OC-0568: Accelerated PBI VS standard radiotherapy (IRMA trial): interim cosmetic and toxicity results

Meduri, Bruno; Baldissera, A.; Galeandro, M.; Donini, E.; Tolento, G.; Giacobazzi, Pierluigi; Calmieri, T.; Vasilyeva, Polina; Morganti, Alessio Giuseppe; Parisi, Salvatore; Kaleci, Shaniko; Lohr, Frank; D'Amico, Raffaello; Poortmans, P.; Bertoni, Francesco; Frezza, G.P.

doi:10.1016/s0167-8140(17)31008-3

Cited by 18 publications

(9 citation statements)

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“…Recently, three randomized trials of external beam APBI have been reported ( 12 , 13 , 18 ). The RAPID trial, which randomly assigned 2,135 patients to receive either external beam APBI (38.5 Gy in 10 fractions twice daily) or whole-breast irradiation, reported more late toxicities in the APBI than whole-breast irradiation group (grade ≥2 late toxicities: 32% vs. 13%) ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…In the IRMA trial, 3,309 patients were randomly assigned to the APBI (38.5 Gy in 10 fractions twice daily) or whole-breast irradiation group. The interim results showed increased rates of late subcutaneous tissue and bone toxicities in the APBI than whole-breast irradiation group (grade 2–4 subcutaneous tissue toxicities: 44% vs. 29%; grade 3–4 bone toxicities: 1% vs. 0%) ( 18 ). The NSABP B-39/RTOG 0413 trial randomly assigned 4,216 patients to either an APBI twice-per-day regimen or whole-breast irradiation.…”

Section: Discussionmentioning

confidence: 99%

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The Acute and Late Toxicities of MRI-Guided External Beam Partial Breast Irradiation Delivered Using a Once-Per-Day Regimen

Lee

Kim

et al. 2021

Front. Oncol.

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Background and PurposeThe use of external beam accelerated partial breast irradiation (APBI) using a twice-per-day regimen has raised concerns about increase rates of late toxicities. We compared toxicity outcomes of external beam APBI using a once-per-day regimen and accelerated hypofractionated whole breast irradiation (AWBI) in patients with early-stage breast cancer.Materials and MethodsThis was a single-institution, retrospective cohort study. Patients aged ≥50 years with pTisN0 or pT1N0 breast cancer who underwent breast-conserving surgery and adjuvant radiotherapy were included. APBI was delivered at 38.5 Gy in 10 fractions once daily using magnetic resonance imaging (MRI)-guided radiotherapy only to patients who were strictly “suitable”, according to the ASTRO-APBI guidelines. AWBI was delivered at 40.5–43.2 Gy in 15 or 16 fractions with or without a boost.ResultsBetween October 2015 and December 2018, 173 and 300 patients underwent APBI and AWBI, respectively. At a median follow-up of 34.9 months (range 7.1 to 55.4 months), the 3-year recurrence-free survival rates of the APBI and AWBI groups were both 99.2% (p=0.63). Acute toxicities were less frequent in the APBI than AWBI group (grade 1: 95 [54.9%] vs. 233 [77.7%] patients; grade 2: 7 [4.0%] vs. 44 [14.7%] patients; no grade ≥3 toxicities were observed in either group, p<0.001). Late toxicities were less common in the APBI than AWBI group (grade 1: 112 [64.7%] vs. 197 [65.7%] patients; grade 2: 9 [5.2%] vs. 64 [21.3%] patients; grade 3: 0 vs. 5 [1.7%] patients, p<0.001). Multivariate analysis showed that APBI was significantly associated with fewer late toxicities of grade ≥2 compared with AWBI (odds ratio 4.17, p=0.006).ConclusionOnce-per-day APBI afforded excellent locoregional control and fewer toxicities compared with AWBI. This scheme could be an attractive alternative to AWBI in patients who meet the ASTRO-APBI guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Acute and Late Toxicities of MRI-Guided External Beam Partial Breast Irradiation Delivered Using a Once-Per-Day Regimen

Lee

Kim

et al. 2021

Front. Oncol.

