The Assisi Think Tank Meeting and Survey of post MAstectomy Radiation Therapy after breast reconstruction: The ATTM-SMART report

Aristei, Cynthia; Kaidar‐Person, Orit; Tagliaferri, Luca; Arenas, Meritxell; Coles, Charlotte E.; Offersen, Birgitte Vrou; Frezza, G.; Leonardi, Maria Cristina; Valentini, Vincenzo; Bourgier, C.; Poortmans, Philip

doi:10.1016/j.ejso.2018.01.010

Cited by 20 publications

(10 citation statements)

References 46 publications

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“…Younger age [27][28][29][30], breast laterality [28,30], breast volume [30], radiation plan (in)homogeneity [27], receipt of adjuvant chemotherapy [27,28,30], BC stage [27] and triple-negative biology [28] were all reported to lead to lower HF-WBI utilisation. The use of HFRT schedules is likewise not universally adopted in patients with BC who require PMRT or RNI due to concerns regarding acute and late toxicities, especially with respect to lymphedema, shoulder symptoms and peripheral neuropathy [29,31]. In our study, we have identified factors limiting HF-WBI utilisation in the routine clinical practice that !20% of 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% the responding ROs addressed: breast size, the impact of higher dose per fraction on the dose to OARs and treatment plan inhomogeneity.…”

Section: Discussionmentioning

confidence: 97%

Hypofractionated radiation therapy for breast cancer: Preferences amongst radiation oncologists in Europe – Results from an international survey

Ratoša

Chirilă

Steinacher

et al. 2021

Radiotherapy and Oncology

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Background and purpose: We aimed to assess the prescription preference about hypofractionated radiation therapy (HFRT) for breast cancer (BC) patients amongst radiation oncologists (ROs) practicing in Europe and to identify restraints on HFRT utilisation. Materials and methods: An online survey was circulated amongst ROs in Europe through personal, RO and BC societies' networks, from October 2019 to March 2020. The statistical analyses included descriptive statistics, chi-squared testing, and logistic regression analysis. Results: We received 412 responses from 44 countries. HFRT was chosen as the preferred schedule for whole breast irradiation (WBI) by 54.7% and for WBI with regional nodes irradiation (RNI) by 28.7% of the responding ROs. In the case of postmastectomy RT with or without reconstruction, HFRT was preferred by 21.1% and 29.6%, respectively. Overall, 69.2% of the responding ROs selected at least one factor influencing the decision to utilise HFRT, the most frequent of which included age (51.4%), RNI (46.9%), internal mammary lymph nodes irradiation (39.7%), BC stage (33.5%) and implant-based breast reconstruction (31.6%). ROs working in academic centres (odds ratio, (OR), 1.7; 95% confidence interval, (CI); 1.1-2.6, p = 0.019), practicing in Western Europe (OR, 4.2; 95%CI; 2.7-6.6, p < 0.0005) and/or dedicating >50% of clinical time to BC patients (OR, 2.5; 95%CI; 1.5-4.2, p = 0.001) more likely preferred HFRT. Conclusion: Although HFRT is recognised as a new standard, its implementation in routine RT clinical practice across Europe varies for numerous reasons. Better dissemination of evidence-based recommendations is advised to improve the level of awareness about this clinical indication.

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Section: Discussionmentioning

confidence: 97%

Hypofractionated radiation therapy for breast cancer: Preferences amongst radiation oncologists in Europe – Results from an international survey

Ratoša

Chirilă

Steinacher

et al. 2021

Radiotherapy and Oncology

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“…Unfortunately, only a limited number of studies have focused on the role of geriatric assessment in treatment decisions for older early breast cancer patients [46]. It is well known that elderly women are undertreated with breastconserving surgery (BCS) in favor of mastectomy [47,48].…”

Section: Discussionmentioning

confidence: 99%

Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion

Tagliaferri

Lancellotta

Colloca

et al. 2020

Journal of Oncology

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Introduction. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. Material and Method. A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results. Seven papers fulfilled the eligibility criteria. The number of evaluated patients was 405 and the median age was 77.7 years. The disease-free survival (DFS) range was 96.1%–100%, the grade 3-4 toxicity range was 0%–6.6%, the cancer-specific survival (CSS) range was 97.9%–100%, and the overall survival (OS) range was 87%–100%. All studies reported excellent/good cosmetic results in a range of 74% to 99%. Conclusion. Accelerated partial breast irradiation (APBI) results in a safe and effective substitute for the adjuvant external beam radiotherapy in selected elderly early-stage breast cancer patients. Based on the relatively low toxicity, APBI should be advised in selected patients with life expectancies larger than 5–10 years.

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“…The main indication for the use of bolus after IB-IBR is skin involvement. As long as patients with skin involvement were not offered skin-sparing mastectomy, most of the European radiation oncologists did not use bolus [7], however nowadays the need for using bolus increases and up to two-thirds of radiation oncologists declare that they do not use bolus "unless the skin is involved" [10]. This may impact the aesthetic outcomes of IB-IBR, as the use of bolus was recognized as the only "technical" radiotherapy factor negatively influencing cosmetic results [27].…”

Section: Boost Dose and The Use Of Bolusmentioning

confidence: 99%

“…The implant-based IBR (IB-IBR) is usually preferable in the majority of patients with breast cancer facing PMRT due to its preservation of autologous tissue for salvage and often acceptable outcomes, whereas most guidelines do not routinely recommend autologous reconstruction in patients who will definitely need PMRT [8,9]. In current practice, reconstruction with tissue expander (TE) followed by PMRT and subsequent permanent reconstruction with prosthesis is prevalent [10].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiation therapy after immediate implant-based breast reconstruction

Socha

2020

Nowotwory. Journal of Oncology

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The role of radiotherapy in the postmastectomy setting with substantial lymph node burden or locally advanced disease has been well described. In the last decade, the indications for postmastectomy radiotherapy (PMRT) have expanded in light of a measurable disease-free survival benefit, even in T1-2N1-patient subgroup. Concurrently, immediate breast reconstruction (IBR) rates after mastectomy are rapidly increasing. Optimal integration of IBR and PMRT is challenging, as PMRT has a known deleterious effect on reconstruction outcomes and IBR has been reported to pose challenges to PMRT delivery. Implant-based reconstruction is the most common type of IBR performed nowadays. This article reviews the current problems regarding integration of the implant-based IBR with optimum radiation delivery and discusses the advantages and disadvantages of each reconstruction method with PMRT.

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The Assisi Think Tank Meeting and Survey of post MAstectomy Radiation Therapy after breast reconstruction: The ATTM-SMART report

Cited by 20 publications

References 46 publications

Hypofractionated radiation therapy for breast cancer: Preferences amongst radiation oncologists in Europe – Results from an international survey

Hypofractionated radiation therapy for breast cancer: Preferences amongst radiation oncologists in Europe – Results from an international survey

Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion

Adjuvant radiation therapy after immediate implant-based breast reconstruction

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