Long‐term outcomes of patients with conserved breast cancer treated with adjuvant hypofractionated prone breast intensity‐modulated radiation therapy

Abstract

Introduction: New techniques for adjuvant radiation therapy after breast conservation include prone positioning, hypofractionation and intensity-modulated radiation therapy (IMRT). Long-term evaluations of this combination are lacking, and we report our own experience. Methods: Patients with invasive breast cancer followed for a minimum 36 months post-IMRT were eligible. Dose used was 40 Gray in 15 fractions over 3 weeks to the whole breast via forward-planned prone, whole breast IMRT. A 10 Gy in 5 fraction supine boost was offered. Results: Between January 2012 and January 2020, 2199 patients had breast conservation and adjuvant radiation: 489 received hypofractionated prone breast IMRT, with 155 eligible for our evaluation. Median follow-up was 52 months. Median age was 62 (range 36-80), 78.7% were T1, 20.6% were T2, and 12.3% were node-positive. Grade was 1 in 26.5%, 2 in 43.9% and 3 in 29.7%; 87.1% were oestrogen receptor positive, 3.2% were HER2 positive, and 11.0% were triple negative. 58.6% received a boost, 74.8% endocrine therapy and 32.3% chemotherapy. No patient developed local recurrence. One regional recurrence was successfully salvaged. Six patients (3.9%) developed metastases, and 1.9% died. Five-year actuarial local recurrence-free, regional recurrence-free and breast cancer-specific survival rates were 100.0%, 98.2% and 94.8%. Late grade 1 and 2 breast pain occurred in 20.0% and 1.3% of patients. Only 11.0% had new pain compared to pre-radiation. No patient developed radiation-induced pneumonitis, pulmonary fibrosis, rib fracture or cardiac toxicity. All patients scored cosmesis as 'good' or better. Conclusion: Adjuvant hypofractionated prone breast IMRT has excellent locoregional control and minimal toxicity.

Long‐term outcomes of definitive radiation with volumetric modulated arc therapy and concurrent chemotherapy for squamous cell carcinoma of the anus in a regional Australian cancer centre

“…We report efficacy and toxicity outcomes that are very comparable to those reported in major metropolitan Australian centres. This is not surprising to us, as we have previously demonstrated excellent efficacy and toxicity outcomes for a number of other cancer types when using IMRT and VMAT 15–17 …”

“…This is not surprising to us, as we have previously demonstrated excellent efficacy and toxicity outcomes for a number of other cancer types when using IMRT and VMAT. [15][16][17] Furthermore, the treatment of anal cancer is guided by consensus-driven protocols such as eviQ and the Australasian Gastrointestinal Trials Group guidelines, which enable all cancer centres to offer standardised, peer-reviewed, high-quality treatment whose outcomes can be compared for quality control. We contend that, with appropriate experience and support services, regional cancer centres can deliver exceptional results.…”

PET/MRI Assessment of Acute Cardiac Inflammation 1 Month After Left-Sided Breast Cancer Radiation Therapy

“…Although cardiac risk reduction strategies such as the role of active-breathing modalities (22), patient positioning (23,24), and accelerated partial breast irradiation (25) are discussed, few efforts in randomized controlled trials have validated the cardiac-sparing techniques or looked into the early response of cardiac substructures to breast RT. The fact that 3 patients received a higher mean heart dose in free-breathing RT but showed no differences in other dosimetric parameters of the heart and its substructures implies that DIBH RT can achieve better sparing in terms of the whole heart than free-breathing RT can.…”

Effects of Tumor-Rib Distance and Dose-Dependent Rib Volume on Radiation-Induced Rib Fractures in Patients with Breast Cancer

“…Treatment in a prone position allows the breast tissue to sag down, which increases the tumor-rib distance, and, additionally, a prone position reduces the absolute rib volume receiving a certain radiation dose. Notably, a study of patients who underwent breast radiotherapy in the prone position reported no RIRF occurrence [26]. However, a prone position is less effective for chest wall irradiation in patients without remnant breast tissue and is unsuitable for treating advanced-stage patients requiring the inclusion of regional lymph nodes.…”