scholarly journals The Impact of Cardiac Sparing Techniques on Heart and Lung Dose in the Setting of Partial Breast Irradiation: A Dosimetric Follow-up to the IMPORT Low Trial

2020 ◽  
Vol 108 (3) ◽  
pp. e31
Author(s):  
A. Bajaj ◽  
K.G. Petras ◽  
C.R. Goodman ◽  
A. Elmasri ◽  
E.D. Donnelly ◽  
...  
Keyword(s):  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Lung Dose ◽  
Cardiac Sparing ◽  
The Impact

Five-day accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) in stage 0-II breast cancer: A report of 214 cases with up to 39 month follow-up.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12508-e12508
Author(s):  
Rufus J. Mark ◽  
Valerie Gorman ◽  
Michal Wolski ◽  
Steven McCullough
Keyword(s):  
Breast Cancer ◽  
Intensity Modulated Radiation Therapy ◽  
Target Volume ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Skin Reactions ◽  
Cosmetic Results ◽  
Non Invasive

e12508 Background: Randomized trials in stage 0-II breast cancer have proven that APBI given via HDR implant in 5 days is equivalent to whole breast irradiation (WBI) given in 5-6 weeks in regard to breast tumor local recurrence (LR). However, complications have been significant. Recently APBI using non-invasive IMRT given in 5 fractions has been shown in another randomized trial with 10 year follow-up to be equivalent to WBI in 6 weeks, with respect to LR. IMRT was superior in regard to acute effects, late effects, and cosmesis. In the randomized clinical trial of APBI IMRT, the Clinical Target Volume (CTV) was defined by the injection of individual fiducial markers bordering the surgical cavity. We have used the Biozorb fiducial system to localize the CTV for IMRT. We sought to confirm the APBI IMRT results with this simpler less labor intensive fiducial placement system. Methods: Between 2017 and 2021, 214 patients have undergone IMRT targeted to a Biozorb defined CTV with the walls of the surgical cavity sewn to the Biozorb device. Eligible patients were older than age 40, had tumor sizes < 3 cm, negative surgical margins, and negative sentinel node dissections. IMRT dose was 30 Gy given in 5 fractions. Dose Constraints were as follows : V-30 Gy < 105%, Ipsilateral Breast V-15 Gy < 50%, Ipsilateral Lung V-10 Gy < 20%, Contralateral Lung V-5 Gy < 10%, Heart V-3 Gy < 20%, Contralateral Breast Dmax < 2 Gy and Skin Dmax < 27 Gy. The Planning Target Volume (PTV) ranged from 27 to 355 cc with a median of 80 cc. PTV = CTV + 1-2 cm. Results: Follow-up ranged from 1-39 months with a median of 20 months. LR has been 0% (0/214). There have been no skin reactions or seromas. Infection has occurred in one patient (0.5%). Four (1.9%) patients developed pain around the Biozorb site. This resolved on a short courses of steroids in all cases. Cosmetic results as rated by the Surgeon, Radiation Oncologist, and Nurse, were rated excellent in 99.0% (212/214) of cases. Conclusions: Non-invasive APBI with IMRT given qd over 5 days targeted to Biozorb has resulted in LR, complications, and cosmetic results which compare favorably to invasive APBI given bid with HDR implant. At last follow-up, there have been no LR, skin reactions, or significant complications. Cosmesis has been excellent in 99.0% of patients.

Postmastectomy Radiation and Partial Breast Irradiation

2012 ◽  
pp. 50-52
Author(s):  
Richard C. Zellars
Keyword(s):  
Local Therapy ◽  
Partial Breast Irradiation ◽  
Adjuvant Radiation ◽  
Treatment Concept ◽  
Breast Irradiation ◽  
Postmastectomy Radiation ◽  
Major Shift ◽  
Postmastectomy Radiation Therapy ◽  
Meta Analyses

Overview: Between 1997 and 1999, three modern postmastectomy radiation therapy (PMXRT) trials were published. These trials showed a significant benefit with respect to local control and survival in women who received adjuvant radiation after mastectomy. Despite two decades of follow-up, reanalyses, meta-analyses and vigorous and often acrimonious debate, questions about the benefit of PMXRT in women with one to three positive lymph nodes (LNs) remain unanswered for many. This persistent debate has limited the use of PMXRT. A treatment concept certain to be as vigorously debated as that of PMXRT is that of partial breast irradiation (PBI). However, unlike PMXRT, the acceptance of PBI, by community physicians, has been nothing short of meteoric and represents the first major shift in the local therapy paradigm in more than 10 years. Herein, information will be presented that will suggest we are nearing the end of one debate—PMXRT in patients with one to three positive LNs—and beginning another—appropriateness of PBI.

