Radiotherapy For Early Breast Cancer Research Articles

184. A retrospective study on acute and late toxicity in early breast cancer radiotherapy: Preliminary analysis on Field in Field technique

PurposeField-in-Field (FinF) technique improves dose coverage and homogeneity with respect to standard wedged fields (WF). The aim of our analyses is to investigate whether acute or late toxicities are influenced by plan technique. Methods374 patients at early stage breast cancer were treated using either WF or FinF technique. For each patient, baseline clinical characteristics were recorded, treatment characteristics and dosimetric values were extracted from plans. Acute and late toxicities were assessed according to CTCAE-v3 criteria. The statistically significant correlations were assessed in the whole group, then comparisons were performed by grouping patients according to plan technique. ResultsMedian follow-up time was 593 days (range 18–966). Patient treated with FinF technique were 149 with a median follow-up time of 436 days, shorter than pts treated with WF technique (764 days). The two technique subgroups were homogeneous according to baseline clinical characteristics. In the whole group factors significantly correlating with acute toxicity are dose prescription (degree of erythema P < 0.0001 and desquamation P < 0.0001), breast volume (degree of erythema P < 0.0001, desquamation P < 0.0001, desquamation sites P = 0.0028), age (erythema resolution time P = 0.02). Factors significantly correlated with late toxicity are V95 (fibrosis P = 0.005, degree of breast lymphedema P = 0.0007), breast volume (scar retraction P = 0.03, late mastitis P = 0.01, degree of breast lymphedema P < 0.0001) and age (pain P = 0.03, hyperpigmentation P < 0.0001). At univariate analysis there was no evidence of statistically significant differences between the two technique subgroups for each acute or late toxicity. Dosimetric values were also analyzed resulting in a better dose coverage (for V95: P < 0.0001) in spite of higher doses to OAR’s (for lung mean dose: P = 0.0003). ConclusionsPreliminary statistic analysis shows that FinF technique provides better dose coverage with respect to WF without affecting acute or late toxicity in spite of the shorter follow-up time.

Effect of Delayed Adjuvant Radiotherapy in Early Breast Cancer on Local Control, Distant Metastasis and Overall Survival: an Evidence-Based Case Report

Breast cancer is the second most common cancer in the world and, by far, the most frequent cancer among women with an estimated 1,67 million new cancer diagnosed in 2012 (25% of all cancers). In principle, radiation therapy is indicated in early breast cancer after breast conserving surgery or after radical mastectomy-with-positive-or-near-margin. Unfortunately, not all aforementioned indicated patients could receive immediate treatment, often due to limited radiation therapy facility. We constructed this report to investigate comprehensively, whether delayed radiation therapy for indicated-post-surgical-early breast cancer case has a significant effect to survival (either locoregional or distant metastasis-free survival). Searching was conducted on PubMed ® , Cochrane ® , and Scopus ® . After screening for titles and abstracts, we found 25 articles, 15 of which we finally included for performing full reading. From this systematic searching, we found that time to radiation is inconsistently related to locoregional survival, overall survival, and distant metastasis-free survival.

Up to 5 years outcomes following intraoperative radiotherapy for early breast cancer

Up to 5 years outcomes following intraoperative radiotherapy for early breast cancer

Up to 5 years outcomes following intraoperative radiotherapy for early breast cancer

Background: Whole breast radiation therapy (WBRT) is the standard of care for early breast cancer after lumpectomy, but it has side effects. For elderly women with good prognostic cancer, intra-operative radiotherapy (IORT) is an alternative. We report our results with IORT. Methods: We performed a retrospective cohort study to observe clinical outcomes after IORT, between 2012 and 2017. Patients had inclusion criteria for RIOP INCA (French national institute of cancer) (group A) or for TARGIT E (group B). Results: Ninety women were included (91 tumors). The mean age was 73.1 years (range, 56.0–87.0 years) and 95.6% of tumors were under 20 mm. After a median follow-up of 27.4 months (range, 3.0–51.0 months), overall survival was 100%, with two local recurrences out of the 84 tumors followed at least 3 months (2.4%). After IORT, 34.1% of patients had adjuvant WBRT; 70.2% of tumors had fibrosis at least once in the follow-up, 47.6% had cystosteatonecrosis, 25.8% had breast pain grades 1–2, 6% had over grade 2 toxicities, with no grade 4, and 94.0% had good to very good subjective global aspect. Conclusions: IORT is a good alternative to WBRT when ASTRO’s guidelines indications are respected, with promising results, but need carry on following up with patients.

