Stereotactic partial breast irradiation in primary breast cancer: A comprehensive review of the current status and future directions

Takanen, Silvia; Pinnarò, Paola; Farina, Ilaria; Sperati, Francesca; Botti, Claudio; Vici, Patrizia; Soriani, A.; Marucci, Laura; Sanguineti, Giuseppe

doi:10.3389/fonc.2022.953810

Cited by 5 publications

(2 citation statements)

References 56 publications

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“…TONIC trial demonstrated that SBRT (24Gy/3f) combined with nivolumab can increase the proportion of patients free of progression at 24 weeks than nivolumab alone (17% vs 8%) (Voorwerk et al, 2019). Another small sample research has indicated that preoperative with neoadjuvant chemotherapy may result in fair pCR rates of 36%, with the maximum response (pCR 67%) was obtained at a dose of 25.5Gy/3f (Bondiau et al, 2013), as well as no increase in the incidences of early or late-term adverse events (AEs) (Piras et al, 2023;Takanen et al, 2022). Together, these studies suggested SBRT may have strong immunomodulatory effects, rendering a synergistic antitumor effect with immunotherapy and chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of neoadjuvant stereotactic body radiotherapy plus adebrelimab and chemotherapy for triple-negative breast cancer: A pilot study

Chen,

Gu,

Zhang

et al. 2023

Preprint

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Background:Emerging data have supported the immunostimulatory role of radiotherapy, which could exert a synergistic effect with immune checkpoint inhibitors (ICIs). With proven effective but suboptimal efficacy of ICI and chemotherapy in triple-negative breast cancer (TNBC), we designed a pilot study to explore the efficacy and safety of neoadjuvant stereotactic body radiotherapy (SBRT) plus adebrelimab and chemotherapy in TNBC patients.Methods:Treatment-naïve TNBC patients received two cycles of intravenous adebrelimab (20mg/kg, every 3 weeks), and SBRT (24Gy/3f, every other day) started at the second cycle, then followed by six cycles of adebrelimab plus nab-paclitaxel (125 mg/m² on days 1 and 8) and carboplatin (area under the curve 6 mg/mL per min on day 1) every 3 weeks. The surgery was performed within 3-5 weeks after the end of neoadjuvant therapy. Primary endpoint was pathological complete response (pCR, ypT0/is ypN0). Secondary endpoints included objective response rate (ORR), residual cancer burden (RCB) 0-I and safety.Results:13 patients were enrolled and received at least one dose of therapy. 10 (76.9%) patients completed SBRT and were included in efficacy analysis. 90% (9/10) of patients achieved pCR, both RCB 0-I and ORR reached 100% with 3 patients achieved complete remission. Adverse events (AEs) of all?grade and grade 3-4 occurred in 92.3% and 53.8%, respectively. 1 (7.7%) patient had treatment-related serious AEs. No radiation-related dermatitis or death occurred.Conclusions:Adding SBRT to adebrelimab and neoadjuvant chemotherapy led to a substantial proportion of pCR with acceptable toxicities, supporting further exploration of this combination in TNBC patients.Funding:This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Clinical trial number:NCT05132790.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of neoadjuvant stereotactic body radiotherapy plus adebrelimab and chemotherapy for triple-negative breast cancer: A pilot study

Chen,

Gu,

Zhang

et al. 2023

Preprint

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“…Partial breast irradiation after breast conserving surgery is an integral part of breast-conserving therapy for treatment of early-stage breast cancer (Njeh et al 2010). Several clinical trials have investigated the stereotactic partial breast irradiation (S-PBI) (Takanen et al 2022). In the S-PBI, accurate delineation of post-surgical clinical target volume (CTV) is a critical step for personalized and efficient treatment planning and delivery.…”

Section: Introductionmentioning

confidence: 99%

A deep learning approach for automatic delineation of clinical target volume in stereotactic partial breast irradiation (S-PBI)

et al. 2023

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Accurate and efficient delineation of the clinical target volume (CTV) is of utmost significance in post-operative breast cancer radiotherapy. However, CTV delineation is challenging as the exact extent of microscopic disease encompassed by CTV is not visualizable in radiological images and remains uncertain. We proposed to mimic physicians’ contouring practice for CTV segmentation in Stereotactic Partial Breast Irradiation (S-PBI) where CTV is derived from tumor bed volume (TBV) via a margin expansion followed by correcting the extensions for anatomical barriers of tumor invasion (e.g., skin, chest wall). We proposed a deep-learning model, where CT images and the corresponding TBV masks formed a multi-channel input for a 3D U-Net based architecture. The design guided the model to encode the location-related image features and directed the network to focus on TBV to initiate CTV segmentation. Gradient weighted Class Activation Map (Grad-CAM) visualizations of the model predictions revealed that the extension rules and geometric/anatomical boundaries were learnt during model training to assist the network to limit the expansion to a certain distance from the chest wall and the skin. We retrospectively collected 175 prone CT images from 35 post-operative breast cancer patients who received 5-fraction partial breast irradiation (PBI) regimen on GammaPod. The 35 patients were randomly split into training (25), validation (5) and test (5) sets. Our model achieved mean (standard deviation) of 0.94 (0.02), 2.46 (0.5) mm, and 0.53 (0.14) mm for Dice similarity coefficient, 95th percentile Hausdorff distance, and average symmetric surface distance respectively on the test set. The results are promising for improving the efficiency and accuracy of CTV delineation process during on-line treatment planning procedure.

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Utility of Stereotactic Body Radiation Therapy in Establishing Local Control for Patients With Invasive Breast Cancer Not Undergoing Definitive Surgery

Zabrocka,

Polce,

Roberson

et al. 2024

International Journal of Radiation Oncology*Biology*Physics

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Stereotactic partial breast irradiation in primary breast cancer: A comprehensive review of the current status and future directions

Cited by 5 publications

References 56 publications

Efficacy and Safety of neoadjuvant stereotactic body radiotherapy plus adebrelimab and chemotherapy for triple-negative breast cancer: A pilot study

Efficacy and Safety of neoadjuvant stereotactic body radiotherapy plus adebrelimab and chemotherapy for triple-negative breast cancer: A pilot study

A deep learning approach for automatic delineation of clinical target volume in stereotactic partial breast irradiation (S-PBI)

Utility of Stereotactic Body Radiation Therapy in Establishing Local Control for Patients With Invasive Breast Cancer Not Undergoing Definitive Surgery

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