Effect of age and radiation dose on local control after breast conserving treatment: EORTC trial 22881-10882

Antonini, Ninja; Jones, Heather; Horiot, J.C.; Poortmans, Philip; Struikmans, H.; Bogaert, Walter Van den; Barillot, I.; Fourquet, A.; Jager, J.J.; Hoogenraad, W.J.; Collette, Laurence; Piérart, M.; Hart, Guus; Bartelink, Harry

doi:10.1016/j.radonc.2006.09.014

Cited by 157 publications

(76 citation statements)

References 21 publications

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“…Studies have confirmed that hypofractionated radiotherapy as effective as conventional fractionation schedules using 1.8-2 Gy per fraction with no significant compromise of the cosmetic outcomes [5,6,14,15]. This approach could be advantageous for patients at higher risk of local recurrence [16].…”

Section: Discussionmentioning

confidence: 93%

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Moorthy¹,

Elhateer²,

Majumdar³

et al. 2012

J Nucl Med Radiat Ther

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Purpose: Whole breast irradiation is part of breast conservative management for early breast cancer; addition of boost dose to tumor bed improves local recurrence rates and is currently the standard of care. Randomized trials reported low a/b ratio for breast cancer that predict a radiobiological advantage for hypofractionation. Simultaneous boost radiation as a method of hypofractionation proved safe and effective for head and neck tumors. In this study we attempt to compare and analyze the dosimetric aspects of adding Simultaneous Integrated Boost (SIB) over Sequential Boost (SB) to a hypofractionated treatment schedule in breast cancer patients after BCS. Materials and methods:CT simulation data sets for 23 patients were selected for this planning study; Targets and OAR were delineated as per RTOG guidelines. Multiple dynamic field IMRT plans were generated for each patient. The prescribed dose was 40 Gy/15 fractions to whole breast (2.67 Gy/fraction) and 48 Gy/15fractions to lumpectomy cavity (3.2 Gy/fraction) for SIB, and 40 Gy/15 fractions followed by 10Gy/5 fractions for SB. Generated Treatment plans were evaluated by experienced radiation oncologist, and the best plan was selected for the dosimetric analysis. Results:The pre specified target coverage criteria were met for the lumpectomy cavity as well as whole breast in all plans. All quality indices for PTV coverage showed to be significantly improved with SIB for both whole breast and tumor bed volumes. SB technique showed more dose spillage outside the boost volume. SIB-IMRT was better in sparing OAR ,the volume of the ipsilateral lung V20 Gy was 19.8 % compared to 22.8 % (p = 0.04), maximum dose to LAD was 17.6 Gy Vs. 21.6 (p= 0.01) and contralateral breast mean dose was 0.36 Gy Vs. 1.27 Gy (p = 0.01) for SIB and SB respectively. Conclusions:Hypofractionated breast SIB is feasible with better PTV coverage and OAR. Along with further reduction of the overall period which may increase patient convenience and resource utilization benefit.

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Section: Discussionmentioning

confidence: 93%

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Moorthy¹,

Elhateer²,

Majumdar³

et al. 2012

J Nucl Med Radiat Ther

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“…Furthermore, women less than 40 years of age treated with bct plus radiotherapy had a higher relapse rate at any site: 36% at 10 years compared with 21% for women in their 40s. Even with boost doses, as described in the eortc boost study, the 10-year relapse rate was 13% in women less than 40 years of age compared with 4.9% in women in their 50s 13 .…”

Section: Ebctcg Most Recently the Early Breast Cancer Trialists'mentioning

confidence: 84%

Comparison of Recurrence and Survival Rates after Breast-Conserving Therapy and Mastectomy in Young Women with Breast Cancer

2013

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Multiple randomized trials have demonstrated that breast-conserving therapy with partial mastectomy and radiotherapy provides survival equivalent to that seen with mastectomy for patients with early-stage breast cancer. Breast-conserving therapy has been associated with better quality of life relative to mastectomy and has become the standard of care for patients with early-stage breast cancer. Young age has been identified as a risk factor for recurrence and death from breast cancer. Some studies have suggested that young women (less than 35 or 40 years of age) have inferior outcomes with breast-conserving therapy, implying that such women may be better served by mastectomy. On review of the available literature, there is no definitive evidence that mastectomy provides a consistent, unequivocal recurrence-free or overall survival benefit over breast-conserving therapy. However, available meta-analyses have not compared outcomes in young women specifically, and such analyses should be performed. In the interim, breast-conserving therapy is not contraindicated in young women (less than 40 years of age) and can be used cautiously; however, such women should be advised of the lack of unequivocal data proving that survival is equivalent to that with mastectomy in their age group.

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“…[24][25][26][27][28][29][30] Boost treatment may be delivered using photons, electrons, or brachytherapy.…”

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confidence: 99%

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Gradishar¹,

Anderson

Balassanian

et al. 2017

J Natl Compr Canc Netw

396

346

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These NCCN Guidelines Insights highlight the important updates/changes to the surgical axillary staging, radiation therapy, and systemic therapy recommendations for hormone receptor-positive disease in the 1.2017 version of the NCCN Guidelines for Breast Cancer. This report summarizes these updates and discusses the rationale behind them. Updates on new drug approvals, not available at press time, can be found in the most recent version of these guidelines at NCCN.org.

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Effect of age and radiation dose on local control after breast conserving treatment: EORTC trial 22881-10882

Cited by 157 publications

References 21 publications

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Comparison of Recurrence and Survival Rates after Breast-Conserving Therapy and Mastectomy in Young Women with Breast Cancer

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

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