ACTIVE - a randomised feasibility trial study protocol of a behavioural intervention to reduce fatigue in women undergoing radiotherapy for early breast cancer: study protocol

BackgroundFatigue is rated as the most distressing side effect of radiotherapy treatment for curable breast cancer. About four in ten women treated experience fatigue, which can last for years after treatment. The impact of this debilitating tiredness is loss of independence and impaired physical and mental function. Our study will take a behavioural intervention with demonstrated effect in treating fatigue in a mixed group of chemotherapy patients and adapt it for women undergoing radiotherapy for early breast cancer. The purpose of this trial is to evaluate the feasibility of delivering the intervention in the radiotherapy pathway for patients at a high risk of fatigue and to explore participants’ experiences of the trial and intervention.MethodsA pragmatic single-site non-blinded feasibility trial of a behavioural intervention. Main inclusion criteria are prescription of the UK standard 40 Gy in 15 fractions over 3 weeks of radiotherapy (± tumour bed boost) for early (stage 0–IIIa) breast cancer. The total projected sample size after attrition is 70. A previously developed fatigue risk score tool will be used to predict individual’s likelihood of experiencing fatigue. Thirty women predicted to be at a high risk of experiencing significant fatigue will be allocated in the ratio 2:1 to the behavioural intervention or education trial arms, respectively. These feasibility trial participants will be assessed at baseline, after 10 and 15 fractions of radiotherapy and 10 days, 3 weeks and 6 months after radiotherapy. A further 40 women predicted to be at a lower risk of fatigue will join a risk score validation group.Measures to assess feasibility include recruitment, retention and completion rates and variation in implementation of the intervention. Process evaluation with intervention providers and users includes fidelity and adherence checks and qualitative interviews to understand how changes in behaviour are initiated and sustained.DiscussionThis feasibility study collates data to both inform the progression to and design of a future definitive trial and to refine the intervention.Trial registrationISRCTN 10303368. Registered August 2017 (retrospectively registered); Health and Care Research Wales Clinical Research Portfolio (CRP) registration 31419.

EP-1303: Less is good: once-weekly hypofractionated radiotherapy for early breast cancer in elderly women

EP-1303: Less is good: once-weekly hypofractionated radiotherapy for early breast cancer in elderly women

Abstract P2-11-15: Adjuvant radiotherapy of early breast cancer induces a decrease in levels of TGFβ-1, MMP-9 and PDGF

