1
|
Mast M, Leong A, Korreman S, Lee G, Probst H, Scherer P, Tsang Y. ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation. Tech Innov Patient Support Radiat Oncol 2023; 28:100219. [PMID: 37745181 PMCID: PMC10511493 DOI: 10.1016/j.tipsro.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- M.E. Mast
- Department of Radiation Oncology, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - A. Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
- Bowen Icon Cancer Centre, Wellington, New Zealand
| | - S.S. Korreman
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Oncology, Aarhus University Hospital, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - G. Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - H. Probst
- Sheffield Hallam University, Sheffield, United Kingdom
| | - P. Scherer
- Department of Radiotherapy and Radio-Oncology, LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - Y. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Stowe HB, Andruska ND, Reynoso F, Thomas M, Bergom C. Heart Sparing Radiotherapy Techniques in Breast Cancer: A Focus on Deep Inspiration Breath Hold. BREAST CANCER: TARGETS AND THERAPY 2022; 14:175-186. [PMID: 35899145 PMCID: PMC9309321 DOI: 10.2147/bctt.s282799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022]
Abstract
Adjuvant radiation therapy is a critical component of breast cancer management. However, when breast cancer patients receive incidental radiation to the heart, there is an increased risk of cardiac disease and mortality. This is most common for patients with left-sided breast cancers and those receiving nodal irradiation as part of treatment. The overall risk of cardiac toxicity increases 4–16% with each Gray increase in mean heart radiation dose, with data suggesting that no lower limit exists which would eliminate cardiac risk entirely. Radiation techniques have improved over time, leading to lower cardiac radiation exposure than in the past. This decline is expected to reduce the incidence of radiation-induced heart dysfunction in patients. Deep inspiration breath hold (DIBH) is one such technique that was developed to reduce the risk of cardiac death and coronary events. DIBH is a non-invasive approach that capitalizes on the natural physiology of the respiratory cycle to increase the distance between the heart and the therapeutic target throughout the course of radiation therapy. DIBH has been shown to decrease the mean incidental radiation doses to the heart and left anterior descending coronary artery by approximately 20–70%. In this review, we summarize different techniques for DIBH and discuss recent data on this technique.
Collapse
Affiliation(s)
- Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Neal D Andruska
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Francisco Reynoso
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Maria Thomas
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Cardio-Oncology Center of Excellence, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Alvin J. Siteman Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Correspondence: Carmen Bergom, Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, Email
| |
Collapse
|
3
|
Reproducibility of Deep-Inspiration Breath Hold treatments on Halcyon™ performed using the first clinical version of AlignRT InBore™: results of CYBORE study. Clin Transl Radiat Oncol 2022; 35:90-96. [PMID: 35662884 PMCID: PMC9156859 DOI: 10.1016/j.ctro.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
|
4
|
Hennequin C, Belkacémi Y, Bourgier C, Cowen D, Cutuli B, Fourquet A, Hannoun-Lévi JM, Pasquier D, Racadot S, Rivera S. Radiotherapy of breast cancer. Cancer Radiother 2021; 26:221-230. [PMID: 34955414 DOI: 10.1016/j.canrad.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adjuvant radiotherapy is an essential component of the treatment of breast cancer. After conservative surgery for an infiltrating carcinoma, radiotherapy must be systematically performed, regardless of the characteristics of the disease, because it decreases the rate of local recurrence and by this way, specific mortality. A boost dose over the tumour bed is required if the patient is younger than 50 years-old. Partial breast irradiation could be routinely proposed as an alternative to whole breast irradiation, but only in selected and informed patients. For ductal carcinoma in situ, adjuvant radiotherapy must be also systematically performed after lumpectomy. After mastectomy, chest wall irradiation is required for pT3-T4 tumours and if there is an axillary nodal involvement, whatever the number of involved lymph nodes. After neoadjuvant chemotherapy and mastectomy, in case of pN0 disease, chest wall irradiation is recommended if there is a clinically or radiologically T3-T4 or node positive disease before chemotherapy. Axillary irradiation is recommended only if there is no axillary surgical dissection and a positive sentinel lymph node. Supra- and infraclavicular irradiation is advised in case of positive axillary nodes. Internal mammary irradiation must be discussed case by case, according to the benefit/risk ratio (cardiac toxicity). Hypofractionation regimens (42.5Gy in 16 fractions, or 41,6Gy en 13 or 40Gy en 15) are equivalent to conventional irradiation and must prescribe after tumorectomy in selected patients. Delineation of the breast, the chest wall and the nodal areas are based on clinical and radiological evaluations. 3D-conformal irradiation is the recommended technique, intensity-modulated radiotherapy must be proposed only in specific clinical situations. Respiratory gating could be useful to decrease the cardiac dose. Concomitant administration of chemotherapy in unadvised, but hormonal treatment could be start with or after radiotherapy.
Collapse
Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Y Belkacémi
- Hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - C Bourgier
- Institut du cancer Montpellier (ICM), 34000 Montpellier, France
| | - D Cowen
- Hôpital La Timone, AP-HM, 13000 Marseille, France
| | - B Cutuli
- Polyclinique Courlancy, 51000 Reims, France
| | - A Fourquet
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - J-M Hannoun-Lévi
- Centre Antoine-Lacassagne, 33, avenue Valombrose, 06000 Nice, France
| | - D Pasquier
- Centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - S Racadot
- Centre Léon-Bérard, 69000 Lyon, France
| | - S Rivera
- Institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| |
Collapse
|
5
|
Msika R, Tkatchenko N, Robilliard M, Fourquet A, Kirova Y. Evaluation of a software for automatic delineation of the mammary gland and organs at risk in patients treated for breast cancer in lateral position. Cancer Radiother 2020; 24:799-804. [PMID: 33046361 DOI: 10.1016/j.canrad.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE OF THE STUDY The purpose of this study was to assess the potential for improvement of routine breast and organs at risk contouring in patients treated in the lateral decubitus position using Workflow Box™ (Mirada Medical™, UK) automatic contouring software. MATERIALS AND METHODS Automatic contouring of the breast by this software is currently based on an atlas created from isodoses representing 95% of the prescribed dose in a population of patients previously treated at institut Curie. Forty cases of breast cancer (20 right breasts and 20 left breasts) were contoured by three radiation oncologists specialized in breast cancer, allowing the creation of a new atlas in the automatic contouring software. This study assessed the quality of contouring in 20 patients (ten right breasts and ten left breasts) by comparing manual contouring performed by the expert radiation oncologists (reference) with those generated by the old and new atlases developed at Institut Curie. The accuracy of contouring was assessed by overlap volume and the associated standard deviations. RESULTS Breast contouring based on the new atlas and by radiation oncologists presented a mean overlap of 0.80±0.09 for the right breast and 0.81±0.06 for the left breast. By comparing volumes of interest contoured by radiation oncologists and those obtained from the old atlas, mean overlap volumes were 0.75±0.08 and 0.74±0.13 for the right and left breasts, respectively. Twenty cases (ten right breasts and ten left breasts) used to create the new atlas were also reprocessed by this same atlas in order to assess the quality of automatic contouring of the breast when the case was already known to the software. The mean overlap volume in this case was 0.84±0.08 for the right breast and 0.83±0.06 for the left breast. Finally, after automatic contouring of organs at risk by means of the new atlas, the mean overlap volume was 0.87±0.04 for the heart and 0.93 for each lung (±0.05 for the right lung and±0.04 for the left lung). CONCLUSION Workflow Box™ automatic contouring software, based on our new atlas provides reliable and clinically relevant organs at risk and breast contouring. The contours proposed by the software from the new atlas were better than those obtained with the previous atlas based on 95% isodoses obtained from old treatment plans. This software has therefore become more efficient, justifying its use in routine clinical practice for breast cancer contouring in patients treated in the lateral decubitus position. Investigations are currently underway to develop a fully automated process to ensure reliable, robust and operator-independent contouring and breast cancer treatment dosimetry in the lateral decubitus position. Promising preliminary results have already been obtained.
