Trends in Radiotherapy After Breast-Conserving Surgery in Elderly Patients with Early-Stage Breast Cancer

Luu, Carrie; Goldstein, Leanne; Goldner, Bryan; Schoellhammer, Hans F.; Chen, Steven L.

doi:10.1245/s10434-013-3150-z

Cited by 17 publications

(9 citation statements)

References 19 publications

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“…Even if the incidence of breast cancer is growing in the elderly and its management has become a medical and economic issue, rates of radiation recommendation in the elderly have been steadily decreasing [22]. Recently, Hughes et al [23] updated the results of a phase III trial (CALGB 9343) that randomized in the elderly who presented breast cancer (T1N0, HR positive) lumpectomy plus Tamoxifen with or without WBI.…”

Section: Discussionmentioning

confidence: 99%

Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy

et al. 2014

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ObjectiveTo evaluate clinical outcome after accelerated partial breast irradiation (APBI) in the elderly after high-dose-rate interstitial multi-catheter brachytherapy (HIBT).Methods and materialsBetween 2005 and 2013, 70 patients underwent APBI using HIBT. Catheter implant was performed intra or post-operatively (referred patients) after lumpectomy and axillary sentinel lymph node dissection. Once the pathological results confirmed the indication of APBI, planification CT-scan was performed to deliver 34 Gy/10f/5d or 32 Gy/8f/4d. Dose-volume adaptation was manually achieved (graphical optimization). Dosimetric results and clinical outcome were retrospectively analyzed. Physician cosmetic evaluation was reported.ResultsWith a median follow-up of 60.9 months [4.6 – 90.1], median age was 80.7 years [62 – 93.1]. Regarding APBI ASTRO criteria, 61.4%, 18.6% and 20% were classified as suitable, cautionary and non-suitable respectively. Axillary sentinel lymph node dissection was performed in 94.3%; 8 pts (11.5%) presented an axillary involvement. A median dose of 34 Gy [32 – 35] in 8 to 10 fractions was delivered. Median CTV was 75.2 cc [16.9 – 210], median D90 EQD2 was 43.3 Gy [35 – 72.6] and median DHI was 0.54 [0.19 – 0.74]. One patient experienced ipsilateral recurrence (5-year local free recurrence rate: 97.6%. Five-year specific and overall survival rates were 97.9% and 93.2% respectively. Thirty-four patients (48%) presented 47 late complications classified grade 1 (80.8%) and grade 2 (19.2%) with no grade ≥ 3. Cosmetic results were considered excellent/good for 67 pts (95.7%).ConclusionAPBI using HIBT and respecting strict rules of implantation and planification, represents a smart alternative between no post-operative irradiation and whole breast irradiation delivered over 6 consecutive weeks.

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Section: Discussionmentioning

confidence: 99%

Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy

et al. 2014

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“…Several definitions of the HI are available. The HI that we used is defined as All dose and volume indexes were tested statistically with use of the Kruskal-Wallis test [16], which is a non-parametric method for testing differences among more than two groups; the significance of the trend for each of the dose and volume indexes that depended on the pitch angle error was confirmed by use of the Jonckheere-Terpstra test [17]. …”

Section: Methodsmentioning

confidence: 99%

Impact of pitch angle setup error and setup error correction on dose distribution in volumetric modulated arc therapy for prostate cancer

Takemura

Togawa

Yokoi

et al. 2016

Radiol Phys Technol

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In volumetric modulated arc therapy (VMAT) for prostate cancer, a positional and rotational error correction is performed according to the position and angle of the prostate. The correction often involves body leaning, and there is concern regarding variation in the dose distribution. Our purpose in this study was to evaluate the impact of body pitch rotation on the dose distribution regarding VMAT. Treatment plans were obtained retrospectively from eight patients with prostate cancer. The body in the computed tomography images for the original VMAT plan was shifted to create VMAT plans with virtual pitch angle errors of ±1.5 and ±3 degrees. Dose distributions for the tilted plans were recalculated with use of the same beam arrangement as that used for the original VMAT plan. The mean value of the maximum dose differences in the dose distributions between the original VMAT plan and the tilted plans was 2.98 ± 0.96%. The value of the homogeneity index for the planning target volume (PTV) had an increasing trend according to the pitch angle error, and the values of the D 95 for the PTV and D 2ml , V 50 , V 60 and V 70 for the rectum had decreasing trends (p<0.05). However, there was no correlation between differences in these indexes and the maximum dose difference. The pitch angle error caused by body leaning had little effect on the dose distribution, in contrast, the pitch angle correction reduced the effects of organ displacement and improved these indexes. Thus, the pitch angle setup error in VMAT for prostate cancer should be corrected. Keywordsvolumetric modulated arc therapy, prostate cancer, setup error, dose distribution, pitch angle 4

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“…The use of radiotherapy in older patients with breast cancer mirrors that observed for chemotherapy, with lower levels of radiotherapy uptake in older age [6,79]. This might be similarly due to the lack of evidence on long-term survival benefit after radiotherapy in this cohort [80e82].…”

Section: Frailty and Adjuvant Therapies In Breast Cancer: Radiotherapymentioning

confidence: 98%

Addressing frailty in patients with breast cancer: A review of the literature

Jauhari

Gannon

Horgan

et al. 2020

European Journal of Surgical Oncology

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a b s t r a c tVarious studies have documented variation in the management of older patients with breast cancer, and some of this variation stems from different approaches to balancing the expected benefit of different treatments, with the ability of patients to tolerate them. Frailty is an emerging concept that can help to make clinical decisions for older patients more consistent, not least by providing a measure of 'biological' ageing. This would reduce reliance on 'chronological' age, which is not a reliable guide for decisions on the appropriate breast cancer care for older patients.This article examines the potential of frailty assessment to inform on breast cancer treatments. Overall, the current evidence highlights various benefits from implementing comprehensive geriatric assessment and screening for frailty in breast cancer patients. This includes a role in supporting the selection of appropriate therapies and improving physical fitness prior to treatment. However, there are challenges in implementing routine frailty assessments in a breast cancer service. Studies have used a diverse array of frailty assessment instruments, which hampers the generalisability of research findings. Consequently, a number of issues need to be addressed to clearly establish the optimal timing of frailty assessment and the role of geriatric medicine specialists in the breast cancer care pathway.

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Trends in Radiotherapy After Breast-Conserving Surgery in Elderly Patients with Early-Stage Breast Cancer

Cited by 17 publications

References 19 publications

Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy

Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy

Impact of pitch angle setup error and setup error correction on dose distribution in volumetric modulated arc therapy for prostate cancer

Addressing frailty in patients with breast cancer: A review of the literature

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