Abstract Purpose Radiotherapy (RT) of early breast cancer is associated with cardiovascular morbidity. Transforming growth factor beta 1 (TGFβ-1) is a pro-fibrotic cytokine that also has a role in immunological activation and epithelial proliferation, but its clinical role remains unclear. Endoglin, matrix metalloproteinase 9 (MMP-9), platelet derived growth factor (PDGF), and oxidative stress are involved in regulation of TGFβ-1. 8-isoprostane is a biomarker of oxidative stress. The aim of our study was to evaluate the behavior of these fibrosis-associated biomarkers during adjuvant RT of early breast cancer. Materials and methods The study included 67 patients with early breast cancer or ductal carcinoma in situ (DCIS) receiving adjuvant RT, but no chemotherapy. The dose of RT was either 42.56 Gy in 2.66 Gy fractions or 50 Gy in 2 Gy fractions with or without boost of 10 or 16 Gy. TGFβ-1 (ng/ml), endoglin (ng/ml), PDGF (ng/ml), MMP-9 (ng/ml) and 8-isoprostane (pg/ml) were measured by enzyme-linked immunoassay (ELISA) from serum samples acquired before starting RT, 2 weeks (for 42.56 Gy) or 3 week (for 50 Gy) into RT and at the end of RT. Results Adjuvant RT induced significant decreases in the levels of TGFβ-1 (p=0.002), MMP-9 (p=0.017) and PDGF (p&amp;lt;0.001) from before RT to after RT (Table 1). Whereas, the levels of endoglin and 8-isoprostane remained stable. For the first 2 or 3 weeks of RT, TGFβ-1 remained stable and then decreased significantly by the end of RT (p=0.022). The decrease in MMP-9 was significant only from before RT to after RT (p=0.017). On the other hand, PDGF also decreased significantly during the first 2 or 3 weeks (p=0.016) and from 2-3 weeks to after RT (p=0.038). Although, endoglin remained stable throughout the whole RT, the decrease during first 2-3 weeks was significant (p=0.002). Table 1 Change in biomarkers during RT Before RT2-3 weeksAfter RTp1p2p3TGFβ-1, Md (IQR)25.2 (21.1-30.7)25.5 (21.0-31.1)23.8 (19.6-26.9)0.2080.0220.002endoglin, Md (IQR)26.7 (22.9-29.7)25.3 (21.7-29.2)26.5 (22.4-29.4)0.0020.2490.098MMP-9, Md (IQR)334 (249-485)330 (217-475)289 (209-384)0.1690.1670.017PDGF, Md (IQR)18.7 (13.7-23.5)16.7 (13.0-22.6)16.1 (12.8-19.8)0.0160.038&amp;lt;0.0018-isoprostane, Md (IQR)85.9 (53.0-134.3)72.8 (36.2-120.5)80.8 (45.7-134.3)0.2460.3470.841Md median, IQR interquartile range, 1Wilcoxon signed ranks test for change from before RT to 2-3 weeks into RT, 2Wilcoxon signed ranks test for change from 2-3 weeks into RT to after RT, 3 Wilcoxon signed ranks test for change from before RT to after RT Conclusion This study demonstrates the behavior of TGFβ-1, endoglin, MMP-9, PDGF and 8-isoprostane during adjuvant RT of early breast cancer. Although the role TGFβ-1 as profibrotic cytokine is widely accepted, it has not been extensively studied in radiotherapy of breast cancer. The fibrotic effects of RT take years to manifest, including increased cardiovascular morbidity. More extensive studies, with longer follow-up, are needed to determine whether the changes in TGFβ-1 and its modulators are associated with clinical, RT related, cardiovascular complications in breast cancer patients. Citation Format: Aula H, Skyttä T, Luukkaala T, Hämäläinen M, Moilanen E, Kellokumpu-Lehtinen P-L. Adjuvant radiotherapy of early breast cancer induces a decrease in levels of TGFβ-1, MMP-9 and PDGF [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-15.

AB054. 112. Intraoperative radiotherapy for early breast cancer: Beaumont hospital experience

: One of the main objectives of breast cancer therapy is local control. This goal is primarily achieved by surgery and whole breast irradiation. The vast majority of local recurrences however occur within the same breast quadrant as the index lesion. Partial breast irradiation has been developed to address this fact and to reduce the duration of radiation treatment for suitable breast cancer patients. We introduced intra-operative radiation therapy (IORT) for early breast cancer to Beaumont Hospital 18 months ago. This report outlines our experience to date. We have treated 17 patients using the INTRABeam device (Carl Zeiss). The mean age was 66 years, all tumours were T1–2 (mean=17 mm), all tumours were ER+ve and Her2-ve and any patients who demonstrated unfavorable characteristics post pathological analysis went on to receive standard external beam radiation (EBRT). IORT added an additional 20–45 mins to the standard operating time. Fifteen patients were treated with WLE and IORT alone, two patients of the group required standard EBRT in addition to IORT. There was one haematoma and two problematic seromas recorded for the group. Although we have a short follow-up to date that there have been no local recurrences or deaths recorded. All patients have reported very good to excellent satisfaction rates.

A multi-institutional analysis of intraoperative radiotherapy for early breast cancer: Does age matter?

