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Bruand M, Salleron J, Guihard S, Crety CM, Liem X, Pasquier D, Lamrani-Ghaouti A, Charra-Brunaud C, Peiffert D, Clavier JB, Desandes E, Faivre JC. Acute skin toxicity of conventional fractionated versus hypofractionated radiotherapy in breast cancer patients receiving regional node irradiation: the real-life prospective multicenter HYPOBREAST cohort. BMC Cancer 2022; 22:1318. [PMID: 36526987 PMCID: PMC9755801 DOI: 10.1186/s12885-022-10402-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Large-scale trials have shown that hypofractionated adjuvant breast radiotherapy was as effective in terms of survival and local control as conventional fractionated radiotherapy, and acute toxicity was reduced with hypofractionated radiotherapy. However, there is a lack of data about the toxicity of breast with regional nodal irradiation (RNI). The aim of this study was to assess the effect of fractionation on radiation-related acute skin toxicity in patients receiving RNI in addition to whole-breast or chest wall irradiation, using real-life data. METHODS We conducted a prospective, multicenter cohort study with systematic computerized data collection integrated into Mosaiq®. Three comprehensive cancer centers used a standardized form to prospectively collect patient characteristics, treatment characteristics and toxicity. RESULTS Between November 2016 and January 2022, 1727 patients were assessed; 1419 (82.2%) and 308 (17.8%) patients respectively received conventional fractionated and hypofractionated radiation therapy. Overall, the incidence of acute grade 2 or higher dermatitis was 28.4% (490 patients). Incidence was lower with hypofractionated than with conventional fractioned radiation therapy (odds ratio (OR) 0.34 [0.29;0.41]). Two prognostic factors were found to increase the risk of acute dermatitis, namely 3D (vs IMRT) and breast irradiation (vs chest wall). CONCLUSION Using real-life data from unselected patients with regional nodal irradiation, our findings confirm the decreased risk of dermatitis previously reported with hypofractionated radiation therapy in clinical trials. Expansion of systematic data collection systems to include additional centers as well as dosimetric data is warranted to further evaluate the short- and long-term effects of fractionation in real life.
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Affiliation(s)
- Marie Bruand
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France ,grid.29172.3f0000 0001 2194 6418EA 4360 APEMAC, Université de Lorraine, Nancy, France
| | - Julia Salleron
- grid.452436.20000 0000 8775 4825Unité de biostatistiques, Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - Sébastien Guihard
- grid.512000.6Service de Radiothérapie, ICANS - Institut de Cancérologie Strasbourg Europe, 67200 Strasbourg, France
| | - Charles Marchand Crety
- grid.418448.50000 0001 0131 9695Service de Radiothérapie, Institut Jean Godinot, 51100 Reims, France
| | - Xavier Liem
- grid.452351.40000 0001 0131 6312Service de Radiothérapie, Centre Oscar Lambret, 59000 Lille, France
| | - David Pasquier
- grid.452351.40000 0001 0131 6312Service de Radiothérapie, Centre Oscar Lambret, 59000 Lille, France ,grid.503422.20000 0001 2242 6780RIStAL, UMR 9189, Université de Lille, 59000 Lille, France
| | | | - Claire Charra-Brunaud
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France
| | - Didier Peiffert
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France ,grid.29172.3f0000 0001 2194 6418EA 4360 APEMAC, Université de Lorraine, Nancy, France
| | - Jean-Baptiste Clavier
- grid.512000.6Service de Radiothérapie, ICANS - Institut de Cancérologie Strasbourg Europe, 67200 Strasbourg, France
| | - Emmanuel Desandes
- grid.29172.3f0000 0001 2194 6418EA 4360 APEMAC, Université de Lorraine, Nancy, France ,grid.452436.20000 0000 8775 4825Service en Charge des Données de Santé, Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - Jean-Christophe Faivre
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France
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Evenepoel M, Haenen V, De Baerdemaecker T, Meeus M, Devoogdt N, Dams L, Van Dijck S, Van der Gucht E, De Groef A. Pain Prevalence During Cancer Treatment: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2022; 63:e317-e335. [PMID: 34563628 DOI: 10.1016/j.jpainsymman.2021.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022]
Abstract