Collapse
Affiliation(s)
- R Msika
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - N Tkatchenko
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - M Robilliard
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| |
Collapse
|
6
|
Msika R, Fourquet A, Laki F, Porte B, Servois V, Kirova Y. Institut Curie guidelines on breast target volume delineation for patients treated in lateral position. Cancer Radiother 2020; 24:795-798. [PMID: 32981844 DOI: 10.1016/j.canrad.2020.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/28/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To develop guidelines for and describe the delineation of breast for patients treated in lateral position and to transform this three-dimensional technique based on the virtual simulation to volume-based modern intensity-modulated irradiation technique. MATERIAL AND METHODS In our department, during the daily delineation, radiation oncologists specialized in breast cancer treatment sought consensus on the delineation of clinical treatment volume of the breast through dialogue based on cases. A radiation oncologist delineated clinical treatment volumes on CT scans of five to 20 patients, followed by a discussion and adaptation of the delineation between all radiation oncologists of the team. The consensus established between clinicians was discussed, corrected and improved. All patients were delineated in treatment position; skin markers were used to visualize the breast tissue after careful palpation. RESULTS Breast clinical treatment volume was situated and delineated between pectoral muscle and 5mm below the skin (dosimetric considerations), within the space outlined by skin markers, that showed the limits of the palpable breast tissue. In lateral position some vessels were very useful to define the limits as rami mammarii (from thoracica interna) for the internal one and thoracica lateralis for the external. This is the first atlas proposed for the delineation of the breast clinical treatment volumes for breast cancer using alternative technique of breast irradiation (lateral). CONCLUSION This atlas will be helpful for the volume definition in our daily practice of breast irradiation in lateral position and can open perspectives to develop also atlases for other alternative techniques as treatment in prone position.
Collapse
Affiliation(s)
- R Msika
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Laki
- Department of surgical oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - B Porte
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - V Servois
- Department of radiology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| |
Collapse
|
7
|
Krhili S, Costa E, Xu HP, Kirova YM. Whole breast radiotherapy in the isocentric lateral decubitus position: Role of the immobilization device and table on clinical results. Cancer Radiother 2019; 23:209-215. [PMID: 31053514 DOI: 10.1016/j.canrad.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate clinical results and the "effect bolus" based on the table design of different linear accelerators in patients with breast cancer treated by previously published whole breast irradiation in the isocentric lateral decubitus position. MATERIAL AND METHODS We studied 248 consecutive female patients with early stage breast cancer treated by conservative surgery followed by three-dimensional conformal whole breast irradiation in the isocentric lateral decubitus position between January 2013 and February 2014. Radiotherapy was performed on linear accelerators using a Varian. The energy used was 4 and 10MV photons or 6MV photons. All patients were evaluated weekly by the radiation oncologist, acute toxicity was assessed using the NCICTC v 3.0 scale. Late toxicity and cosmetic results were evaluated 18 months after the radiotherapy. Cosmetic results were defined as excellent, good, middle or bad. RESULTS Among the 248 women included, the median age was 67 years (range: 35-91 years). All received whole breast radiotherapy with boost in 144 patients (58%). One-hundred-twenty patients received normofractionated and 124 patients hypofractionated whole breast radiotherapy. Median follow-up was 18 months. Acute skin toxicity in the whole breast radiotherapy in the isocentric lateral decubitus position was acceptable: there was 47% of grade 1 radiodermatitis, 50% of grade 2 and 3% grade 3 and no grade 4 for normofractionated radiotherapy; 89% of grade 1 dermatitis and 11% of grade 2 for hypofractionated radiotherapy; 89.7% of grade 0-1 dermatitis and 10.3% of grade 2 for the "flash" scheme and did not differ between the three linear accelerators (P=0.2, P=0.9 and P=0.2 respectively for the normofractionated radiotherapy, hypofractionated radiotherapy and the "flash"scheme). Late toxicity was acceptable with 84% of grade 0-1 fibrosis for normofractionated radiotherapy, 94% of patients for hypofractionated radiotherapy and 77% for "flash" scheme and did not differ between the three linear accelerators (P=0.44, P=1 and P=0.22 resp.). Most of patients (81%) had an excellent or a good cosmetic outcome. CONCLUSIONS Whole breast radiotherapy in the isocentric lateral decubitus position is well tolerated. Clinical results are comparable based on different immobilization device allowed by linear accelerators. Particularly, there was no influence of the couch on skin tolerance and cosmetic results.
Collapse
Affiliation(s)
- S Krhili
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - E Costa
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - H-P Xu
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Department of Radiation Oncology, Ruijin Hospital, Shangai Jiaotong University, School of Medicine, Shanghai, China
| | - Y M Kirova
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| |
Collapse
|
8
|
Xu HP, Bronsart E, Costa É, Krhili S, Logerot C, Bazire L, Fournier-Bidoz N, Belshi A, Fourquet A, Kirova YM. Patterns of locoregional failure in women with early-stage breast cancer treated by whole breast irradiation in the lateral isocentric decubitus position: Large-scale single-centre experience. Cancer Radiother 2019; 23:116-124. [PMID: 30935887 DOI: 10.1016/j.canrad.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/01/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate locoregional control and describe the patterns of failure in patients with breast cancer receiving whole breast radiotherapy in the isocentric lateral decubitus position technique. PATIENTS AND METHODS In a series of 832 consecutive female patients with early-stage breast cancer including invasive and in situ tumours treated by breast-conserving surgery followed by three-dimensional conformal whole breast irradiation in the isocentric lateral decubitus position between 2005 and 2010, all patients who experienced locoregional recurrence were studied. Five-year recurrence-free and overall survival rates were calculated. Regional recurrence mapping patterns were also determined. RESULTS The median age of this series of 832 women was 61.5 years (range: 29-90 years). Various types of fractionation were used: 50Gy in 25 fractions (17.9%), 66Gy in 33 fractions (50Gy in 25 fractions to breast followed by sequential boost to tumour bed to a total dose 66Gy in 33 fractions.) (46.5%), 40Gy in 15 fractions or 41.6Gy in 13 fractions (26.1%) and 30Gy in 5 fractions (9.5%). With a median follow-up of 6.4 years, only 36 patients experienced locoregional recurrence and no association with the fractionation regimen was identified (P=0.2). In this population of 36 patients, 28 (3.3%) had "in-breast" local recurrences (77.8%), two had local recurrences and regional lymph node recurrence (5.6%), and six had regional lymph node recurrence only (in non-irradiated areas; 16.6%). The median time to recurrence was 50 months. Complete mapping of patterns of recurrences was performed and, in most cases, local recurrences were situated adjacent to the primary tumour bed. Cases of local recurrences presented a significantly lower distant metastasis rate (P<0.001) and had a significantly longer overall survival compared to patients with regional lymph node recurrence (P<0.001). However, multivariate Cox regression analysis showed that the site of recurrence had no significant impact on overall survival (P=0.14). CONCLUSION The results of this study indicate a low local recurrence rate. Further careful follow-up and recording of recurrences is needed to improve the understanding of patterns of recurrence.
