Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

Rahimi, Asal; Thomas, Kris G.; Spangler, Ann; Rao, Roshni; Leitch, Marilyn; Wooldridge, Rachel; Rivers, Aeisha; Seiler, Stephen; Albuquerque, Kevin; Stevenson, Stella; Goudreau, Sally; Garwood, Dan; Haley, Barbara; Euhus, David M.; Heinzerling, J.H.; Ding, Chuxiong; Gao, Ang; Ahn, Chul; Timmerman, Robert

doi:10.1016/j.ijrobp.2017.01.020

Cited by 57 publications

(67 citation statements)

References 37 publications

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“…Dose constraints used in this report ( Table 2 ) were based on TG 101 and the recently reported phase 1 dose escalation trial for early stage breast cancer using 5-fraction (maximum dose of 40 Gy) stereotactic body radiation therapy for partial-breast radiation. 14 , 17 This phase 1 dose escalation trial reported excellent clinical outcomes, minimal toxicity, and good cosmesis using these OAR dose constraints. 14 An additional chest wall dose constraint was applied on the basis of Memorial Sloan Kettering data evaluating the risk of chest wall toxicity in patients treated with 5-fraction stereotactic body radiation therapy for early stage non-small cell lung cancer.…”

Section: Methodsmentioning

confidence: 91%

“… 14 , 17 This phase 1 dose escalation trial reported excellent clinical outcomes, minimal toxicity, and good cosmesis using these OAR dose constraints. 14 An additional chest wall dose constraint was applied on the basis of Memorial Sloan Kettering data evaluating the risk of chest wall toxicity in patients treated with 5-fraction stereotactic body radiation therapy for early stage non-small cell lung cancer. 18 …”

Section: Methodsmentioning

confidence: 91%

“…in which 75 patients underwent partial mastectomy followed by stereotactic partial breast irradiation, up to 40 Gy in 5 fractions, reported physician-evaluated cosmetic outcomes as excellent or good in >95% of patients at all evaluated time points (up to 24 months). 14 Additional research is required to determine whether small-volume breast radiation in tumors that are adjacent to the skin and chest wall and treated with ablative radiation doses also lead to acceptable cosmetic outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The prescription dose was chosen for its ablative potential in other cancer sites including non-small cell lung cancer as well as the higher BED relative to a previously reported 5-fraction schedule used in the adjuvant breast cancer setting. 14 , 15 In addition, prior clinical research on definitive radiation treatment for breast cancer identified that an EQD2 of 75 Gy is required to achieve clinical outcomes similar to those of surgery plus adjuvant radiation. 16 …”

Section: Methodsmentioning

confidence: 99%

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Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

Lischalk

Chen

Repka

et al. 2018

Advances in Radiation Oncology

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PurposeFew definitive treatment options exist for elderly patients diagnosed with early stage breast cancer who are medically inoperable or refuse surgery. Historical data suggest very poor local control with hormone therapy alone. We examined the dosimetric feasibility of hypofractionated radiation therapy using stereotactic ablative radiotherapy (SABR) and proton beam therapy (PBT) as a means of definitive treatment for early stage breast cancer.Methods and MaterialsFifteen patients with biopsy-proven early stage breast cancer with a clinically visible tumor on preoperative computed tomography scans were identified. Gross tumor volumes were contoured and correlated with known biopsy-proven malignancy on prior imaging. Treatment margins were created on the basis of set-up uncertainty and image guidance capabilities of the three radiation modalities analyzed (3-dimensional conformal radiation therapy [3D-CRT], SABR, and PBT) to deliver a total dose of 50 Gy in 5 fractions. Dose volume histograms were analyzed and compared between treatment techniques.ResultsThe median planning target volume (PTV) for SABR, PBT, and 3-dimensional CRT was 11.91, 21.03, and 45.08 cm3, respectively, and were significantly different (P < .0001) between treatment modalities. Overall target coverage of gross tumor and clinical target volumes was excellent with all three modalities. Both SABR and PBT demonstrated significant dosimetric improvements, each in its own unique manner, relative to 3D-CRT. Dose constraints to normal structures including ipsilateral/contralateral breast, bilateral lungs, and heart were all consistently achieved using SABR and PBT. However, skin or chest wall dose constraints were exceeded in some cases for both SABR and PBT plans and was dictated by the anatomic location of the tumor.ConclusionsDefinitive hypofractionated radiation therapy using SABR and PBT appears to be dosimetrically feasible for the treatment of early stage breast cancer. The anatomical location of the tumor relative to the skin and chest wall appears to be the primary limiting dosimetric factor.

