Progress of research on adjuvant radiotherapy for breast cancer / 中国辐射卫生

@#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.

Research progress on the whole breast radiotherapy in prone position after breast-conserving surgery for early breast cancer / 中国辐射卫生

Whole breast radiotherapy after breast-conserving surgery for early-stage breast cancer increases local control rate and reduces postoperative recurrence. Compared to supine position, whole breast radiation therapy in the prone position provides dosimetric advantages and cosmetic outcomes in patients with large breasts. With the development of various radiotherapy techniques and tools, the radiation volume and dose for target and organs at risk (such as heart and lung) have changed. Models for the prediction of preferable treatment position in breast radiotherapy without the need for CT simulation and plan evaluation in both positions have been developed and implemented in radiotherapy practice. This paper briefly reviews the progression in the techniques and dosimetry of whole breast radiotherapy in prone position after breast-conserving surgery for early breast cancer.

Progress of hypofractionated radiotherapy after breast-conserving surgery / 中国肿瘤临床

Breast-conserving surgery plus adjuvant whole-breast irradiationmay reduce the risk of local tumors and improve living con-ditions of patients. Conventional whole-breast radiotherapy confers good tumor control and esthetic effects with lower toxicity. How-ever, treatment periods of 5-7 weeks are inconvenient for patients and may lead to the wastage of medical resources. Thus, increasing-ly more individuals tend to choose a short-term radiotherapy mode, such as hypofractionated radiotherapy or partial breast irradia-tion. Many published reports suggest that short-term radiotherapy is safe and effective, similar to conventional fractionation, with comparable tumor control and fewer side effects than noted with conventional fractionation. Therefore, in contrast to conventional whole-breast radiotherapy, short-time radiotherapy shows remarkable advantages in shortening the total treatment duration, reduc-ing medical costs, saving medical resources, and improving the quality of life of patients.

Efficacy analysis of accelerated partial breast irradiation versus whole breast irradiation with simultaneous integrated boost after breast-conserving surgery for early-stage breast cancer / 中华放射医学与防护杂志

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.

Frontiers of modern radiotherapy techniques in management of breast cancer after breast-conserving surgery / 医疗卫生装备

The latest progress of modern radiotherapy techniques in the management of breast cancer after breast-conserving surgery was introduced first.Then the clinical effect and the adverse effect of these advanced techniques were analyzed.Finally,in order to provide an up-to-date evidence based data on the role of modern radiotherapy techniques in the management of breast cancer,the importance of how to choose appropriate patients for these advanced techniques was discussed.

Local recurrence after whole breast irradiation combined with tumor bed boost in patients with breast ductal carcinoma in situ after breast-conservingsurgery: A Meta-analysis / 肿瘤

Objective: To conduct a Meta-analysis to analyze the short-term and long-term preventive effects of whole breast irradiation combined with tumor bed boost on short- and long-term local recurrence rates and local recurrence rate of ipsilateral invasive breast cancer in patients with breast ductal carcinoma in situ (DCIS) after breast conserving-surgery (BCS). Methods: A computer-based online search of PubMed, China Journal Full-text Database (CJFD), China Biology Medicine disc (CBMdisc), Embase and Cochrane Library was performed to include eligible studies in accordance with the inclusion and exclusion criteria. Newcastle Ottawa Quality Assessment Scale was used for quality assessment of included articles. RevMan 5.3 software was used for Meta-analysis. Results: A total of 14 non-randomized controlled trials (13 were cohort study, and 1 was nonsimultaneous controlled trial) involving 8679 patients with breast DCIS were included. The results of this Meta-analysis showed that no statistically significant differences between whole breast irradiation and whole breast irradiation combined with tumor bed boost in terms of 5-year local recurrence rate [odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.46-1.82; P = 0.81], 7-year local recurrence rate (OR = 0.70, 95% CI: 0.45-1.09; P = 0.11), ≥ 10-year local recurrence rate (OR = 0.95, 95% CI: 0.79-1.15; P= 0.62) and the local recurrence rate of ipsilateral invasive breast cancer (OR = 0.89, 95% CI: 0.62-1.29; P = 0.55). Conclusion: As compared with whole breast irradiation, the whole breast irradiation combined with tumor bed boost in patients with DCIS after BCS can not obviously decrease the 5-year, 7-year and ≥ 10-year local recurrence rates, as well as the local recurrence rate of ipsilateral invasive breast cancer.

Recent Development of Radiation Therapy for Breast Cancer

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.