Risk of Radiation Pneumonitis Following Individualized Modern Radiation Therapy with IMRT, a Breath-Holding Technique and Prone Positioning for Breast Cancer

Lee, B.M.; Chang, Jee Suk; Keum, Ki Chang; Suh, Chang Ok; Kim, Y.B.

doi:10.1016/j.ijrobp.2018.06.089

Cited by 2 publications

(2 citation statements)

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“…As expected, the risk of RP increased significantly when lymph node irradiation was indicated, expressed as symptomatic RP incidences increased by a factor of 1.6 (PCN inclusion) and 2.6 (PCN + IMN inclusion). Due to the applied moderately higher dose concepts used during the study, the observed overall RP incidence was higher than reported for comparable patient cohorts, especially as IMRT/VMAT is commonly performed nowadays [38][39][40][41][42]. However, in our cohort, all 40 patients with diagnosed RP ≤ grade II exhibited moderate symptoms, and all of them recovered completely within a median time of 9 months (range 1 to 24 months).…”

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confidence: 54%

Systematic risk analysis of radiation pneumonitis in breast cancer: role of cotreatment with chemo-, endocrine, and targeted therapy

et al. 2022

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Purpose A major complication of sequential and concomitant chemoradiation in breast cancer treatment is interstitial pneumonitis induced by radiation therapy (RT), systemic therapy, or a combination of both. Dose and volume of co-irradiated lung tissue directly correlate with the risk of radiation pneumonitis. Especially in case of combined treatment, it is often unclear which of the used therapeutic agents promote pneumonitis. Methods This was a prospective monocentric study including 396 breast cancer patients. A systematic analysis of single and combined therapeutic measures was performed in order to identify treatment-related factors enhancing the risk of pneumonitis post RT. Results Overall incidence of pneumonitis of any grade was 38%; 28% were asymptomatic (grade 1) and 10% were symptomatic (> grade 1). Pneumonitis > grade 2 did not occur. Beside age, smoking status, and mean lung dose, the combined treatment with goserelin and tamoxifen significantly enhanced the risk of pneumonitis in a supra-additive pattern (odds ratio [OR] 4.38), whereas each agent alone or combined with other drugs only nonsignificantly contributed to a higher pneumonitis incidence post RT (OR 1.52 and OR 1.16, respectively). None of the other systemic treatments, including taxanes, increased radiation pneumonitis risk in sequential chemoradiation. Conclusion Common treatment schedules in sequential chemoradiation following breast-conserving surgery only moderately increase lung toxicity, mainly as an asymptomatic complication, or to a minor extent, as transient pneumonitis ≤ grade 2. However, combined treatment with tamoxifen and the LHRH analog goserelin significantly increased the risk of pneumonitis in breast cancer patients after chemoradiation. Thus, closer surveillance of involved patients is advisable.

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confidence: 54%

Systematic risk analysis of radiation pneumonitis in breast cancer: role of cotreatment with chemo-, endocrine, and targeted therapy

et al. 2022

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“…Adequate target coverage was achieved when the prescribed dose covered 95% of the PTV. A dose gradient was also assessed, and the treatment plans should meet the number of organs at risk dose-volume constraints [24][25][26][27] based on published studies (Supplementary Table 1). The treatment was delivered by the linear accelerator Varian TrueBeam STX v.…”

Section: Treatmentmentioning

confidence: 99%

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

Burkon,

Selingerova,

Slavik

et al. 2024

Radiat Oncol

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Background Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. Methods Early breast cancer patients after partial mastectomy were equally randomized into two arms– external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. Results The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21–45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. Conclusion External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. Trial registration NCT06007118.

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Risk of Radiation Pneumonitis Following Individualized Modern Radiation Therapy with IMRT, a Breath-Holding Technique and Prone Positioning for Breast Cancer

Cited by 2 publications

References 0 publications

Systematic risk analysis of radiation pneumonitis in breast cancer: role of cotreatment with chemo-, endocrine, and targeted therapy

Systematic risk analysis of radiation pneumonitis in breast cancer: role of cotreatment with chemo-, endocrine, and targeted therapy

Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study

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