BackgroundSingle-session intraoperative radiation therapy (IORT) minimizes treatment demands associated with traditional whole breast radiation therapy (WBRT) but outcomes on local disease control and morbidity among the elderly is limited. MethodsA multi-institutional retrospective registry was established from 19 centers utilizing IORT from 2007 to 2013. Patient, tumor, and treatment variables were analyzed for ages <70 and ≥70. ResultsWe evaluated 686 patients (<70 = 424; ≥70 = 262) who were margin and lymph node negative. Patients <70 were more likely to have longer operative time, oncoplastic closure, higher rates of IORT used as planned boost, and receive chemotherapy and post-operative WBRT. Wound complication rates were low and not significantly different between age groups. Median follow-up was 1.06 (range 0.51–1.9) years for < 70 and 1.01 (range 0.5–1.68) years for ≥ 70. There were 5 (0.73%) breast recurrences (4 in <70 and 1 ≥ 70, p = 0.65) and no axillary recurrences during follow-up. ConclusionsIORT was associated with a low rate of wound complication and local recurrence on short-term follow-up in this cohort.

EP-1152: Intraoperative radiotherapy for early breast cancer: a monocentric experience

EP-1152: Intraoperative radiotherapy for early breast cancer: a monocentric experience

Precision medicine for early breast cancer radiotherapy: Opening up new horizons?

So far most efforts put forth to test the value of predictive and prognostic tools in the field of breast radiotherapy remained globally disappointing, or at least below the convincing levels reached for systemic therapy. Nevertheless the addition of predictive tools to the clinical armament tends to prevail over the use of the sole prognostic factors, also in radiotherapy. A number of predictive assays, clinically validated or not, have recently elicited significant associations between molecular profiles and tumor biological aggressiveness and/or radiosensitivity levels. Will it take a long time for these radiation-specific assays to provide added value to the - already crowded - constellation of predictive tools in the breast cancer? On the one hand, optimizing radiotherapy through the integration of precision medicine into the breast cancer management still remains a challenging issue. On the other hand, recent advances in predictive assays aimed at distinguishing patients with a more radioresistant tumor that necessitates radiation dose escalation or a switch to therapeutic approaches other than radiotherapy, plea in favor of an increasing role, in a near future, for radiation-specific molecular signatures. Streamlining predictive assays platforms via concerted actions should imperatively be given high priority, also in terms of health economics.

Dosimetric comparison of simultaneous integrated boost with whole-breast irradiation for early breast cancer.

PurposeThe purpose of this study was to identify a more suitable boost plan for simultaneously integrated boost scheme in patients with breast cancer by comparing among 3 types of whole-breast irradiation plus tumor bed boost plans.MethodsTwenty patients who received radiotherapy following breast-conserving surgery for early breast cancer were enrolled in this study. We performed 1 type of electron plan (E1P plan) and 2 types of 3-dimensional conformal plans using a photon (P3P and P5P plans). The dosimetric parameters for the heart, total lung and the target volume between the 3 treatment types were compared.ResultsFor the tumor bed, the difference in the mean dose between the 3 plans was maximally 0.1 Gy. For normal breast parenchyma, the difference in the mean dose between the 3 plans was maximally 1.1 Gy. In the dose range over the prescribed dose of 51 Gy, V55 and V60 in the E1P plan were lower than those in the P3P and P5P plans, which indicated that the E1P plan was more suitable than the P3P and P5P plans. In case of the heart and total lung, the values of clinically important parameters were slightly higher in the E1P plan than in the P3P and P5P plans. However, these differences were less than 2%.ConclusionWe observed that a simple electron plan for tumor bed boost is preferable over multi-field photon plans in terms of the target volume coverage and normal tissue sparing.

