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@#Breast cancer is the most common malignancy and the fifth leading cause of cancer-related mortality in the world. Breast cancer is a global health problem that poses a heavy burden on patients and their families as well as socioeconomic development. As an important component in the management of breast cancer, radiotherapy plays a vital role in its comprehensive treatment. This review describes advances made toward the application of adjuvant radiotherapy in the treatment of breast cancer.
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Currently, whole breast radiotherapy (WBRT) is the standard treatment for early breast cancer after breast-conserving surgery, which effectively reduces the recurrence rate. Accelerated partial breast irradiation (APBI), a special radiotherapy that only targets the limited volume of tissues surrounding the primary lesion, has attracted more and more attention because of the high proportion of tumor recurrence adjacent to the tumor resection cavity. In recent years, a number of prospective randomized controlled trails have demonstrated its safety and effectiveness, which is a feasible choice for specific low-risk patients after breast-conserving surgery. Compared with WBRT, APBI shortens the treatment time, reduces the treatment cost and improves the cosmetic effect. At the same time, more and more APBI technologies have been developed, which enhance the accessibility and possess unique advantages for partial patients undergoing breast-conserving surgery. Nevertheless, the efficacy and side effects of APBI technologies still differ, which need to be treated differently. In this paper, multiple APBI technologies, research progresses at home and abroad and applicable population were reviewed. The unresolved problems were proposed and development prospect was predicted, aiming to provide reference for clinical application.
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Objective To evaluate the efficacy of accelerated partial breast irradiation ( APBI ) and whole breast irradiation ( WBI ) with simultaneous integrated boost ( SIB ) from the perspective of economics, and provide a reference for postoperative adjuvant therapy mode selection for early-stage breast cancer after breast-conserving surgery. Methods A total of 355 early-stage breast cancer patients who underwent APBI or WBI-SIB after breast-conserving surgery were evaluated on efficacy and cost-effectiveness, of which 177 patients received APBI, and 178 patients received WBI-SIB. Survival analysis was done according to treatment received. NCI-CTC 3.0 was used to score the toxicities. Breast aesthetic outcome were evaluated with Harris standards. Results Median follow-up was 42 months ( 5.8 -92.7 months) . The 3-year locoregional recurrence free survival( LRFS) rates in APBI group and WBI-SIB group were 98.2％ and 97.6％, distant metastasis free survival( DMFS) were 94.3％ and 93.7％, disease-free survival ( DFS) were 93.1％ and 91.6％, and overall survival 95.5％ and 94.3％, respectively, without statistically significant differences(P>0.05). Compared with WBI-SIB group, the acute reaction rates in APBI group decreased from 5. 6％ to 3.4％(χ2 =6.044, P <0. 05), and late reactions from 5.6％ to 2.3％ (χ2 =6.149, P<0. 05), while the cosmetic outcome improved from 88.8％ to 93.8％(χ2 =5.22, P<0. 05). Moreover, the processing average time was shortened by 26.5 d (χ2 =40.76, P<0. 05). Conclusions After breast-conserving surgery, the efficacy of APBI showed no difference from WBI-SIB with respect to 3-year local control, disease-free survival, and overall survival, but displayed a significantly better toxicity profile and cost-effectiveness ratio for early breast cancer patients. It can be used as a good radiotherapy model after breast-conserving surgery in early-stage breast cancer.
