Two-year toxicity of simultaneous integrated boost in hypofractionated prone breast cancer irradiation: Comparison with sequential boost in a randomized trial

Hulle, Hans Van; Desaunois, Eline; Vakaet, Vincent; Paelinck, Leen; Schoepen, Max; Post, Giselle; Greveling, Annick Van; Speleers, Bruno; Mareel, Marcus; Neve, Wilfried De; Monten, Christel; Deseyne, Pieter; Veldeman, Liv

doi:10.1016/j.radonc.2021.02.010

Cited by 14 publications

(28 citation statements)

References 25 publications

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“…In terms of the comparison between sequential and simultaneous integrated boost, the results of a phase III randomized study conducted by Paelinck et al 15 demonstrated that grade 2/3 dermatitis was significantly more frequent in the SEB-HFWBI arm and that the incidence of edema was lower in the SIB-HFWBI arm. But the latest data showed the physician-assessed two-years toxicity and photographic analysis were not significantly different between SIB and SEB treatment arms 31 . Nevertheless, Onal et al 32 demonstrated that the SIB technique showed better target-volume dose distribution and better sparing heart in volumetric-modulated arc therapy and helical-tomotherapy compared to the SEB technique.…”

Section: Discussionmentioning

confidence: 94%

A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

Sun

et al. 2021

Sci Rep

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This study explored the dosimetric difference between hypofractionated whole-breast irradiation (HFWBI) with sequential boost (SEB) and simultaneous integrated boost (SIB) based on supine and prone positions to identify the superior boost mode and superior position. Thirty breast cancer patients eligible for HFWBI after breast-conserving surgery were enrolled. All patients underwent 3DCT simulation scanning in both supine and prone positions. For the SEB-HFWBI plan, the dose prescribed for the planning target volume (PTV) of whole breast (WB) was 2.67 Gy per fraction with a total of 15 fractions, followed by a sequential boost of 3.2 Gy per fraction to the PTV of tumor bed (TB) in 3 fractions. For the SIB-HFWBI plan, the dose prescribed for the PTV of WB was 2.67 Gy per fraction with a total of 15 fractions, with a simultaneously integrated boost of 3.2 Gy per fraction to the PTV of TB with a total of 15 fractions. Regardless of the position, for the PTV of TB, the conformal index (CI) in the SIB-HFWBI plans was greater than those in the SEB-HFWBI plans (T = − 8.114, − 8.114; both P < 0.05). The CI for the PTV of WB increased significantly in the prone position relative to the supine position in both two plans(Z = − 3.340, − 3.501; all P < 0.05). The study suggested that prone SIB-HFWBI might be more suitable for postoperative radiotherapy after breast-conserving surgery for early-stage breast cancer patients.

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Section: Discussionmentioning

confidence: 94%

A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

Sun

et al. 2021

Sci Rep

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“…The characteristics of the studies are reported in Table 1 . The articles were published from 2012 to 2021 [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . Two trials were randomized and controlled [ 17 , 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…The articles were published from 2012 to 2021 [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . Two trials were randomized and controlled [ 17 , 18 ]. One trial was multicentric [11] .…”

Section: Resultsmentioning

confidence: 99%

“… [13] 2021 0 0 Acute skin toxicity 149 NA 61 16 2.5 3 59% 3DRT and 41% IMRT 6 Van Hulle et al. [17] 2021 1 1 Cosmetic results at 2 years 150 24 55.5 15 3.12 3.33 NA NA 3DRT: tridimensional radiotherapy; Gy: gray; IMRT: intensity-modulated radiation therapy; NA: not available; VMAT: volumetric-modulated arc therapy. …”

Section: Resultsmentioning

confidence: 99%

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Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: A systematic literature review

Schmitt

Menoux

Chambrelant

et al. 2022

Translational Oncology

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“…In the FAST-FORWARD trial, the boost was given in additional fractions after whole breast radiotherapy, adding at least one week to the treatment [ 10 ]. A further decrease in OTT can be achieved by a simultaneously integrated boost (SIB) to the tumor(bed) in the treatment without decreasing cosmesis or increasing acute and late toxicity [ [15] , [16] , [17] ]. Using NART in 5 fractions with SIB should result in even a shorter OTT, since the waiting time between surgery and RT is omitted.…”

Section: Introductionmentioning

confidence: 99%

Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial

Vakaet¹,

Hulle²,

Koen³

et al. 2022

The Breast

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Objective Neo-adjuvant radiotherapy (NART) for breast cancer has shown promising survival results in retrospective trials. However, there are some obstacles such as a chemotherapy delay, an increased overall treatment time (OTT) and the risk of increasing surgical morbidity. Accelerated radiotherapy (RT) in 5 fractions allows to deliver NART in a very short time span and minimizes the delay of surgery and chemotherapy. This trial investigates this NART schedule for safety, feasibility and OTT. Material and methods Twenty patients eligible for neo-adjuvant chemotherapy (NACT) and breast conserving surgery, were randomized between NART before NACT or NACT and postoperative RT. In both arms, RT treatment was given in 5 fractions to the whole breast with a simultaneously integrated boost (SIB) on the tumor(bed). Lymph node irradiation was given concomitantly in case of lymph node involvement. OTT was defined as the time from diagnosis to last surgery in the intervention group, while in the control group the time between diagnosis and last RT-fraction was used. In the intervention group NACT-delay was defined as time between diagnosis and start of chemotherapy. Results 20 patients were included, and 19 patients completed treatment. OTT was significantly shorter in the intervention group (mean 218 days, range 196–253) compared to the control group (mean 237, range 211–268, p = 0.001). The difference in mean duration from diagnosis to the first treatment was a non-significant 4 days longer (31 vs 27 days, p = 0.28), but the start of NACT after diagnosis was delayed by 21 days (48 vs 27 days, p < 0.001). NART did not result in additional surgery complications. Conclusion This pilot trial is the first to report on accelerated NART in 5 fractions with SIB. NART before NACT resulted in a shorter OTT with good safety results.

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Two-year toxicity of simultaneous integrated boost in hypofractionated prone breast cancer irradiation: Comparison with sequential boost in a randomized trial

Cited by 14 publications

References 25 publications

A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: A systematic literature review

Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial

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