P160 - Intraoperative radiotherapy in early breast cancer: 10 years experience in one institution

P160 - Intraoperative radiotherapy in early breast cancer: 10 years experience in one institution

Prolongation of overall treatment time as a cause of treatment failure in early breast cancer: An analysis of the UK START (Standardisation of Breast Radiotherapy) trials of radiotherapy fractionation

BackgroundTests of tumour treatment time effect in patients prescribed post-operative radiotherapy for early breast cancer have focussed on time to start of radiotherapy rather than overall treatment time. The START randomised trials of radiotherapy fractionation provide an opportunity to directly estimate the effect of treatment acceleration. MethodsBetween 1986 and 2002, a total of 5861 women with early breast cancer were recruited into the UK START pilot (START-P), START-A and START-B randomised trials. START-P and START-A tested 13 fractions of 3.0–3.3Gy against 25 fractions of 2.0Gy with a fixed treatment duration of 5weeks for all schedules; START-B tested 15 fractions of 2.67Gy in 3weeks against 25 fractions of 2.0Gy over 5weeks. Estimates of the effect of length of treatment for local–regional relapse and for a measure of late normal tissue effects (change in photographic breast appearance, for patients following breast conserving surgery) were obtained from Cox proportional hazards regression analyses stratified according to trial. ResultsAt a median follow-up of 10years, 444/5831 (7.6%) patients with data available had a local–regional relapse, and 1135/3185 (35.6%) had mild or marked change in photographic breast appearance by 5years. Adjusting for prognostic factors, the estimate of the overall treatment time effect for local–regional relapse was 0.60Gy/day (95%CI 0.10 to 1.18Gy/day, p=0.02), and 0.14Gy/day (95%CI −0.09 to 0.34Gy/day, p=0.29) for change in photographic breast appearance. ConclusionsCombined analysis of the START trials generates the hypothesis that overall treatment time is a significant determinant of local cancer control after adjuvant whole breast radiotherapy, with approximately 0.6Gy per day ‘wasted’ in compensating for tumour cell proliferation.

Partial breast irradiation for early breast cancer.

Breast-conserving therapy for women with breast cancer consists of local excision of the tumour (achieving clear margins) followed by radiotherapy (RT). RT is given to sterilize tumour cells that may remain after surgery to decrease the risk of local tumour recurrence. Most true recurrences occur in the same quadrant as the original tumour. Whole breast radiotherapy (WBRT) may not protect against the development of a new primary cancer developing in other quadrants of the breast. In this Cochrane review, we investigated the delivery of radiation to a limited volume of the breast around the tumour bed (partial breast irradiation (PBI)) sometimes with a shortened treatment duration (accelerated partial breast irradiation (APBI)). To determine whether PBI/APBI is equivalent to or better than conventional or hypo-fractionated WBRT after breast-conserving therapy for early-stage breast cancer. We searched the Cochrane Breast Cancer Group Specialized Register (4 May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 5), MEDLINE (January 1966 to 4 May 2015), EMBASE (1980 to 4 May 2015), CINAHL (4 May 2015) and Current Contents (4 May 2015). We searched the International Standard Randomised Controlled Trial Number Register (5 May 2015), the World Health Organization's International Clinical Trials Registry Platform (4 May 2015) and ClinicalTrials.gov (17 June 2015). We searched for grey literature: OpenGrey (17 June 2015), reference lists of articles, several conference proceedings and published abstracts, and applied no language restrictions. Randomized controlled trials (RCTs) without confounding, that evaluated conservative surgery plus PBI/APBI versus conservative surgery plus WBRT. Published and unpublished trials were eligible. Two review authors (BH and ML) performed data extraction and used Cochrane's 'Risk of bias' tool, and resolved any disagreements through discussion. We entered data into Review Manager 5 for analysis. We included seven RCTs and studied 7586 women of the 8955 enrolled.Local recurrence-free survival appeared worse for women receiving PBI/APBI compared to WBRT (hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.11 to 2.35; six studies, 6820 participants, low-quality evidence). Cosmesis (physician-reported) appeared worse with PBI/APBI (odds ratio (OR) 1.51, 95% CI 1.17 to 1.95, five studies, 1720 participants, low-quality evidence). Overall survival did not differ with PBI/APBI (HR 0.90, 95% CI 0.74 to 1.09, five studies, 6718 participants, high-quality evidence).Late radiation toxicity (subcutaneous fibrosis) appeared worse with PBI/APBI (OR 6.58, 95% CI 3.08 to 14.06, one study, 766 participants, moderate-quality evidence). Acute skin toxicity appeared reduced with PBI/APBI (OR 0.04, 95% CI 0.02 to 0.09, two studies, 608 participants). Telangiectasia (OR 26.56, 95% CI 3.59 to 196.51, 1 study, 766 participants) and radiological fat necrosis (OR 1.58, 95% CI 1.02 to 2.43, three studies, 1319 participants) appeared worse with PBI/APBI. Late skin toxicity (OR 0.21, 95% CI 0.01 to 4.39, two studies, 608 participants) and breast pain (OR 2.17, 95% CI 0.56 to 8.44, one study, 766 participants) appeared not to differ with PBI/APBI.'Elsewhere primaries' (new primaries in the ipsilateral breast) appeared more frequent with PBI/APBI (OR 3.97, 95% CI 1.51 to 10.41, three studies, 3009 participants).We found no clear evidence of a difference for the comparison of PBI/APBI with WBRT for the outcomes of: cause-specific survival (HR 1.08, 95% CI 0.73 to 1.58, five studies, 6718 participants, moderate-quality evidence), distant metastasis-free survival (HR 0.94, 95% CI 0.65 to 1.37, four studies, 3267 participants, moderate-quality evidence), relapse-free survival (HR 1.36, 95% CI 0.88 to 2.09, three studies, 3811 participants), loco-regional recurrence-free survival (HR 1.80, 95% CI 1.00 to 3.25, two studies, 3553 participants) or mastectomy rates (OR 1.20, 95% CI 0.77 to 1.87, three studies, 4817 participants, low-quality evidence). Compliance was met: more than 90% of the women in all studies received the RT they were assigned to receive. We found no data for the outcomes of costs, quality of life or consumer preference. It appeared that local recurrence and 'elsewhere primaries' (new primaries in the ipsilateral breast) are increased with PBI/APBI (the difference was small), but we found no evidence of detriment to other oncological outcomes. It appeared that cosmetic outcomes and some late effects were worse with PBI/APBI but its use was associated with less acute skin toxicity. The limitations of the data currently available mean that we cannot make definitive conclusions about the efficacy and safety or ways to deliver of PBI/APBI. We await completion of ongoing trials.