Accelerated partial-breast irradiation using strut-based brachytherapy in ductal carcinoma in situ patients: A report on 321 patients with median 25-month follow-up.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 92-92
Author(s):  
John Paul Einck ◽  
Steven E. Finkelstein ◽  
Ben Han ◽  
Robert Hong ◽  
Lydia T. Komarnicky ◽  
...  
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Late Toxicity ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Skin Dose ◽  
Breast Irradiation ◽  
Median Maximum

92 Background: Limited data are available on the treatment of ductal carcinoma in situ (DCIS) with accelerated partial breast irradiation (APBI). The American Society for Radiation Oncology (ASTRO) consensus guidelines on APBI classify patients with DCIS as “cautionary”. We present the largest series of DCIS patients reported to date treated with APBI using strut-based brachytherapy. Methods: The SAVI Collaborative Research Group (SCRG) database was used to identify APBI patients with DCIS at 15 institutions treated with strut-based brachytherapy. All patients had a histologic diagnosis of DCIS and received monotherapy APBI (34 Gy in 10 fractions). Data on patient age and margin status, implant dosimetry, device size, disease status and toxicity in this population were analyzed. Results: From 2007-2011, 321 patients (322 breasts) with DCIS received APBI using strut-based brachytherapy. Patient ages ranged from 40-88 with a median age of 62. 51 patients were under 50 years of age. Detailed dosimetry data were reported on 245 patients. Long-term follow up was available on 221 breasts (median F/U = 25 months). Sixty patients have been followed for >3 years. Skin spacing was a challenge in a significant number of patients including 52 with skin spacing ≤ 5mm and 20 with skin spacing ≤ 3mm. Median maximum skin dose in those patient groups were 87% and 84% of prescription dose (PD), respectively. Overall reported dosimetry (n=245) was excellent: median percent of target volume receiving 90% PD was 96.9%, median maximum skin dose was 83.2%, V150% and V200% (volume at 150% and 200% PD) were 25.2 cc and 12.7 cc respectively. The ipsilateral recurrence rate was 2.2% (1.1% TR/MM). Late toxicity (grade ≥ 2) was low: hyperpigmentation = 0.0%, telangiectasias =1.4%, seroma = 3.2%, and fat necrosis in 1.8%. Conclusions: APBI using strut-based brachytherapy appears to be an effective treatment for patients with DCIS with acceptably low ipsilateral breast recurrence rates and low rates of late toxicity. 52 patients in our series had skin spacing 5 mm or less. APBI using brachytherapy may not have been possible for these women with other single-entry devices.

scholarly journals Preliminary Report of Partial-breast Irradiation Following Neoadjuvant Chemotherapy from COMBAT-NEO: Clinical Outcome of Multicatheter BrAchyTherapy after NEOadjuvant Chemotherapy

2021 ◽  
pp. 149-155
Author(s):  
Kazuhiko Sato ◽  
Hiromi Fuchikami ◽  
Naoko Takeda ◽  
Takahiro Shimo ◽  
Masahiro Kato ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Clinical Outcome ◽  
Adverse Events ◽  
Small Sample ◽  
Single Stage ◽  
Partial Breast Irradiation ◽  
Wound Complications ◽  
Tumor Control ◽  
Breast Irradiation

Background: Breast-conserving therapy (BCT) with partial-breast irradiation (PBI) has become a standard alternative to whole-breast irradiation. Recently, neoadjuvant chemotherapy (NACT) has been widely performed for early breast cancer. Although BCT using perioperative PBI decreased invasiveness and geographic miss, risks of adverse events and local recurrence remain a concern for patients receiving NACT. Thus, a prospectively registered study, the Clinical Outcome of Multicatheter BrAchyTherapy after NEOadjuvant chemotherapy (COMBAT-NEO), was conducted.Methods: Patients who underwent BCT using multicatheter-interstitial brachytherapy (MIB) by intraoperative catheter implant were analyzed. Early and late adverse events (AEs) including higher grade skin toxicities and wound complications, and tumor control of patients receiving NACT were evaluated in comparison with adjuvant chemotherapy (ACT) and no chemotherapy (no-CT).Results: Between April 2017 and February 2020, 265 consecutive patients who received single-stage BCT were evaluated, including 13 NACT (4.9%), 68 ACT (25.7%), and 184 no-CT (69.4%). The median follow-up time and age were 30.0 months and 59.0 years, respectively. All patients were followed up for at least 12 months. Although AEs in NACT, ACT, and no-CT were observed in 1 (7.7%), 5 (7.4%), and 11 (6.0%) patients, respectively (p = 0.91) and there was no acute AE in NACT patients. Overall, 3 (1.1%) ipsilateral and 1 (0.4%) contralateral breast tumor recurrences were observed in no-CT patients. There were no regional and distant recurrences.Conclusion: Although this pilot study was based on a small sample size with short follow-up, these preliminary results support the study of a single-stage BCT with MIB-PBI following NACT.

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