Collapse
Affiliation(s)
- H-P Xu
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - E Bronsart
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - É Costa
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - S Krhili
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - C Logerot
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - L Bazire
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - N Fournier-Bidoz
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Belshi
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y-M Kirova
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| |
Collapse
|
9
|
Chung Y, Yu JI, Park W, Choi DH. Korean First Prospective Phase II Study, Feasibility of Prone Position in Postoperative Whole Breast Radiotherapy: A Dosimetric Comparison. Cancer Res Treat 2019; 51:1370-1379. [PMID: 30776884 PMCID: PMC6790854 DOI: 10.4143/crt.2018.423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This first Korean prospective study is to evaluate the feasibility of prone breast radiotherapy after breast conserving surgery for left breast cancer patients who have relatively small breast size and we present dosimetric comparison between prone and supine positions. Materials and Methods Fifty patients underwent two computed tomography (CT) simulations in supine and prone positions. Whole breast, ipsilateral lung, heart, and left-anterior-descending coronary artery were contoured on each simulation CT images. Tangential-fields treatment plan in each position was designed with total 50 Gy in 2-Gy fractions, and then one of the positions was designated for the treatment by comparing target coverage and dose to normal organs. Also, interfractional and intrafractional motion was evaluated using portal images. RESULTS In total 50 patients, 32 cases were decided as prone-position-beneficial group and 18 cases as supine-position-beneficial group based on dosimetric advantage. Target dose homogeneity was comparable, but target conformity in prone position was closer to optimal than in supine position. For both group, prone position significantly increased lung volume. However, heart volumewas decreased by prone position for prone-position-beneficial group but was comparable between two positions for supine-position-beneficial group. Lung and heart doses were significantly decreased by prone position for prone-position-beneficial group. However, prone position for supine-position-beneficial group increased heart dose while decreasing lung dose. Prone position showed larger interfractional motion but smaller intra-fractional motion than supine position. CONCLUSION Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.
Collapse
Affiliation(s)
- Yoonsun Chung
- Department of Nuclear Engineering, Hanyang University, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Bergom C, Currey A, Desai N, Tai A, Strauss JB. Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation. Front Oncol 2018; 8:87. [PMID: 29670854 PMCID: PMC5893752 DOI: 10.3389/fonc.2018.00087] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/13/2018] [Indexed: 12/17/2022] Open
Abstract
Historically, heart dose from left-sided breast radiotherapy has been associated with a risk of cardiac injury. Data suggests that there is not a threshold for the deleterious effects from radiation on the heart. Over the past several years, advances in radiation delivery techniques have reduced cardiac morbidity due to treatment. Deep inspiration breath hold (DIBH) is a technique that takes advantage of a more favorable position of the heart during inspiration to minimize heart doses over a course of radiation therapy. In the accompanying review article, we outline several methods used to deliver treatment with DIBH, quantify the benefits of DIBH treatment, discuss considerations for patient selection, and identify challenges associated with DIBH techniques.
Collapse
Affiliation(s)
- Carmen Bergom
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Adam Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Nina Desai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jonathan B Strauss
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
11
|
Ferrari A, Ivaldi G, Leonardi MC, Rondi E, Orecchia R. Prone Breast Radiotherapy in a Patient with Early Stage Breast Cancer and a Large Pendulous Breast. TUMORI JOURNAL 2018; 95:394-7. [DOI: 10.1177/030089160909500323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In women with large and pendulous breasts postoperative radiotherapy in the supine position could represent a technical challenge because of the resulting dose inhomogeneity and the large amount of lung and heart receiving a high percentage of the prescribed dose. Breast-conserving surgery is therefore relatively contraindicated in these patients. Alternative positions for radiation therapy treatment have been proposed, and prone breast irradiation in particular has been recognized as a useful alternative to conventional treatment in the supine position. We report the case of a large-breasted patient treated in prone position in our radiation therapy division.
Collapse
Affiliation(s)
- Annamaria Ferrari
- Radiation Oncology Department, European Institute of Oncology, Milan, Italy
| | - Giovanni Ivaldi
- Radiation Oncology Department, European Institute of Oncology, Milan, Italy
| | | | - Elena Rondi
- Medical Physics Department, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Radiation Oncology Department, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| |
Collapse
|
12
|
Helal A, Farouk M, Gamie SH, Abdo M, Mosa L, Aziz AA. The impact of semilateral decubitus position on the dose-volume parameters of the heart and lung for left sided breast cancer patients: A comparative dosimetric study. Pract Radiat Oncol 2018; 8:71-80. [PMID: 29339047 DOI: 10.1016/j.prro.2017.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 09/17/2017] [Accepted: 11/22/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE When treating breast cancer with radiation therapy, the impact of treatment position on heart and lung dose-volume parameters (DVPs) is largely dependent on the maximal heart distance (MHD) and central lung distance (CLD). We evaluate how much heart and lung sparing can be achieved using the semilateral decubitus (SLD) position without and with breath hold compared with the standard supine position for left-sided breast cancer patients. A secondary aim was to investigate the impact of MHD and CLD on heart and lung DVPs. METHODS AND MATERIALS Thirty-five left-sided breast cancer patients were simulated in supine, free breathing SLD, and SLD with breath hold positions. A dosimetry plan was developed for each of these and 3 plans were compared for target coverage and organs at risk sparing. A correlation between CLD, MHD, and planning target volume, and heart and ipsilateral lung DVPs was tested. RESULTS SLD breath hold position showed a significant reduction in percentage of heart receiving ≥5 Gy (V5Gy), V10Gy, V25Gy, V30Gy, mean dose and maximum dose (P < .001), ipsilateral lung V20Gy, and mean dose compared with supine (P < 001) and free breathing SLD (P = .003 and .006). There was also a significant reduction in the heart DVPs (P < .001) and ipsilateral lung DVPs (P < .001 and .007) with free breathing SLD compared with the supine position. SLD with or without breath hold were associated with significant reduction in MLD (P < .001) and CLD (P = .030 and .003) compared with the supine position. CONCLUSION Treatment plans for patients in the SLD position with or without breath hold for left-sided breast cancer patients demonstrated a superior heart and lung sparing compared with the supine position due to significant reduction in MHD and CLD. MHD and CLD are important simulation factors that affect the heart and lung DVP.
Collapse
Affiliation(s)
- Azza Helal
- Physics Department, King Abdulaziz University, Jeddah, Saudi Arabia; Medical Physics Unit, Radiology and Intervention Department, Faculty of Medicine, Alexandria University, Egypt.
