scholarly journals Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: results of a prospective trial

2020 ◽  
Author(s):  
David Krug ◽  
René Baumann ◽  
Katja Krockenberger ◽  
Reinhard Vonthein ◽  
Andreas Schreiber ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Prospective Trial ◽  
Treatment Protocol ◽  
Breast Conserving Surgery ◽  
Simultaneous Integrated Boost ◽  
Hypofractionated Radiotherapy ◽  
Tumor Bed ◽  
Integrated Boost ◽  
3D Crt

Abstract Purpose We report results of a multicenter prospective single-arm phase II trial (ARO-2013-04, NCT01948726) of moderately accelerated hypofractionated radiotherapy with a simultaneous integrated boost (SIB) in patients with breast cancer receiving adjuvant radiotherapy after breast-conserving surgery. Methods The eligibility criteria included unifocal breast cancer with an indication for adjuvant radiotherapy to the whole breast and boost radiotherapy to the tumor bed. The whole breast received a dose of 40 Gy and the tumor bed a total dose of 48 Gy in 16 fractions of 2.5 and 3 Gy, respectively. Radiotherapy could be given either as 3D conformal RT (3D-CRT) or as intensity-modulated radiotherapy (IMRT). The study was designed as a prospective single-arm trial to evaluate the acute toxicity of the treatment regimen. The study hypothesis was that the frequency of acute skin reaction grade ≥2 would be 20% or less. Results From November 2013 through July 2014, 149 patients were recruited from 12 participating centers. Six patients were excluded, leaving 143 patients for analysis. Eighty-four patients (58.7%) were treated with 3D-CRT and 59 (41.3%) with IMRT. Adherence to the treatment protocol was high. The rate of grade ≥2 skin toxicity was 14.7% (95% confidence interval 9.8–21.4%). The most frequent grade 3 toxicity (11%) was hot flashes. Conclusion This study demonstrated low toxicity of and high treatment adherence to hypofractionated adjuvant radiotherapy with SIB in a multicenter prospective trial, although the primary hypothesis was not met.

scholarly journals Hypofractionated Simultaneous Integrated Boost Radiotherapy Versus Conventional Fractionation Radiotherapy of Early Breast Cancer After Breast-Conserving Surgery: Clinical Observation and Analysis

2021 ◽  
Vol 20 ◽  
pp. 153303382110647
Author(s):  
Jinling Dong ◽  
Ya Yang ◽  
Dan Han ◽  
Qian Zhao ◽  
Chengxin Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Skin Toxicity ◽  
Breast Conserving Surgery ◽  
Simultaneous Integrated Boost ◽  
Conventional Fractionation ◽  
Tumor Bed ◽  
Integrated Boost ◽  
Radiation Pneumonia ◽  
Boost Radiotherapy

Purpose: The objective of this retrospective study is to evaluate the efficacy and safety of hypofractionated simultaneous integrated boost radiotherapy for early breast cancer patients undergoing breast-conserving surgery. Methods: A total of 185 women with early breast cancer undergoing breast-conserving surgery were retrospectively divided into hypofractionated simultaneous integrated boost group and conventional fractionation group. Hypofractionated simultaneous integrated boost included 104 patients and the dose of whole-breast radiation reached 42.56 Gy in 16 fractions and simultaneously tumor bed boost to 48 Gy in 16 fractions, which course of radiotherapy was 22 days. The 81 patients of the conventional fractionation group received whole breast radiation to 50 Gy in 25 fractions and followed by tumor bed boost to 10 Gy in 5 fractions, which course of radiotherapy was 40 days. Clinical information including patients’ characteristics, skin toxicity, myelosuppression, radiation pneumonia, and cosmetic effects was recorded to analyze the influence of age, chemotherapy, position, and breast volume on the results of radiotherapy. Results: Hypofractionated simultaneous integrated boost group had no case of recurrence after a median follow-up of 25.6 months (9-47 months)) as compared with 2 after a median follow-up of 33.4 months (25-45 months) in the conventional fractionation group. The 2 groups had similar results in skin toxicity, cosmetic outcomes, and radiation pneumonia. In terms of myelosuppression, grade 1, grade 2, and grade 3 of myelosuppression in the hypofractionated simultaneous integrated boost group accounted for 16.7%, 12.3%, and 3.5% as compared with 30.0%, 21.1%, and 12.3% of the conventional fractionation group, respectively ( P = .000). Conclusions: HF-SIB RT is a considerable option in patients after breast-conserving surgery with a lower degree of myelosuppression and shorter treatment time.

