dose to the GTV or CTV, respectively. The employed OAR constraints were a D mean < 3.6 Gy to the ipsilateral lung, a V 2.8Gy < 10% and V 4.7Gy < 5% to the heart, a D 20cc < 16.3 Gy to the chest wall, and a D 1cc < 12 Gy to the skin or a D 1cc < 16 Gy if the CTV aligned the skin [15] . Dose to the ipsilateral and contralateral breast was kept as low as possible.…”

Section: Methodsmentioning

confidence: 99%

“…MR-guided CT-linac based single dose APBI delivered preoperatively in the prone treatment position has recently been evaluated as feasible for low-risk non-lobular carcinoma or ductal carcinoma in situ (DCIS) [13] . Furthermore, an MR-guided supine preoperative approach has also been shown to be dosimetrically feasible and is currently under clinical investigation with promising preliminary results [14] , [15] . This single dose preoperative RT delivery results in a burden minimizing treatment for patients, and opens a new window of opportunity to evaluate a radiosurgical approach for breast cancer patients [15] , [16] , [17] .…”

Section: Introductionmentioning

confidence: 99%

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Single dose partial breast irradiation using an MRI linear accelerator in the supine and prone treatment position

Charaghvandi

Westeinde

Yoo

et al. 2019

Clinical and Translational Radiation Oncology

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Single dose partial breast irradiation using an MRI linear accelerator in the supine and prone treatment position

Charaghvandi

Westeinde

Yoo

et al. 2019

Clinical and Translational Radiation Oncology

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Hyperbaric Oxygen Therapy and Late Local Toxic Effects in Patients With Irradiated Breast Cancer

Mink van der Molen,

Batenburg,

Maarse

et al. 2024

JAMA Oncol

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ImportanceHyperbaric oxygen therapy (HBOT) is proposed as treatment for late local toxic effects after breast irradiation. Strong evidence of effectiveness is lacking.ObjectiveTo assess effectiveness of HBOT for late local toxic effects in women who received adjuvant radiotherapy for breast cancer.Design, Setting, and ParticipantsThis was a hospital-based, pragmatic, 2-arm, randomized clinical trial nested within the prospective UMBRELLA cohort following the trials within cohorts design in the Netherlands. Participants included 189 women with patient-reported moderate or severe breast, chest wall, and/or shoulder pain in combination with mild, moderate, or severe edema, fibrosis, or movement restriction 12 months or longer after breast irradiation. Data analysis was performed from May to September 2023.InterventionReceipt of 30 to 40 HBOT sessions over a period of 6 to 8 consecutive weeks.Main Outcomes and MeasuresBreast, chest wall, and/or shoulder pain 6 months postrandomization measured by the European Organization for Research and Treatment of Cancer QLQ-BR23 questionnaire. Secondary end points were patient-reported fibrosis, edema, movement restriction, and overall quality of life. Data were analyzed according to intention-to-treat (ITT) and complier average causal effect (CACE) principles.ResultsBetween November 2019 and August 2022, 125 women (median [range] age at randomization, 56 [37-85] years) with late local toxic effects were offered to undergo HBOT (intervention arm), and 61 women (median [range] age at randomization, 60 [36-80] years) were randomized to the control arm. Of those offered HBOT, 31 (25%) accepted and completed treatment. The most common reason for not accepting HBOT was high treatment intensity. In ITT, moderate or severe pain at follow-up was reported by 58 of 115 women (50%) in the intervention arm and 32 of 52 women (62%) in the control arm (odds ratio [OR], 0.63; 95% CI, 0.32-1.23; P = .18). In CACE, the proportion of women reporting moderate or severe pain at follow-up was 32% (10 of 31) among those completing HBOT and 75% (9.7 of 12.9) among control participants expected to complete HBOT if offered (adjusted OR, 0.34; 95% CI, 0.15-0.80; P = .01). In ITT, moderate or severe fibrosis was reported by 35 of 107 (33%) in the intervention arm and 25 of 49 (51%) in the control arm (OR, 0.36; 95% CI, 0.15-0.81; P = .02). There were no significant differences in breast edema, movement restriction, and quality of life between groups in ITT and CACE.Conclusions and RelevanceIn this randomized clinical trial, offering HBOT to women with late local toxic effects was not effective for reducing pain, but was effective for reducing fibrosis. In the subgroup of women who completed HBOT, a significant reduction in pain and fibrosis was observed. A smaller than anticipated proportion of women with late local toxic effects was prepared to undergo HBOT.Trial RegistrationClinicalTrials.gov Identifier: NCT04193722

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Multi‐parametric MRI (mpMRI) for treatment response assessment of radiation therapy

Wang

Padgett

et al. 2021

Medical Physics

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Magnetic resonance imaging (MRI) plays an important role in the modern radiation therapy (RT) workflow. In comparison with computed tomography (CT) imaging, which is the dominant imaging modality in RT, MRI possesses excellent soft‐tissue contrast for radiographic evaluation. Based on quantitative models, MRI can be used to assess tissue functional and physiological information. With the developments of scanner design, acquisition strategy, advanced data analysis, and modeling, multiparametric MRI (mpMRI), a combination of morphologic and functional imaging modalities, has been increasingly adopted for disease detection, localization, and characterization. Integration of mpMRI techniques into RT enriches the opportunities to individualize RT. In particular, RT response assessment using mpMRI allows for accurate characterization of both tissue anatomical and biochemical changes to support decision‐making in monotherapy of radiation treatment and/or systematic cancer management. In recent years, accumulating evidence have, indeed, demonstrated the potentials of mpMRI in RT response assessment regarding patient stratification, trial benchmarking, early treatment intervention, and outcome modeling. Clinical application of mpMRI for treatment response assessment in routine radiation oncology workflow, however, is more complex than implementing an additional imaging protocol; mpMRI requires additional focus on optimal study design, practice standardization, and unified statistical reporting strategy to realize its full potential in the context of RT. In this article, the mpMRI theories, including image mechanism, protocol design, and data analysis, will be reviewed with a focus on the radiation oncology field. Representative works will be discussed to demonstrate how mpMRI can be used for RT response assessment. Additionally, issues and limits of current works, as well as challenges and potential future research directions, will also be discussed.

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Redefining radiotherapy for early-stage breast cancer with single dose ablative treatment: a study protocol

Cited by 35 publications

References 47 publications

Single dose partial breast irradiation using an MRI linear accelerator in the supine and prone treatment position

Single dose partial breast irradiation using an MRI linear accelerator in the supine and prone treatment position

Hyperbaric Oxygen Therapy and Late Local Toxic Effects in Patients With Irradiated Breast Cancer

Multi‐parametric MRI (mpMRI) for treatment response assessment of radiation therapy

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