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“…Treatment is often given twice daily for 4-5 days although some studies suggest increase toxicity when EBRT is given in this manner. Reducing treatment volume using more conformal EBRT approaches may reduce toxicity and on-going trials are evaluating this approach [41]. Alternatively, investigators are also evaluating the delivery of RT once daily.…”

Section: Future Directionsmentioning

confidence: 99%

Accelerated Partial Breast Irradiation (APBI): Where Are We Now?

Goldberg

Whelan

2020

Curr Breast Cancer Rep

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Purpose of Review Accelerated partial breast irradiation (APBI) is an alternative approach to breast conserving therapy (BCT) where radiation (RT) is delivered over a shorter period of time compared with whole breast irradiation (WBI), resulting in improved patient convenience and cost savings. APBI can be delivered using brachytherapy, intraoperative RT, or conformal external beam radiation therapy (EBRT) techniques. In this review, the authors appraise the latest modern randomized controlled trials (RCTs) of APBI and discuss the application of the data to clinical practice. Recent Findings The OCOG-RAPID and NSABP B-39/RTOG 0413 trials recently reported long-term outcomes of APBI. The OCOG-RAPID trial delivered 38.5 Gy/10 fractions twice daily (at least 6 h apart using EBRT) or WBI and demonstrated noninferiority of APBI compared with WBI (8-year cumulative rate of ipsilateral breast tumor recurrence (IBTR) was 3% after APBI or 2.8% after WBI, HR 1.27, 90%CI: 0.84-1.91). While acute toxicity was reduced, late toxicity and breast cosmesis were worse with APBI. The NSABP B-39 trial included higher risk patients and was unable to demonstrate equivalence between APBI (38.5 Gy/10 fractions delivered twice daily using EBRT or brachytherapy techniques) and WBI. However, 10-year IBTR rates were low: 4.6% vs. 3.9%, respectively, HR 1.22, 90%CI: 0.94-1.58. The University of Florence demonstrated low rates of local recurrence at 10 years and overall excellent breast cosmetic outcomes when APBI was delivered using EBRT to a dose of 30 Gy/ 5 fractions delivered on non-consecutive days. Summary Recent RCTs of APBI have shed light on important factors for the integration of APBI into clinical practice, including patient selection and treatment delivery. APBI should be limited to patients with low-risk ductal carcinoma in situ or early stage (T1) invasive ductal cancer with clear margins of excision, estrogen receptor positivity, and node negative disease. Ongoing research should focus on the optimal dose/fractionation for delivery of EBRT-based APBI.

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“…Partial breast irradiation demonstrated lower rates of changes in breast appearance and firmness when compared to the control group. Lastly, the awaited NSABP B39/RTOG 0413 trial published early results in their EBRT APBI arm that showed low rates of grade 2 or greater toxicity of 15% (38).…”

Section: External Beam-based Apbimentioning

confidence: 99%

“…et al reported the IRMA study in abstract form with 3-year Select external beam APBI studies physician and patient reports of unacceptable cosmesis at rates of 20% and 14% respectively with 60-month median follow-up(38). Again, there was no statistical difference in toxicity.…”

mentioning

confidence: 99%

Accelerated partial breast radiotherapy: a review of the literature and future directions

Bennion¹,

Baine²,

Granatowicz³

et al. 2018

Gland Surg

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Breast conservation therapy exemplifies the tailoring of medicine in the care of patients with cancer. Akin to improvements in surgical approaches, accelerated partial breast irradiation (APBI) tailors the treatment volume and duration to the needs of well selected patients. Here, we examine the evidence supporting APBI as well as the lessons in patient selection, dose and delivery techniques. Examination of historical techniques and their associated outcomes will support more correct patient selection and treatment delivery in an era where we await the reports of several large prospective trials.

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OC-0568: Accelerated PBI VS standard radiotherapy (IRMA trial): interim cosmetic and toxicity results

Cited by 18 publications

References 0 publications

The Acute and Late Toxicities of MRI-Guided External Beam Partial Breast Irradiation Delivered Using a Once-Per-Day Regimen

The Acute and Late Toxicities of MRI-Guided External Beam Partial Breast Irradiation Delivered Using a Once-Per-Day Regimen

Accelerated Partial Breast Irradiation (APBI): Where Are We Now?

Accelerated partial breast radiotherapy: a review of the literature and future directions

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