Research

Jump to: Review

9 pages, 1916 KiB

Open AccessArticle

Implementation of External Beam Five-Fraction Adjuvant Breast Irradiation in a US Center

by Jacob Eckstein, Peter Taylor, Ruqin Zheng, Lucille Lee, William Chen, Louis Potters and Clary Evans

Cancers 2022, 14(6), 1556; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14061556 - 18 Mar 2022

Cited by 5 | Viewed by 1722

Abstract

Five-fraction adjuvant whole breast radiation has been shown to be a safe and effective alternative to longer fractionation regimens. Given the lack of international consensus on patient selection for the protocol, we developed a consensus protocol to guide patient selection and facilitate safe [...] Read more.

Five-fraction adjuvant whole breast radiation has been shown to be a safe and effective alternative to longer fractionation regimens. Given the lack of international consensus on patient selection for the protocol, we developed a consensus protocol to guide patient selection and facilitate safe and efficient five-fraction radiation in our radiation medicine department. In developing the directive, we surveyed departmental physicians about their choice of adjuvant breast regimen for various clinical scenarios. Patient travel burden was the factor most strongly impacting radiation oncologists’ decision-making when considering prescribing a five-fraction course of adjuvant breast radiation; the length of clinical trial follow-up data and acute and late normal tissue effects also impacted it, along with personal clinical experience and experience of dosimetry and physics personnel. Relative value unit (RVU) reimbursement and financial toxicity to the patient were reported to be less important in decision-making. Physicians were most comfortable using five-fraction radiation in women >50 years of age with low-risk cancer and for patients unable to attend for longer treatment courses. Eight months after implementation, the protocol accounts for 4.7% of breast irradiation delivered in our department. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures

Figure 1

10 pages, 1052 KiB

Open AccessArticle

The Impact of an Incidental Dose on Axillary Tumor Control and Toxicity in Localized Breast Cancer: A Retrospective Analysis

by Martin Schmitt, Isabelle Chambrelant, Parigna Hong Chheang, Carole Pflumio, Carole Hild, Thierry Petit and Georges Noël

Cancers 2022, 14(3), 807; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14030807 - 04 Feb 2022

Cited by 2 | Viewed by 1320

Abstract

Purpose: The dosimetric analysis of the incidental axillary dose delivered to axillary lymph node levels I–III by different techniques of whole breast irradiation and the analysis of prognostic factors of axillary recurrence of breast cancer. Methods: We perform a retrospective analysis that includes [...] Read more.

Purpose: The dosimetric analysis of the incidental axillary dose delivered to axillary lymph node levels I–III by different techniques of whole breast irradiation and the analysis of prognostic factors of axillary recurrence of breast cancer. Methods: We perform a retrospective analysis that includes 171 patients with localized breast carcinoma irradiated at Centre Paul Strauss. To be included in the study, patients had to have a histological confirmation of breast cancer diagnosis, surgical treatment without axillary lymph node dissection (ALND), whole breast irradiation without axillary irradiation by a specific field, and a treatment plan available. Results: Three patients had lymph node recurrence. There was no significant correlation between the maximal or mean dose delivered at the three axillary levels and the risk of axillary lymph node recurrence. There was no significant correlation between the irradiation technique and the risk of axillary lymph node recurrence. Two patients, both in the HT group, had lymphoedema. There was significantly more lymphoedema in the HT group than in the ST and IMRT groups (p < 0.048). The mean dose in level II was significantly higher in the group of patients with lymphoedema (3.45 Gy (1.08; 9.62) vs. 23.4 Gy (23.1; 23.6)) (p < 0.02). Conclusion: The irradiation technique has an influence on the incidental dose delivered to the axillary area, but has no influence on the risk of axillary recurrence. The risk of lymphoedema could be related to the use of HT and the mean dose delivered at level II. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures

Figure 1

10 pages, 3749 KiB

Open AccessArticle

Do We Need to Delineate the Humeral Head in Breast Cancer Patients?

by Lahcene Belaidi, Pierre Loap and Youlia Kirova

Cancers 2022, 14(3), 496; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14030496 - 19 Jan 2022

Cited by 1 | Viewed by 1845

Abstract

Humeral heads can be unintentionally exposed during breast radiotherapy, particularly when regional lymph nodes are targeted. Moreover, rotational intensity-modulated radiation therapy techniques, such as helical tomotherapy (HT), increase the low-dose bath, the consequences of which are subject to debate. The aim of this [...] Read more.

