Radiation Oncology Journal

  • 제35권4호
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  • Pages.325-331
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  • 2017
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  • 2234-1900(pISSN)
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  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
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Long-term cosmesis following a novel schedule of accelerated partial breast radiation in selected early stage breast cancer: result of a prospective clinical trial

  • Sayan, Mutlay (Department of Radiation Oncology, University of Vermont Medical Center) ;
  • Hard, Daphne (Department of Radiation Oncology, University of Vermont Medical Center) ;
  • Wilson, Karen (University of Vermont Cancer Center) ;
  • Nelson, Carl (Department of Radiation Oncology, University of Vermont Medical Center) ;
  • Gagne, Havaleh (Department of Radiation Oncology, University of Vermont Medical Center) ;
  • Rubin, Deborah (Department of Radiation Oncology, University of Vermont Medical Center) ;
  • Heimann, Ruth (Department of Radiation Oncology, University of Vermont Medical Center)
  • 투고 : 2017.04.03
  • 심사 : 2017.07.10
  • 발행 : 2017.12.31
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초록

Purpose: There is controversy regarding the cosmetic outcome after accelerated partial breast radiation (APBR). We report the cosmetic outcome from a single-arm prospective clinical trial of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I breast cancer (BC), using a novel fractionation schedule. Materials and Methods: Forty-two patients aged ${\geq}65$, with Stage I BC who underwent breast-conserving surgery were enrolled in a phase I/II study evaluating a 2-week course of APBR. Thirty eligible patients received 40 Gy in 4 Gy daily fractions. Cosmetic outcome was assessed subjectively by physician/patient and objectively by using a computer program (BCCT.core) before APBR, during, and after completion of the treatment. Results: The median age was 72 years, the median tumor size was 0.8 cm, and the median follow-up was 50.5 months. The 5-year locoregional control in this cohort was 97% and overall survival 87%. At the last follow-up, patients and physicians rated cosmesis as 'excellent' or 'good' in 100% and 91 %, respectively. The BCCT.core program scored the cosmesis as 'excellent' or 'good' in 87% of the patients at baseline and 81% at the last follow-up. The median $V_{50}$ (20 Gy) of the whole breast volume (WBV) was 37.2%, with the median WBV $V_{100}$ (40 Gy) of 10.9%. Conclusion: An excellent rate of tumor control was observed in this prospective trial. By using multiple assessment techniques, we are showing acceptable cosmesis, supporting the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.

