Toxicity of Three-Dimensional Conformal Radiotherapy for Accelerated Partial Breast Irradiation

Hepel, Jaroslaw T.; Tokita, Mari; MacAusland, Stephanie G.; Evans, Suzanne B.; Hiatt, Jessica R.; Price, Lori Lyn; DiPetrillo, Thomas A.; Wazer, David E.

doi:10.1016/j.ijrobp.2009.01.009

Cited by 205 publications

(123 citation statements)

References 29 publications

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“…4 Single-arm studies have also reported higher rates of fair to poor cosmetic outcomes in approximately 20% of patients treated with EBRT-based APBI. 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.…”

Section: Comment On External Beam Apbimentioning

confidence: 98%

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

519

342

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Section: Comment On External Beam Apbimentioning

confidence: 98%

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

519

342

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“…20 Chen veViccini çalışma-sında tedavi edilen 75 hastanın ilk iki yıllık takiplerinde kabul edilebilir oranda toksisite görülmüş ve zamanla artmamıştır. 21 Burada uygulanan doz LDR (Low dose Rate-Düşük doz hızı) ile yapıldıysa 50 Gy/96 saat, HDR (High dose rate, Yüksek doz hızı) ile yapıldıysa 32 Gy/8 fr ya da 34Gy/10 fr şeklinde günde iki fraksiyondadır.…”

Section: Discussionunclassified

Three Dimensional Conformal External Accelerated Partial Breast Irradiation (APBI): Early Clinical Outcomes

Karaman¹,

Aydın²,

Küçücük³

et al. 2013

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmamızda erken evre meme kanserinde, postoperatif üç boyutlu konformal eksternal radyoterapi (3B-KRT) ile akselere parsiyel meme ışınlaması (APMI) yapılan hastalarda teknik uygulanabilirlik, erken ve geç komplikasyon oranları ile kozmetik sonuçların sunulması amaçlandı. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Postmenopozal erken evre meme kanseri nedeni ile meme koruyucu ameliyat yapılmış, seçim kriterleri, volumetrik ve dozimetrik kısıtlamaları Radyasyon Tedavisi Onkoloji Grubu (RTOG) kriterlerine uygun olan 17 hasta tedaviye alındı. Bu hastalarda, tümör yatağına üç boyutlu konformal radyoterapi kullanılarak, akselere parsiyel meme ışınlaması yapıldı. Hastaların tedavileri 3850 cGy/10 fraksiyon, günde iki kez uygulanarak toplam beş günde tamamlandı. Tüm hastalara endokrin tedavi verildi; kemoterapi uygulanmadı. Erken ve geç yan etkiler ile kozmetik sonuçlar kaydedildi. B Bu ul lg gu ul la ar r: : Tedavi öncesi, tedavi sonrası ilk hafta, 1., 3., 6. ay, 1. ve 2. yılda sonuçlar kaydedildi. Sadece Grade 1-2 toksisite görüldü. Hastaların 6. ay kontrollerinde kozmetik sonuçlar 13 (%76,5) hastada mükemmel, dört (%23,5) hastada iyi olarak değerlendirildi. Birinci ve ikinci yıl kontrolünü dolduran 17 hastanın 15'inde mükemmel, ikisinde iyi kozmetik sonuç elde edildi. S So on nu uç ç: : Yapılan tedavi ek cihaz ve ek tedavi maliyeti gerektirmemektedir. Non-invaziv olan bu yöntem ile tedavi süresi kısalmaktadır. Tekniğin özelliği nedeni ile sadece tümörün olduğu kadrana radyoterapi uygulandığı için radyoterapi alanı küçülmekte ve dolayısıyla akciğer, kalp ve diğer meme gibi kritik organların maruz kaldığı dozlar en düşük düzeyde kalmaktadır. Akselere parsiyel meme ışınlaması, doğru hasta seçimine bağlı olarak başarılı sonuç verebilecek, öğrenme süresi gerektiren, uzun dönemli sonuçları henüz bilinmeyen, bu nedenle halen klinik çalışma kapsamında yapılması uygun olan bir tedavi şeklidir.A An na ah ht ta ar r K Ke el li im me el le er r: : Meme tümörleri; radyoterapi, uyumlu A AB BS ST TR RA AC CT T P Pu ur rp po os se e: : This study aimed to present the early clinic and dosimetric results of patients who underwent postoperative accelerated partial breast irradiation with three-dimensional conformal radiotherapy. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Seventeen postmenopausal early-stage breast cancer patients who had eligible clinical and dosimetric features according to the Radiation Therapy Oncology Group (RTOG) criteria were included in the study. Accelerated partial breast irradiation (APBI) treatment was delivered to the tumour bed twice a day in ten fractions of 385 cGy after delineating defined volumes, for five days. All patients recieved hormonotherapy concurrent with irradiation and no chemotherapy. Dosimetric features, early and late side effects and cosmetic results were evaluated. R Re es su ul lt ts s: : Side effects at week 1, month 1, 3, and 6, and year 1 and 2 were recorded. Only grade 1-2 toxicity was observed. The cosmetic results of 13 ...

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“…al. 49 also reported on a positive correlation between the volume of breast tissue treated with PBI and cosmesis outcome. 60 patients were treated with PBI to a dose of 38.5…”

Section: D-crt/imrt Based Pbi (Level IV Evidence)mentioning

confidence: 94%

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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Toxicity of Three-Dimensional Conformal Radiotherapy for Accelerated Partial Breast Irradiation

Cited by 205 publications

References 29 publications

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

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

Three Dimensional Conformal External Accelerated Partial Breast Irradiation (APBI): Early Clinical Outcomes

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

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