CONTEXT Pain is one of the most complex and prevalent symptoms in the cancer population. Despite the protective role of acute cancer-related pain, it is also an important predictor for the likelihood of developing chronic pain after cancer treatment. OBJECTIVES Since the last systematic review on pain prevalence rates during cancer treatment dates already from 2016, the aim of the present systematic review was to provide an overview of pain prevalence rates during cancer treatment since this previous review. METHODS A systematic search of the literature, including studies between 2014 and 2020, was conducted using the databases Pubmed, Embase, Scopus, Web of Science and Cochrane. Studies reporting pain prevalence rates during or within three months after curative cancer treatment was included. Title/abstract and full-text was screened double-blinded, followed by independent evaluation of the risk of bias. All prevalence rates were pooled within meta-analyses and a meta-regression was performed to clarify the amount of heterogeneity. RESULTS Of the 9052 studies, 12 studies were included in the meta-analysis of which 10 included breast cancer and two lung cancer patients. The pooled pain prevalence rate was 40% (95%CI 0.29-0.51), with a heterogeneity of 96%. Out of the meta-regression, only the covariate "method of pain measurement" significantly clarified the heterogeneity (P < 0.05), resulting in a residual heterogeneity of 94.88%. CONCLUSION Five years after the last systematic review published on this topic, pain is still very prevalent during cancer treatment. However, the pain prevalence rates were also very heterogeneous. These two findings emphasize the need for further research on the development of adequate pain assessment and pain management approaches during cancer treatment.
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Affiliation(s)
- Margaux Evenepoel
- Department of Rehabilitation Sciences and Physiotherapy (M.E., V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), MOVANT, University of Antwerp, Antwerp, Belgium
| | - Vincent Haenen
- Department of Rehabilitation Sciences and Physiotherapy (M.E., V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), MOVANT, University of Antwerp, Antwerp, Belgium; Department of Rehabilitation Sciences (V.H., T.D.B., N.D., L.D., E.V.G., A.D.G.), KU Leuven, University of Leuven, Leuven, Belgium; Pain in Motion International Research Group (V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), Brussels, Belgium
| | - Tom De Baerdemaecker
- Department of Rehabilitation Sciences (V.H., T.D.B., N.D., L.D., E.V.G., A.D.G.), KU Leuven, University of Leuven, Leuven, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy (M.E., V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), MOVANT, University of Antwerp, Antwerp, Belgium; Pain in Motion International Research Group (V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), Brussels, Belgium; Department of Rehabilitation Sciences (M.M.), Ghent University, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences (V.H., T.D.B., N.D., L.D., E.V.G., A.D.G.), KU Leuven, University of Leuven, Leuven, Belgium; Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation (N.D.), Center for Lymphoedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy (M.E., V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), MOVANT, University of Antwerp, Antwerp, Belgium; Department of Rehabilitation Sciences (V.H., T.D.B., N.D., L.D., E.V.G., A.D.G.), KU Leuven, University of Leuven, Leuven, Belgium; Pain in Motion International Research Group (V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), Brussels, Belgium
| | - Sophie Van Dijck
- Department of Rehabilitation Sciences and Physiotherapy (M.E., V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), MOVANT, University of Antwerp, Antwerp, Belgium; Pain in Motion International Research Group (V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), Brussels, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences and Physiotherapy (M.E., V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), MOVANT, University of Antwerp, Antwerp, Belgium; Department of Rehabilitation Sciences (V.H., T.D.B., N.D., L.D., E.V.G., A.D.G.), KU Leuven, University of Leuven, Leuven, Belgium; Pain in Motion International Research Group (V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), Brussels, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences and Physiotherapy (M.E., V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), MOVANT, University of Antwerp, Antwerp, Belgium; Department of Rehabilitation Sciences (V.H., T.D.B., N.D., L.D., E.V.G., A.D.G.), KU Leuven, University of Leuven, Leuven, Belgium; Pain in Motion International Research Group (V.H., M.M., L.D., S.V.D., E.V.G., A.D.G.), Brussels, Belgium.
