The christie hospital breast conservation trial: An update at 8 years from inception

Ribeiro, G; Magee, Brian; Swindell, Ric; Harris, Martin; Banerjee, Shiladitya

doi:10.1016/s0936-6555(05)80900-8

Cited by 256 publications

(143 citation statements)

References 11 publications

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“…They compared EBRT PBI with whole breast RT for patients with tumors <4 cm in size. This study demonstrated a greater incidence of recurrence among infiltrating obular histologic type tumors, 34% for PBI vs. 8% for vnole breast RT (25), possibly reflecting the different natirai biologic course between the two histologic types. Two different approaches of EBRT PBI have been reported from William Beaumont Hospital and New York University.…”

Section: Ireast Rt Protocols Used In Analysismentioning

confidence: 68%

“…For tumor control, if we used an alß value of 10 Gy, the typical value for many tumors (25,26), in this calculation, the BED computed for the hypofractionated schedule would be substantially lower than that for the standard treatments. : ^aking into account cell proliferation during course of treatment.…”

Section: Justification Of Radiobiologic Dose and Fractionationmentioning

confidence: 99%

“…25 ' 26 Because of the limited risk ot breast cancer death in this subset of patients, the likelihood that potentially suboptimal radiation therapy would affect survival seemed very small, making it acceptable to conduct trials exploring PBI in this group. Moreover, there is evidence that postoperative radiation therapy has often been omitted for elderly women, especially those with significant comorbid conditions because of concern that they will not be able to complete (for medical or logistical reasons) 6 weeks of daily treatment.…”

Section: Rationale For Patient Selection Criteria For Prone Eb-pbi Pomentioning

confidence: 99%

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Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed after Segmental Mastectomy

Formenti¹

2007

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Section: Ireast Rt Protocols Used In Analysismentioning

confidence: 68%

Section: Justification Of Radiobiologic Dose and Fractionationmentioning

confidence: 99%

Section: Rationale For Patient Selection Criteria For Prone Eb-pbi Pomentioning

confidence: 99%

See 1 more Smart Citation

Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed after Segmental Mastectomy

Formenti¹

2007

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“…However, these are significant differences in the radiotherapy techniques and fractionation schedules used by these two groups, making it difficult to draw quantitative conclusions on the radiation volume effect on breast tissue. The other reported randomised trial from Christie reported higher rates of breast fibrosis and telangiectasia in the PBI arm 39 . A dose-response relationship for late radiation effects including telangiectasia and breast fibrosis is well known 2,69,70 and these dissimilar results may be explainable if one calculates the 2Gy equivalent dose (EQD2) for the PBI and WBI groups using an α/β ratio of 3.1 16 for fibrosis.…”

Section: Qualitative Effect Of Treatment Volumementioning

confidence: 89%

“…A group from The Christie hospital reported in 1993 39 . Their study randomised 708 patients with breast tumours ≤ 4 cm in diameter to PBI or WBI plus regional lymph nodes irradiation.…”

Section: Randomised Controlled Trials Of Partial Breast Irradiation Vmentioning

confidence: 99%

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

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Background Whole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT). Objectives Primary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken. Design Multicentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT. Setting Five radiotherapy departments, participating in IMPORT-HIGH. Participants Two-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH. Interventions There was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images. Main outcome measures Difference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging. Results The primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3 (range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is ...

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Full-Dose Intraoperative Radiotherapy With Electrons During Breast-Conserving Surgery

Veronesi¹,

Gatti²,

Luini

et al. 2003

Arch Surg

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The current standard treatment for early breast cancer includes conservative surgery followed by entire breast radiotherapy (RT). Recent study findings show that most local recurrences are in the scar tissue area suggesting that whole-breast RT may not always be necessary. If the volume of breast tissue to be irradiated is limited, RT may be performed intraoperatively. Intraoperative RT delivered with electrons at the total isodose of 2100 rad (21 Gy) could in principle substitute the currently used radiation course of external RT after breast-conserving surgery in selected cases. Patients and Methods: We report our findings on intraoperative RT using a specially designed mobile linear accelerator delivering 4 energy levels of electrons (3, 5, 7, and 9 MeV) via a head maneuvered by a robot arm. We applied this technique to 237 patients with breast cancer (mean age, 59 years; age range, 33-80 years) with tumors smaller than 2 cm in maximum diameter (T1); most underwent wide resection and an axillary sentinel node biopsy. Results: After a median follow-up of 19 months (range, 7-33 months), the rate of posttreatment complications is very low. Four patients (1.7%) developed breast fibrosis-mild in 3 patients and severe in 1 patient-that resolved in 24 months. Three patients (1.4%) developed ipsilateral breast cancer-2 (1.0%) contralateral breast cancer, 1 (0.5%) supraclavicular node metastasis, and 1 (0.5%) distant metastases. Conclusions: Intraoperative RT with electron beams reduces irradiation to the skin, subcutaneous tissue, and contralateral breast and lung. It appears to be a promising method for irradiating conservatively treated breasts and it avoids the long period of postoperative RT that may not be easily accessible to all patients.

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The christie hospital breast conservation trial: An update at 8 years from inception

Cited by 256 publications

References 11 publications

Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed after Segmental Mastectomy

Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed after Segmental Mastectomy

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Full-Dose Intraoperative Radiotherapy With Electrons During Breast-Conserving Surgery

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