Volume matters: Breast induration is associated with irradiated breast volume in the Danish Breast Cancer Group phase III randomized Partial Breast Irradiation trial

Thomsen, M.S.; Alsner, Jan; Nielsen, Hanne Melgaard; Jakobsen, Erik; Nielsen, M.; Møller, Mette; Pedersen, Anders N.; Yates, Esben Svitzer; Berg, M.; Lorenzen, Ebbe Laugaard; Jensen, I.; Jensen, Maj‐Britt; Overgaard, Jens; Offersen, Birgitte Vrou

doi:10.1016/j.radonc.2022.09.024

Cited by 21 publications

(5 citation statements)

References 28 publications

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“…The data presented from all the mentioned studies indicates that PTV volumes up to 150-180 cc are safe for applying the dose of 30 Gy in 5 fractions. Moreover, two studies used the same dose fractionation for WBI and PBI and showed that reducing the irradiated volume alone reduced late toxicity [6,54].…”

Section: Discussionmentioning

confidence: 99%

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Burkon,

Selingerova,

Slavik

et al. 2024

Radiat Oncol

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Background Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. Methods Early breast cancer patients after partial mastectomy were equally randomized into two arms– external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. Results The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21–45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. Conclusion External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. Trial registration NCT06007118.

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Section: Discussionmentioning

confidence: 99%

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Burkon,

Selingerova,

Slavik

et al. 2024

Radiat Oncol

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show abstract

“…We can hypothesize that hypofractionation leads to lower acute toxicity; therefore, the difference against APBI could be less pronounced. Two studies[6] and the Danish Breast Cancer Group [54] used the same dose fractionation for WBI and APBI and showed that reducing the irradiated volume alone reduced late toxicity. Given current knowledge and recommendations, WBI with a boost can mean certain overtreatment [55], and accordingly, a boost may not be indicated in older patients with su cient resection margins.…”

Section: Discussionmentioning

confidence: 99%

Toxicity of External Beam Accelerated Partial-Breast Irradiation (APBI) in Adjuvant Therapy of Early-stage Breast Cancer: Randomized Prospective Study

Burkon,

Selingerova,

Slavik

et al. 2023

Preprint

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Background: Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used accelerated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. Methods: Early breast cancer patients after partial mastectomy were equally randomized into two arms – external APBI and accelerated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used. Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. Results: The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms. A significant difference in favor of the APBI arm in grade ≥2 late skin toxicity was observed (p=0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. Conclusion: External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. Trial registration: NCT06007118

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“…For breast size and irradiated breast volume, a 3-year induration incidence was found in large-versus small-breasted patients of 13% (WBI) and 6% (PBI) versus 6% (WBI) and 5% (PBI) respectively. In a separate publication the DBCG concluded that breast induration risk increased significantly with larger irradiated breast volume, not the breast size itself, strongly favouring small volumes and therefore PBI [ 34 ]. The 5-year locoregional recurrence risk was WBI 0.7% (95%CI 0.2–1.9) and PBI 1.2% (95%CI 0.4–2.6), showing no significant difference (p = 0.47).…”

Section: Partial Breast and Hypofractionationmentioning

confidence: 99%

Hypofractionation: The standard for external beam breast irradiation

Haviland¹

2023

The Breast

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Volume matters: Breast induration is associated with irradiated breast volume in the Danish Breast Cancer Group phase III randomized Partial Breast Irradiation trial

Cited by 21 publications

References 28 publications

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Toxicity of External Beam Accelerated Partial-Breast Irradiation (APBI) in Adjuvant Therapy of Early-stage Breast Cancer: Randomized Prospective Study

Hypofractionation: The standard for external beam breast irradiation

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