Comparison of Two Radiotherapeutic Hypofractionated Schedules in the Application of Tumor Bed Boost

Zygogianni, Anna; Kouloulias, Vassilis; Kyrgias, George; Armpilia, Christina; Antypas, Christos; Theodorou, K.; Kouvaris, John

doi:10.1016/j.clbc.2013.02.007

Cited by 5 publications

(5 citation statements)

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“…Whole breast irradiation was carried out 4 times a week; additionally, we applied a margin-directed boost of 9 - 12 Gy in 3-4 fractions on day 5 of each week shown to be effective in conventional fractionation [13]. In contrast to the above mentioned randomized trials in which no boost [7] or a conventional fractionated boost of 5-7× 2.0 Gy = 10-14 Gy was applied in 43-75% of all cases [8,9], we applied a hypofractionated boost as described by Liau et al and other study groups to further shorten overall treatment time [12,14-16]. Outcome was satisfactory with 100% local and loco-regional control and very satisfying or satisfying cosmesis in 100% at mean/median 32/38 months.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated radiotherapy for breast cancer acceleration of the START A treatment regime: intermediate tolerance and efficacy

et al. 2014

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PurposeProspective evaluation of accelerated hypofractionated radiotherapy (RT) in breast cancer patients treated with 41.6 Gy in 13 fractions plus boost delivered five times a week.Patients and methodsBetween 03/2009 and 10/2012 98 consecutive patients aged >55 years presenting with breast cancer (invasive cancer: n = 95, ductal carcinoma in situ (DCIS): n = 3) after breast conserving surgery were treated in our institution with the following schedule: 41.6 Gy in 13 fractions 4 times a week and 9 or 12 Gy boost in 3 or 4 fractions (on day 5 each week), cumulative dose: 50.6 Gy in 3.2 weeks or 53.6 Gy in 3.4 weeks, respectively depending on resection status. 56 patients had a T1 tumor, 39 a T2 tumor. N-status was as follows: N0: n = 71, N1: n = 25, N2/3: n = 2. 23 patients (24%) received chemotherapy before RT. A prospectively planned follow-up (FU) visit with objective and subjective assessment of treatment tolerance (questionnaires) was performed 0 and 8 weeks after RT completion, and one, two and four years later, respectively.ResultsMean/median follow-up was 32/28 months (range: 12-56). After 2 years local control, loco-regional control and disease-free survival was 100%, 100%, and 98%, respectively. Overall survival was 96% at 2 years. Cosmetic outcome was very good with patients being satisfied or very satisfied in 99% (n = 86/87), 97% (n = 55/57) and 100% (n = 25/25) after one, two and four years after RT, respectively. No grade ≥ 2 pain was described in the 25 patients with a FU of at least 4 years. Fibrosis, telangiectasia and edema were found in 7-15%, 0-22% and 0-11% at one, two, and four years, respectively, and are comparable to other trials.ConclusionThe applied hypofractionated RT regime with single doses of 3.2 Gy plus boost doses of 9-12 Gy in 3–4 fractions applied in 5 sessions a week was effective and well tolerated on intermediate term FU.

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Section: Discussionmentioning

confidence: 99%

Hypofractionated radiotherapy for breast cancer acceleration of the START A treatment regime: intermediate tolerance and efficacy

et al. 2014

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“…However, due to huge work load, a hypofractionated protocol with the same radiobiological equivalent might be the solution for reduction of both the number of fractions and the total treatment duration. Our institution has already reported on hypofractionated radiotherapy in breast cancer in relation to irradiation after conservative surgery [2][3][4][5]. The aim of the present study was to investigate the potential efficacy, acute toxicity and long-term side effects of hypofractionated schedules.…”