| | - Mohamed Farouk
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Sherief H Gamie
- Department of Radiotherapy,University of Southern California, Los Angeles, California
| | - Mahran Abdo
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Lila Mosa
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Amr Abdul Aziz
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| |
Collapse
|
13
|
Abdul Aziz A, Moussa L, Farouk M, Helal A, Abdo M. Significant reductions in heart and lung doses using semi lateral decubitus techniques for left sided breast cancer patients: A comparative dosimetric study with supine techniques. ALEXANDRIA JOURNAL OF MEDICINE 2017. [DOI: 10.1016/j.ajme.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Amr Abdul Aziz
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Lila Moussa
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed Farouk
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Azza Helal
- Medical Physics Unit, Radiology and Intervention Dept, Faculty of Medicine, Alexandria University, Egypt
- Physics Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahran Abdo
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| |
Collapse
|
14
|
Bronsart E, Dureau S, Xu HP, Bazire L, Chilles A, Costa E, Logerot C, Falcou MC, Campana F, Berger F, Fourquet A, Kirova YM. Whole breast radiotherapy in the lateral isocentric lateral decubitus position: Long-term efficacy and toxicity results. Radiother Oncol 2017; 124:214-219. [DOI: 10.1016/j.radonc.2017.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 01/30/2023]
|
15
|
|
16
|
Celi S, Costa E, Wessels C, Mazal A, Fourquet A, Francois P. EPID based in vivo dosimetry system: clinical experience and results. J Appl Clin Med Phys 2016; 17:262-276. [PMID: 27167283 PMCID: PMC5690938 DOI: 10.1120/jacmp.v17i3.6070] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/31/2016] [Accepted: 01/21/2016] [Indexed: 11/23/2022] Open
Abstract
Mandatory in several countries, in vivo dosimetry has been recognized as one of the next milestones in radiation oncology. Our department has implemented clinically an EPID based in vivo dosimetry system, EPIgray, by DOSISOFT S.A., since 2006. An analysis of the measurements per linac and energy over a two‐year period was performed, which included a more detailed examination per technique and treatment site over a six‐month period. A comparison of the treatment planning system doses and the doses estimated by EPIgray shows a mean of the differences of 1.9% (±5.2%) for the two‐year period. The 3D conformal treatment plans had a mean dose difference of 2.0% (±4.9%), while for intensity‐modulated radiotherapy and volumetric‐modulated arc therapy treatments the mean dose difference was −3.0 (±5.3%) and −2.5 (±5.2%), respectively. In addition, root cause analyses were conducted on the in vivo dosimetry measurements of two breast cancer treatment techniques, as well as prostate treatments with intensity‐modulated radiotherapy and volumetric‐modulated arc therapy. During the breast study, the dose differences of breast treatments in supine position were correlated to patient setup and EPID positioning errors. Based on these observations, an automatic image shift correction algorithm is developed by DOSIsoft S.A. The prostate study revealed that beams and arcs with out‐of‐tolerance in vivo dosimetry results tend to have more complex modulation and a lower exposure of the points of interest. The statistical studies indicate that in vivo dosimetry with EPIgray has been successfully implemented for classical and complex techniques in clinical routine at our institution. The additional breast and prostate studies exhibit the prospects of EPIgray as an easy supplementary quality assurance tool. The validation, the automatization, and the reduction of false‐positive results represent an important step toward adaptive radiotherapy with EPIgray. PACS number(s): 87.53.Bn, 87.55.Qr, 87.56.Fc, 87.57.uq
Collapse
|
17
|
Niglas M, McCann C, Keller BM, Makhani N, Presutti J, Vesprini D, Rakovitch E, Elzibak A, Mashouf S, Lee J. A dosimetric study of cardiac dose sparing using the reverse semi-decubitus technique for left breast and internal mammary chain irradiation. Radiother Oncol 2016; 118:187-93. [DOI: 10.1016/j.radonc.2015.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/07/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
|
18
|
Chargari C, Guy JB, Falk AT, Schouver ED, Trone JC, Moncharmont C, Védrine L, Magné N. Cardiotoxicity research in breast cancer patients: past and future. Am J Cardiol 2014; 113:1447-8. [PMID: 24685328 DOI: 10.1016/j.amjcard.2014.01.421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
|
19
|
Shaitelman SF, Khan AJ, Woodward WA, Arthur DW, Cuttino LW, Bloom ES, Shah C, Freedman GM, Wilkinson JB, Babiera GV, Julian TB, Vicini FA. Shortened radiation therapy schedules for early-stage breast cancer: a review of hypofractionated whole-breast irradiation and accelerated partial breast irradiation. Breast J 2014; 20:131-46. [PMID: 24479632 DOI: 10.1111/tbj.12232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Breast-conserving therapy consisting of segmental mastectomy followed by whole-breast irradiation (WBI) has become widely accepted as an alternative to mastectomy as a treatment for women with early-stage breast cancer. WBI is typically delivered over the course of 5-6 weeks to the whole breast. Hypofractionated whole-breast irradiation and accelerated partial breast irradiation have developed as alternative radiation techniques for select patients with favorable early-stage breast cancer. These radiation regimens allow for greater patient convenience and the potential for decreased health care costs. We review here the scientific rationale behind delivering a shorter course of radiation therapy using these distinct treatment regimens in this setting as well as an overview of the published data and pending trials comparing these alternative treatment regimens to WBI.
Collapse
Affiliation(s)
- Simona F Shaitelman
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Fourquet A, Kirova Y, Massabeau C, Costa E, Campana F. E14. New techniques in radiotherapy of breast cancer. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70066-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
21
|
Kirova YM, Hijal T, Campana F, Fournier-Bidoz N, Stilhart A, Dendale R, Fourquet A. Whole breast radiotherapy in the lateral decubitus position: A dosimetric and clinical solution to decrease the doses to the organs at risk (OAR). Radiother Oncol 2014; 110:477-81. [DOI: 10.1016/j.radonc.2013.10.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/27/2013] [Accepted: 10/19/2013] [Indexed: 10/25/2022]
|
22
|
Bollet MA, Kirova YM, Fourquet A, de Cremoux P, Reyal F. Prognostic factors for local recurrence following breast-conserving treatment in young women. Expert Rev Anticancer Ther 2014; 10:1215-27. [DOI: 10.1586/era.10.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
23
|
Liem X, Chira C, Fourquet A, Campana F, Peurien D, Fournier-Bidoz N, Kirova Y. Résultats préliminaires d’une tomothérapie hélicoïdale adjuvante avec boost intégré dans le cadre d’un traitement conservateur d’un cancer du sein. Cancer Radiother 2014; 18:15-22. [DOI: 10.1016/j.canrad.2013.07.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/22/2013] [Accepted: 07/03/2013] [Indexed: 12/24/2022]
|
24
|
Jacob J, Belin L, Gobillion A, Daveau-Bergerault C, Dendale R, Beuzeboc P, Campana F, Bollet MA, Fourquet A, Kirova Y. Étude prospective monocentrique de la toxicité et de l’efficacité du trastuzumab concomitant à la radiothérapie. Cancer Radiother 2013; 17:183-90. [DOI: 10.1016/j.canrad.2012.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 12/14/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
|
25
|
Fourquet A, Kirova Y. Radiation therapy after breast-conserving surgery. BREAST CANCER MANAGEMENT 2012. [DOI: 10.2217/bmt.12.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Whole-breast irradiation in combination with breast-conserving surgery is a recognized standard alternative to mastectomy for the local treatment of early breast cancer. This article will review the evidence on the relationship of local control in the treated breast and survival, the indications of a boost dose to the tumor bed and the need for breast irradiation in ductal carcinoma in situ. Novel, shorter fractionation schemes allow the constraints of daily treatment courses over several weeks to be reduced, and recent technical improvements in treatment delivery will improve the results of treatment – in terms of local control and reduction of toxicity, and long-term sequelae. Research should focus on identifying molecular markers of radiation sensitivity and designing specific, targeted modulators of the radiation response in breast cancer.
Collapse
Affiliation(s)
- Alain Fourquet
- Departement de Radiotherapie, Institut Curie, 26 rue d’Ulm, Paris, France
| | - Youlia Kirova
- Departement de Radiotherapie, Institut Curie, 26 rue d’Ulm, Paris, France
| |
Collapse
|
26
|
Bourgier C, Aimard L, Bodez V, Bollet MA, Cutuli B, Franck D, Hennequin C, Kirova YM, Azria D. Adjuvant radiotherapy in the management of axillary node negative invasive breast cancer: a qualitative systematic review. Crit Rev Oncol Hematol 2012; 86:33-41. [PMID: 23088955 DOI: 10.1016/j.critrevonc.2012.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/06/2012] [Accepted: 09/25/2012] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To actualize and to detail guidelines used in technical radiotherapy and indications for innovative radiation technologies in early axillary node negative breast cancer (BC). METHODS Dosimetric and treatment planning studies, phase II and III trials, systematic reviews and retrospective studies were all searched (Medline(®) database). Their quality and clinical relevance were also checked against validated checklists. A level of evidence was associated for each result. RESULTS A total of 75 references were included. Adjuvant BC radiotherapy (50Gy/25 fractions/5 weeks followed by a tumor boost of 16Gy/8 fractions) is still the standard of care. Overall treatment time could be shortened for patients who present with low local relapse risk BC by using either hypofractionated whole breast irradiation; or accelerated partial breast irradiation. BC IMRT is not used in current practice. CONCLUSION Our group aimed to provide guidelines for technical and clinical applications of innovative BC radiation technologies.
