scholarly journals Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence

Breast Care ◽  
2014 ◽  
Vol 10 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Pierfrancesco Franco ◽  
Domenico Cante ◽  
Piera Sciacero ◽  
Giuseppe Girelli ◽  
Maria Rosa La Porta ◽  
...  

Radiation therapy delivered with hypofractionation, which involves the delivery of a higher dose per fraction in fewer fractions (generally with a lower total nominal dose) over a shorter overall treatment time, is an established therapeutic option at least for a selected group of early breast cancer patients after breast-conserving surgery. Optimal delivery of the tumor bed boost dose in terms of timing, fractionation, and total dose whenever a hypofractionated schedule is employed has yet to be established. We herein present a review of the current evidence on the role of boost integration in whole breast radiotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12090-e12090 ◽  
Author(s):  
Hans-Christian Kolberg ◽  
Gyoergy Loevey ◽  
Leyla Akpolat-Basci ◽  
Miltiades Stephanou ◽  
Peter A. Fasching ◽  
...  

e12090 Background: Targeted intraoperative radiotherapy (TARGIT – IORT) as a tumor bed boost during breast conserving surgery is an established option for women with early breast cancer. In a previous study our group could show a beneficial effect of TARGIT-IORT on overall survival after neoadjuvant chemotherapy compared to an external boost in an unselected cohort. In this study we present an analysis of the hormone receptor positive HER2 negative subgroup. Methods: In this non-randomized cohort study involving 46 hormone receptor positive HER2 negative patients after NACT we compared outcomes of 21 patients who received a tumour bed boost with IORT (TARGIT-IORT) during lumpectomy versus 25 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Disease free survival (DFS) and overall survival (OS) were compared. Results: There were no statistical differences between the two groups regarding tumor size, grading, nodal status and pCR rates. Median follow up was 49 months. Whereas DFS was not significantly different between the groups the 5-year Kaplan-Meier estimate of OS was significantly better by 21% with IORT: TARGIT-IORT 0 events 100%, EBRT 5 events 79%, log rank p = 0.028. Conclusions: Although our results have to be interpreted with caution due to a possible selection bias and the small numbers, we could show that the improved OS as previously demonstrated in our dataset for TARGIT-IORT during lumpectomy after neoadjuvant chemotherapy as a tumor bed boost compared to an external beam radiotherapy boost is driven by the hormone receptor positive HER2 negative subgroup. These data give further support to the inclusion of such patients in the TARGIT-B (Boost) randomised trial that is testing whether IORT boost is superior to EBRT boost and to the analysis of subgroups based on tumor biology in this trial.


2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 626-626
Author(s):  
F. K. Wenz ◽  
G. Welzel ◽  
E. Blank ◽  
B. Hermann ◽  
V. Steil ◽  
...  

626 Background: Recently, the concept of IORT during BCS has been introduced using linear accelerators, brachytherapy or dedicated mobile IORT devices generating fast electrons or low energy X-rays. Here, we report the first 5 years of a single center experience after introduction of a novel approach to deliver IORT as a tumor bed boost during BCS for breast cancer. Methods: 155 breast cancers in 154 women (median age 63 yrs, range 30 - 83 yrs, T1/T2 = 110/45, N0/N+ = 104/51) were treated between February 2002 and December 2007 at the University Medical Center Mannheim/University of Heidelberg, in whom IORT as tumor bed boost was applied using 50 kV X rays (20 Gy, INTRABEAM, Carl Zeiss Oberkochen, additional OR time about 45 - 60 min) followed by 46 - 50 Gy external beam whole breast radiotherapy (EBRT). Chemotherapy was given before EBRT. The median interval between BCS+IORT and EBRT was 10 wks. Median follow-up was 34 mon (max 79.6 mon, 1 pt lost to f/u). Overall survival (OS), local relapse free survival (LRFS) and disease free survival (DFS) were calculated at 5 yrs using the Kaplan Meier method. 81 patients were evaluated at 3 yr f/u for normal tissue effects using the LENT SOMA scoring system. Results: Ten patients have died, 2 pts suffered from in breast relapse and 8 pts developed distant metastases yielding a 5yr OS of 87.0%, a 5yr LRFS of 98.4% and a 5 yr DFS of 73.9%. Grade 3 fibroses of the tumor bed were detected in 6% of the patients after 3 yrs. Skin toxicity was mild (teleangiectases and hyperpigmentations in 6% each). Conclusions: IORT as a tumor bed boost using the INTRABEAM system yields low recurrence and toxicity rates when followed by external beam whole breast radiotherapy. [Table: see text]


