scholarly journals Intensification of radiation therapy for localized breast cancer in the settings of the COVID-19 pandemic: A literature review

2021 ◽  
Vol 62 (4) ◽  
pp. 48-56
Author(s):  
S. A. Kopochkina ◽  
A. Savkhatova ◽  
M. Zekebaev ◽  
D. Chen ◽  
E. Davletgildeyev
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Randomized Trials ◽  
Radiation Treatment ◽  
Breast Conserving Surgery ◽  
Malignant Neoplasms ◽  
Radiation Toxicity ◽  
Standard Regimen ◽  
Healthcare Facilities ◽  
Pubmed Database

Relevance: Since 2004, breast cancer steadily ranks first in the structure of the incidence of malignant neoplasms in the Republic of Kazakhstan in both sexes. In 2020, its share was 14.5% (vs. 15.2% in 2019). Breast cancer also constantly ranks first in the structure of female cancer incidence, with 44.3‰ in 2020 (vs. 51.6‰in 2019). In the early 1980s, radiation therapy was a standard specialized treatment for breast cancer. The current realities of the COVID-19 pandemic require a reorganization of healthcare facilities to determine the priorities. It is also important to balance the economic and clinical efficacy of radiotherapy methods applied. The study aimed to analyze the results of large randomized trials and compare breast cancer outcomes after hypofractionated and standard fractionation radiation treatment. Methods: We reviewed the results of large randomized trials of hypofractionated radiation therapy, emphasizing adequate patient selection according to the American Society of Therapeutic Radiology and Oncology (ASTRO) guidelines. Radiobiological aspects of hypofractionation were considered due to its implementation in clinical practice. The research materials were obtained from the “PubMed” database of evidence-based medicine by the keywords “radiotherapy,” “breast cancer,” “hypofractionation dose” for the period 2000-2021. Large randomized trials involving patients of any age diagnosed with stages T1-3, N0-1 breast cancer, who underwent beam therapy in standard or hypofractionated mode, met the criteria for inclusion in this study. Results: According to the results of large randomized trials, the hypofractionated regimen is similar to the standard regimen in terms of late effects on normal tissues and ensures good control over the oncological process. Conclusions: Hypofractionation has proven effectiveness and safety and has lower late and/or acute radiation toxicity when treating early breast cancer. Hypofractionation can become a new standard of radiation therapy at early stages after breast-conserving surgery.

Does Locoregional Radiation Therapy Improve Survival in Breast Cancer? A Meta-Analysis

2000 ◽  
Vol 18 (6) ◽  
pp. 1220-1229 ◽  
Author(s):  
Timothy J. Whelan ◽  
Jim Julian ◽  
Jim Wright ◽  
Alejandro R. Jadad ◽  
Mark L. Levine
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Systemic Therapy ◽  
Odds Ratio ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Radical Mastectomy ◽  
Node Positive ◽  
Meta Analyses ◽  
Positive Breast Cancer

PURPOSE: Recent randomized trials in women with node-positive breast cancer who received systemic treatment report that locoregional radiation therapy improves survival. Previous trials failed to detect a difference in survival that results from its use. A systematic review of randomized trials that examine the effectiveness of locoregional radiation therapy in patients treated by definitive surgery and adjuvant systemic therapy was conducted. METHODS: Randomized trials published between 1967 and 1999 were identified through MEDLINE database, CancerLit database, and reference lists of relevant articles. Relevant data was abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on any recurrence, locoregional recurrence, and mortality. RESULTS: Eighteen trials that involved a total of 6,367 patients were identified. Most trials included both pre- and postmenopausal women with node-positive breast cancer treated with modified radical mastectomy. The type of systemic therapy received, sites irradiated, techniques used, and doses of radiation delivered varied between trials. Data on toxicity were infrequently reported. Radiation was shown to reduce the risk of any recurrence (odds ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.83), local recurrence (odds ratio, 0.25; 95% CI, 0.19 to 0.34), and mortality (odds ratio, 0.83; 95% CI, 0.74 to 0.94). CONCLUSION: Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.

Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy

2006 ◽  
Vol 101 (2) ◽  
pp. 207-214 ◽  
Author(s):  
Kristie Long Foley ◽  
Gretchen Kimmick ◽  
Fabian Camacho ◽  
Edward A. Levine ◽  
Rajesh Balkrishnan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Breast Conserving Surgery ◽  
Breast Cancer Patients

scholarly journals Тhe effect of cancer patients’ positioning accuracy during radiation therapy sessions using medical linear electron accelerators on the parameters of their individual 3D dose distribution

Doklady BGUIR ◽  
2020 ◽  
Vol 18 (7) ◽  
pp. 31-39
Author(s):  
M. N. Piatkevich ◽  
E. V. Titovich ◽  
G. V. Belkov
Keyword(s):  
Radiation Therapy ◽  
Radiation Treatment ◽  
Malignant Tumors ◽  
Rapid Development ◽  
Treatment Session ◽  
Malignant Neoplasms ◽  
Horizontal Position ◽  
Individual Dose ◽  
Dose Distributions ◽  
The Impact