Humeral heads can be unintentionally exposed during breast radiotherapy, particularly when regional lymph nodes are targeted. Moreover, rotational intensity-modulated radiation therapy techniques, such as helical tomotherapy (HT), increase the low-dose bath, the consequences of which are subject to debate. The aim of this study was to analyze late adverse events involving humeral heads occurring after adjuvant locoregional breast radiotherapy with HT. This single-center retrospective study included 159 breast cancer patients locoregionally irradiated, including the regional lymph nodes, in an adjuvant setting with HT at Institut Curie (Paris, France), between January 2010 and 2016. After a median delay of 48 months, six patients (3.8%) developed localized bone pain, three (1.9%) developed a shoulder functional limitation and one (0.6%) developed a traumatic humeral head fracture. The average mean and maximum doses to humeral heads were 9.18 Gy and 24.41 Gy, respectively, and were not statistically associated with humeral head adverse events. Adverse events were statistically more frequent after mastectomy than after breast-conserving surgery. Berg’s level 1 and 2/3 irradiation, and right-sided radiotherapy were associated with an increased maximum dose. In summary, clinical adverse events were rare, and radiation exposure to humeral heads was low. No correlation was found between dosimetric parameters and late toxicity. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures

Graphical abstract

15 pages, 1247 KiB

Open AccessArticle

Radiotherapy in the Management of Non-Metastatic Inflammatory Breast Cancers: A Retrospective Observational Study

by Benjamin Nicaise, Pierre Loap, Delphine Loirat, Fatima Laki, Jean-Yves Pierga, Alain Fourquet and Youlia Kirova

Cancers 2022, 14(1), 107; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14010107 - 27 Dec 2021

Cited by 2 | Viewed by 2327

Abstract

(1) Background: Inflammatory breast cancers (IBC) are characterized by a poor prognosis. This retrospective study aims to describe the clinical outcomes of non-metastatic IBC patients treated with a multidisciplinary approach with neo-adjuvant chemotherapy, surgery, and radiotherapy. (2) Methods: This single-center retrospective study included [...] Read more.

(1) Background: Inflammatory breast cancers (IBC) are characterized by a poor prognosis. This retrospective study aims to describe the clinical outcomes of non-metastatic IBC patients treated with a multidisciplinary approach with neo-adjuvant chemotherapy, surgery, and radiotherapy. (2) Methods: This single-center retrospective study included all women patients diagnosed with non-metastatic IBC between January 2010 and January 2018 at the Institut Curie (Paris, France) and treated with neoadjuvant chemotherapy, surgery, and radiotherapy. Overall survival (OS), disease-free survival (DFS), and locoregional free survival (LRRFS) were calculated from the time of diagnosis. Prognostic factors for patient survival were analyzed based on univariate and multivariate regressions. (3) Results: We identified 113 patients with a median age of 51 years. 79.7% had node-positive tumors; triple-negative breast cancers (TNBC) represented 34.6% of the cases. A large majority of patients (91.2%) received adjuvant post-mastectomy while ten patients (8.8%) received preoperative radiotherapy. Non-pathological complete response (non-pCR) was observed in 67.3% of patients. Radiotherapy delivered a median dose of 50 Gy to the breast or the chest wall in 25 fractions. With a median follow-up of 54 months, 5-year OS, DFS and LRRFS were 78% (CI: 70.1–86.8%), 68.1% (59.6–77.7%), and 85.2% (78.4–92.7%), respectively. In multivariate analysis, non-pCR was an adverse prognosis factor for OS, DFS, and LRRFS; pre-operative radiotherapy was an adverse prognosis factor for OS and DFS. Radiation-related adverse events were limited to acute skin toxicity (22% of Grade 2 and 2% of grade 3 dermatitis); no late radiation-induced toxicity was reported. (4) Conclusions: High locoregional control could be achieved with multidisciplinary management of non-metastatic IBC, suggesting the anti-tumor efficacy of radiotherapy in this rare but pejorative clinicopathological presentation. While comparing favorably with historical cohorts, OS and DFS could be potentially improved in the future with the use of new systemic treatments, such as PARP-inhibitors or immunotherapy. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures

Figure 1

13 pages, 1559 KiB

Open AccessArticle

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

by Diane Jornet, Pierre Loap, Jean-Yves Pierga, Fatima Laki, Anne Vincent-Salomon, Youlia M. Kirova and Alain Fourquet

Cancers 2021, 13(20), 5107; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13205107 - 12 Oct 2021

Cited by 2 | Viewed by 1478

Abstract

Background: Neoadjuvant concurrent radiochemotherapy makes it possible to increase the breast conservation rate. This study reports the long term outcome of this treatment. Methods: From 2001 to 2003, 59 women with T_2–3 N_0–2 M₀ invasive breast cancer (BC) not amenable [...] Read more.

Background: Neoadjuvant concurrent radiochemotherapy makes it possible to increase the breast conservation rate. This study reports the long term outcome of this treatment. Methods: From 2001 to 2003, 59 women with T_2–3 N_0–2 M₀ invasive breast cancer (BC) not amenable to upfront breast conserving treatment (BCS) were included in this prospective, non-randomized phase II study. Chemotherapy (CT) consisted of four cycles of continuous 5-FU infusion and Vinorelbine. Starting concurrently with the second CT cycle, normofractionated RT was delivered to the breast and LN. Breast surgery was then performed. Results: Median follow-up (FU) was 13 years [3–18]. BCS was performed in 41 (69%) patients and mastectomy in 18 patients, with pathological complete response rate of 27%. Overall and distant-disease free survivals rates at 13 years were 70.9% [95% CI 59.6–84.2] and 71.5% [95% CI 60.5–84.5] respectively. Loco regional and local controls rates were 83.4% [95% CI 73.2–95.0] and 92.1% [95% CI 83.7–100], respectively. Late toxicity (CTCAE-V3) was assessed in 51 patients (86%) with a median follow-up of 13 years. Fifteen presented grade 2 fibrosis (29.4%), 8 (15.7%) had telangiectasia, and 1 had radiodermatitis. Conclusions: This combined treatment provided high long-term local control rates with limited side-effects. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures