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참고문헌

  1. Arthur DW, Winter K, Kuske RR, et al. A Phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 95-17. Int J Radiat Oncol Biol Phys 2008;72:467-73. https://doi.org/10.1016/j.ijrobp.2007.12.056
  2. Cuttino LW, Keisch M, Jenrette JM, et al. Multi-institutional experience using the MammoSite radiation therapy system in the treatment of early-stage breast cancer: 2-year results. Int J Radiat Oncol Biol Phys 2008;71:107-14. https://doi.org/10.1016/j.ijrobp.2007.09.046
  3. Vicini F, Winter K, Wong J, et al. Initial efficacy results of RTOG 0319: three-dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/ II breast carcinoma. Int J Radiat Oncol Biol Phys 2010;77:1120-7. https://doi.org/10.1016/j.ijrobp.2009.06.067
  4. Jagsi R, Ben-David MA, Moran JM, et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys 2010;76:71-8. https://doi.org/10.1016/j.ijrobp.2009.01.041
  5. Oliver M, Chen J, Wong E, Van Dyk J, Perera F. A treatment planning study comparing whole breast radiation therapy against conformal, IMRT and tomotherapy for accelerated partial breast irradiation. Radiother Oncol 2007;82:317-23. https://doi.org/10.1016/j.radonc.2006.11.021
  6. Rusthoven KE, Carter DL, Howell K, et al. Accelerated partialbreast intensity-modulated radiotherapy results in improved dose distribution when compared with three-dimensional treatment-planning techniques. Int J Radiat Oncol Biol Phys 2008;70:296-302. https://doi.org/10.1016/j.ijrobp.2007.08.047
  7. Saibishkumar EP, MacKenzie MA, Severin D, et al. Skin-sparing radiation using intensity-modulated radiotherapy after conservative surgery in early-stage breast cancer: a planning study. Int J Radiat Oncol Biol Phys 2008;70:485-91. https://doi.org/10.1016/j.ijrobp.2007.06.049
  8. Al-Ghazal SK, Blamey RW. Cosmetic assessment of breastconserving surgery for primary breast cancer. Breast 1999;8:162-8. https://doi.org/10.1054/brst.1999.0017
  9. Pezner RD, Lipsett JA, Vora NL, Desai KR. Limited usefulness of observer-based cosmesis scales employed to evaluate patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys 1985;11:1117-9. https://doi.org/10.1016/0360-3016(85)90058-6
  10. Al-Ghazal SK, Fallowfield L, Blamey RW. Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity? Eur J Surg Oncol 1999;25:571-3. https://doi.org/10.1053/ejso.1999.0708
  11. Heil J, Dahlkamp J, Golatta M, et al. Aesthetics in breast conserving therapy: do objectively measured results match patients' evaluations? Ann Surg Oncol 2011;18:134-8. https://doi.org/10.1245/s10434-010-1252-4
  12. Cardoso JS, Cardoso MJ. Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment. Artif Intell Med 2007;40:115-26. https://doi.org/10.1016/j.artmed.2007.02.007
  13. Cardoso MJ, Cardoso JS, Oliveira HP, Gouveia P. The breast cancer conservative treatment. Cosmetic results - BCCT.core - Software for objective assessment of esthetic outcome in breast cancer conservative treatment: a narrative review. Comput Methods Programs Biomed 2016;126:154-9. https://doi.org/10.1016/j.cmpb.2015.11.010
  14. Sayan M, Wilson K, Nelson C, Gagne H, Rubin D, Heimann R. A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial. Radiat Oncol J 2017;35:32-8. https://doi.org/10.3857/roj.2016.01963
  15. Rose MA, Olivotto I, Cady B, et al. Conservative surgery and radiation therapy for early breast cancer: long-term cosmetic results. Arch Surg 1989;124:153-7. https://doi.org/10.1001/archsurg.1989.01410020023002
  16. Shah C, Wilkinson JB, Lanni T, et al. Five-year outcomes and toxicities using 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Clin Breast Cancer 2013;13:206-11. https://doi.org/10.1016/j.clbc.2012.09.020
  17. Berrang TS, Olivotto I, Kim DH, et al. Three-year outcomes of a Canadian multicenter study of accelerated partial breast irradiation using conformal radiation therapy. Int J Radiat Oncol Biol Phys 2011;81:1220-7. https://doi.org/10.1016/j.ijrobp.2010.07.2003
  18. Olivotto IA, Whelan TJ, Parpia S, et al. Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol 2013;31:4038-45. https://doi.org/10.1200/JCO.2013.50.5511
  19. Leonard KL, Hepel JT, Hiatt JR, Dipetrillo TA, Price LL, Wazer DE. The effect of dose-volume parameters and interfraction interval on cosmetic outcome and toxicity after 3-dimensional conformal accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2013;85:623-9. https://doi.org/10.1016/j.ijrobp.2012.06.052
  20. Liss AL, Ben-David MA, Jagsi R, et al. Decline of cosmetic outcomes following accelerated partial breast irradiation using intensity modulated radiation therapy: results of a single-institution prospective clinical trial. Int J Radiat Oncol Biol Phys 2014;89:96-102. https://doi.org/10.1016/j.ijrobp.2014.01.005
  21. Lewin AA, Derhagopian R, Saigal K, et al. Accelerated partial breast irradiation is safe and effective using intensitymodulated radiation therapy in selected early-stage breast cancer. Int J Radiat Oncol Biol Phys 2012;82:2104-10. https://doi.org/10.1016/j.ijrobp.2011.02.024
  22. Lei RY, Leonard CE, Howell KT, et al. Four-year clinical update from a prospective trial of accelerated partial breast intensitymodulated radiotherapy (APBIMRT). Breast Cancer Res Treat 2013;140:119-33. https://doi.org/10.1007/s10549-013-2623-x
  23. Williams MV, Denekamp J, Fowler JF. A review of alpha/beta ratios for experimental tumors: implications for clinical studies of altered fractionation. Int J Radiat Oncol Biol Phys 1985;11:87-96. https://doi.org/10.1016/0360-3016(85)90366-9
  24. Shaitelman SF, Kim LH, Grills IS, et al. Predictors of long-term toxicity using three-dimensional conformal external beam radiotherapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2011;81:788-94. https://doi.org/10.1016/j.ijrobp.2010.06.062

피인용 문헌

  1. Evaluation of tissue computed tomography number changes and dosimetric shifts after conventional whole-breast irradiation in patients undergoing breast-conserving surgery vol.40, pp.8, 2017, https://doi.org/10.1177/1010428318791882
  2. Whole-Breast Irradiation Is the Preferred Standard of Care for the Majority of Patients With Early-Stage Breast Cancer vol.38, pp.20, 2020, https://doi.org/10.1200/jco.19.02388
  3. Oncoplastic Surgery: Does Patient and Medical Specialty Influences the Evaluation of Cosmetic Results? vol.21, pp.3, 2021, https://doi.org/10.1016/j.clbc.2020.09.012