Oligometastasis in breast cancer-current status and treatment options from a radiation oncology perspective

Evidence from a few small randomized trials and retrospective cohorts mostly including various tumor entities indicates a prolongation of disease free survival (DFS) and overall survival (OS) from local ablative therapies in oligometastatic disease (OMD). However, it is still unclear which patients benefit most from this approach. We give an overview of the several aspects of stereotactic body radiotherapy (SBRT) in extracranial OMD in breast cancer from a radiation oncology perspective. A PubMed search referring to this was conducted. An attempt was made to relate the therapeutic efficacy of SBRT to various prognostic factors. Data from approximately 500 breast cancer patients treated with SBRT for OMD in mostly in small cohort studies have been published, consistently indicating high local tumor control rates and favorable progression-free (PFS) and overall survival (OS). Predictors for a good prognosis after SBRT are favorable biological subtype (hormone receptor positive, HER2 negative), solitary metastasis, bone-only metastasis, and long metastasis-free interval. However, definitive proof that SBRT in OMD breast cancer prolongs DFS or OS is lacking, since, with the exception of one small randomized trial (n = 22 in the SBRT arm), none of the cohort studies had an adequate control group. Further studies are needed to prove the benefit of SBRT in OMD breast cancer and to define adequate selection criteria. Currently, the use of local ablative SBRT should always be discussed in a multidisciplinary tumor board

Current controversies in radiotherapy for breast cancer

Multimodal treatment approaches have substantially improved the outcome of breast cancer patients in the last decades. Radiotherapy is an integral component of multimodal treatment concepts used in curative and palliative intention in numerous clinical situations from precursor lesions such as ductal carcinoma in situ (DCIS) to advanced breast cancer. This review addresses current controversial topics in radiotherapy with special consideration of DCIS, accelerated partial breast irradiation (APBI) and regional nodal irradiation (RNI) and provides an update on the clinical practice guidelines of the Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

Prophylactic Management of Radiation-Induced Nausea and Vomiting

The incidence of nausea and vomiting after radiotherapy is often underestimated by physicians, though some 50–80% of patients may experience these symptoms. The occurrence of radiotherapy-induced nausea and vomiting (RINV) will depend on radiotherapy-related factors, such as the site of irradiation, the dosing, fractionation, irradiated volume, and radiotherapy techniques. Patients should receive antiemetic prophylaxis as suggested by the international antiemetic guidelines based upon a risk assessment, taking especially into account the affected anatomic region and the planned radiotherapy regimen. In this field the international guidelines from the Multinational Association of Supportive Care in Cancer (MASCC)/European Society of Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) guidelines as well as the National Comprehensive Cancer Network (NCCN) are widely endorsed. The emetogenicity of radiotherapy regimens and recommendations for the appropriate use of antiemetics including 5-hydroxytryptamine (5-HT3) receptor antagonists, steroids, and other antiemetics will be reviewed in regard to the applied radiotherapy or radiochemotherapy regimen

Prevention of Nausea and Vomiting in Cancer Patients

IX, 59 p. 20 illus., 4 illus. in color.online res

Radiotherapeutic Options for Symptom Control in Breast Cancer

SUMMARY: The majority of breast cancer patients will require radiation therapy at some time during the course of their disease. An estimated 30–50% of all radiation treatments are of palliative nature, either to alleviate symptoms or prophylactic to prevent deterioration of quality of life due to locally progressive disease. Radiotherapy is a locally effective tool, and typically causes no systemic and mostly mild acute side effects. The following article provides an overview of options and decision-making in palliative radiotherapy for symptom control

Clinical Recommendations of DEGRO and AGO on Preferred Standard Palliative Radiotherapy of Bone and Cerebral Metastases, Metastatic Spinal Cord Compression, and Leptomeningeal Carcinomatosis in Breast Cancer