Collapse
Affiliation(s)
- C Bourgier
- Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Chargari C, Castro-Pena P, Toledano I, Bollet MA, Savignoni A, Cottu P, Laki F, Campana F, Fourquet A, Kirova YM, Kirova YM. Concurrent use of aromatase inhibitors and hypofractionated radiation therapy. World J Radiol 2012; 4:318-23. [PMID: 22900133 PMCID: PMC3419868 DOI: 10.4329/wjr.v4.i7.318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 04/13/2012] [Accepted: 04/20/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively assess the acute and long-term toxicity using aromatase inhibitors (AI) therapy concurrently with hypofractionated radiotherapy (HFRT) in breast cancer patients.
METHODS: From November 1999 to October 2007, 66 patients were treated with breast HFRT and concurrent AI. In 63 patients (95.5%), HFRT delivered a total dose of 32.5 Gy to the whole breast within 5 wk (five fractions, one fraction per week). Other fractionations were chosen in three patients for the patients’ personal convenience. A subsequent boost to the tumor bed was delivered in 35 patients (53.0%). Acute toxicities were scored according to the Common Toxicity Criteria for Adverse Events v3. Late toxicity was defined as any toxicity occurring more than 6 mo after completion of HFRT and was scored according to the Late Effects Normal Tissue Task Force-Subjective, Objective, Management and Analytic scale.
RESULTS: At the end of the HFRT course, 19 patients (28.8%) had no irradiation-related toxicity. Acute grade 1-2 epithelitis was observed in 46 patients (69.7%). One grade 3 toxicity (1.5%) was observed. With a median follow-up of 34 mo (range: 12-94 mo), 31 patients (47%) had no toxicity, and 35 patients (53%) presented with grade 1-2 fibrosis. No grade 3 or greater delayed toxicity was observed.
CONCLUSION: We found that AI was well tolerated when given concurrently with HFRT. All toxicities were mild to moderate, and no treatment disruption was necessary. Further prospective assessment is warranted.
Collapse
|
28
|
Poortmans P, Orecchia R. E3. What is Hot in breast cancer radiation oncology in 2012? Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Haberer S, Belin L, Le Scodan R, Kirova YM, Savignoni A, Stevens D, Moisson P, Decaudin D, Pierga JY, Reyal F, Campana F, Fourquet A, Bollet MA. [Breast conserving surgery in locoregional treatment of breast carcinoma after Hodgkin lymphoma]. Cancer Radiother 2012; 16:128-35. [PMID: 22341508 DOI: 10.1016/j.canrad.2011.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 09/09/2011] [Accepted: 10/12/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To report characteristics and outcome of breast cancer after irradiation for Hodgkin lymphoma with special focus on breast conservation surgery. PATIENTS AND METHODS Medical records of 72 women who developed either ductal carcinoma in situ or stage I-III invasive carcinoma of the breast after Hodgkin lymphoma between 1978 and 2009 were retrospectively reviewed. RESULTS Median age at Hodgkin lymphoma diagnosis was 23 years old. Median total dose received by the mediastinum was 40 Gy, mostly by a mantle field technique. Breast cancer occurred after a median time interval of 21 years. Ductal invasive carcinoma and ductal carcinoma in situ represented respectively 71% and 19% of the cases. Locoregional treatment for breast cancer consisted of mastectomy with or without radiotherapy in 39 patients and of lumpectomy with or without adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were respectively 74.5% and 82% for invasive carcinoma and 100% and 92% for in situ carcinoma. Thirteen patients died of progressive breast cancer and contralateral breast cancer was diagnosed in ten patients (14%). CONCLUSIONS Breast conserving treatment can be an option for breast cancers that occur after Hodgkin lymphoma despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position.
Collapse
Affiliation(s)
- S Haberer
- Département de radiothérapie, institut Curie, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Gupta D, Shukla P, Munshi A, Aggarwal JP. Cardioprotective radiotherapy: the circadian way. Med Hypotheses 2012; 78:353-5. [PMID: 22260990 DOI: 10.1016/j.mehy.2011.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 08/20/2011] [Accepted: 08/24/2011] [Indexed: 11/30/2022]
Abstract
Radiotherapy (RT) has been established to improve both local control as well as overall survival rates in breast cancer. However, RT especially in left-sided breast cancer also irradiates a portion of the heart. Radiation associated toxicity to the heart assumes significance because of improval in survival of breast cancer patients. A circadian pattern has been reported in the myocardial oxygen demand and myocardial ischaemia with the cardiac tissue being more susceptible to injury between 6 am and noon. Radiation damages blood vessels of all sizes causing an increase in capillary wall permeability and dilatation of vessels leading to the characteristic radiation erythema followed by an inflammatory cell infiltrate. Coronary artery spasm may be the reason behind some cases of sudden death occurring in patients after radiation therapy. Endothelial behaviour also has a circadian variation and vasodilation is significantly attenuated in the morning. Critical coronary artery disease occurs 10-15 years after radiotherapy. Radiation in the morning hours may be one of the associated risk factor. The application of chrono-therapeutics with radiation therapy in carcinoma breast and in other chest wall irradiation, could possibly decrease the radiation associated cardiac toxicity.
Collapse
Affiliation(s)
- Deepak Gupta
- Department of Radiation Oncology, Tata Memorial Cancer Centre, Mumbai, Maharashtra, India
| | | | | | | |
Collapse
|
31
|
Cutuli B, Fourquet A. Irradiation hypofractionnée dans le cancer du sein : pour ou contre ? Cancer Radiother 2011; 15:445-9. [DOI: 10.1016/j.canrad.2011.07.235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 07/18/2011] [Indexed: 11/15/2022]
|
32
|
Toxicité cardiaque de la radiothérapie. Cancer Radiother 2011; 15:495-503. [DOI: 10.1016/j.canrad.2011.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 06/16/2011] [Indexed: 11/20/2022]
|
33
|
Fournier-Bidoz N, Kirova YM, Campana F, Dendale R, Fourquet A. Simplified field-in-field technique for a large-scale implementation in breast radiation treatment. Med Dosim 2011; 37:131-7. [PMID: 21945169 DOI: 10.1016/j.meddos.2011.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 03/16/2011] [Accepted: 03/17/2011] [Indexed: 11/18/2022]
Abstract
We wanted to evaluate a simplified "field-in-field" technique (SFF) that was implemented in our department of Radiation Oncology for breast treatment. This study evaluated 15 consecutive patients treated with a simplified field in field technique after breast-conserving surgery for early-stage breast cancer. Radiotherapy consisted of whole-breast irradiation to the total dose of 50 Gy in 25 fractions, and a boost of 16 Gy in 8 fractions to the tumor bed. We compared dosimetric outcomes of SFF to state-of-the-art electronic surface compensation (ESC) with dynamic leaves. An analysis of early skin toxicity of a population of 15 patients was performed. The median volume receiving at least 95% of the prescribed dose was 763 mL (range, 347-1472) for SFF vs. 779 mL (range, 349-1494) for ESC. The median residual 107% isodose was 0.1 mL (range, 0-63) for SFF and 1.9 mL (range, 0-57) for ESC. Monitor units were on average 25% higher in ESC plans compared with SFF. No patient treated with SFF had acute side effects superior to grade 1-NCI scale. SFF created homogenous 3D dose distributions equivalent to electronic surface compensation with dynamic leaves. It allowed the integration of a forward planned concomitant tumor bed boost as an additional multileaf collimator subfield of the tangential fields. Compared with electronic surface compensation with dynamic leaves, shorter treatment times allowed better radiation protection to the patient. Low-grade acute toxicity evaluated weekly during treatment and 2 months after treatment completion justified the pursuit of this technique for all breast patients in our department.