No Need for Whole Breast Radiotherapy in Early Breast Cancer

No Need for Whole Breast Radiotherapy in Early Breast Cancer

Cancer du sein au stade précoce : stopper la désescalade en radiothérapie

REFLEXIONS ABOUT NEW STRATEGIES OF RADIOTHERAPY FOR EARLY BREAST CANCER: Radiotherapy (RT) remains a major treatment element in early breast cancer, with a major impact on local control and survival. For ductal carcinoma in situ (DCIS), RT reduces local recurrence (LR) rates by 50 to 60 % after conservative surgery (both in situ and invasive). This was confirmed by four randomized trials and one meta-analysis. For infiltrating breast cancers (IBC), RT also reduces LR rates by 65 to 75 % after conservative surgery. Boost allows an additional reduction of LR. RT is efficient in all age categories, but hypofractionated schemes are particularly adapted to elderly women. Partial breast irrradiation techniques are very much heterogeneous and lack follow-up. They should be used in LR low-risk patients only and in the frame of controlled studies. Locoregional RT for high-risk patients (especially in pN+) remains essential to reduce the locoregional recurrence rate and to increase survival, as confirmed in several meta-analyses. Four studies showed a survival benefit (2-3 %), thanks to internal mammary chain irradiation in LR high-risk patients. Moreover, axillary RT seems to be a likely valuable alternative to axillary dissection in case of sentinel node invasion. Finally, with the modern techniques and dosimetric optimization, RT toxicity was reduced, or even cancelled, arousing hope for a better increased benefit for the patients in the future.

