High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: Seven-year results of a comparative study

Polgár, Csaba; Major, Tibor; Fodor, János; Németh, György; Orosz, Zsolt; Sulyok, Zoltán; Udvarhelyi, Nóra; Somogyi, A.; Takácsi‐Nagy, Zoltán; Lövey, Katalin; Ágoston, Péter; Kásler, Miklós

doi:10.1016/j.ijrobp.2004.05.012

Cited by 213 publications

(118 citation statements)

References 48 publications

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“…The four matched case series [44][45][46][47] which compared PBI and WBI also showed favourable cosmesis and lower NTCP risk with PBI with the exception of higher grade 2-3 fibrosis observed in the Hungarian series 44 . It is possible that significant dose heterogeneity with the use of Ir192 implants could explain the increased grade 2-3 fibrosis in the PBI arm in the Hungarian series.…”

Section: Qualitative Effect Of Treatment Volumementioning

confidence: 82%

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A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

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Background Whole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT). Objectives Primary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken. Design Multicentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT. Setting Five radiotherapy departments, participating in IMPORT-HIGH. Participants Two-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH. Interventions There was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images. Main outcome measures Difference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging. Results The primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3 (range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is ...

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Section: Qualitative Effect Of Treatment Volumementioning

confidence: 82%

“…Polgar et al 44 A blinded panel of experts scored photographic assessment of cosmesis on a four-part scale (excellent, good, fair, poor). At 20 months follow up, 75% patients in the PBI group and 84% patients with WBI had excellent or good cosmesis (not statistically significant).…”

Section: Case-matched Pair Studies (Level III Evidence)mentioning

confidence: 99%

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

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“…Interstitial implants have been in use for over 10 years and published reports describe excellent results; however, these are mainly single-institution Phase I/II studies [39][40][41][42][43][44][45][46]. The largest matched-pair analysis from the William Beaumont Hospital compared 199 interstitial catheter APBI patients treated between 1980 and 1997 with 199 WBRT patients randomly selected from 709 eligible control subjects [39].…”

Section: Brachytherapymentioning

confidence: 99%

Partial breast irradiation: a review of techniques and indications

Stewart

Khan²,

Devlin³

2010

BJR

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ABSTRACT. The addition of whole-breast external beam radiotherapy (EBRT) to breastconserving surgery results in a significant reduction in the risk of death due to breast cancer, but this may be offset by an increase in deaths from other causes and toxicity to surrounding organs. Because of this, and with a view to patterns of local recurrence, irradiation of the tumour bed has been explored in selected patients with early breast cancer using a variety of radiotherapeutic modalities. This review article explores the treatment options for partial breast irradiation and examines their role within the field of breast cancer treatment.

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“…En estos estudios se analizan las recaídas después de irradiación del lecho tumoral en lugar de toda la mama. Los datos de fallo local oscilan entre 0,3-0,8% y son similares al tratamiento convencional [25][26][27] . Por ello, se han puesto en marcha estudios fase III, de los que destacan los que realizan los grupos de la EORTC y RTOG, con el objetivo de confirmar estos resultados 28,29 .…”

Section: Cáncer De Mamaunclassified

Braquiterapia guiada por imagen

Villafranca

Romero

Sola

et al. 2009

Anales Sis San Navarra

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RESUMENLa braquiterapia consiste en la administración de radiación en contacto íntimo con el tumor, con una baja exposición de los tejidos sanos circundantes. Empezó a utilizarse a comienzos del siglo XX y desde entonces ha ido desarrollándose: diferentes radioisótopos, sistemas de tratamiento a distancia, programas informáticos que permiten un cálculo individualizado de la dosis.Los cambios en los últimos años dentro de la braquiterapia han afectado a dos aspectos. En primer lugar, la incorporación de las técnicas de imagen como la ecografía, la tomografía computarizada (TC) y la resonancia magnética (RM), imprescindibles para el diagnóstico y la estadificación tumoral. Su utilización mientras se realiza el implante ayuda a guiarlo y realizarlo con mayor precisión. En segundo lugar, la utilización de TC, RM y ecografía permiten mejorar la cobertura del tumor o reducir la dosis a los órganos sanos. Se utilizan dentro de sistemas de planificación inversa, que realizan el cálculo de dosis a partir de las recomendaciones de las dosis a administrar al tumor y a los órganos sanos. En estos programas de planificación es posible hacer los cálculos con mucha rapidez, teniendo en cuenta la colocación en cada momento de la fuente. Esta técnica, llamada planificación en tiempo real, empieza a mostrar ventajas en el tratamiento de los cánceres de próstata.La incorporación de las técnicas de imagen y las mejoras en los sistemas de cálculo han hecho que en la actualidad la braquiterapia juegue un papel importante en el tratamiento del cáncer de próstata, cérvix, mama, tumores de cabeza y cuello, bronquio o esófago.Palabras clave. Braquiterapia guiada por imagen. Planificación en tiempo real. Cáncer de próstata. Cáncer de mama. Cáncer de cérvix. ABSTRACTBrachytherapy consists in the administration of radiation in intimate contact with the tumour, with a low exposure of neighbouring healthy tissues. Its use began in the early XX century and it has developed since then: different radioisotopes, systems of remote treatment, computer programs making individual dose calculation possible.In recent years there have been changes affecting two aspects of brachytherapy. In the first place, the incorporation of imaging techniques such as echography, computerised tomography (CT) and magnetic resonance (MR), indispensable for diagnosis and tumoural staging. Their use when the implant is being done helps in guiding and carrying out the operation with greater precision. In the second place, the use of CT, MR and echography makes better coverage of the tumour possible, or reduces the dose to healthy organs. They are used in inverse planning systems, which carry out dose calculation on the basis of the doses to be administered to the tumour and healthy organs. In these planning programs it is possible to make calculations more rapidly, taking account of the placement of the source at each moment in time. This technique, called real-time planning, is starting to show advantages in the treatment of prostate cancer.Incorporation of imaging techni...

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High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: Seven-year results of a comparative study

Cited by 213 publications

References 48 publications

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Partial breast irradiation: a review of techniques and indications

Braquiterapia guiada por imagen

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