HOME
.................................................
ASTRO 2011 Summary
.................................................
3D Conformal APBI Toxicity: Discussion at ASTRO
.................................................
Meeting Highlights
.................................................
Literature Corner
................................................
Editors' Bios
Pamela Benitez, MD
Dr. Benitez is a general surgeon
focusing exclusively on diseases
of the breast and breast cancer
at William Beaumont Hospital in
Royal Oak, Michigan
Martin Keisch, MD
Dr. Keisch is a board-certified radiation oncologist at University of Miami Hospital and President of Cancer HealthCare Associates (CHCA)
|
1. Int J Radiat Oncol Biol Phys. 2011 Sep 21. [Epub ahead of print]
Impact of Lymph Node Status on Clinical Outcomes After Accelerated Partial Breast
Irradiation.
Shah C, Wilkinson JB, Shaitelman S, Grills IS, Chen PY, Dekhne N, Jaiyesimi I, Wallace M, Mitchell CK, Vicini FA. Department of Radiation Oncology, William Beaumont School of Medicine, Royal Oak,
MI.
Abstract:
PURPOSE: To compare outcomes after accelerated partial breast irradiation (APBI) between node-negative and node-positive patients.
METHODS AND MATERIALS: A total of 534 patients with early-stage breast cancer received APBI including 39 node-positive (N+) cases. Clinical, pathologic, and treatment-related factors were compared between node-negative (N-) and N+ cohorts. Local recurrence (LR), regional recurrence (RR), axillary failure (AF), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS) were analyzed.
RESULTS: N+ patients were younger (p = 0.04), had larger tumors (p < 0.001), and were more likely to receive chemotherapy (p < 0.001). Mean follow-up was 7.8 years for N+ patients and 6.3 years for N- patients (p = 0.06). No differences were seen in 5-year actuarial rates of LR (2.2% vs. 2.6%, p = 0.86), AF (0% vs. 0%, p = 0.69), DFS (90.0% vs. 88.0%, p = 0.79), or OS (91.0 vs. 84.0%, p = 0.65) between the two groups, whereas higher rates of RR (0% vs. 6.1%, p < 0.001) and DM (2.2% vs. 8.9%, p = 0.005) were noted in N+ patients. A trend for improved CSS (p = 0.06), was seen in N- patients. Age, tumor size, receptor status, T-stage, chemotherapy, APBI technique, and nodal status (p = 0.86) were not associated with LR, while a trend for an association with LR was noted with close/positive margins, (p = 0.07), and failure to receive adjuvant hormonal therapy (p = 0.06).
CONCLUSIONS: No differences were seen in the rates of LR or AF between N- and N+ patients after APBI. These results support the continued enrollment of node-positive patients in Phase III trials evaluating the efficacy of APBI including the National Surgical Adjuvant Breast and Bowel Project-B39/Radiation Therapy Oncology Group 0413.
2. Radiother Oncol. 2011 Sep 8. [Epub ahead of print]
Partial breast irradiation for locally recurrent breast cancer within a second breast conserving treatment: Alternative to mastectomy? Results from a prospective trial.
Kauer-Dorner D, Pötter R, Resch A, Handl-Zeller L, Kirchheiner Mag K, Meyer-Schell K, Dörr W.
Department of Radiotherapy, Medical University of Vienna, Austria.
Abstract:
PURPOSE: To assess the outcome of multi-catheter pulse dose rate (PDR) brachytherapy of re-irradiation for local ipsilateral breast tumour recurrence (IBTR) in regard to local control, survival, morbidity and quality of life (QoL).
PATIENTS AND METHODS: Between 1999 and 2006, 39 patients were included with histologically confirmed IBTR, Karnofsky index ⩾80% and refusal of mastectomy. Exclusion criteria were multicentric invasive growth pattern, unclear surgical margins, distant metastasis and a postoperative breast not suitable for interstitial brachytherapy. Primary endpoint was local tumour control. Morbidity, cosmetic outcome and QoL were assessed in 24/39 patients. |
RESULTS: The five year actuarial local control rate was 93% after a mean follow up of 57 (±30) months with two second local relapses. Overall survival and disease free survival, both at 5years, were 87% and 77%, respectively. Late side effects Grade 1-2 were observed in 20/24 patients after a mean follow-up of 30 (±18) months. Late side effects ⩾Grade 3 occurred in 4/24 patients. Cosmetic outcome was excellent to fair in 76% of women. Overall QoL was comparable to a healthy control group. Mean scores of scales and items of QLQ-BR23 were comparable to primary breast conserving therapy.
CONCLUSIONS: Accelerated PDR-brachytherapy following breast conserving surgery (BCS) for local IBTR results in local tumour control comparable to mastectomy. Morbidity is moderate; the cosmetic outcome is good and hardly any impairment on QoL is observed.
3. Brachytherapy. 2011 Jul 2. [Epub ahead of print]
Four-year results using balloon-based brachytherapy to deliver accelerated partial breast irradiation with a 2-day dose fractionation schedule.
Wilkinson JB, Martinez AA, Chen PY, Ghilezan MI, Wallace MF, Grills IS, Shah CS, Mitchell CK, Sebastian E, Limbacher AS, Benitez PR, Brown EA, Vicini FA.
Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Abstract:
PURPOSE: We present 4-year results from a Phase I/II trial using balloon-based brachytherapy to deliver accelerated partial breast irradiation in 2 days.
MATERIALS/METHODS: Forty-five patients received breast-conserving surgery followed by adjuvant radiation therapy using a balloon-based brachytherapy applicator delivering 2800cGy in four fractions over 2 days. Outcomes analyzed include toxicities scored using the NCI Common Toxicity Criteria v3.0 scale, ipsilateral breast tumor recurrence, regional nodal failure, distant metastasis, disease-free survival, cause-specific survival, and overall survival.
RESULTS: Median age was 66 years (range, 48-83 years) and median tumor size was 0.6cm (range, 0.2-2.3cm). Five percent of patients were node positive (n=2), whereas 73% was estrogen receptor positive (n=33). Median followup was 3.7 years (2.4-7.0 years) with greater than 2 years of followup for all patients. Only Grades 1 and 2 chronic toxicities were noted with fat necrosis (18%) and asymptomatic seromas (42%) being the most common toxicities. Seven percent of patients developed ipsilateral rib fractures (n=3), although this was not statistically associated with maximum rib dose (p=0.31). Ninety-eight percent of patients had a good or excellent radiation-related cosmetic outcome at the time of last followup. There were no ipsilateral breast tumor recurrences or regional nodal failures; however, 2 patients developed distant metastases. Four-year actuarial disease-free survival, cause-specific survival, and overall survival were 96%, 100%, and 93%, respectively.
CONCLUSIONS: Treatment of early-stage breast cancer patients with breast-conserving therapy using a 2-day radiation dose schedule resulted in acceptable chronic toxicity and similar clinical outcomes as standard 5-day fractionation. |
|