Due to the rapid development and further improvement of radiation treatment technologies oncologists have an opportunity to precisely deliver individual dose distributions to the tumor, minimizing the doses obtained by critical organs and healthy structures. For the correct and successful application of these complex methods of radiation therapy, it was necessary to enforce the requirements for the technical and dosimetric parameters of the radiotherapy equipment. The purpose of the research is to determine the magnitude of the possible error for patients’ positioning during their radiotherapy treatments using medical linear accelerators by modeling the impact of the patient’s body on the treatment couch. To determine the values of a possible error, the authors have considered the design and characteristics of a typical treatment couch, developed a model of the “average” patient’s body (phantom), which allowed changing the load to the treatment couch with a step of 1 kg. The position parameters of treatment couches were determined for the main types of localization of radiation therapy for malignant tumors: head and neck tumors, breast tumors and pelvic tumors. Numerical values of the treatment coach deviations from prescribed horizontal position were experimentally established for a load from 40 to 180 kg for a treatment couch used at the N.N. Alexandrov National Cancer Centre of Belarus. Based on the obtained experimental data, the necessity to correct the patient's treatment conditions at the stage of treatment planning were confirmed in order to ensure the delivery accuracy of individual dose distributions as required by the radiation therapy protocols. Authors stated that an analysis of the dependence of the deviations in the dose delivered to the patients on the deviation of the radiotherapy table from its horizontal position should be carried out for each radiotherapy table used in clinical practice. The development and implementation of a mechanism that will allow considering this information when choosing the parameters of the patient’s treatment session and prescribing the dose for any localization of malignant neoplasms is needed.

No long-term increase in cardiac-related mortality after breast-conserving surgery and radiation therapy using modern techniques.

1998 ◽  
Vol 16 (4) ◽  
pp. 1374-1379 ◽  
Author(s):  
A J Nixon ◽  
J Manola ◽  
R Gelman ◽  
B Bornstein ◽  
A Abner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Conservative Surgery ◽  
Breast Conserving Surgery ◽  
Breast Irradiation ◽  
Breast Radiotherapy ◽  
Treatment Characteristics ◽  
Increased Risk ◽  
Significant Difference ◽  
Related Mortality

PURPOSE To determine whether left-breast irradiation using modern techniques after breast-conserving surgery leads to an increased risk of cardiac-related mortality. METHODS Between 1968 and 1986, 1,624 patients were treated for unilateral stage I or II breast cancer at the Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA, with conservative surgery and breast irradiation. Seven hundred forty-five patients with a potential follow-up of at least 12 years were analyzed. Clinical, pathologic, and treatment characteristics were compared between the 365 patients (49%) who received left-sided irradiation and the 380 patients (51%) who received right-sided irradiation. The relationship between left-sided breast irradiation and the risk of nonbreast cancer- and cardiac-related mortality was examined. RESULTS There was no significant difference in the distribution of clinical, pathologic, or treatment characteristics between the two groups, with the exception of a small difference in pathologic tumor size (medians, left, 2.0 cm, right, 1.5 cm; P = .007). At 12 years, a majority of patients still were alive. Slightly more patients with left-sided tumors had died of breast cancer (31% v 27%; P = NS). Equivalent proportions from each group died of nonbreast cancer causes (11%), including nine patients (2%) from each group who died from cardiac causes. The risk of cardiac mortality did not increase as time after treatment increased for patients who received left-sided irradiation compared with right-sided irradiation. A model that controlled for clinical, pathologic, and treatment differences showed no significant increase in any category of cause of death (breast, cardiac, or other) for patients who received left-sided irradiation. CONCLUSION These results suggest that modern breast radiotherapy is not associated with an increased risk of cardiac-related mortality within at least the first 12 years after treatment.

scholarly journals Investigating confounders of the association between survival and adjuvant radiation therapy after breast conserving surgery in a sample of elderly breast Cancer patients in Appalachia

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fabian Camacho ◽  
Roger Anderson ◽  
Gretchen Kimmick
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Structural Model ◽  
Failure Time ◽  
Breast Conserving Surgery ◽  
Adjuvant Radiation ◽  
Percentage Increase ◽  
Adjuvant Radiation Therapy ◽  
Percent Change ◽  
Dual Status

Abstract Background To explain the association between adjuvant radiation therapy after breast conserving surgery (BCS RT) and overall survival (OS) by quantifying bias due to confounding in a sample of elderly breast cancer beneficiaries in a multi-state region of Appalachia. Methods We used Medicare claims linked registry data for fee-for-service beneficiaries with AJCC stage I-III, treated with BCS, and diagnosed from 2006 to 2008 in Appalachian counties of Kentucky, Ohio, North Carolina, and Pennsylvania. Confounders of BCS RT included age, rurality, regional SES, access to radiation facilities, marital status, Charlson comorbidity, Medicaid dual status, institutionalization, tumor characteristics, and surgical facility characteristics. Adjusted percent change in expected survival by BCS RT was examined using Accelerated Failure Time (AFT) models. Confounding bias was assessed by comparing effects between adjusted and partially adjusted associations using a fully specified structural model. Results The final sample had 2675 beneficiaries with mean age of 75, with 81% 5-year survival from diagnosis. Unadjusted percentage increase in expected survival was 2.75 times greater in the RT group vs. non-RT group, with 5-year survival of 85% vs 60%; fully adjusted percentage increase was 1.70 times greater, with 5-year rates of 83% vs 71%. Quantification of incremental confounding showed age accounted for 71% of the effect reduction, followed by tumor features (12%), comorbidity (10%), dual status(10%), and institutionalization (8%). Adjusting for age and tumor features only resulted in only 4% bias from fully adjusted percent change (70% change vs 66%). Conclusion Quantification of confounding aids in determining covariates to adjust for and in interpreting raw associations. Substantial confounding was present (60% of total association), with age accounting for the largest share (71%); adjusting for age plus tumor features corrected for most of the confounding (4% bias). The direct effect of BCS RT on OS accounted for 40% of the total association.

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