MRI-guided single fraction ablative radiotherapy for early-stage breast cancer: a brachytherapy versus volumetric modulated arc therapy dosimetry study
“…Surgery requires hospitalization and induces pain, hemorrhage, and infection in a nonnegligible proportion of patients and may also impair cosmetic outcome [9][10][11][12][13]. Noninvasive or minimally invasive treatments such as radiofrequency ablation (RFA), magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, and single-dose ablative radiotherapy are being developed as alternatives to breast surgery [14,15]. MR-HIFU ablation is a noninvasive treatment that uses focused ultrasound beams to induce lethal temperatures in the targeted cancerous tissue [16,17].…”
This study showed no significant preference for minimally invasive treatment for breast cancer. Using hypothetical scenarios, breast cancer survivors attributed the highest scores to BCT, whereas healthy volunteers showed a slight preference for minimally invasive treatments.
“…Surgery requires hospitalization and induces pain, hemorrhage, and infection in a nonnegligible proportion of patients and may also impair cosmetic outcome [9][10][11][12][13]. Noninvasive or minimally invasive treatments such as radiofrequency ablation (RFA), magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, and single-dose ablative radiotherapy are being developed as alternatives to breast surgery [14,15]. MR-HIFU ablation is a noninvasive treatment that uses focused ultrasound beams to induce lethal temperatures in the targeted cancerous tissue [16,17].…”
This study showed no significant preference for minimally invasive treatment for breast cancer. Using hypothetical scenarios, breast cancer survivors attributed the highest scores to BCT, whereas healthy volunteers showed a slight preference for minimally invasive treatments.
“…To account for microscopic disease, the GTV is uniformly expanded by 2 cm to create a clinical target volume (CTV), thereby excluding the first 5 mm beneath the skin and the chest wall. Both GTV and CTV are uniformly expanded by 3 mm to obtain the planning target volumes PTV GTV and PTV CTV , respectively, thereby excluding the first 5 mm beneath the skin [29, 30]. Organs at risk (OARs), such as skin, ipsilateral and contralateral breast, lungs, heart and chest wall are delineated according to predefined protocols [29].…”
Section: Methodsmentioning
confidence: 99%
“…Both GTV and CTV are uniformly expanded by 3 mm to obtain the planning target volumes PTV GTV and PTV CTV , respectively, thereby excluding the first 5 mm beneath the skin [29, 30]. Organs at risk (OARs), such as skin, ipsilateral and contralateral breast, lungs, heart and chest wall are delineated according to predefined protocols [29]. Figure 2 illustrates the delineations of the target volumes and OARs.Fig.…”
Section: Methodsmentioning
confidence: 99%
“…2). VMAT plans are optimized for target volume coverage and a dose as low as possible to the OARs, thereby not exceeding the predefined constraints (Additional file 1) [29]. Figure 3 illustrates an example of a single dose ablative APBI treatment plan.Fig.…”
BackgroundA shift towards less burdening and more patient friendly treatments for breast cancer is currently ongoing. In low-risk patients with early-stage disease, accelerated partial breast irradiation (APBI) is an alternative for whole breast irradiation following breast-conserving surgery. MRI-guided single dose ablative APBI has the potential to offer a minimally burdening, non-invasive treatment that could replace current breast-conserving therapy.MethodsThe ABLATIVE study is a prospective, single arm, multicenter study evaluating preoperative, single dose, ablative radiation treatment in patients with early-stage breast cancer. Patients with core biopsy proven non-lobular invasive breast cancer, (estrogen receptor positive, Her2 negative, maximum tumor size 3.0 cm on diagnostic MRI) and a negative sentinel node biopsy are eligible. Radiotherapy (RT) planning will be performed using a contrast enhanced (CE) planning CT-scan, co-registered with a CE-MRI, both in supine RT position. A total of twenty-five consecutive patients will be treated with a single ablative RT dose of 20 Gy to the tumor and 15 Gy to the tumorbed. Follow-up MRIs are scheduled within 1 week, 2, 4 and 6 months after single-dose RT. Breast-conserving surgery is scheduled at six months following RT.Primary study endpoint is pathological complete response. Secondary study endpoints are the radiological response and toxicity. Furthermore, patients will fill out questionnaires on quality of life and functional status. Cosmetic outcome will be evaluated by the treating radiation oncologist, patient and ‘Breast Cancer Conservation Treatment cosmetic results’ software. Recurrence and survival rates will be assessed. The patients will be followed up to 10 years after diagnosis. If patients give additional informed consent, a biopsy and a part of the irradiated specimen will be stored at the local Biobank and used for future research on radiotherapy response associated genotyping.DiscussionThe ABLATIVE study evaluates MRI-guided single dose ablative RT in patients with early-stage breast cancer, aiming at a less burdening and non-invasive alternative for current breast-conserving treatment.Trial registrationClinicalTrials.gov registration number NCT02316561. The trial was registrated prospectively on October 10th 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3144-5) contains supplementary material, which is available to authorized users.
“…Hypofractionated partial breast irradiation (HPBI) has been proposed as an ablative procedure to replace surgical resection1, 2 and also for the preoperative/postoperative adjuvant settings 3, 4. As an ablative procedure, HPBI has been proposed to reduce the treatment burden for those patients who cannot tolerate surgery.…”
PurposeHypofractionated partial breast irradiation (HPBI) involves treatment to the breast tumor using high doses per fraction. Recent advances in MRI‐Linac solutions have potential in being applied to HPBI due to gains in the soft tissue contrast of MRI; however, there are potentially deleterious effects of the magnetic field on the dose distribution. The purpose of this work is to determine the effects of the magnetic field on the dose distribution for HPBI tumors using a tangential beam arrangement (TAN), 5‐beam intensity‐modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT).MethodsFive patients who have received HPBI were selected with two patients having bilateral disease resulting in a total of two tumors in this study. Six planning configurations were created using a treatment planning system capable of modeling magnetic field dose effects: TAN, IMRT and VMAT beam geometries, each of these optimized with and without a transverse magnetic field of 1.5 T.ResultsThe heart and lung doses were not statistically significant when comparing plan configurations. The magnetic field had a demonstrated effect on skin dose: for VMAT plans, the skin (defined to a depth of 3 mm) D1cc was elevated by +11% and the V30 by +146%; for IMRT plans, the skin D1cc was increased by +18% and the V30 by +149%. Increasing the number of beam angles (e.g., going from IMRT to VMAT) with the magnetic field on reduced the skin dose.ConclusionThe impact of a magnetic field on HPBI dose distributions was analyzed. The heart and lung doses had clinically negligible effects caused by the magnetic field. The magnetic field increases the skin dose; however, this can be mitigated by increasing the number of beam angles.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
