Very accelerated partial breast irradiation Phase I–II multicenter trial (VAPBI): Feasibility and early results

Guinot, José Luis; González-Pérez, Víctor; Mészáros, Norbert; Major, Tibor; Najjari-Jamal, Dina; Gutiérrez-Miguélez, Cristina; Santos, Miguel; Smanykó, Viktor; Laplana, María; Polgár, Csaba

doi:10.1016/j.brachy.2020.10.010

Cited by 26 publications

(12 citation statements)

References 24 publications

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“…The PD was 25 Gy with a fractionation of 4 x 6.25 Gy, which is an accepted fractionation regime in the GEC-ESTRO VAPBI study. 39 The treatment time of one fraction ranged between 5 and 15 minutes according to the volume of the PTV and the source strength.…”

Section: Methodsmentioning

confidence: 99%

Multicatheter interstitial brachytherapy versus stereotactic radiotherapy with CyberKnife for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk

Herein

Stelczer

Pesznyák

et al. 2021

Radiology and Oncology

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Background The aim of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation (APBI) especially concerning the dose of organs at risk (OAR-s). Patients and methods Treatment plans of thirty-two MIBT and CK patients were compared. The OAR-s included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left-sided cases. The fractionation was identical (4 x 6.25 Gy) in both treatment groups. The relative volumes (e.g. V100, V90) receiving a given relative dose (100%, 90%), and the relative doses (e.g. D0.1cm3, D1cm3) delivered to the most exposed small volumes (0.1 cm3, 1 cm3) were calculated from dose-volume histograms. All dose values were related to the prescribed dose (25 Gy). Results Regarding non-target breast CK performed slightly better than MIBT (V100: 0.7% vs. 1.6%, V50: 10.5% vs. 12.9%). The mean dose of the ipsilateral lung was the same for both techniques (4.9%), but doses irradiated to volume of 1 cm3 were lower with MIBT (36.1% vs. 45.4%). Protection of skin and rib was better with MIBT. There were no significant differences between the dose-volume parameters of the heart, but with MIBT, slightly larger volumes were irradiated by 5% dose (V5: 29.9% vs. 21.2%). Contralateral breast and lung received a somewhat higher dose with MIBT (D1cm3: 2.6% vs. 1.8% and 3.6% vs. 2.5%). Conclusions The target volume can be properly irradiated by both techniques with similar dose distributions and high dose conformity. Regarding the dose to the non-target breast, heart, and contralateral organs the CK was superior, but the nearby organs (skin, ribs, ipsilateral lung) received less dose with MIBT. The observed dosimetric differences were small but significant in a few parameters at the examined patient number. More studies are needed to explore whether these dosimetric findings have clinical significance.

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Section: Methodsmentioning

confidence: 99%

Multicatheter interstitial brachytherapy versus stereotactic radiotherapy with CyberKnife for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk

Herein

Stelczer

Pesznyák

et al. 2021

Radiology and Oncology

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“…Moreover, very accelerated partial breast irradiation (VAPBI) with multi-catheter interstitial brachytherapy was tested by a phase I-II trial endorsed by the GEC-ESTRO Breast Working Group. Indeed four- or three-fraction VAPBI in 2–3 days is a feasible treatment and reports acceptable toxicity profile, improving patients’ compliance and reducing the workload of the brachytherapy units [ 44 ]. Similarly, the single-fraction VAPBI showed excellent oncologic results for elderly with early breast cancer.…”

Section: Existing Data On Pbimentioning

confidence: 99%

Partial Breast Irradiation

Meattini¹,

Franco²,

Salvestrini³

et al. 2023

The Breast

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“…The second remark, which is partly linked to the first, concerns the irradiation technique used to perform uAPBI. According to uAPBI experiences reported in literature, the uAPBI techniques used high-dose rate brachytherapy approaches (in-breast irradiation device) with either multicatheter interstitial brachytherapy [31][32][33][34][35][36][37][38] or balloon-based brachytherapy [39][40][41][42] (Table 3). For example, with a single fraction of 16 Gy delivered by multicatheter brachytherapy in breast cancer ab4, the EQD2 is about 53 Gy, but close to 85 Gy if the hyperdose volumes inside the clinical target volume are considered [43].…”

Section: Ultra Accelerated Partial Breast Irradiation (Uapbi)mentioning

confidence: 99%

Endocrine therapy with accelerated Partial breast irradiatiOn or exclusive ultra-accelerated Partial breast irradiation for women aged ≥ 60 years with Early-stage breast cancer (EPOPE): The rationale for a GEC-ESTRO randomized phase III-controlled trial

Hannoun‐Lévi¹,

Chamorey²,

Boulahssass³

et al. 2021

Clinical and Translational Radiation Oncology

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Breast cancer in the elderly has become a public health concern; there is a need to re-design its treatment with a view to de-escalation. Our paper sets out the rationale for a phase 3 randomized trial to evaluate less burdensome adjuvant procedures that remain effective and efficient. Materials and methods: For low-risk breast cancer in the elderly, adjuvant treatment has been adjusted in order to make it more suitable and efficient. Hypofractionated radiation therapy based on accelerated or non-accelerated regimens as well as accelerated and ultra-accelerated partial breast irradiation (APBI) protocols were reviewed. Withdrawal of radiation (RT) or endocrine therapies (ET) from the adjuvant procedure were also investigated. Based on molecular and APBI classifications, inclusion criteria were discussed. Results: Phase 3 randomized trials which compared standard vs. accelerated/non-accelerated hypofractionated regimens confirmed that the latter were non-inferior in terms of local control. Similarly, except for intraoperative-based techniques, APBI achieved non-inferior local control rates compared to whole breast irradiation for low-risk breast cancer. In phase 2 prospective trials using ultra APBI, encouraging results were observed regarding oncological outcome and toxicity profile. In phase 3 trials, adjuvant ET without RT significantly increased the rate of local relapse with no impact on overall survival while RT alone proved effective. Elderly patients aged 60 or more with low-risk, luminal A breast cancer were chosen as the target population in a phase 3 randomized trial comparing APBI + 5-year ET vs. uAPBI (16 Gy 1f) alone. Conclusion: To investigate de-escalation adjuvant treatment for elderly breast cancer patients, we have defined a road map for testing more convenient strategies. This EPOPE phase 3 randomized trial is supported by the GEC-ESTRO breast cancer working group.

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Very accelerated partial breast irradiation Phase I–II multicenter trial (VAPBI): Feasibility and early results

Cited by 26 publications

References 24 publications

Multicatheter interstitial brachytherapy versus stereotactic radiotherapy with CyberKnife for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk

Multicatheter interstitial brachytherapy versus stereotactic radiotherapy with CyberKnife for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk

Partial Breast Irradiation

Endocrine therapy with accelerated Partial breast irradiatiOn or exclusive ultra-accelerated Partial breast irradiation for women aged ≥ 60 years with Early-stage breast cancer (EPOPE): The rationale for a GEC-ESTRO randomized phase III-controlled trial

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