Research progress on accelerated partial breast irradiation for early breast cancer after breast-conserving surgery / 中华放射肿瘤学杂志

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.

When to indicate radiotherapy after nipple-sparing mastectomy? Systematic review / Quando indicar radioterapia após mastectomia nipple-sparing? Revisão sistemática

Introduction: Nipple-sparing mastectomy (NSM) and preservation of the nipple-areola complex (NAC) represent a therapeutic option of breast cancer with a better aesthetic result, a positive impact on body image and more satisfaction than the reconstruction of the NAC. It is questioned the indication of radiotherapy when the NAC is maintained and its potential aesthetic impairment. Objective: To examine the indication of radiotherapy in NSM and, secondarily, the incidence of NAC involvement and local recurrence rates. Methods: Systematic review carried out in the PubMed database with the terms ("breast neoplasm" [Mesh] OR "breast cancer") AND ("radiotherapy" OR "radiation therapy") AND ("nipple sparing mastectomy" OR "mastectomies" OR "subcutaneous mastectomies"). The selection of the studies, the evaluation of its quality and data extraction were carried out independently by four reviewers. Results: The indications for radiotherapy after NSM were: positive axilla, tumors over 5 cm and retroareolar tissue remaining greater than 5 mm. The NAC involvement occurred in 5 to 26.1% in the definitive anatomopathological study. NAC recurrence occurred from 2.59 to 10%. NAC necrosis occurred in 2.2 to 43.4%. Conclusions: The radiotherapy indications for NSM seem to follow the same classical indications for radiotherapy after mastectomy. The relapse index in NAC was not shown to be larger and without difference for the type of radiotherapy used. Radiotherapy should be based on factors that suggest a high risk for NAC involvement

Introdução: A mastectomia nipple-sparing (MNS) e a conservação do complexo aréolo-papilar (CAP) representam uma manobra terapêutica do câncer de mama com melhor resultado estético, impacto positivo na imagem corporal e mais satisfação do que a reconstrução do CAP. Questiona-se a indicação de radioterapia quando da manutenção do CAP e seu potencial prejuízo estético. Objetivo: Examinar a indicação de radioterapia em MNS e, secundariamente, a incidência do envolvimento do CAP e as taxas de recorrência local. Métodos: Revisão sistemática realizada na base de dados do PubMed com os termos ("breast neoplasm" [Mesh] OR "breast cancer") AND ("radiotherapy" OR "radiation therapy") AND ("nipple sparing mastectomy" OR "mastectomies" OR "subcutaneous mastectomies"). A seleção dos estudos, a avaliação da qualidade do estudo e a extração de dados foram realizadas de forma independente por quatro revisores. Resultados: As indicações para radioterapia após MNS foram: axila positiva, tumores acima de 5 cm e tecido retroareolar remanescente maior que 5 mm. O envolvimento do CAP ocorreu em 5 a 26,1% no anatomopatológico definitivo. A recorrência no CAP ocorreu de 2,59 a 10%. A necrose do CAP ocorreu em 2,2 a 43,4%. Conclusão: As indicações de radioterapia para MNS parecem seguir as mesmas indicações clássicas para radioterapia após mastectomia. O índice de recidiva no CAP não mostrou ser maior com uso de radioterapia nem ter diferença quanto ao seu tipo. A decisão de realizar a radioterapia deve se basear em fatores que sugerem alto risco para envolvimento do CAP

Clinical value of radiotherapy in 78 patients with pT3 N0 M0 breast cancer after modified radical mastectomy / 中华放射肿瘤学杂志

Objective To investigate the value of post-mastectomy radiotherapy ( PMRT ) in patients with T3 N0 breast cancer ( BC ) who were treated with modified radical mastectomy ( MRM ) . Methods A retrospective analysis was performed on the clinical data of BC patients treated with MRM from 1997 to 2014. The inclusion criteria were as follows:( 1 ) female patients;( 2 ) pathological diagnosis of invasive BC;(3) tumor volume greater than 5 cm without axillary lymph node metastasis;(4) the patients who received no neoadjuvant chemotherapy or endocrine therapy and had no distant metastasis or other second primary cancers. A total of 78 patients met the inclusion criteria. Forty patients ( 51%) received PMRT and sixty-seven patients (86%) received adjuvant chemotherapy. The Kaplan-Meier method was used to calculate overall survival ( OS ) , disease-free survival ( DFS ) ( DFS ) , and local-regional recurrence ( LRR) rates, and survival differences between groups were analyzed by the log-rank test. Results The median follow-up time was 79 months ( 6-232 months) . For all patients, the 5-year OS, DFS, and LRR rates were 89%, 87%, and 2%, respectively. The 5-year DFS, OS and LRR rates for radiotherapy group were 84%, 84% and 0%, respectively, versus 91%( P= 0641 ) , 96%( P= 0126 ) , and 5% for non-radiotherapy group. Only estrogen receptor/progesterone receptor ( ER/PR) status and molecular type had significant impacts on DFS ( P=0002 and 0031, respectively) . One patient in non-radiotherapy group had chest wall recurrence. Conclusions MRM is effective in reducing LRR in T3 N0 M0 BC patients. Only ER/PR status and molecular type significantly influence DFS. Effective systemic therapy may be helpful for some T3 N0 patients to avoid chest wall and supraclavicular radiotherapy after MRM, but large-sample studies are needed to further confirm this conclusion.

