Randomized Trial of Breast Irradiation Schedules After Lumpectomy for Women With Lymph Node-Negative Breast Cancer

Whelan, Timothy J.; MacKenzie, Robert G.; Julian, Jim A.; Levine, Mark; Shelley, Wendy; Grimard, Lával; Lada, Barbara; Lukka, Himu; Perera, Francisco; Fyles, Anthony; Laukkanen, Ethan; Gulavita, Sunil; Benk, V.; Szechtman, Barbara

doi:10.1093/jnci/94.15.1143

Cited by 596 publications

(386 citation statements)

References 39 publications

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“…Treatment plans were available in DICOMRT or RTOG electronic formats with full CT planning for 469 patients (51.2% of 915) from 11 centres, and of these, 390 (83.1% of 469) had a score for change in photographic breast appearance at 2 years available, forming the dataset for analysis in this study. Reasons for the 2-year photographic score being unavailable were breast reconstruction (1), recurrence or second primary (3), died (4), emigrated or moved (3), no baseline photograph (17), patient not seen at 2 years (6), 2-year photograph not taken (3), patient withdrew from photographic study (4) and reason unknown (38).…”

Section: Resultsmentioning

confidence: 99%

“…Radiotherapy and Oncology 104 (2012) 143-147 The routine use of hypofractionation in breast radiotherapy is supported by outcome data of four large randomised clinical trials in women with early breast cancer [1][2][3][4][5][6][7]. Residual concerns include the impact of dose inhomogeneity on the risk of adverse effects after hypofractionated schedules, so-called 'treble trouble' [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Tsang

Haviland

Venables

et al. 2012

Radiotherapy and Oncology

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a b s t r a c tBackground and purpose: Linear quadratic models predict that hypofractionation increases the biological effect of physical dose inhomogeneity. The clinical significance of this effect was tested retrospectively in a trial of adjuvant breast hypofractionation. Methods: The UK FAST trial randomised 915 women after breast conservation surgery between standard fractionation and two dose levels of a 5-fraction regimen delivering 5.7 or 6.0 Gy fractions in 5 weeks, using 3D dosimetry. Logistic regression tested for association between the absolute volumes receiving different isodose level >100% of prescribed dose (hotspots) and the risk of change in 2-year photographic breast appearance. The strength of this association was compared between control and hypofractionated groups. Results: Three hundred and ninety datasets from 11 participating centres were available for analysis. At 2 years post-randomisation, 81 (20.8%) had mild change and 24 (6.2%) had marked change in photographic breast appearance. After adjusting for breast size and surgical deficit, there was no statistically significant association between the risk of 2-year change in breast appearance and dose inhomogeneity in either the control or hypofractionated schedules, according to the various definitions of hotspots analysed. The magnitude of the effect of dosimetry on 2-year change in breast appearance did not vary significantly between control and hypofractionated schedules for any of the dosimetry parameters (p > 0.05 for all heterogeneity tests). Conclusion: Dose inhomogeneity had no greater impact on the risk of 2-year change in photographic breast appearance after hypofractionated breast radiotherapy than after standard fractionation.Ó 2012 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 104 (2012) 143-147The routine use of hypofractionation in breast radiotherapy is supported by outcome data of four large randomised clinical trials in women with early breast cancer [1][2][3][4][5][6][7]. Residual concerns include the impact of dose inhomogeneity on the risk of adverse effects after hypofractionated schedules, so-called 'treble trouble' [8][9][10]. A causal association between breast dose inhomogeneity and the risk of late tissue complications is suggested by the 5 years follow up results of a UK randomised trial (N = 306) comparing 2D versus 3D breast dosimetry [11]. Assuming dose distribution matters, it is not known if residual dose inhomogeneity in patients treated using 3D dose compensation contributes to a higher risk of adverse effects after hypofractionated radiotherapy than after standard regimens. Against this background, a retrospective analysis of a UK hypofractionation trial, which recently published its 2 years follow-up results [12], has been undertaken to test the hypothesis that residual dose inhomogeneity has a greater impact on late adverse effect in women prescribed hypofractionated whole breast radiotherapy, even when delivered in conformity with the International Commission on Radiation Units...

