Whole breast radiotherapy in the lateral isocentric lateral decubitus position: Long-term efficacy and toxicity results

Bronsart, E.; Dureau, Sylvain; Xu, Hao; Bazire, Louis; Chillès, A.; Costa, É.; Logerot, C.; Falcou, Marie-Christine; Campana, F.; Berger, Frédérique; Fourquet, A.; Kirova, Youlia

doi:10.1016/j.radonc.2017.07.001

Cited by 29 publications

(15 citation statements)

References 24 publications

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“…Note that radiotherapy consisted of 3D conformal radiotherapy using a cobalt source. The toxicities reported in this study do not constitute a limiting factor for the growth of neoadjuvant radiotherapy, as modern radiotherapy techniques allow much better results by acting on several technical factors, such as the use of photon beams or even protons [12], 3D conformal radiotherapy or IMRT, an integrated boost dose [13], the lateral decubitus position [14], and respiratory gating [15]. This neoadjuvant strategy could also have the advantage of improving cosmetic results in the context of breast reconstruction [16].…”

Section: Discussionmentioning

confidence: 80%

Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial

Jornet

Loap

Pierga

et al. 2021

Cancers

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Background: Neoadjuvant concurrent radiochemotherapy makes it possible to increase the breast conservation rate. This study reports the long term outcome of this treatment. Methods: From 2001 to 2003, 59 women with T2–3 N0–2 M0 invasive breast cancer (BC) not amenable to upfront breast conserving treatment (BCS) were included in this prospective, non-randomized phase II study. Chemotherapy (CT) consisted of four cycles of continuous 5-FU infusion and Vinorelbine. Starting concurrently with the second CT cycle, normofractionated RT was delivered to the breast and LN. Breast surgery was then performed. Results: Median follow-up (FU) was 13 years [3–18]. BCS was performed in 41 (69%) patients and mastectomy in 18 patients, with pathological complete response rate of 27%. Overall and distant-disease free survivals rates at 13 years were 70.9% [95% CI 59.6–84.2] and 71.5% [95% CI 60.5–84.5] respectively. Loco regional and local controls rates were 83.4% [95% CI 73.2–95.0] and 92.1% [95% CI 83.7–100], respectively. Late toxicity (CTCAE-V3) was assessed in 51 patients (86%) with a median follow-up of 13 years. Fifteen presented grade 2 fibrosis (29.4%), 8 (15.7%) had telangiectasia, and 1 had radiodermatitis. Conclusions: This combined treatment provided high long-term local control rates with limited side-effects.

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Section: Discussionmentioning

confidence: 80%

Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial

Jornet

Loap

Pierga

et al. 2021

Cancers

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“…Some teams have studied radiation therapy delivered in the lateral decubitus position [ 2 ]. Bronsart et al [ 29 ] evaluated the efficacy and safety of breast radiation therapy in the isocentric lateral decubitus position in 832 patients with a median follow-up of 6.4 years. Acute and late toxicity rates were very low: 2.8% of grade 3 radiodermatitis and 4.3% of grade 2/3 fibrosis during the study.…”

Section: Resultsmentioning

confidence: 99%

Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review

Allali

Kirova

2021

Cancers

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Background: Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity. We will review the incidence of radiodermatitis and fibrosis according to the various radiation and fractionation techniques. We will then focus on the various methods used to manage, prevent, and quantify this toxicity. Method: More than 1753 articles were identified using the various search terms. We selected 53 articles to answer the questions addressed in this study according to criteria set in advance. Result: The literature reports lower acute toxicity with IMRT compared to 3DCRT, but no significant differences in terms of late toxicities. Partial breast irradiation appears to be less effective in terms of local control with a higher rate of late toxicity. Intra operative radiation therapy appears to provide good results in terms of both local control and late toxicity. The hypofractionation has equivalent efficacy and safety to the normofractionated regimen, but with lower rates of radiodermatitis and fibrosis. The adddition of a boost, particularly a sequential boost, increases the risk of fibrosis and radiodermatitis during treatment. Conclusion: The development of IMRT has significantly reduced acute toxicity and has improved tolerability during treatment. Modified fractionation has reduced treatment time, as well as adverse effects.

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“…Long-term toxicity results were published by the Institut Curie group. 14 , 60 Women with a median BMI of 26.3 were treated with different types of fractionation. Acute dermatitis of any grade was present in 93 % of the patients and G3 dermatitis in only 2.8 %.…”

Section: Resultsmentioning

confidence: 99%

“…In a multivariate analysis, the cup size and the fractionation had a significant influence on acute dermatitis. 14 …”

Section: Resultsmentioning

confidence: 99%

“…Advances in BC radiotherapy – among them being moderate hypofractionation schedule (HF), intensity modulated radiotherapy (IMRT), and prone or lateral decubitus position – have all the potential to reduce the rates of acute and long-term radiotherapy-related side effects of BCT. 6 , 7 , 10 , 11 , 12 , 13 , 14 The observed normal tissue toxicity rates and breast cosmetic outcome depend on treatment and patient-related factors such as the type and number of surgical procedures, systemic treatment, breast size and shape, race, age, comorbidities, smoking, individual sensitivity to ionizing radiation, choice of fractionation and radiation dose, skin bolus, inter-fraction time interval, volume irradiated, and radiotherapy delivery modality. 15 It is a widely accepted fact that patient-related factors, such as higher body mass index (BMI) and larger breasts 7 , 10 , 16 increase the risk of ≥ grade 2 (G2) dermatitis, regardless of the fractionation regimen.…”

Section: Introductionmentioning

confidence: 99%

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Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Ratoša

Jenko

Oblak

2018

Radiology and Oncology

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BackgroundBreast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size.ConclusionsInhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.

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Whole breast radiotherapy in the lateral isocentric lateral decubitus position: Long-term efficacy and toxicity results

Cited by 29 publications

References 24 publications

Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial

Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial

Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

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