Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: Five‐year results of a phase I–II study and initial findings of a randomized phase III trial

Polgár, Csaba; Sulyok, Zoltán; Fodor, János; Orosz, Zsolt; Major, Tibor; Takácsi‐Nagy, Zoltán; Mangel, László; Somogyi, A.; Kásler, Miklós; Németh, György

doi:10.1002/jso.10110

Cited by 225 publications

(93 citation statements)

References 29 publications

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“…Even when comparing relatively similar brachy-therapy techniques for delivering APBI, there remains uncertainty regarding the appropriate dosimetric criteria needed to minimize the risk of toxicities such as fat necrosis. In the initial clinical experiences with interstitial catheter-based brachy-therapy, symptomatic fat necrosis reported range from 2% to 21% of cases [81,82] .The current guidelines in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG 0413 protocol regarding the volume of higher doses of radiation permissible on study are based on earlier dosimetric analyses from Tufts University and Virginia Commonwealth University that correlated larger volumes of high doses of radiation in the breast with the development of fat necrosis [83]. It is difficult to know how to translate these dosimetric constraints from one brachytherapy modality to another, which is important given that balloon and single-entry catheter based brachytherapy catheters yield significantly different dose distributions.…”

Section: Comparison Of Apbi Modalities:-mentioning

confidence: 99%

Accelerated Partial-Breast Irradiation: A State of the Art Strategy.

Hamoud¹,

Ghorbel²,

Falfali³

et al. 2017

IJAR

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Breast conservative surgery, partial breast irradiation, whole breast irradiation, , cosmetic results, Brachytherapy Breast-conserving therapy consists of wide local excision (WLE) followed by whole-breast irradiation (WBI).It is already widely accepted as an alternative to mastectomy. It is used for the treatment of patients with early-stage breast cancer. Accelerated partial-breast irradiation (APBI) is a new strategy. It is characterized by being shorter & an alternative radiation technique for a highly selected patients with favorable early-stage breast cancer. The objective of this review article is to analyze different modalities of APBI delivery and discuss the possible benefits and harms associated with this new platform. …………………………………………………………………………………………………….... Introduction:-Breast cancer has the highest incidence among all cancers in female. In early-stage breast cancer (stage ≤ II), the use of breast-conserving therapy (BCT) is a well-established treatment option. It is comparable to total mastectomy with good results as far as rates of local-regional control and overall survival. It enables patients to maintain their breasts with an acceptable cosmetic results [1]. In the initial trials regarding BCT that were done in the 1970s and 1980s, the new strategy typically involved segmental mastectomy with level I & II axillary lymph node dissection, followed by whole-breast irradiation (WBI). Radiation therapy (RT) is given with a dose of 45-50 Gy over the course of 5 weeks, with or without a boost to the tumor bed. WBI is a relatively well-tolerated treatment. This modality has resulted in good long-term cosmetic results, with low rates of treatment-associated morbidity. The Early Breast Cancer Trialists' Collaborative Group in their meta-analysis has demonstrated that the addition of radiation therapy (RT) to breast-conserving surgery has improved not only local-regional control, but also long-term overall survival [2]. In accelerated partial breast irradiation (APBI) a limited volume of breast tissue is irradiated. This includes tumor bed, lumpectomy or wide local excision with safety margins. It is delivered over a short period of time with increasing the fraction dose. Changing the strategy from whole breast irradiation to a small target (only part of the breast) as in APBI needs full investigation & scrutiny not only because of potential changes in local control but also for its possible impact on the overall survival . Aim of This Review:-Despite of the presence of advanced studies, the role, indication and the optimum APBI technique are still yet to be clearly identified. Therefore, in this review, we will try to find an answer for a number of controversial issues for better identification of the following:

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Section: Comparison Of Apbi Modalities:-mentioning

confidence: 99%

Accelerated Partial-Breast Irradiation: A State of the Art Strategy.

Hamoud¹,

Ghorbel²,

Falfali³

et al. 2017

IJAR

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“…Interstitial implants have been in use for over 10 years and published reports describe excellent results; however, these are mainly single-institution Phase I/II studies [39][40][41][42][43][44][45][46]. The largest matched-pair analysis from the William Beaumont Hospital compared 199 interstitial catheter APBI patients treated between 1980 and 1997 with 199 WBRT patients randomly selected from 709 eligible control subjects [39].…”

Section: Brachytherapymentioning

confidence: 99%

Partial breast irradiation: a review of techniques and indications

Stewart

Khan²,

Devlin³

2010

BJR

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ABSTRACT. The addition of whole-breast external beam radiotherapy (EBRT) to breastconserving surgery results in a significant reduction in the risk of death due to breast cancer, but this may be offset by an increase in deaths from other causes and toxicity to surrounding organs. Because of this, and with a view to patterns of local recurrence, irradiation of the tumour bed has been explored in selected patients with early breast cancer using a variety of radiotherapeutic modalities. This review article explores the treatment options for partial breast irradiation and examines their role within the field of breast cancer treatment.

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“…However, no subset of patients who should forego radiation therapy after BCS has been identified [11][12][13] and local recurrence after BCS with WBI is most likely to occur in the vicinity of the lumpectomy site [14][15][16][17]. Considering the above, the efficacy and feasibility of accelerated partial breast irradiation (APBI) as an alternative to WBI have been evaluated in many Phases II and III studies [18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Sentinel-Node-Driven Personalized Radiation Techniques Ranging from Partial Breast Irradiation to Regional Nodal Radiation after Breast-Conserving Surgery

Sato¹,

Mizuno²,

Fuchikami³

et al. 2013

JCT

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Background: Breast-conserving surgery (BCS) followed by whole breast irradiation (WBI) has become the standard of care for treating patients with early-stage breast cancer. Recently, various radiation techniques followed by BCS have been reported. We have been investigating "personalized radiotherapy after BCS" ranging from accelerated partial breast irradiation (APBI) to WBI with regional nodal irradiation (RNI) based on the axillary node status. In this study, we compared different cohorts that received personalized radiotherapy. Method: Of 317 consecutive patients who underwent BCS followed by radiotherapy since November 2007, 187 who received APBI and 122 who received WBI were analyzed. Results: The local-only recurrence rate was 1.1% in the APBI group and 3.3% in the WBI group, and the regional-only recurrence rate was 1.1% for APBI and 0.8% for WBI. Conclusions: The clinical efficacy of APBI for local control after BCS was comparable to that of WBI ± RNI. Although this study was based on a small number of patients with a short follow-up period, the feasibility of breast-conserving therapy using multicatheter brachytherapy to achieve acceptable clinical outcomes was demonstrated.

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Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: Five‐year results of a phase I–II study and initial findings of a randomized phase III trial

Cited by 225 publications

References 29 publications

Accelerated Partial-Breast Irradiation: A State of the Art Strategy.

Accelerated Partial-Breast Irradiation: A State of the Art Strategy.

Partial breast irradiation: a review of techniques and indications

Sentinel-Node-Driven Personalized Radiation Techniques Ranging from Partial Breast Irradiation to Regional Nodal Radiation after Breast-Conserving Surgery

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