10 research outputs found
NRG Oncology-Radiation Therapy Oncology Group Study 1014: 1-Year Toxicity Report From a Phase 2 Study of Repeat Breast-Preserving Surgery and 3-Dimensional Conformal Partial-Breast Reirradiation for In-Breast Recurrence.
PURPOSE: To determine the associated toxicity, tolerance, and safety of partial-breast reirradiation.
METHODS AND MATERIALS: Eligibility criteria included in-breast recurrence occurring \u3e1 year after whole-breast irradiation, \u3c3 \u3ecm, unifocal, and resected with negative margins. Partial-breast reirradiation was targeted to the surgical cavity plus 1.5 cm; a prescription dose of 45 Gy in 1.5 Gy twice daily for 30 treatments was used. The primary objective was to evaluate the rate of grade ≥3 treatment-related skin, fibrosis, and/or breast pain adverse events (AEs), occurring ≤1 year from re-treatment completion. A rate of ≥13% for these AEs in a cohort of 55 patients was determined to be unacceptable (86% power, 1-sided α = 0.07).
RESULTS: Between 2010 and 2013, 65 patients were accrued, and the first 55 eligible and with 1 year follow-up were analyzed. Median age was 68 years. Twenty-two patients had ductal carcinoma in situ, and 33 had invasive disease: 19 ≤1 cm, 13 \u3e1 to ≤2 cm, and 1 \u3e2 cm. All patients were clinically node negative. Systemic therapy was delivered in 51%. All treatment plans underwent quality review for contouring accuracy and dosimetric compliance. All treatment plans scored acceptable for tumor volume contouring and tumor volume dose-volume analysis. Only 4 (7%) scored unacceptable for organs at risk contouring and organs at risk dose-volume analysis. Treatment-related skin, fibrosis, and/or breast pain AEs were recorded as grade 1 in 64% and grade 2 in 7%, with only 1 (
CONCLUSION: Partial-breast reirradiation with 3-dimensional conformal radiation therapy after second lumpectomy for patients experiencing in-breast failures after whole-breast irradiation is safe and feasible, with acceptable treatment quality achieved. Skin, fibrosis, and breast pain toxicity was acceptable, and grade 3 toxicity was rare
Probabilistic analysis of the planning and delivery of partial breast irradiation with balloon brachytherapy: Unsettling uncertainty
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Optimized Dose Coverage of Regional Lymph Nodes in Breast Cancer: The Role of Intensity-Modulated Radiotherapy
To determine whether the use of intensity-modulated radiotherapy (IMRT) would lead to improved dosimetry for the breast and regional nodes.
Ten patients with left-sided breast cancer were selected. The clinical target volume included left breast and internal mammillary (IM), supraclavicular (SC), and axillary (AX) nodes. The critical structures included heart, right and left lungs, contralateral breast, esophagus, thyroid, and humeral head. Conventional and a series of IMRT plans were generated for comparison.
The average heart D
3 was reduced from 31.4 ± 18.9 with three-dimensional conformal radiotherapy (3D-CRT) to 15 ± 7.2 Gy with 9-field (9-FLD IMRT). The average left lung D
30 was also decreased from 27.9 ± 11.5 Gy (3D-CRT) to 12.6 ± 8.2 Gy (9-FLD IMRT). The average contralateral breast D
2 was reduced from 4.4 ± 5.3 Gy (3D-CRT) to 1.8 ± 1.2 Gy (4-FLD IMRT). Esophagus D
2 was increased from 9.3 ± 8.1 Gy (3D-CRT) to 29.4 ± 5.4 (9-FLD IMRT); thyroid D
50 was increased from 0.9 ± 0.6 Gy (3D-CRT) to 11.9 ± 6.6 (9-FLD IMRT); humeral head D
2 was increased from 36.1 ± 13.1 Gy (3D-CRT) to 39.9 ± 6.5 (9-FLD IMRT).
The use of IMRT improves breast and regional node coverage while decreasing doses to the lungs, heart, and contralateral breast when compared with 3D-CRT. Doses to esophagus, thyroid, and humeral head, however, were increased with IMRT