Heterogeneity of variance in objective measures of aesthetic outcome associated with whole breast external beam radiotherapy compared with intraoperative radiotherapy in early breast cancer.

e12532Background: Breast cancer is an increasingly treatable disease which means that many women will live a long time with the aesthetic consequences of their treatment. The majority of women with early breast cancer are given whole breast external beam radiotherapy (EBRT) after lumpectomy (breast conservation). It has been demonstrated, using an objective assessment of aesthetic outcome in patients from a randomised trial, that “redness”, a surrogate for radiation induced erythema grade I or II, is significantly greater after one year in patients receiving EBRT compared with those receiving intraoperative radiotherapy (IORT) using TARGIT. However, it has been observed that not all women given EBRT have detectable erythema, which implies that there is a greater variability in this group. In order to test this hypothesis a test of unequal group variances was performed. Methods: 991 frontal digital photographs were analysed from women participating in the TARGIT A Trial (NCT00983684) at four sites (Lublin,...

Reduced Mortality With Partial-Breast Irradiation for Early Breast Cancer: A Meta-Analysis of Randomized Trials

With earlier detection and more effective treatment, mortality from breast cancer continues to fall and it has become increasingly important to reduce the toxicity of treatments. Partial-breast radiation therapy, which focuses radiation to the tumor bed, may achieve this aim. We analyzed mortality differences in randomized trials of partial-breast irradiation (PBI). We included data from published randomized trials of PBI (alone or as part of a risk-adapted approach) versus whole-breast irradiation (WBI) for invasive breast cancer suitable for breast-conserving therapy. We identified trials using PubMed and Google searches with the terms "partial breast irradiation" OR "intraoperative radiotherapy" OR "IMRT" OR ("accelerated" AND "radiation") AND "randomised/randomized," as well as through discussion with colleagues in the field. We calculated the proportion of patients who had events in each randomized arm at 5years' follow-up and created a forest plot using Stata, version 14.1. We identified 9 randomized trials of PBI versus WBI in invasive breast cancer; 5-year outcomes were available for non-breast cancer mortality in 5 trials (n=4489) and for breast cancer mortality in 4 trials (n=4231). The overall mortality was 4.9%. There was no detectable heterogeneity between the trials for any of the outcomes. There was no difference in the proportion of patients dying of breast cancer (difference, 0.000% [95% confidence interval (CI), -0.7 to +0.7]; P=.999). Non-breast cancer mortality with PBI was lower than with WBI (difference, 1.1% [95% CI, -2.1% to -0.2%]; P=.023). Total mortality with PBI was also lower than with WBI (difference, 1.3% [95% CI, -2.5% to 0.0%]; P=.05). Use of PBI instead of WBI in selected patients results in a lower 5-year non-breast cancer and overall mortality, amounting to a 25% reduction in relative terms. This information should be included when breast-conserving therapy is proposed to a patient.

An accelerated hypofractionated schedule with a daily concomitant boost after breast conservation surgery: the feasibility and toxicity

Aims and backgroundReduction of overall treatment time of postoperative irradiation and evaluation of the feasibility and preliminary toxicity of an accelerated hypofractionated whole breast irradiation with an addition of a concomitant daily boost in patients with early breast cancer submitted to conservation surgery. MaterialsBetween June 2010 and September 2011, 122 patients underwent accelerated hypofractionated adjuvant radiation after conservation surgery (pT1 or pT2, pN0-N1). Radiotherapy consisted of 45Gy, to the whole breast in 20 fractions with 2.25Gy/fraction; an additional daily boost dose of 0.25Gy was concomitantly delivered to the lumpectomy cavity, total dose 5Gy. Toxicity was assessed at the end of radiation therapy and at 3, 6, and 12months using the RTOG/EORTC toxicity scale. Cosmetic results were assessed in agreement with the Harvard criteria. ResultsMedian follow-up was 31months, 74% showed grade 0–1 skin toxicity, 20% grade 2, and 6% grade 3. At 3months of follow-up, grade 0 skin toxicity was observed in 51% of cases; grade 1 in 36%, and grade 2 in 13%. At 6months, late skin and subcutaneous tissue toxicities were scored as grade 0 in 71%, grade 1 in 18%, and grade 2 in 11% of patients.At 1year almost all the patients showed grade 0–1 skin toxicity. 97% of patients showed excellent or good cosmetic results. ConclusionsAccelerated hypofractionated radiotherapy for early breast cancer with concomitant electron boost seems to be feasible providing consistent clinical results with acceptable toxicity profile.