Collapse
|
34
|
Kirova YM, Fromantin I, De Rycke Y, Fourquet A, Morvan E, Padiglione S, Falcou MC, Campana F, Bollet MA. Can we decrease the skin reaction in breast cancer patients using hyaluronic acid during radiation therapy? Results of phase III randomised trial. Radiother Oncol 2011; 100:205-9. [PMID: 21624699 DOI: 10.1016/j.radonc.2011.05.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/12/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Radio-induced early skin reactions still remain a clinical challenge. Preliminary results with Hyaluronic acid, one of the most recent topical products used in this indication are proving interesting. To evaluate the efficacy of Hyaluronic acid compared to placebo. MATERIAL AND METHODS Breast cancer patients with grade 1-2 radio-induced dermatitis during postoperative radiotherapy were eligible. They were randomised to receive either hyaluronic acid (A) or a simple emollient (B). The primary endpoint was the clinical evaluation of the erythema (success versus failure). Secondary endpoints were the evaluation of skin colorimetry, pain, and quality of life. RESULTS Two-hundred patients were enrolled (A=99, B=101). Ninety-five patients per treatment arm could be evaluated. Failures occurred in 23 patients (24%) in the hyaluronic acid arm, and 32 (34%) in the emollient arm (p=0.15). Seventy-three patients (36.5%) prematurely stopped the treatment without any ensuing difference between the two arms. Body mass index and the size of the epithelitis were both independently associated with the failure of the local treatment. The relative reduction of colorimetric levels was 20% in the hyaluronic acid group, and 13% in the emollient group (p=0.46). Concerning the quality of life assessment, there was a trend towards a lower level of pain in patients receiving hyaluronic acid (p=0.053). CONCLUSIONS The present study showed no significant difference between hyaluronic acid and simple emollient in the treatment of acute radio-induced dermatitis. There was however a trend towards an improvement in both pain level and skin colorimetry.
Collapse
Affiliation(s)
- Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Haberer S, Belin L, Le Scodan R, Kirova YM, Savignoni A, Stevens D, Moisson P, Decaudin D, Pierga JY, Reyal F, Campana F, Fourquet A, Bollet MA. Locoregional treatment for breast carcinoma after Hodgkin's lymphoma: the breast conservation option. Int J Radiat Oncol Biol Phys 2011; 82:e145-52. [PMID: 21605948 DOI: 10.1016/j.ijrobp.2011.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/01/2011] [Accepted: 03/17/2011] [Indexed: 01/30/2023]
Abstract
PURPOSE To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin's lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. METHODS AND MATERIALS Medical records of 72 women who developed either ductal carcinoma in situ or Stage I-III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. RESULTS Median age at HL diagnosis was 23 years (range, 14-53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5-40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0-2 tumors (82%), 5 cN1-3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64-88%) and 82% (95% CI, 72-93%) for invasive carcinoma and 100% (95% CI, 100 -100%) and 92% (95% CI, 79-100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69-91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). CONCLUSIONS Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the underlying heart and lung.
Collapse
Affiliation(s)
- Sophie Haberer
- Department of Radiation Oncology, Institut Curie, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Daveau C, Savignoni A, Abrous-Anane S, Pierga JY, Reyal F, Gautier C, Kirova YM, Dendale R, Campana F, Fourquet A, Bollet MA. Cancers du sein de stade II-IIIA : la radiothérapie exclusive est-elle une option en cas de réponse clinique complète à la chimiothérapie néoadjuvante ? Cancer Radiother 2011; 15:106-14. [DOI: 10.1016/j.canrad.2010.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 06/07/2010] [Accepted: 06/16/2010] [Indexed: 11/17/2022]
|
37
|
Menard J, Campana F, Kirov KM, Bollet MA, Dendale R, Fournier-Bidoz N, Marchand V, Mazal A, Estève M, Fourquet A, Kirova YM. [Radiotherapy for breast cancer and pacemaker]. Cancer Radiother 2011; 15:197-201. [PMID: 21420890 DOI: 10.1016/j.canrad.2010.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 10/11/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the breast cancer patients who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of patients. PATIENTS AND METHODS From November 2008 to December 2009, more than 900 patients received radiotherapy for their breast cancer in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven patients were with permanent pacemaker. All patients have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. Patients who underwent conserving surgery followed by breast irradiation were boosted when indicated to tumour bed with 16 Gy/8 fractions. All patients were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the patients' cardiologist. RESULTS Seven patients were referred in our department for postoperative breast cancer radiotherapy. Among them, only one patient was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six patients, aged between 48 and 84 years underwent irradiation for their breast cancer. Four patients were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. CONCLUSION The multidisciplinary work with position change of the pacemaker before radiotherapy and everyday monitoring permitted the safe treatment of our patients. Updated guidelines are definitely needed with more details about acceptable doses at the different parts of the pacemaker.
Collapse
Affiliation(s)
- J Menard
- Oncologie-radiothérapie, institut Curie, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Caussa L, Kirova YM, Gault N, Pierga JY, Savignoni A, Campana F, Dendale R, Fourquet A, Bollet MA. The acute skin and heart toxicity of a concurrent association of trastuzumab and locoregional breast radiotherapy including internal mammary chain: a single-institution study. Eur J Cancer 2010; 47:65-73. [PMID: 20843680 DOI: 10.1016/j.ejca.2010.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/26/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND To evaluate the skin and heart toxicity of a concurrent adjuvant trastuzumab-radiotherapy for breast cancer (BC), especially in the case of internal mammary chain (IMC) irradiation. MATERIAL AND METHODS Prospective study of 106 patients treated between 06/2003 and 03/2007 by concurrent trastuzumab-radiotherapy for non-metastatic BC. Left ventricular ejection fractions (LVEF) was assessed at baseline, before and after radiotherapy and then every 4-6 months. All toxicities were evaluated using CTCAEV3. RESULTS Median age was 52 years (25-76). Chemotherapy with anthracycline was administered in 92% of patients. All patients received trastuzumab every three weeks (8 mg/kg followed by 6 mg/kg) for a median duration of 12 months (3-40). The IMC was irradiated in 83% of patients. There were: 87 grade 1, 14 grade 2 and 2 grade 3 skin reactions. There were 13 oesophagitis: 9 grade 1; 3 grade 2, and 1 grade 3. Out of 101 patients with assessments after 6 months, late telangiectasia grade 1 occurred in 5 patients, local pain grade 1 in 19 patients and grade 2 in 3 patients, fibrosis grade 1 in 16 patients. A reversible grade ≥2 left ventricular systolic dysfunction occurred in 6 patients. CONCLUSION In this prospective study of breast cancer patients treated with trastuzumab-radiotherapy with, in most cases, anthracycline-based chemotherapy and IMC irradiation, both the rate of abnormal LVEF after concurrent trastuzumab-radiotherapy and the skin toxicity were deemed acceptable. Further follow-up is needed.