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Tsang

Haviland

Venables

et al. 2012

Radiotherapy and Oncology

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“…The underlying cell and molecular processes that explain these differences are not clear, but a mechanistic understanding is not needed to apply the linear-quadratic model safely and effectively. Over the last 20 years, several randomized trials involving a combined total of >7,000 women compared hypofractionated adjuvant radiotherapy to a standard regimen of 50 Gy in 25 fractions (Tables 1 and 2) (14)(15)(16)(17)(18)(19). UK Royal Marsden Hospital/Gloucestershire Oncology Centre (RMH/GOC) and Standardisation of Breast Radiotherapy Trial A (START A) trials tested two dose levels of a 13-fraction regimen in terms of late adverse effects and tumor control; the study design allowed direct estimates of a/b for each trial (15)(16)(17).…”

Section: What Recent Trials Showmentioning

confidence: 99%

“…UK Royal Marsden Hospital/Gloucestershire Oncology Centre (RMH/GOC) and Standardisation of Breast Radiotherapy Trial A (START A) trials tested two dose levels of a 13-fraction regimen in terms of late adverse effects and tumor control; the study design allowed direct estimates of a/b for each trial (15)(16)(17). Based on a combined total of 278 local-regional tumor relapses in the two trials, the adjusted a/b value for tumor control was 4.6 Gy (95% (14,19). Schedules are expected to be equivalent in terms of late normal tissue and tumor responses assuming an a/b value of 3.0 Gy for each and no influence of treatment time.…”

Section: What Recent Trials Showmentioning

confidence: 99%

Hypofractionated Whole-Breast Radiotherapy for Women With Early Breast Cancer: Myths and Realities

Yarnold

Bentzen

Coles

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

148

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“…At the same evaluation, the circumference of the treated arm was measured (treated arm 15 cm above the lateral epicondyle) and compared with that of the contralateral arm. [28][29][30][31][32][33] …”

Section: Statistical Analysesmentioning

confidence: 99%

Comparison of Mastoscopic and Conventional Axillary Lymph Node Dissection in Breast Cancer: Long-term Results From a Randomized, Multicenter Trial

Luo

Guo

Yang

et al. 2012

Mayo Clinic Proceedings

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Objective: To compare the long-term results of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND). Patients and Methods: From January 1, 2003, through December 31, 2005, a group of 1027 consecutive patients with operable breast cancer were randomly assigned to 1 of 2 study groups: MALND and CALND. The median follow-up was 63 months. The primary end points of the study were operative outcomes, complication reduction, function conservation, and cosmetics. The secondary end points were disease-free and overall survival. Results: The mean operative blood loss in the MALND group was less than in the CALND group (PϽ.001). The patients who underwent MALND had less axillary pain, numbness or paresthesias, and arm swelling (PϽ.001). The aesthetic appearance of the axilla in the MALND group was much better than that in the CALND group (Pϭ.001 at 6 months and Pϭ.002 at 24 months). A significant difference was found between the 2 groups in distant metastasis (Pϭ.04). The disease-free survival rate was 64.5% in the MALND group and 60.8% in the CALND group (Pϭ.88). The overall survival rate was 81.7% in the MALND group and 78.6% in the CALND group (Pϭ.95).

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Randomized Trial of Breast Irradiation Schedules After Lumpectomy for Women With Lymph Node-Negative Breast Cancer

Abstract: The more convenient 22-day fractionation schedule appears to be an acceptable alternative to the 35-day schedule.

Cited by 596 publications

References 39 publications

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Hypofractionated Whole-Breast Radiotherapy for Women With Early Breast Cancer: Myths and Realities

Comparison of Mastoscopic and Conventional Axillary Lymph Node Dissection in Breast Cancer: Long-term Results From a Randomized, Multicenter Trial

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