2019 ◽  
Vol 106 (6) ◽  
pp. 518-523
Author(s):  
Rosalinda Ricotti ◽  
Eleonora Miglietta ◽  
Maria Cristina Leonardi ◽  
Federica Cattani ◽  
Samantha Dicuonzo ◽  
...  

Objective: To report treatment times (door to door) of adjuvant treatments of breast cancer (BC) with intensity-modulated radiotherapy (IMRT). Methods: Treatment times of 62 patients with BC on the TomoTherapy Hi-Art System were collected for the analysis. Patients underwent either locoregional radiotherapy (postmastectomy radiotherapy [PMRT]) with helical modality (TomoHelical) or whole breast radiotherapy (RT) with simultaneous integrated boost (WBRT-SIB) with direct modality (TomoDirect). Door-to-door time was broken down into different steps, which were crucial to RT session. Results: A total of 594 treatment fractions were monitored. Median treatment time was 22.4 minutes (17.2–30.8) for PMRT and 14.4 minutes (10.9–23.5) for WBRT-SIB. The mean beam-on time accounted for 61.36% of the overall treatment time for PMRT compared to 57% for WBRT-SIB. The beam-on time was a much more time-consuming process. Conclusion: This treatment times analysis on the use of IMRT for BC might be useful to organize and improve the workflow efficiency in RT facilities.


2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hans Van Hulle ◽  
Vincent Vakaet ◽  
Giselle Post ◽  
Annick Van Greveling ◽  
Chris Monten ◽  
...  

Abstract Background In early-stage breast cancer, the cornerstone of treatment is surgery. After breast-conserving surgery, adjuvant radiotherapy has shown to improve locoregional control and overall survival rates. The use of breast radiotherapy in the preoperative (preop) setting is far less common. Nevertheless, it might improve disease-free survival as compared to postoperative radiotherapy. There is also a possibility of downsizing the tumour which might lead to a lower need for mastectomy. There are some obstacles that complicate its introduction into daily practice. It may complicate surgery or lead to an increase in wound complications or delayed wound healing. Another fear of preop radiotherapy is delaying surgery for too long. At Ghent University Hospital, we have experience with a 5-fraction radiotherapy schedule allowing radiotherapy delivery in a very short time span. Methods Twenty female breast cancer patients with non-metastatic disease receiving preop chemotherapy will be randomized between preop or postoperative radiotherapy. The feasibility of preop radiotherapy will be evaluated based on overall treatment time. All patients will be treated in 5 fractions of 5.7 Gy to the whole breast with a simultaneous integrated boost to the tumour/tumour bed of 5 × 6.2 Gy. In case of lymph node irradiation, the lymph node regions will receive a dose of 27 Gy in 5 fractions of 5.4 Gy. The total duration of therapy will be 10 to 12 days. In the preop group, overall treatment time is defined as the time between diagnosis and the day of last surgery, in the postop group between diagnosis and last irradiation fraction. Toxicity related to surgery, radio-, and chemotherapy will be evaluated on dedicated case-report forms at predefined time points. Tumour response will be evaluated on the pathology report and on MRI at baseline and in the interval between chemotherapy and surgery. Discussion The primary objective of the trial is to investigate the feasibility of preop radiotherapy. Secondary objectives are to search for biomarkers of response and toxicity and identify the involved cell death mechanisms and the effect of preop breast radiotherapy on the in-situ immune micro-environment.


JAMA Oncology ◽  
2017 ◽  
Vol 3 (1) ◽  
pp. 21 ◽  
Author(s):  
Laurie W. Cuttino ◽  
Charlotte Dai Kubicky

2020 ◽  
Vol 14 (4) ◽  
pp. 144
Author(s):  
Sinta Prastiana Dewi

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.


Sign in / Sign up

Export Citation Format

Share Document