Clinical value of radiotherapy in 78 patients with pT3 N0 M0 breast cancer after modified radical mastectomy / 中华放射肿瘤学杂志

Objective To investigate the value of post-mastectomy radiotherapy ( PMRT ) in patients with T3 N0 breast cancer ( BC ) who were treated with modified radical mastectomy ( MRM ) . Methods A retrospective analysis was performed on the clinical data of BC patients treated with MRM from 1997 to 2014. The inclusion criteria were as follows:( 1 ) female patients;( 2 ) pathological diagnosis of invasive BC;(3) tumor volume greater than 5 cm without axillary lymph node metastasis;(4) the patients who received no neoadjuvant chemotherapy or endocrine therapy and had no distant metastasis or other second primary cancers. A total of 78 patients met the inclusion criteria. Forty patients ( 51%) received PMRT and sixty-seven patients (86%) received adjuvant chemotherapy. The Kaplan-Meier method was used to calculate overall survival ( OS ) , disease-free survival ( DFS ) ( DFS ) , and local-regional recurrence ( LRR) rates, and survival differences between groups were analyzed by the log-rank test. Results The median follow-up time was 79 months ( 6-232 months) . For all patients, the 5-year OS, DFS, and LRR rates were 89%, 87%, and 2%, respectively. The 5-year DFS, OS and LRR rates for radiotherapy group were 84%, 84% and 0%, respectively, versus 91%( P= 0641 ) , 96%( P= 0126 ) , and 5% for non-radiotherapy group. Only estrogen receptor/progesterone receptor ( ER/PR) status and molecular type had significant impacts on DFS ( P=0002 and 0031, respectively) . One patient in non-radiotherapy group had chest wall recurrence. Conclusions MRM is effective in reducing LRR in T3 N0 M0 BC patients. Only ER/PR status and molecular type significantly influence DFS. Effective systemic therapy may be helpful for some T3 N0 patients to avoid chest wall and supraclavicular radiotherapy after MRM, but large-sample studies are needed to further confirm this conclusion.

Probabilities of Pulmonary and Cardiac Complications and Radiographic Parameters in Breast Cancer Radiotherapy / 대한방사선종양학회지

PURPOSE: To evaluate the relationship between the normal tissue complication probability (NTCP) of 3- dimensional (3-D) radiotherapy and the radiographic parameters of 2-dimensional (2-D) radiotherapy such as central lung distance (CLD) and maximal heart distance (MHD). MATERIALS AND METHODS: We analyzed 110 patients who were treated with postoperative radiotherapy for breast cancer. A two-field tangential technique, a three-field technique, and the reverse hockey stick method were used. The radiation dose administered to whole breast or the chest wall was 50.4 Gy, whereas a 45 Gy was administered to the supraclavicular field. The NTCPs of the heart and lung were calculated by the modified Lyman model and the relative seriality model. RESULTS: For all patients, the NTCPs of radiation-induced pneumonitis and cardiac mortality were 0.5% and 0.7%, respectively. The NTCP of radiation-induced pneumonitis was higher in patients treated with the reverse hockey stick method than in those treated by other two techniques (0.0%, 0.0%, 3.1%, p<0.001). The NTCP of radiation-induced pneumonitis increased with CLD. The NTCP of cardiac mortality increased with MHD (R2=0.808). CONCLUSION: We found a close correlation between the NTCP of 3-D radiotherapy and 2-D radiographic parameters. Our results are useful to reanalyze the previous 2-D based clinical reports about breast radiation therapy complications as a viewpoint of NTCP.

Optimization of registration template of cone-beam CT guided whole breast irradiation after lumpectomy of breast cancer / 中华放射医学与防护杂志

Objective To optimize the registration template of kilovohage cone-beam CT (CBCT) guided radiotherapy in whole breast irradiation(WBI)after lumpectomy of breast cancer.Methods From April 2006 to July 2009,twelve patients undergoing WBI with intensity-modulated radiotherapy (IMRT)were recruited in this study.All patients were performed with both conventional planning CT and CBCT integrated on Varian 23 EX.Six distinguishable referenee points(the diameter 1 mm)around the lumpectomy cavity and the surrounding gland on the planning CT image were marked.The images were manually registered offline based on the breast surface,surgical clips,breast gland,contiguous rib,ipsilaterai lung and its external contours,respectively.The same six reference points were then marked on the CBCT image.The performance of the five registration templates was compared using the concept of registration error,while the registration time was taken into account.The registration error was calculated based on the six reference points'translations between the planning CT image and CBCT image,and analyzed with SPSS 13.0 software using one-way ANOVA.Results The values of the registration error for the breast surface,surgical clips,breast gland, contiguous rib,ipsilateral lung and its external contours were(0.60±0.20),(0.43±0.15),(0.49±0.19),(0.69±0.36)and(0.94±0.49)cm,respectively,and the registration time were(3.8±1.1),(3.0±0.9),(4.7±1.7),(4.3±1.3)and(4.5±1.3)min,respectively.There was no statistical difforence between the breast surface,surgical clips and breast gland registration template(t=0.48-1.36,P>0.05),the same result trend to contiguous rib compared with ipsilateral lung(t=2.00,P=0.055),however,there was significant difference between surgical clips and the last two registration methods(t=2.08-4.08,P<0.05).Conclusion In this initial study with a modest number of patients,surgical clips show a best registration template from the standpoint of accuracy and efficiency,whereas contiguous rib and ipsilateral lung are not an ideal method.