SUMMARY: BACKGROUND: To provide guidance for clinical practice on preferred standard palliative radiotherapy (RT) of different sites of metastasis for breast cancer patients based on current published evidence complemented by expert opinion. METHODS: The breast cancer expert panel of the German Society for Radiation Oncology (DEGRO) and members of the Working Party of Gynecologic Oncology (AGO) Breast Committee formulated recommendations based on the panel's interpretation of the level of evidence referring to the criteria of evidence-based medicine added to the AGO grades of recommendation. RESULTS: For different types and sites of metastasis, distinct therapeutic goals (alleviation of symptoms, pain relief, local tumor control, prevention or improvement of neurological deficits, stabilization of the spine or other bones) require complex approaches considering individual factors (i.e. life expectancy, tumor progression at other sites). With regard to different therapeutic goals, different dose concepts and fractionation schedules, and single-versus multi-fraction palliative RT should be adapted individually. CONCLUSIONS: RT is an effective tool in palliation treatment of bone metastasis (BM), cerebral metastasis (CM) and metastatic spinal cord compression (MSCC), or leptomeningeal carcinomatosis (LC) and plays a central role in an interdisciplinary approach. Preferred technique, targeting, and different dose schedules are described in detail in the DEGRO guidelines, which are also integrated in the updated 2010 AGO recommendations

Clinical Recommendations of DEGRO and AGO on Preferred Standard Palliative Radiotherapy of Bone and Cerebral Metastases, Metastatic Spinal Cord Compression, and Leptomeningeal Carcinomatosis in Breast Cancer

Background: To provide guidance for clinical practice on preferred standard palliative radiotherapy (RT) of different sites of metastasis for breast cancer patients based on current published evidence complemented by expert opinion. Methods: The breast cancer expert panel of the German Society for Radiation Oncology (DEGRO) and members of the Working Party of Gynecologic Oncology (AGO) Breast Committee formulated recommendations based on the panel’s interpretation of the level of evidence referring to the criteria of evidence-based medicine added to the AGO grades of recommendation. Results: For different types and sites of metastasis, distinct therapeutic goals (alleviation of symptoms, pain relief, local tumor control, prevention or improvement of neurological deficits, stabilization of the spine or other bones) require complex approaches considering individual factors (i.e. life expectancy, tumor progression at other sites). With regard to different therapeutic goals, different dose concepts and fractionation schedules, and single- versus multi-fraction palliative RT should be adapted individually. Conclusions: RT is an effective tool in palliation treatment of bone metastasis (BM), cerebral metastasis (CM) and metastatic spinal cord compression (MSCC), or leptomeningeal carcinomatosis (LC) and plays a central role in an interdisciplinary approach. Preferred technique, targeting, and different dose schedules are described in detail in the DEGRO guidelines, which are also integrated in the updated 2010 AGO recommendations.Hintergrund: Erstellung praktischer Handlungsempfehlungen zur palliativen Radiotherapie (RT) verschiedener Metastasierungsmanifestationen bei Patientinnen mit Mammakarzinom auf Basis aktuell publizierter Evidenz und ergänzender Expertenmeinung. Methodik: Die vom Expertengremium der Organgruppe Mamma der Deutschen Gesellschaft für Radioonkologie (DEGRO) und Mitgliedern der Kommission Mamma in der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) erstellten Empfehlungen basieren auf der Analyse kontrollierter klinischer Studien und internationalen sowie nationalen praktischen Handlungsanleitungen und den Interpretationen der Evidenzgrade nach Kriterien der Evidenz- basierten Medizin, ergänzt um die Empfehlungsgrade der AGO-Kommission. Ergebnisse: Unterschiedliche Therapieziele für die Palliation (Schmerzlinderung, lokale Tumorkontrolle, Prävention und Rückbildung neurologischer Ausfälle, ossäre Stabilisierung) erfordern jeweils auf den individuellen Fall abgestimmte, differenzierte, radioonkologische Behandlungskonzepte unter Berücksichtigung von Lebenserwartung und Tumoraktivität an den verschiedenen Manifestationsorten. Je nach Palliationsziel kommen unterschiedliche Dosiskonzepte und Fraktionierungsschemata in Form von Einzel- oder Multifraktionierungs-RT zur Anwendung. Schlussfolgerungen: Die RT ist ein effektiver Bestandteil bei der palliativen Behandlung bei ossärer (BM) oder zerebraler (CM) Metastasierung, des tumorbedingten spinalen Kompressionssyndroms (MSCC) oder bei Leptomeningeosis carcinomatosa (LC). Techniken, Zielvolumenbestimmungen und verschiedene Dosiskonzepte für unterschiedliche klinische Konstellationen werden in den DEGRO-Handlungsempfehlungen, die in die aktualisierten AGO-Empfehlungen 2010 integriert wurden, detailliert beschrieben

2016 updated MASCC/ESMO consensus recommendations:prevention of radiotherapy-induced nausea and vomiting

School of Nursin