Figure 1

Review

Jump to: Research

21 pages, 360 KiB

Open AccessReview

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

by Gabrielle Metz, Kylie Snook, Samriti Sood, Sally Baron-Hay, Andrew Spillane, Gillian Lamoury and Susan Carroll

Cancers 2022, 14(7), 1685; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14071685 - 25 Mar 2022

Cited by 2 | Viewed by 2239

Abstract

Oncoplastic breast surgery encompasses a range of techniques used to provide equitable oncological outcomes compared with standard breast surgery while, simultaneously, prioritizing aesthetic outcomes. While the outcomes of oncoplastic breast surgery are promising, it can add an extra complexity to the treatment paradigm [...] Read more.

Oncoplastic breast surgery encompasses a range of techniques used to provide equitable oncological outcomes compared with standard breast surgery while, simultaneously, prioritizing aesthetic outcomes. While the outcomes of oncoplastic breast surgery are promising, it can add an extra complexity to the treatment paradigm of breast cancer and impact on decision-making surrounding adjuvant therapies, like chemotherapy and radiotherapy. As such, early discussions at the multidisciplinary team meeting with surgeons, medical oncologists, and radiation oncologists present, should be encouraged to facilitate best patient care. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

16 pages, 1528 KiB

Open AccessReview

Particle Therapy for Breast Cancer

by Roman O. Kowalchuk, Kimberly S. Corbin and Rachel B. Jimenez

Cancers 2022, 14(4), 1066; https://doi.org/10.3390/cancers14041066 - 20 Feb 2022

Cited by 10 | Viewed by 2110

Abstract

Particle therapy has received increasing attention in the treatment of breast cancer due to its unique physical properties that may enhance patient quality of life and reduce the late effects of therapy. In this review, we will examine the rationale for the use [...] Read more.

Particle therapy has received increasing attention in the treatment of breast cancer due to its unique physical properties that may enhance patient quality of life and reduce the late effects of therapy. In this review, we will examine the rationale for the use of proton and carbon therapy in the treatment of breast cancer and highlight their potential for sparing normal tissue injury. We will discuss the early dosimetric and clinical studies that have been pursued to date in this domain before focusing on the remaining open questions limiting the widespread adoption of particle therapy. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures

Figure 1

15 pages, 715 KiB

Open AccessReview

Combination of Modern Radiotherapy and New Targeted Treatments for Breast Cancer Management

by Arnaud Beddok, Paul Cottu, Alain Fourquet and Youlia Kirova

Cancers 2021, 13(24), 6358; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13246358 - 18 Dec 2021

Cited by 10 | Viewed by 3135

Abstract

Background: The objective of the present study was to review the essential knowledge about the combinations of the most commonly used or under development targeted treatments and radiation therapy (RT). Methods: Preclinical and clinical studies investigating this combination were extensively reviewed. Results: Several [...] Read more.

Background: The objective of the present study was to review the essential knowledge about the combinations of the most commonly used or under development targeted treatments and radiation therapy (RT). Methods: Preclinical and clinical studies investigating this combination were extensively reviewed. Results: Several studies showed that the combination of RT and tamoxifen increased the risk of radiation-induced pulmonary toxicity; therefore, both modalities should not be given concomitantly. The combination of HER2 inhibitors (trastuzumab, pertuzumab) and RT seems to be safe. However, trastuzumab emtansine (T-DM1) should not be administered concurrently with brain RT since this combination could increase the risk of brain radionecrosis. The combination of RT and other new target treatments such as selective estrogen receptor degradants, lapatinib, cell cycle inhibitors, immune checkpoint inhibitors, or molecules acting on DNA damage repair seems feasible but was essentially evaluated on retrospective or prospective studies with a small number of patients. Furthermore, there is considerable heterogeneity among these studies regarding the dose and fractionation of radiation, the dosage of drugs, and the sequence of treatments used. Conclusions: The combination of RT with most targeted therapies for BC appears to be well-tolerated, but these results need to be confirmed in prospective randomized studies. Full article

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures

Figure 1

15 pages, 422 KiB

Open AccessReview

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

by Sofiane Allali and Youlia Kirova

Cancers 2021, 13(23), 5928; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13235928 - 25 Nov 2021

Cited by 10 | Viewed by 2312

Abstract

Background: Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity. We will review the incidence of radiodermatitis and fibrosis according to the various radiation and fractionation techniques. We will then focus on the various methods [...] Read more.

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

(This article belongs to the Special Issue Breast Cancer Radiotherapy: The State of the Art)

► Show Figures