Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review

Vicini, Frank A.; Broughman, James R.; Halima, Ahmed; Mayo, Zachary; Obi, Elizabeth; Al‐Hilli, Zahraa; Arthur, Douglas W.; Wazer, David E.; Shah, Chirag

doi:10.1016/j.ijrobp.2021.11.026

Cited by 10 publications

(2 citation statements)

References 129 publications

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“…A one-week hypofractionated WBI regimen has become standard in the UK. For local disease control, the WBI schedule of 26 Gy in 5 fractions over one week is noninferior to 40 Gy in 15 fractions over three weeks [55][56][57]. Although it seems safe in terms of normal tissue effects for up to 5 years, this regimen has not been tested within a PBI phase 3 trial.…”

Section: Discussionmentioning

confidence: 99%

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Burkon,

Selingerova,

Slavik

et al. 2024

Radiat Oncol

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Background Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. Methods Early breast cancer patients after partial mastectomy were equally randomized into two arms– external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. Results The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21–45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. Conclusion External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. Trial registration NCT06007118.

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Section: Discussionmentioning

confidence: 99%

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Burkon,

Selingerova,

Slavik

et al. 2024

Radiat Oncol

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show abstract

“…However, with advancements in radiation therapy technology, such as robotic SAPBI that allows for more robust treatment, improved long-term local control may be realized with limited toxicity. 15 , 39 Furthermore, with treatment modalities that reduce potential inaccuracy during treatment delivery such as patient positioning and tumor shift during respiration, less normal tissue may be irradiated. 40 , 41 To eliminate much of the uncertainty of target positioning, surgically placed fiducial markers, which have been shown to be a strong radiographic surrogate for the breast lumpectomy cavity, can be used.…”

Section: Discussionmentioning

confidence: 99%

Robotic Stereotactic Body Radiation Therapy for the Adjuvant Treatment of Early-Stage Breast Cancer: Outcomes of a Large Single-Institution Study

Jaysing

Lischalk²,

Sanchez³

et al. 2023

Advances in Radiation Oncology

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Radiation-induced skin changes after breast or chest wall irradiation in patients with breast cancer and skin of color: a systematic review

Purswani

Nwankwo²,

Adotama³

et al. 2023

Clinical Breast Cancer

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Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review

Cited by 10 publications

References 129 publications

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Robotic Stereotactic Body Radiation Therapy for the Adjuvant Treatment of Early-Stage Breast Cancer: Outcomes of a Large Single-Institution Study

Radiation-induced skin changes after breast or chest wall irradiation in patients with breast cancer and skin of color: a systematic review

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