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Introducción El tratamiento estándar en estadios tempranos del cáncer de mama es la cirugía conservadora (cc) más radioterapia del volumen total mamario (wbi). Dado que la mayoría de las recidivas locales ocurren cercanas al sitio del tumor (85%) y existiendo la posibilidad de acortar tiempos de irradiación debido a que esta insume varias semanas, podría no ser necesario irradiar toda la mama, sino el área donde estaba situado el tumor más margen de seguridad, lo que insume un menor tiempo. Este el fundamento de la Irradiación Parcial Acelerada Mama (apbi). Consensos internacionales proporcionan guías para administrar apbi fuera de ensayos clínicos. Objetivos El objetivo principal de este trabajo es determinar y analizar las características clinico-anatomopatológicas e inmunohistoquímicas de las pacientes que fueron operadas y luego seleccionadas para ser irradiadas con técnica de apbi con radioterapia externa con intensidad modulada guiada por imágenes (imrt). Material y método Se trata de un trabajo prospectivo, no randomizado. La muestra está constituida por las primeras 20 pacientes ingresadas al protocolo apbi. El reclutamiento se realizó entre marzo de 2012 y julio de 2014. Se analizaron las características clínico-patológicas e inmunohistoquímicas de esas pacientes luego de cc más biopsia del ganglio centinela (bgc). Resultados Media de seguimiento en meses: 37,7 (r: 22-51); edad media: 65,7 años. Tamaño tumoral medio por anatomía patológica: 12,03 mm. Media de número de ganglios centinelas extirpados: 1,7. Todos los tumores fueron unifocales. Los márgenes quirúrgicos resultaron negativos en todos los casos. Tumores Luminal A: 19 pacientes; tumores Luminal B: 1 paciente. Hormonoterapia adyuvante en todas las pacientes. Control locorregional: 100%. Conclusiones A pesar del corto tiempo de seguimiento y del escaso número de pacientes, este análisis sugiere que la apbi en el lecho del tumor marcado intraoperatoriamente con fiduciales de titanio es factible para pacientes que reúnen los criterios estrictos clínico-patológicos e inmunohistoquímicos acordes con las guías internacionales.
Introduction The standard conservative treatment for early stage breast carcinomas is the breast conservative surgery plus whole breast irradiation. Because most local recurrences occur close to the site of the primary tumor (80- 90%) and the possibility of shortening the irradiation times because it takes several weeks, it may not be necessary to irradiate the entire breast, but the area where the tumor was located plus a margin of safety in less time. This is the basis of Accelerated Partial Irradiation of the Breast Objectives Determination and analysis of clinical-pathological and immunohistochemical characteristics in patients selected for Accelerated Partial Breast Irradiation (apbi) performed by imrt + igrt technique after breast conservative surgery plus sentinel node biopsy. Materials and method A prospective, non-randomized study of the first 20 patients performed apbi strictly following the recommendations of international consensus. It was initiated in March 2012 until July 2014. Clinical-pathological and immunohistochemical characteristics of these patients were analyzed to be selected for apbi, after breast conservative surgery plus sentinel node biopsy. Results Median follow up: 37.7 months (r: 22-51); average age: 65.7 years. Mean tumor size by pathological analysis: 12.03 mm. Mean number of sentinel nodes removed: 1.7. All tumors were unifocal. Negative surgical margins in all cases. Luminal A tumors: 19 patients; Luminal B tumors: 1 patient. Adjuvant hormone therapy in all patients. Loco-regional control: 100%. Conclusions Despite the short time of follow up and the small numbers of patients, this analysis suggests that apbi performed by imrt + igrt technique added to the placement of fiduciary marks at the time of surgery is feasible for highly selected patients who meet the clinical-pathological and immunohistochemical selection criteria according to international guidelines
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Humans , Female , Breast Neoplasms , Radiotherapy , Titanium , Sentinel Lymph Node Biopsy , GangliaABSTRACT
AIM OF STUDY: Breast conserving surgery (BCS) is the standard treatment for stage I and II breast cancer. Multiple studies have shown that recurrences after lumpectomy occur mainly in or near the tumor bed. Use of accelerated partial breast irradiation (APBI) allows for significant reduction in the overall treatment time that results in increasing patient compliance and decreasing healthcare costs. We conducted a treatment planning study to evaluate the role of intensity modulated radiation therapy (IMRT) with regards to three‑dimensional conformal radiation therapy (3DCRT) in APBI. MATERIALS AND METHODS: Computed tomography planning data sets of 33 patients (20 right sided and 13 left sided) with tumor size less than 3 cm and negative axillary lymph nodes were used for our study. Tumor location was upper outer, upper inner, central, lower inner, and lower outer quadrants in 10, 10, 5, 4 and 4 patients, respectively. Multiple 3DCRT and IMRT plans were created for each patient. Total dose of 38.5 Gy in 10 fractions were planned. Dosimetric analysis was done for the best 3DCRT and IMRT plans. RESULTS: The target coverage has been achieved by both the methods but IMRT provided better coverage (P = 0.04) with improved conformity index (P = 0.01). Maximum doses were well controlled in IMRT to below 108% (P < 0.01). Heart V2 Gy (P < 0.01), lung V5 Gy (P = 0.01), lung V10 Gy (P = 0.02), contralateral breast V1 Gy (P < 0.01), contralateral lung V2 Gy (P < 0.01), and ipsilateral uninvolved breast (P < 0.01) doses were higher with 3DCRT compared to IMRT. CONCLUSION: Dosimetrically, IMRT–APBI provided best target coverage with less dose to normal tissues compared with 3DCRT‑APBI.