EP-1228: Adjuvant radiotherapy using simultaneous integrated boost technique for breast conserving surgery

2014 ◽  
Vol 111 ◽  
pp. S65
Author(s):  
R. Del Moral ◽  
I. Tovar ◽  
M. Zurita ◽  
R. Guerrero ◽  
M. Martínez ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Breast Conserving Surgery ◽  
Simultaneous Integrated Boost ◽  
Integrated Boost

scholarly journals Clinicogenomic Radiotherapy Classifier Predicting the Need for Intensified Locoregional Treatment After Breast-Conserving Surgery for Early-Stage Breast Cancer

2019 ◽  
Vol 37 (35) ◽  
pp. 3340-3349 ◽  
Author(s):  
Martin Sjöström ◽  
S. Laura Chang ◽  
Nick Fishbane ◽  
Elai Davicioni ◽  
Shuang G. Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cumulative Incidence ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Treatment Strategies ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Phase Iii ◽  
Primary Tumors ◽  
Tumor Bed

PURPOSE Most patients with early-stage breast cancer are treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) to prevent locoregional recurrence (LRR). However, no genomic tools are used currently to select the optimal RT strategy. METHODS We profiled the transcriptome of primary tumors on a clinical grade assay from the SweBCG91-RT trial, in which patients with node-negative breast cancer were randomly assigned to either whole-breast RT after BCS or no RT. We derived a new classifier, Adjuvant Radiotherapy Intensification Classifier (ARTIC), comprising 27 genes and patient age, in three publicly available cohorts, then independently validated ARTIC for LRR in 748 patients in SweBCG91-RT. We also compared previously published genomic signatures for ability to predict benefit from RT in SweBCG91-RT. RESULTS ARTIC was highly prognostic for LRR in patients treated with RT (hazard ratio [HR], 3.4; 95% CI, 2.0 to 5.9; P < .001) and predictive of RT benefit ( Pinteraction = .005). Patients with low ARTIC scores had a large benefit from RT (HR, 0.33 [95% CI, 0.21 to 0.52], P < .001; 10-year cumulative incidence of LRR, 6% v 21%), whereas those with high ARTIC scores benefited less from RT (HR, 0.73 [95% CI, 0.44 to 1.2], P = .23; 10-year cumulative incidence of LRR, 25% v 32%). In contrast, none of the eight previously published signatures were predictive of benefit from RT in SweBCG91-RT. CONCLUSION ARTIC identified women with a substantial benefit from RT as well as women with a particularly elevated LRR risk in whom whole-breast RT was not sufficiently effective and, thus, in whom intensified treatment strategies such as tumor-bed boost, and possibly regional nodal RT, should be considered. To our knowledge, ARTIC is the first classifier validated as predictive of benefit from RT in a phase III clinical trial with patients randomly assigned to receive or not receive RT.

scholarly journals Accelerated Hypofractionated Radiotherapy With Simultaneous Integrated Boost With Volumetric Modulated Arc Technique in Patients With Breast Cancer: a Phase 2 Study.

2021 ◽  
Author(s):  
Budhi Singh Yadav ◽  
Shipra Gupta ◽  
Divya Dahiya ◽  
Ankita Gupta ◽  
Arun Oinam
Keyword(s):  
Breast Cancer ◽  
Organs At Risk ◽  
Disease Free Survival ◽  
Skin Toxicity ◽  
Simultaneous Integrated Boost ◽  
Hypofractionated Radiotherapy ◽  
Acute Skin Toxicity ◽  
Integrated Boost ◽  
Left And Right ◽  
Accelerated Hypofractionated Radiotherapy

Abstract PurposeTo assess feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) with volumetric modulated arc technique (VMAT) in patients with breast cancer.Methods Total 27 patients after breast conserving surgery (BCS) were included in this study. Patients were planned on 4-dimensional computerized tomogram (4D-CT) and contouring was done using RTOG guidelines. Dose delivered was 34 Gy/10#/2wk to the breast and 40 Gy/10#/2wk to the tumor bed as SIB with VMAT technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs at risk were calculated. Toxicities and cosmesis were assessed using RTOG LENT-SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) was calculated with Kaplan Meier curves.ResultsMean age of the patients was 42 years. Left and right breast cancer was seen in 17 (63%) and 10 (37%) patients, respectively. Ipsilateral lung mean V16 and contralateral lung V5 was 16.01% and 3.73%, respectively. Mean heart dose from the left and right breast was 7.25Gy and 4.37Gy, respectively. Mean dose to the contralateral breast, oesophagus and spinal cord was 2.64Gy, 3.69Gy and 3.15Gy, respectively. Thyroid V25 mean was 19.69%.Grade 1 and 2 acute skin toxicity was observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema and induration were observed in 1 (3.7%), 2 (7.4%) and 4(14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient each. Median follow-up was 48 months (range 12-58 months). At 4 years breast induration, edema and fibrosis each were observed in 1(3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred 1(3.7%) and 2(7.4%) patients, respectively. DFS and OS at 3-years was 88% and 92%, respectively.ConclusionWith this RT schedule acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS and OS were good.

