Time factors in breast carcinoma: influence of delay between external irradiation and brachytherapy

Dubray, Bernard; Mazeron, J. J.; Simon, J.-M.; Péchoux, C. Le; Calitchi, E.; Otmezguine, Y.; Bourgeois, J. P. Le; Pierquin, B

doi:10.1016/0167-8140(92)90246-q

Cited by 27 publications

(6 citation statements)

References 19 publications

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“…Clinical studies indicate that repopulation effects can impact on treatment outcome. A higher risk of recurrence has been reported in several studies (Clarke et al 1985, Dubray et al 1992, Van Limbergen et al 1990 when the treatment time is increased. Clarke et al (1985) found a significant increase in the relative risk (RR) of local recurrence when the interval between the excisional biopsy and the initiation of RT was larger than 7 weeks.…”

Section: Derivation Of a Plausible Lq Parameter Setmentioning

confidence: 87%

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Guerrero

2003

Phys. Med. Biol.

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Numerous studies of early-stage breast cancer treated with breast conserving surgery (BCS) and radiotherapy (RT) have been published in recent years. Both external beam radiotherapy (EBRT) and/or brachytherapy (BT) with different fractionation schemes are currently used. The present RT practice is largely based on empirical experience and it lacks a reliable modelling tool to compare different RT modalities or to design new treatment strategies. The purpose of this work is to derive a plausible set of radiobiological parameters that can be used for RT treatment planning. The derivation is based on existing clinical data and is consistent with the analysis of a large number of published clinical studies on early-stage breast cancer. A large number of published clinical studies on the treatment of early breast cancer with BCS plus RT (including whole breast EBRT with or without a boost to the tumour bed, whole breast EBRT alone, brachytherapy alone) and RT alone are compiled and analysed. The linear quadratic (LQ) model is used in the analysis. Three of these clinical studies are selected to derive a plausible set of LQ parameters. The potential doubling time is set a priori in the derivation according to in vitro measurements from the literature. The impact of considering lower or higher T(pot) is investigated. The effects of inhomogeneous dose distributions are considered using clinically representative dose volume histograms. The derived LQ parameters are used to compare a large number of clinical studies using different regimes (e.g., RT modality and/or different fractionation schemes with different prescribed dose) in order to validate their applicability. The values of the equivalent uniform dose (EUD) and biologically effective dose (BED) are used as a common metric to compare the biological effectiveness of each treatment regime. We have obtained a plausible set of radiobiological parameters for breast cancer: alpha = 0.3 Gy(-1), alpha/beta = 10 Gy and sub-lethal damage repair time T(rep) = 1 h (mono-exponential behaviour is assumed). This set of parameters is consistent with in vitro experiments and with previously reported analyses. Using this set of parameters, we have found that most of the studies, using BCS plus whole breast RT and a boost to the tumour bed, have EUDs ranging from 60-70 Gy. No correlation is found between BED and the local recurrence rate. The treatments of BCS plus brachytherapy alone have a wide range of EUD (30-50 Gy), which is significantly lower than the treatments with whole breast EBRT plus a boost of the tumour bed. The studies with different fractionation schemes for whole breast EBRT also show a significant variation of EUD. Carefully designed clinical studies with large numbers of patients are required to determine clinically the relative effectiveness of these treatment variations. The derived LQ parameter set based on clinical data is consistent with in vitro experiments and previous studies. As demonstrated in the present work, these radiobiological parameters can be pot...

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Section: Derivation Of a Plausible Lq Parameter Setmentioning

confidence: 87%

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Guerrero

2003

Phys. Med. Biol.

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“…Several series support the use of LRR alone in the management of breast c ancer and have shown good locoregional control with local control rates of about 80% at 5 years [46-55]. For example, Dubray et al reported local control rates of 86% and 74% at 5 and 10 years respectively, in 398 (33 T1, 309 T2, 56 T3) breast cancer patients treated conservatively at Hôpital Henri Mondor (France) by an initial course of external irradiation (45 Gy, 25 fractions, 5 weeks) followed by interstitial iridium-192 implant for a further 37 Gy to the tumor [46].…”

Section: Discussionmentioning

confidence: 99%

“…For example, Dubray et al reported local control rates of 86% and 74% at 5 and 10 years respectively, in 398 (33 T1, 309 T2, 56 T3) breast cancer patients treated conservatively at Hôpital Henri Mondor (France) by an initial course of external irradiation (45 Gy, 25 fractions, 5 weeks) followed by interstitial iridium-192 implant for a further 37 Gy to the tumor [46]. We recently studied the impact of LRT, consisting mainly of exclusive LRR, on the survival of breast cancer patients with synchronous metastases treated between January 1984 and December 2004 at Rene Huguenin Cancer Center, Saint Cloud, France [14].…”

Section: Discussionmentioning

confidence: 99%

Exclusive and adjuvant radiotherapy in breast cancer patients with synchronous metastases

2010

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BackgroundData from the Surveillance, Epidemiology, and End Results program and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project indicate that about 6% of women newly diagnosed with breast cancer have stage IV disease, representing about 12 600 new cases per year in the United States in 2005. Historically, local therapy of the primary tumor in this setting has been aimed solely at symptom palliation. However, several studies suggest that surgical excision of the primary tumor can prolong these patients' survival.DiscussionExclusive locoregional radiotherapy is an alternative form of locoregional treatment in this setting and may represent an effective alternative to surgery in this setting. Here we discuss current issues regarding exclusive and adjuvant locoregional radiotherapy in breast cancer patients with synchronous metastases.SummarySeveral studies suggest that surgery or exclusive irradiation of the primary tumor is associated with better survival in breast cancer patients with synchronous metastases and that exclusive locoregional radiotherapy may represent an effective alternative to surgery in this setting. Results of well-designed prospective studies are needed to re-evaluate treatment of the primary breast tumor in patients with metastases at diagnosis, and to identify those patients who are most likely to benefit.

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“…From 1971 to 1983, 398 biopsy-proven adenocarcinomas of the breast were definitively managed by radiotherapy. The breast and regional nodes received 45 Gy 60 Co in 25 fractions over 5 weeks (28,29). Electrons were used to deliver a further 15 Gy/7/1.5 weeks to the internal mammary chain and 25 Gy/11/2.5 weeks to the lower axilla.…”

Section: Low Dose Rate Brachytherapymentioning

confidence: 99%

How to Optimize Therapeutic Ratio in Brachytherapy of Head and Neck Squamous Cell Carcinoma?

Mazeron¹,

Gerbaulet²,

Simon³

et al. 1998

Acta Oncologica

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Time factors in breast carcinoma: influence of delay between external irradiation and brachytherapy

Cited by 27 publications

References 19 publications

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

Exclusive and adjuvant radiotherapy in breast cancer patients with synchronous metastases

How to Optimize Therapeutic Ratio in Brachytherapy of Head and Neck Squamous Cell Carcinoma?

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