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A national multicenter study on 1072 DCIS patients treated with breast-conserving surgery and whole breast radiotherapy (COBCG-01 study). Radiother Oncol 2018; 131:208-214. [PMID: 30075864 DOI: 10.1016/j.radonc.2018.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Breast-conserving surgery (BCS) and whole breast radiation (RT) with or without endocrine therapy (ET) represent the standard of care for ductal carcinoma in situ (DCIS). The use of adjuvant treatments after surgery is still controversial in this setting. We performed a retrospective multicenter analysis on a series of DCIS patients treated with BCS and adjuvant RT. MATERIALS AND METHODS We collected clinical data from nine Italian centers on 1072 women having a diagnosis of DCIS and treated between 1997 and 2012. We reported on the 5- and 10-year local recurrence (LR) rates, overall survival, and breast cancer specific survival (BCSS) employing the Kaplan-Meier method. RESULTS At a median follow-up of 8.4 years, 67 LR (6.3%) and 47 deaths (4.4%) were observed. LR rates at 5 and 10 years were 3.4% and 7.6%, respectively. BCSS rates at 5 and 10 years were 99.7% and 99.1%, respectively. At univariate regression analysis, postmenopausal state (p = 0.009), estrogen receptor (ER) (p = 0.0001) and progesterone receptor (p = 0.018) positivity and ET (p = 0.006) were inversely correlated with LR. Final surgical margins (FSM) status <1 mm was significantly correlated with higher LR (p = 0.003). At multivariate regression analysis postmenopausal state (p = 0.03), and ER positive (p = 0.045) maintained the significant favorable feature, while FSM <1 mm (p = 0.024) confirmed its negative impact on LR. CONCLUSIONS Our real-life study pointed out the significant favorable prognostic role of postmenopausal state and ER positive status on LR occurrence. FSM <1 mm was significantly correlated to a higher chance to experience LR.
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Quality assessment of delineation and dose planning of early breast cancer patients included in the randomized Skagen Trial 1. Radiother Oncol 2017; 123:282-287. [PMID: 28351523 DOI: 10.1016/j.radonc.2017.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE To report on a Quality assessment (QA) of Skagen Trial 1, exploring hypofractionation for breast cancer patients with indication for regional nodal radiotherapy. MATERIAL AND METHODS Deviations from protocol regarding target volume delineations and dose parameters (Dmin, Dmax, D98%, D95% and D2%) from randomly selected dose plans were assessed. Target volume delineation according to ESTRO guidelines was obtained through atlas based automated segmentation and centrally approved as gold standard (GS). Dice similarity scores (DSC) with original delineations were measured. Dose parameters measured in the two delineations were reported to assess their dosimetric outcome. RESULTS Assessment included 88 plans from 12 centres in 4 countries. DSC showed high agreement in contouring, 99% and 96% of the patients had a complete delineation of target volumes and organs at risk. No deviations in the dosimetric outcome were found in 76% of the patients, 82% and 95% of the patients had successful coverage of breast/chestwall and CTVn_L2-4-interpectoral. Dosimetric outcomes of original delineation and GS were comparable. CONCLUSIONS QA showed high protocol compliance and adequate dose coverage in most patients. Inter-observer variability in contouring was low. Dose parameters were in harmony with protocol regardless original or GS segmentation.
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Prades J, Algara M, Espinàs JA, Farrús B, Arenas M, Reyes V, García-Reglero V, Cambra MJ, Rubio E, Anglada L, Eraso A, Pedro A, Fuentes-Raspall MJ, Tuset V, Solà J, Borras JM. Understanding variations in the use of hypofractionated radiotherapy and its specific indications for breast cancer: A mixed-methods study. Radiother Oncol 2017; 123:22-28. [PMID: 28236538 DOI: 10.1016/j.radonc.2017.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/23/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Radiation oncology guidelines favour hypofractionated whole-breast radiotherapy (HWBRT) over more conventional schemes in the conservative treatment of breast cancer, but its adoption still varies in clinical practice. This study assessed the patterns of HWBRT adoption in Catalonia (Spain). MATERIAL AND METHODS We used a mixed-methods approach based on an explanatory sequential design, first collecting and analysing quantitative data on HWBRT use (>2.5Gy per fraction) in 11 public radiotherapy centres (2005-2015) and then performing 25 semi-structured interviews with all department heads and reference radiation oncologist/s. RESULTS Of the 34,859 patients fulfiling the study criteria over the study period, just 12% were hypofractionated, reaching a percentage of 29% in 2015 (p<0.001). Our analysis showed a narrowing age gap between patients receiving conventional fractionation and hypofractionation in centres leading adoption. However, there were important differences in clinicians' interpretation of evidence (e.g. regarding the perceived risk of long-term toxicity) and selection of patients for specific indications, both within and between departments. CONCLUSIONS Differences observed in the rate of adoption of HWBRT could not be tackled only using a rational, evidence-based approach. Factors related to the management of radiotherapy departments play a major role in the diffusion of therapeutic strategies.
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Affiliation(s)
- Joan Prades
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
| | - Manel Algara
- Department of Radiation Oncology, Parc de Salut Mar. University Pompeu Fabra (UPF). Hospital del Mar Medical Research Institute (IMIM). Barcelona, Spain
| | - Josep A Espinàs
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
| | - Blanca Farrús
- Department of Radiation Oncology, Hospital Clínic, Barcelona, Spain
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Spain; University of Rovira and Virgili (URV), Reus, Spain
| | - Victoria Reyes
- Department of Radiation Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Maria Josep Cambra
- Department of Radiation Oncology, Institut Oncològic del Vallés, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Terrassa, Spain
| | - Esther Rubio
- Department of Radiation Oncology, Institut Oncològic del Vallés, Consorci Sanitari de Terrassa, Spain
| | - Lluis Anglada
- Dept. of Radiation Oncology, Catalan Institut of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Arantxa Eraso
- University of Barcelona (IDIBELL), Spain; Department of Radiation Oncology, Catalan Institute of Oncology, L'Hospitalet, Spain
| | - Agustí Pedro
- Department of Radiation Oncology, Hospital Plató, Barcelona, Spain
| | | | - Victòria Tuset
- Department of Radiation Oncology, ICO Badalona. Hospital Universitari Germans Trias i Pujol; Badalona, Spain
| | - Judit Solà
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
| | - Josep M Borras
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain; University of Barcelona (IDIBELL), Spain.
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