Collapse
Affiliation(s)
- Lucas Caussa
- Department of Radiation Oncology, Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Daveau C, Savignoni A, Abrous-Anane S, Pierga JY, Reyal F, Gautier C, Kirova YM, Dendale R, Campana F, Fourquet A, Bollet MA. Is radiotherapy an option for early breast cancers with complete clinical response after neoadjuvant chemotherapy? Int J Radiat Oncol Biol Phys 2010; 79:1452-9. [PMID: 20605368 DOI: 10.1016/j.ijrobp.2010.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 11/13/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine whether the exclusive use of radiotherapy (ERT) could be a treatment option after complete clinical response (cCR) to neoadjuvant chemotherapy (NCT) for early breast cancer (EBC). METHODS AND MATERIALS Between 1985 and 1999, 1,477 patients received NCT for EBC considered too large for primary conservative surgery. Of 165 patients with cCR, 65 patients were treated with breast surgery (with radiotherapy) and 100 patients were treated with ERT. RESULTS The two groups were comparable in terms of baseline characteristics, except for larger initial tumor sizes in the ERT group. There were no significant differences in overall, disease-free and metastasis-free survival rates. Five-year and 10-year overall survival rates were 91% and 77% in the no-surgery group and 82% and 79% in the surgery group, respectively (p = 0.9). However, a nonsignificant trend toward higher locoregional recurrence rates (LRR) was observed in the no-surgery group (31% vs. 17% at 10 years; p = 0.06). In patients with complete responses on mammography and/or ultrasound, LRR were not significantly different (p = 0.45, 10-year LRR: 21% in surgery vs. 26% in ERT). No significant differences were observed in terms of the rate of cutaneous, cardiac, or pulmonary toxicities. CONCLUSIONS Surgery is a key component of locoregional treatment for breast cancers that achieved cCR to NCT.
Collapse
Affiliation(s)
- Caroline Daveau
- Department of Radiation Oncology, Institut Curie, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Yarnold J, Haviland J. Pushing the limits of hypofractionation for adjuvant whole breast radiotherapy. Breast 2010; 19:176-9. [DOI: 10.1016/j.breast.2010.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
41
|
Chargari C, Kirova YM, Laki F, Savignoni A, Dorval T, Dendale R, Bollet MA, Fourquet A, Campana F. The impact of the loco-regional treatment in elderly breast cancer patients: hypo-fractionated exclusive radiotherapy, single institution long-term results. Breast 2010; 19:413-6. [PMID: 20483616 DOI: 10.1016/j.breast.2010.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 04/02/2010] [Accepted: 04/10/2010] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To assess the efficacy of exclusive hypo-fractionated radiotherapy (HFRT) without previous breast-conserving surgery (BCS) in elderly women. MATERIALS AND METHODS From 1995 to 1999, we have treated with breast-conserving treatment 396 patients older than 70 years with early-stage breast cancer (T1,T2 tumours) at the Institut Curie, Paris, France. Seventy-nine consecutive elderly non-metastatic patients treated for early breast cancer have been treated with HFRT. Of them, 50 underwent BCS followed by HFRT of 32.5 Gy/5 fractions/5 weeks, and 29 patients (presented with different co-morbidities, inoperable or patients' refusal, and/or transportation problems) received the same HFRT schedule followed by a 13 Gy boost (two fractions of 6.5 Gy) as exclusive radiotherapy treatment. This population of 29 patients has been studied. In case of hormonal positive status, hormonal therapy was also proposed to the patients. RESULTS There was a median follow-up of 93 months (9-140 months). At 7-year follow-up, the cause-specific survival was 96.4% (confidence interval (CI) 95: 89.8.6-100%), the metastasis-free survival rate was 92.4% (CI 95: 82.8-100%) and the loco-regional control rate was 95.8% (CI 95: 88.2-100%). CONCLUSIONS This long-term follow-up retrospective study demonstrated acceptable local control and good outcome in elderly patients treated by exclusive HFRT for early breast cancer. However, large-scale prospective randomised trials are needed to confirm these results.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/radiotherapy
- Dose Fractionation, Radiation
- Female
- Humans
- Kaplan-Meier Estimate
- Neoadjuvant Therapy
- Proportional Hazards Models
- Radiotherapy, High-Energy/adverse effects
- Radiotherapy, High-Energy/methods
- Retrospective Studies
- Treatment Outcome
Collapse
Affiliation(s)
- Cyrus Chargari
- Radiation Oncology, Institut Curie, 26 rue d'Ulm, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Kirova YM, Castro Pena P, Hijal T, Fournier-Bidoz N, Laki F, Sigal-Zafrani B, Dendale R, Bollet MA, Campana F, Fourquet A. Improving the definition of tumor bed boost with the use of surgical clips and image registration in breast cancer patients. Int J Radiat Oncol Biol Phys 2010; 78:1352-5. [PMID: 20381975 DOI: 10.1016/j.ijrobp.2009.10.049] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/10/2009] [Accepted: 10/13/2009] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the accuracy of a boost technique. METHODS AND MATERIALS Twenty-two patients underwent tumorectomy with placement of two or more clips in the surgical cavity before breast remodeling. Preoperative and postoperative computed tomography scans, with match-point registration, were performed on all patients. The relationship between the location of the gross tumor volume (GTV), defined on the preoperative scan, and clip clinical target volume (CTV) (clips with a 5-mm margin on the postoperative scan) was then studied, by use of commercial volume analysis software. RESULTS Of the patients, 4 had two clips, 2 had three clips, 8 had four clips, and 8 had five clips. The median GTV was 1.06 mL (range, 0.2-5.3 mL); clip CTV ranged from 2.4 to 21.5 mL. Volumetric analysis showed that in 7 cases (32%), there was no intersection between the GTV and the clip CTV, with the following distribution: 4 patients with two clips, 1 patient with three clips, 1 patient with four clips, and 1 patient with five clips. The common contoured volume was defined as the percent ratio between the intersection of the GTV and clip CTV and the GTV. It was found to be significantly increased if three or more clips were used vs. only two clips (common contoured volume, 35.45% vs. 0.73%; p = 0.028). Finally, the GTV and clip CTV volume relationship can be presented as follows: 12.5% to 33% overlap in 8 patients (36.4%), 50% to 75% in 5 patients (22.7%), and greater than 90% in 2 patients (9%). CONCLUSIONS The use of three or more clips during tumorectomy increases the accuracy of tumor bed delineation.
Collapse
Affiliation(s)
- Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Kirova YM. Recent advances in breast cancer radiotherapy: Evolution or revolution, or how to decrease cardiac toxicity? World J Radiol 2010; 2:103-8. [PMID: 21160943 PMCID: PMC2998939 DOI: 10.4329/wjr.v2.i3.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 03/01/2010] [Accepted: 03/09/2010] [Indexed: 02/06/2023] Open
Abstract
Radiation therapy has a major role in the management of breast cancers. However, there is no consensus on how to irradiate and on volume definitions, and there are strong differences in strategies according to different centers and physicians. New treatment protocols and techniques have been used with the principal purpose of decreasing lung and heart toxicity and adapting radiation treatment to patients’ anatomy. There is evidence that indicates internal mammary chain radiotherapy should be used carefully and that high quality techniques should be used for decreasing the dose delivered to the heart. This review of the literature presents the state of the art on breast cancer radiotherapy, with special focus on the indications, techniques, and potential toxicity.
Collapse
|
44
|
|
45
|
Laki F, Kirova YM, Savignoni A, Campana F, Levu B, Estève M, Sigal-Zafrani B, Dorval T, Asselain B, Salmon RJ. Management of operable invasive breast cancer in women over the age of 70: long-term results of a large-scale single-institution experience. Ann Surg Oncol 2010; 17:1530-8. [PMID: 20177798 DOI: 10.1245/s10434-010-0967-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND The treatment of choice for elderly women with breast cancer remains controversial. This retrospective analysis of a cohort from a single institution was designed to evaluate whether such patients are really undertreated because of their age and to reappraise their usual management. METHODS The characteristics of 538 patients aged > or = 70 years with operable breast cancer, treated between 1995 and 1999, were retrospectively analyzed comparing patients aged 70 to 75 years (group I, n = 288), 75 to 80 years (group II, n = 156), and > or = 80 years (group III, n = 94). Cause-specific survival, distant recurrence-free interval, and local control were estimated by the Kaplan-Meier method and compared by log rank test. Multivariate analysis used Cox regression. RESULTS In group III, tumors were more frequently T2 than T1 (P < 0.0001) and estrogen receptor negative (P = 0.045) than in groups I and II. Surgery was performed in 94.6% of patients, breast-conserving in 72.1% (62% in group III; P = 0.0015) with axillary dissection in 89.2% (77% in group III; P = 0.0015); 100% received radiotherapy after lumpectomy (hypofractionated in 63% of group III; P < 0.0001). Adjuvant hormone therapy and chemotherapy were administered to 57 and 3.7% of patients, respectively. At 7 years, no difference in the three groups was observed for cause-specific survival (91% for group I, 89% for group II, 86% for group III) distant recurrence-free interval, and local control (>90%). CONCLUSIONS Elderly patients with operable breast cancer who are completely and correctly treated with realistic treatment options that are based on surgery and adjuvant radiotherapy have a similar chance of being cured as younger patients.
