Long-term Cosmesis Following a Novel Schedule of Accelerated Partial Breast Radiation in Selected Early Stage Breast Cancer: Result of a Prospective Clinical Trial

Overview

Journal Radiat Oncol J

Specialty Oncology

Date 2017 Dec 7

PMID 29207864

Citations 1

Authors

Mutlay Sayan

Daphne Hard

Karen Wilson

Carl Nelson

Havaleh Gagne

Deborah Rubin

Ruth Heimann

Affiliations

Soon will be listed here.

Abstract

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 ≥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 V50 (20 Gy) of the whole breast volume (WBV) was 37.2%, with the median WBV V100 (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.

Citing Articles

Stereotactic image-guided neoadjuvant ablative single-dose radiation, then lumpectomy, for early breast cancer: the SIGNAL prospective single-arm trial of single-dose radiation therapy.

Guidolin K, Yaremko B, Lynn K, Gaede S, Kornecki A, Muscedere G Curr Oncol. 2019; 26(3):e334-e340.

PMID: 31285677 PMC: 6588073. DOI: 10.3747/co.26.4479.

References

Olivotto I, Whelan T, Parpia S, Kim D, Berrang T, Truong P . 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(32):4038-45. DOI: 10.1200/JCO.2013.50.5511. View

Saibishkumar E, Mackenzie M, Severin D, Mihai A, Hanson J, Daly H . Skin-sparing radiation using intensity-modulated radiotherapy after conservative surgery in early-stage breast cancer: a planning study. Int J Radiat Oncol Biol Phys. 2007; 70(2):485-91. DOI: 10.1016/j.ijrobp.2007.06.049. View

Berrang T, Olivotto I, Kim D, Nichol A, Cho B, Mohamed I . Three-year outcomes of a Canadian multicenter study of accelerated partial breast irradiation using conformal radiation therapy. Int J Radiat Oncol Biol Phys. 2010; 81(5):1220-7. DOI: 10.1016/j.ijrobp.2010.07.2003. View

Heil J, Dahlkamp J, Golatta M, Rom J, Domschke C, Rauch G . Aesthetics in breast conserving therapy: do objectively measured results match patients' evaluations?. Ann Surg Oncol. 2010; 18(1):134-8. DOI: 10.1245/s10434-010-1252-4. View

Leonard K, Hepel J, Hiatt J, DiPetrillo T, Price L, Wazer D . 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. 2012; 85(3):623-9. DOI: 10.1016/j.ijrobp.2012.06.052. View

Lewin A, Derhagopian R, Saigal K, Panoff J, Abitbol A, Wieczorek D . Accelerated partial breast irradiation is safe and effective using intensity-modulated radiation therapy in selected early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2011; 82(5):2104-10. DOI: 10.1016/j.ijrobp.2011.02.024. View

Jagsi R, Ben-David M, Moran J, Marsh R, Griffith K, Hayman J . Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2009; 76(1):71-8. PMC: 4414125. DOI: 10.1016/j.ijrobp.2009.01.041. View

Rose M, Olivotto I, Cady B, Koufman C, Osteen R, Silver B . Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Arch Surg. 1989; 124(2):153-7. DOI: 10.1001/archsurg.1989.01410020023002. View

Shah C, Wilkinson J, Lanni T, Jawad M, Wobb J, Fowler A . Five-year outcomes and toxicities using 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Clin Breast Cancer. 2012; 13(3):206-11. DOI: 10.1016/j.clbc.2012.09.020. View

10.

Cardoso M, Cardoso J, Oliveira H, 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. 2015; 126:154-9. DOI: 10.1016/j.cmpb.2015.11.010. View

11.

Al-Ghazal S, Fallowfield L, Blamey R . Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity?. Eur J Surg Oncol. 1999; 25(6):571-3. DOI: 10.1053/ejso.1999.0708. View

12.

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. 2006; 82(3):317-23. DOI: 10.1016/j.radonc.2006.11.021. View

13.

Cardoso J, Cardoso M . Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment. Artif Intell Med. 2007; 40(2):115-26. DOI: 10.1016/j.artmed.2007.02.007. View

14.

Liss A, Ben-David M, Jagsi R, Hayman J, Griffith K, Moran J . 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(1):96-102. PMC: 5446776. DOI: 10.1016/j.ijrobp.2014.01.005. View

15.

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(1):32-38. PMC: 5398344. DOI: 10.3857/roj.2016.01963. View

16.

Shaitelman S, Kim L, Grills I, Chen P, Ye H, Kestin L . Predictors of long-term toxicity using three-dimensional conformal external beam radiotherapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2010; 81(3):788-94. DOI: 10.1016/j.ijrobp.2010.06.062. View

17.

Lei R, Leonard C, Howell K, Henkenberns P, Johnson T, Hobart T . Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT). Breast Cancer Res Treat. 2013; 140(1):119-33. PMC: 3706719. DOI: 10.1007/s10549-013-2623-x. View

18.

Pezner R, Lipsett J, Vora N, Desai K . Limited usefulness of observer-based cosmesis scales employed to evaluate patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys. 1985; 11(6):1117-9. DOI: 10.1016/0360-3016(85)90058-6. View

19.

Vicini F, Winter K, Wong J, Pass H, Rabinovitch R, Chafe S . 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. 2009; 77(4):1120-7. PMC: 3365530. DOI: 10.1016/j.ijrobp.2009.06.067. View

20.

Arthur D, Winter K, Kuske R, Bolton J, Rabinovitch R, White J . 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(2):467-73. PMC: 2604132. DOI: 10.1016/j.ijrobp.2007.12.056. View