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4
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Meehan J, Gray M, Martínez-Pérez C, Kay C, Pang LY, Fraser JA, Poole AV, Kunkler IH, Langdon SP, Argyle D, Turnbull AK. Precision Medicine and the Role of Biomarkers of Radiotherapy Response in Breast Cancer. Front Oncol 2020; 10:628. [PMID: 32391281 PMCID: PMC7193869 DOI: 10.3389/fonc.2020.00628] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/06/2020] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy remains an important treatment modality in nearly two thirds of all cancers, including the primary curative or palliative treatment of breast cancer. Unfortunately, largely due to tumor heterogeneity, tumor radiotherapy response rates can vary significantly, even between patients diagnosed with the same tumor type. Although in recent years significant technological advances have been made in the way radiation can be precisely delivered to tumors, it is proving more difficult to personalize radiotherapy regimens based on cancer biology. Biomarkers that provide prognostic or predictive information regarding a tumor's intrinsic radiosensitivity or its response to treatment could prove valuable in helping to personalize radiation dosing, enabling clinicians to make decisions between different treatment options whilst avoiding radiation-induced toxicity in patients unlikely to gain therapeutic benefit. Studies have investigated numerous ways in which both patient and tumor radiosensitivities can be assessed. Tumor molecular profiling has been used to develop radiosensitivity gene signatures, while the assessment of specific intracellular or secreted proteins, including circulating tumor cells, exosomes and DNA, has been performed to identify prognostic or predictive biomarkers of radiation response. Finally, the investigation of biomarkers related to radiation-induced toxicity could provide another means by which radiotherapy could become personalized. In this review, we discuss studies that have used these methods to identify or develop prognostic/predictive signatures of radiosensitivity, and how such assays could be used in the future as a means of providing personalized radiotherapy.
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Affiliation(s)
- James Meehan
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Gray
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom.,The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Carlos Martínez-Pérez
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom.,Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | - Charlene Kay
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa Y Pang
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer A Fraser
- School of Applied Science, Sighthill Campus, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Amy V Poole
- School of Applied Science, Sighthill Campus, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Ian H Kunkler
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Simon P Langdon
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - David Argyle
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Arran K Turnbull
- Translational Oncology Research Group, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom.,Breast Cancer Now Edinburgh Research Team, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
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Lee SW, Kim YJ, Shin KH, Kim K, Chie EK, Han W, Im SA, Jung SY, Lee KS, Lee ES. A Comparative Study of Daily 3-Gy Hypofractionated and 1.8-Gy Conventional Breast Irradiation in Early-Stage Breast Cancer. Medicine (Baltimore) 2016; 95:e3320. [PMID: 27175630 PMCID: PMC4902472 DOI: 10.1097/md.0000000000003320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We retrospectively compared accelerated hypofractionation (AHF) with conventional fractionation (CF) in the radiation therapy (RT) for early-stage breast cancer patients.Three hundred seventy-nine early-stage (pT1-2 and pN0-1a) breast cancer patients who received RT with AHF after breast-conserving surgery (BCS) were included. These patients were matched with 379 corresponding patients who received BCS and RT with CF at a different center with respect to the year BCS was performed, patient age (±3 years), and cancer stage. The AHF regimen consisted of 39 Gy in 13 fractions to the whole breast and a consecutive boost of 9 to 12 Gy in 3 to 4 fractions to the tumor bed. CF comprised whole-breast irradiation up to 50.4 Gy in 28 fractions and a boost of 9 to 14 Gy in 5 to 7 fractions to the tumor bed.The median follow-up period was 75 months (range, 3.8-110.8 months). There was no statistically significant difference between the AHF and CF groups in terms of age distribution, T and N stage, resection margin, and histologic grade. There were 5 ipsilateral breast tumor relapse (IBTR) cases in the AHF group compared with 7 cases in the CF group. Seven and eight locoregional relapse (LRR) cases were observed in the AHF and CF groups, respectively. The 7-year rates of IBTR-free survival, LRR-free survival, and disease-free survival were 98.9%, 98.4%, and 97.1% in the AHF group and 98.1%, 97.9%, and 96.0% in the CF group, respectively (P > 0.05). The incident rates of grade 3 edema, hyperpigmentation, or wet desquamation at the end of RT were higher in the CF group than in the AHF group (16.4% vs 0.2%, respectively; P < 0.01).AHF RT of 39 Gy to the whole breast plus a 9-Gy boost in 16 fractions showed excellent tumor control and tolerable skin toxicity, a finding that is comparable to CF RT in patients with early-stage breast cancer.
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Affiliation(s)
- Sea-Won Lee
- From the Seoul National University College of Medicine, Seoul (S-WL, KHS, KK, EKC, WH, S-AI); and Research Institute and Hospital, National Cancer Center, Goyang, Korea (Y-JK, S-YJ, KSL, ESL)
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