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Objective To dosimetrically compare three delivery techniques of VMAT,IMRT and 3D-CRT in the treatment of accelerated partial breast irradiation (APBI).Methods Twenty patients with T1/2N0M0breast cancer were treated with VMAT.These cases were subsequently re-planned using static gantry IMRT and 3D-CRT technology to evaluate dosimetric differences.Dosimetric parameters including dose conformity index (CI),dose volume histogram (DVH) analysis of normal tissue coverage,dose parameters of PTV and normal tissues were evaluated,the delivery parameters including MU and delivery time were also analyzed.Results The IMRT and VMAT plans provided lower maximum dose,better mean dose and more conformal target dose distributions than the 3D-CRT plans (F =14.86,8.57,18.23,P ＜0.05).The volume of ipsilateral breast receiving 5 Gy for VMAT technique was significantly less than that of3D-CRTor IMRT(F=5.83,P＜0.05).The ipsilateral lung volume receiving 20 Gy (V20),5 Gy(V5) and the 5％ volume dose (D5) of IMRT were superior to those of 3D-CRT and VMAT(F =16.39,3.62,4.81,P ＜ 0.05).The low volume dose distributions of D5 in contralateral lung for IMRT was better than that of VMAT and 3D-CRT(F =3.99,3.43,P ＜ 0.05).The total mean MUs for VMAT,3D-CRT and IMRT were 621.0 ± 111.9,707.3 ± 130.9 and 1161.4 ± 315.6,respectively (F =31.30,P ＜ 0.05).The average machine delivery time was(1.5 ± 0.2)min for the VMAT plans,(7.0 ± 1.6)min for the 3D-CRT plans and (11.5 ± 1.9)min for the IMRT plans.Conclusions VMAT and IMRT techniques offer improved dose conformity as compared with 3D-CRT techniques without increasing dose to the ipsilateral lung.In terms of MU and delivery time,VMAT is more efficient for APBI than conventional 3D-CRT and static beam IMRT.
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Breast cancer has become one of the most frequent malignancies among Korean women and the role of radiation therapy (RT) is expected to increase continuously. Current concepts in the treatment of breast cancer include a less radical surgery and the emergence of RT and systemic drug treatment. A surgery directed to minimize breast loss and RT to the whole breast has been the treatment of choice for early lesions. The use of whole breast irradiation (WBI) after the minimal breast surgery has been shown to significantly reduce the risk of recurrence in the affected breast and to increase the likelihood of long-term survival. Recently, there has been growing interest in the use of accelerated partial breast irradiation (APBI) as an alternative to WBI. APBI offers decreased overall treatment time and several advantages over WBI, including a decrease in the radiation dose delivered to uninvolved breast and adjacent organs. For the radiotherapy of breast cancer virtual simulation using the CT for three dimensional conformal RT has been widely used for external radiotherapy. The interstitial brachytherapy (insertion of radioactive source into the breast), balloon brachytherapy, and intraoperative electron therapy has been used for the APBI. Three dimensional radiotherapy including intensity modulated radiotherapy will be more widely used for breast cancer. RT fields are progressively reduced and APBI will be a realistic alternative in the future. CONCLUSION: The role of RT for treatment of breast cancer is important and the implementation of new RT technology will increase.