Section: Introductionmentioning

confidence: 98%

A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer

Kouloulias¹,

Mosa²,

Zygogianni³

et al. 2016

Breast Care

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Introduction: The aim of this analysis was a retrospective evaluation of the efficacy and toxicity of 2 hypofractionated irradiation schedules compared to conventional therapy in post-mastectomy patients. Methods: 3 irradiation schedules were analyzed: 48.30 Gy in 21 fractions (group A, n = 60), 42.56 Gy in 16 fractions (group B, n = 27) and 50 Gy in 25 fractions (group C, n = 30) of the front chest wall. All groups were also treated with a supraclavicular field, with 39.10 Gy in 17 fractions (group A), 37.24 Gy in 14 fractions (group B) or 45 Gy in 25 fractions (group C). Results: No local recurrences were noted in any group during 36 months of follow-up. Acute skin toxicity presented in all groups, with 58.3%, 70.4% and 60% of grade I; 35%, 25.9% and 40% of grade II; 6.7%, 3.7% and 0% of grade III being seen in groups A, B and C, respectively. Late skin toxicity was noted only as grade I in 16.7%, 25.9% and 26.7% of groups A, B and C, respectively. No significant difference was noted among all groups for either acute or late skin toxicity, or for radio-pneumonitis (chi2 test, p > 0.05). Conclusion: All schedules were equally effective with equivalent toxicity. A prospective randomized study is needed to confirm our results.

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“…The late skin toxicity, however, was similar between the groups. 15 The safety and feasibility of applying intraoperative electron tumor bed boost followed by HWBI were first described by Ivaldi et al 8 They reported that the skin toxicity might be observed in all patients; however, it was mostly grade 1 that peaked at the end of WBI. In long term follow up, less than 2% patients experienced grade 3 or higher toxicity.…”

Section: Discussionmentioning

confidence: 98%

“…Sample size was calculated 30 patients in each group to achieve a power of 90% to detect skin toxicity differences between two groups using n = ( Z α /2 + Z β ) 2 × ( p 1 (1‐ p 1 ) + p 2 (1‐ p 2 ))/( p 1‐ p 2 ) 2 formula considering prevalence of skin toxicity of 66.6 and 24.1% in HWBI with or without boost, respectively. 15 Data were analyzed by SPSS 11 using Chi‐square, Fisher's exact, and T tests at the level of p < .05. The data had a normal distribution based on Shapiro–Wilk test.…”

Section: Methodsmentioning

confidence: 99%

Outcome of hypofractionated breast irradiation and intraoperative electron boost in early breast cancer: A randomized non‐inferiority clinical trial

et al. 2021

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Background: Intraoperative electron radiotherapy (IOERT) followed by hypofractionated whole breast irradiation (HWBI) provides the shortest possible time of adjuvant breast irradiation. The efficacy of either method has been described in previous reports; however, to our knowledge, the efficacy of combined therapy has not been reported.Aim: To compare the toxicity and cosmetic outcome of IOERT as a tumor bed boost followed by HWBI with conventional whole breast irradiation (CWBI) followed by external electron tumor bed boost (EETBB) after breast conserving surgery (BCS) in patients with invasive breast cancer. Methods: In 2019, a prospective noninferiority trial (IRCT20180919041070N2) was started. After BCS, early-stage breast cancer patients were treated by IOERT (10 Gy) and HWBI (42.56 Gy in 16 fractions) or CWBI (50 Gy in 25 fraction) and EETBB (10 Gy in 5) in a double-arm design. Acute/late toxicity and cosmetic outcome were evaluated by common toxicity criteria (CTC) after 1-year follow-up (FUP) at the level of p < .05.Results: Of 60 eligible patients, 30 were allocated to each group. Regarding acute effects after a median FUP of 12 months, CTC-score of grade II-III erythema (p = .001) and desquamation (p = .005) were significantly higher in CWBI+EETBB compared to IOERT+ HWBI. However, there were no significant differences at the end of radiotherapy and after 1 month, 6 months, and 1 year. Cosmetic outcome after radiation was similar in both groups mostly rating as good/excellent after 1-year FUP.Conclusions: Boost-IOERT/HWBI regimen has comparable acute and late treatment toxicity profiles compared to the CWBI.

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Comparison of Two Radiotherapeutic Hypofractionated Schedules in the Application of Tumor Bed Boost

Cited by 5 publications

References 40 publications

Hypofractionated radiotherapy for breast cancer acceleration of the START A treatment regime: intermediate tolerance and efficacy

Hypofractionated radiotherapy for breast cancer acceleration of the START A treatment regime: intermediate tolerance and efficacy

A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer

Outcome of hypofractionated breast irradiation and intraoperative electron boost in early breast cancer: A randomized non‐inferiority clinical trial

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