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Section: Methodsmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

Lischalk

Chen

Repka

et al. 2018

Advances in Radiation Oncology

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“…To our knowledge, this is the first study summarizing the practice and technological considerations of GYN SABR among experts that practice and have published on this technique [8,[10][11][12][13][14][15][16][17][18][19][20][21]. It is not intended to serve as a consensus guideline.…”

Section: Discussionmentioning

confidence: 99%

Survey of current practices from an international task force for gynecological stereotactic ablative radiotherapy

et al. 2020

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Background: Stereotactic Ablative Radiotherapy (SABR) is an effective treatment that improves local control for many tumours. However, the role of SABR in gynecological cancers (GYN) has not been well-established. We hypothesize that there exists considerable variation in GYN-SABR practice and technique. The goal of this study is to describe clinical and technical factors in utilization of GYN-SABR among 11 experienced radiation oncologists. Materials and methods:A 63 question survey on GYN-SABR was sent to 11 radiation oncologists (5 countries) who have published original research, conducted trials or have an established program at their institutions. Responses were combined and analyzed at a central institution.Results: Most respondents indicated that salvage therapy (non-irradiated or re-irradiated field) for nodal (81%) and primary recurrent disease (91%) could be considered standard options for SABR in the setting of inability to administer brachytherapy. All other indications should be considered on clinical trials. Most would not offer SABR as a boost in primary treatment off-trial without absolute contraindications to brachytherapy. Multi-modality imaging is often (91%) used for planning including PET, CT contrast and MRI. There is a wide variation for OAR tolerances however small bowel is considered the dose-limiting structure for most experts (91%). Fractionation schedules range from 3 to 6 fractions for nodal/primary definitive and boost SABR. Conclusions: Although SABR has become increasingly standard in other oncology disease sites, there remains a wide variation in both clinical and technical factors when treating GYN cancers. Nodal and recurrent disease is considered a potential indication for SABR whereas other indications should be offered on clinical trials. This study summarizes SABR practices among GYN radiation oncologists while further studies are needed to establish consensus guidelines for GYN-SABR treatment.

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On the feasibility of improved target coverage without compromising organs at risk using online adaptive stereotactic partial breast irradiation (A‐SPBI)

Montalvo

Kim

Nwachukwu

et al. 2022

J Applied Clin Med Phys

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Purpose Describe an early‐adopting institution's experience with online adaptive radiation for stereotactic partial breast irradiation. Methods and materials Retrospective review of 22 women treated between May 2021 and March 2022 with adaptive stereotactic partial breast irradiation. A total of 106 of 110 fractions were evaluated for dosimetric changes in target coverage and organ‐at‐risk (OAR) dose. Patient set up with stereotactic wooden frame and adapted per fraction. Treatment and planning times were collected prospectively by radiation therapists. Results Scheduled PTV 30 Gy was <95% in 72.1% and <90% in 38.5% of fractions, and both PTV and CTV coverage were improved significantly after adaption, and 83.7% of fractions were delivered as adapted per physician choice. There was no difference in OAR coverage. Average adaptive treatment planning took 15 min and average time‐on‐couch was 34.4 min. Conclusions Adaptive stereotactic breast irradiation resulted in improved target coverage with equivalent dosing to OARs in an efficient and tolerated treatment time. Improved target coverage allowed for decreased PTV margins compared to prior trial protocols that may improve acute and late toxicities.

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Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

Cited by 57 publications

References 37 publications

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

Survey of current practices from an international task force for gynecological stereotactic ablative radiotherapy

On the feasibility of improved target coverage without compromising organs at risk using online adaptive stereotactic partial breast irradiation (A‐SPBI)

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