Collapse
Affiliation(s)
- Fatima Laki
- Department of Surgery, Institut Curie, Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Hijal T, Fournier-Bidoz N, Castro-Pena P, Kirova YM, Zefkili S, Bollet MA, Dendale R, Campana F, Fourquet A. Simultaneous integrated boost in breast conserving treatment of breast cancer: a dosimetric comparison of helical tomotherapy and three-dimensional conformal radiotherapy. Radiother Oncol 2010; 94:300-6. [PMID: 20171752 DOI: 10.1016/j.radonc.2009.12.043] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 12/20/2009] [Accepted: 12/29/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the dosimetry of helical tomotherapy (HT) and three-dimensional conformal radiotherapy (3D-CRT) in breast cancer patients undergoing whole breast radiation with simultaneous integrated boost (SIB) of the tumor bed. MATERIAL AND METHODS Thirteen patients with breast cancer treated by lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned using both HT and 3D-CRT using the field-in-field technique. The whole breast and tumor bed were prescribed 50.68 Gy and 64.4 Gy, respectively, in 28 fractions. Dosimetries for both techniques were compared. RESULTS Coverage of the whole breast was adequate with both techniques (V(95%)=96.22% vs. 96.25%, with HT and 3D-CRT, respectively; p=0.64). Adequate tumor bed coverage was also achieved, although it was significantly lower with HT (V(95%)=97.18% vs. 99.72%; p<0.001). Overdose of the breast volume outside the tumor bed was significantly lower with HT (V(54.23 Gy)=12.47% vs. 30.83%; p<0.001). Ipsilateral lung V(20 Gy) (6.34% vs. 10.17%; p<0.001), V(5 Gy) (16.54% vs. 18.53%; p<0.05) and mean dose (4.05 Gy vs. 6.36 Gy; p<0.001) were significantly lower with HT. In patients with left-sided tumors, heart V(30 Gy) (0.03% vs. 1.14%; p<0.05) and mean dose (1.35 Gy vs. 2.22 Gy; p<0.01) were significantly lower with HT, but not V(5 Gy). Contralateral breast V(5 Gy) (0.27% vs. 0.00%; p<0.01) and maximum dose were significantly increased with HT. CONCLUSIONS In breast cancer treated with SIB, both HT and 3D-CRT provided adequate target volume coverage and low heart doses. Tumor bed coverage was slightly lower with HT, but HT avoided unnecessary breast overdosage while improving ipsilateral lung dosimetry.
Collapse
Affiliation(s)
- Tarek Hijal
- Department of Radiation Oncology, Institut Curie, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
The lateral decubitus breast boost: description, rationale, and efficacy. Int J Radiat Oncol Biol Phys 2010; 76:100-3. [PMID: 19394161 DOI: 10.1016/j.ijrobp.2009.01.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 01/14/2009] [Accepted: 01/20/2009] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe and evaluate the modified lateral decubitus boost, a breast irradiation technique. Patients are repositioned and resimulated for electron boost to minimize the necessary depth for the electron beam and optimize target volume coverage. METHODS AND MATERIALS A total of 2,606 patients were treated with post-lumpectomy radiation at our institution between January 1, 2000, and February 1, 2008. Of these, 231 patients underwent resimulation in the lateral decubitus position with electron boost. Distance from skin to the maximal depth of target volume was measured in both the original and boost plans. Age, body mass index (BMI), boost electron energy, and skin reaction were evaluated. RESULTS Resimulation in the lateral decubitus position reduced the distance from skin to maximal target volume depth in all patients. Average depth reduction by repositioning was 2.12 cm, allowing for an average electron energy reduction of approximately 7 MeV. Mean skin entrance dose was reduced from about 90% to about 85% (p < 0.001). Only 14 patients (6%) experienced moist desquamation in the boost field at the end of treatment. Average BMI of these patients was 30.4 (range, 17.8-50.7). BMI greater than 30 was associated with more depth reduction by repositioning and increased risk of moist desquamation. CONCLUSIONS The lateral decubitus position allows for a decrease in the distance from the skin to the target volume depth, improving electron coverage of the tumor bed while reducing skin entrance dose. This is a well-tolerated regimen for a patient population with a high BMI or deep tumor location.
Collapse
|
48
|
Kirova YM, Savignoni A, Sigal-Zafrani B, de La Rochefordiere A, Salmon RJ, This P, Asselain B, Stoppa-Lyonnet D, Fourquet A. Is the breast-conserving treatment with radiotherapy appropriate in BRCA1/2 mutation carriers? Long-term results and review of the literature. Breast Cancer Res Treat 2009; 120:119-26. [PMID: 20033769 DOI: 10.1007/s10549-009-0685-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 12/09/2009] [Indexed: 12/24/2022]
Abstract
As tumours in BRCA1/2 mutation carriers might be more sensitive to radiation, we investigated after long-term follow-up whether mutation status influenced the rate of ipsilateral and contralateral breast cancers after breast-conserving treatment (BCT). BRCA1 and BRCA2 genes were screened for germline mutations in 131 patients with a family history of breast and/or ovarian cancer who had undergone BCT and radiotherapy. Patients were matched to 261 controls with sporadic breast cancer according to age at diagnosis and year of treatment. Controls were followed up for at least as long as the interval between diagnosis and genetic screening in familial cases. Rates of ipsilateral and contralateral cancer between groups were compared by the log-rank test. The BRCA1/2 mutations occurred in 20.6% of tested patients. Tumours in mutation carriers were more likely to be grade III (P < 10(-4)) and oestrogen receptor negative (P = 0.005) than in non-carriers and controls. Overall median follow-up was 161 months. There was no significant difference in ipsilateral tumours between mutation carriers, non-carriers and controls (P = 0.13). On multivariate analysis, age was the most significant predictor for ipsilateral recurrence (P < 10(-3)). The rate of contralateral cancer was significantly higher in familial cases: 40.7% (mutation carriers), 20% (non-carriers), and 11% (controls) (P < 10(-4)). After 13.4 years of follow-up, the rate of ipsilateral tumours was no higher in mutation carriers than in non-carriers or controls. As tumours in BRCA1/2 mutation carriers might be more sensitive to radiation, BCT is a possible treatment option.
Collapse
Affiliation(s)
- Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, 26 Rue d'Ulm, 75248, Paris Cedex 05, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Bidard FC, Kirova Y, Vincent-Salomon A, Alran S, de Rycke Y, Sigal-Zafrani B, Sastre-Garau X, Mignot L, Fourquet A, Pierga JY. Disseminated tumor cells and the risk of locoregional recurrence in nonmetastatic breast cancer. Ann Oncol 2009; 20:1836-41. [DOI: 10.1093/annonc/mdp200] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
50
|
CASTRO PENA P, KIROVA YM, CAMPANA F, DENDALE R, BOLLET MA, FOURNIER-BIDOZ N, FOURQUET A. Anatomical, clinical and radiological delineation of target volumes in breast cancer radiotherapy planning: individual variability, questions and answers. Br J Radiol 2009; 82:595-9. [DOI: 10.1259/bjr/96865511] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|