scholarly journals EP-1318: Dosimetric comparison between whole breast irradiation and simultaneous integrated boost for 3D-CRT breast cancer

2015 ◽  
Vol 115 ◽  
pp. S711-S712
Author(s):  
E. Ambroa Rey ◽  
M.A. De la Casa ◽  
A. Seguro Fernández ◽  
R. García Marcos ◽  
P. Samper Ots ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Simultaneous Integrated Boost ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Dosimetric Comparison ◽  
Integrated Boost ◽  
3D Crt

scholarly journals Simultaneous Integrated Boost in Once-weekly Hypofractionated Radiotherapy for Breast Cancer in the Elderly: Preliminary Evidence

In Vivo ◽  
2019 ◽  
Vol 33 (6) ◽  
pp. 1985-1992
Author(s):  
ELISABETTA BONZANO ◽  
LILIANA BELGIOIA ◽  
GIORGIA POLIZZI ◽  
GUIDO SIFFREDI ◽  
PIERO FREGATTI ◽  
...  
Keyword(s):  
Breast Cancer ◽  
The Elderly ◽  
Preliminary Evidence ◽  
Simultaneous Integrated Boost ◽  
Hypofractionated Radiotherapy ◽  
Integrated Boost

scholarly journals Hypofractionated Radiotherapy as Adjuvant Treatment in Early Breast Cancer. A Review and Meta-Analysis of Randomized Controlled Trials

Breast Care ◽  
2015 ◽  
Vol 10 (4) ◽  
pp. 240-245 ◽  
Author(s):  
Wilfried Budach ◽  
Edwin Bölke ◽  
Christiane Matuschek
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Adjuvant Radiotherapy ◽  
Meta Analysis ◽  
Breast Conserving Surgery ◽  
Hypofractionated Radiotherapy ◽  
Breast Cancer Patients ◽  
Fractionated Radiotherapy ◽  
Randomized Controlled ◽  
Conventionally Fractionated

Background: Adjuvant radiotherapy after breast-conserving surgery is indicated in the vast majority of breast cancer patients. Conventionally fractionated radiotherapy with 50 Gy in 25 fractions was considered standard of care for several decades. The recently publishes long-term results of randomized trials that have tested different moderately hypofractionated radiotherapy schedules that may change clinical practice. Patients and Methods: A Pubmed search was carried out to identify the relevant publications on hypofractionated radiotherapy in breast cancer. In total, 4 randomized controlled trials representing the results of 7,095 patients with 10 years of follow-up were identified. A meta-analysis on the primary end point ipsilateral breast cancer recurrence and a review of the toxicity data were performed. Results: Moderately hypofractionated radiotherapy using schedules such as 40 Gy in 15 fractions administered within 3 weeks are as efficient and safe as conventionally fractionated radiotherapy for most breast cancer patients who need adjuvant radiotherapy after breast-conserving surgery. In patients aged < 40 years, after neoadjuvant chemotherapy, and if regional lymph node radiotherapy is indicated, further data are needed. Conclusion: Moderately hypofractionated radiotherapy can be recommended as standard treatment after breast-conserving surgery in the majority of breast cancer patients.

scholarly journals Acute and Late Toxicity In Breast Cancer Patient That Received Hypofractionated Adjuvant Radiotherapy after Breast Conserving Surgery: A Case Report

2020 ◽  
Vol 14 (4) ◽  
pp. 144
Author(s):  
Sinta Prastiana Dewi
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Late Toxicity ◽  
Skin Toxicity ◽  
Breast Conserving Surgery ◽  
Hypofractionated Radiotherapy ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy

Introduction: Breast cancer is the most common female malignancy worldwide. Breastconserving surgery followed by adjuvant radiotherapy is a preferable treatment option. Hypofractionated radiotherapy is an attractive fractionation scheme because of its shorter treatment duration. This paper aims to report the short-term and long-term toxicity of hypofractionated radiotherapy in breast cancer patients at our institution. Case Presentation: A 58-year-old woman with right breast cancer T2N1M0 had undergone breast-conserving surgery with axilla lymph node dissection. This patient underwent adjuvant whole breast radiotherapy with a dose of 42.56 Gy in 16 fractions followed by tumor bed boost with a dose of 16 Gy in 8 fractions. After undergoing the fourth fraction of boost, she had hyperpigmentation on her radiation area (RTOG skin toxicity grade 1). At the 6-month follow-up, the hyperpigmentation still appeared. Until the 24-month follow-up, after she completed radiotherapy, there was no sign of tumor recurrence and toxicity.Conclusion: Hypofractionated radiotherapy could be an option for breast cancer treatment that provides equivalent local control, survival, and side effects to conventional fractionation radiotherapy.

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