Cosmetic Results and Side Effects of Accelerated Partial-Breast Irradiation Versus Whole-Breast Irradiation for Low-Risk Invasive Carcinoma of the Breast: The Randomized Phase III IRMA Trial.

PURPOSE: The results in terms of side effects vary among the published accelerated partial-breast irradiation (APBI) studies. Here, we report the 5-year results for cosmetic outcomes and toxicity of the IRMA trial. METHODS: We ran this randomized phase III trial in 35 centers. Women with stage I-IIA breast cancer treated with breast-conserving surgery, age ≥ 49 years, were randomly assigned 1:1 to receive either whole-breast irradiation (WBI) or external beam radiation therapy APBI (38.5 Gy/10 fraction twice daily). Patients and investigators were not masked to treatment allocation. The primary end point was ipsilateral breast tumor recurrence. We hereby present the analysis of the secondary outcomes, cosmesis, and normal tissue toxicity. All side effects were graded with the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Radiation Morbidity Scoring Schema. Analysis was performed with both intention-to-treat and as-treated approaches. RESULTS: Between March 2007 and March 2019, 3,309 patients were randomly assigned to 1,657 WBI and 1,652 APBI; 3,225 patients comprised the intention-to-treat population (1,623 WBI and 1,602 APBI). At a median follow-up of 5.6 (interquartile range, 4.0-8.4) years, adverse cosmesis in the APBI patients was higher than that in the WBI patients at 3 years (12.7% v 9.2%; P = .009) and at 5 years (14% v 9.8%; P = .012). Late soft tissue toxicity (grade ≥ 3: 2.8% APBI v 1% WBI, P < .0001) and late bone toxicity (grade ≥ 3: 1.1% APBI v 0% WBI, P < .0001) were significantly higher in the APBI arm. There were no significant differences in late skin and lung toxicities. CONCLUSION: External beam radiation therapy-APBI with a twice-daily IRMA schedule was associated with increased rates of late moderate soft tissue and bone toxicities, with a slight decrease in patient-reported cosmetic outcomes at 5 years when compared with WBI, although overall toxicity was in an acceptable range.

Breast-conserving therapy for primary Ductal Carcinoma in Situ in The Netherlands: A multi-center study and population-based analysis.

OBJECTIVE: The aim of this study was to analyse the efficacy of breast-conserving therapy (BCT) for women with primary DCIS in a population-based setting. METHODS: Data were used from five Radiotherapy centres in The Netherlands from 2000 to 2010, all treated with BCT. Of all the cases, 59.2% received a boost of radiotherapy after their whole breast irradiation (WBI), irrespective of margin status. RESULTS: A total of 1248 cases with primary DCIS were analysed. The 10-years LRFS was 92.9%. Age ≤50 years and a positive margin were significantly related to local relapse free survival (LRFS). Having a boost had no impact on LRFS, showing a nearly equal recurrence pattern in patients with and without a boost. Separate analyses were done on patients who had received and not received a boost of radiotherapy after WBI. We noted 9.1% contra-lateral breast tumours. The 10-years disease specific survival (DSS) rate was 99.0%. CONCLUSIONS: DCIS of the breast and treated with BCT results in excellent LRFS and DSS. Primary surgical lumpectomy with negative margins followed by WBI seems to be the treatment of choice in DCIS treated with BCS with respect to IBTR.

Predictors for poor cosmetic outcome in patients with early stage breast cancer treated with breast conserving therapy: Results of the Young boost trial.

PURPOSE: In the Young Boost trial (YBT), breast cancer patients ≤50 years of age, treated with breast conserving therapy (BCT) were randomized between a 26 Gy boost dose and a 16 Gy boost dose, with local recurrence as primary and cosmetic outcome (CO) as secondary endpoint. Data of the YBT was used to investigate which factors are related with worse cosmetic outcome after BCT. METHODS: From 2004 to 2011, 2421 cT1-2N0-2a breast cancer patients were randomized. CO was scored subjectively by the patient and physician, and objectively using BCCT.core: at baseline, one and four years after treatment. Associations between potential risk factors for worse cosmetic outcome, based on the objective BCCT.core, were investigated using a proportional odds model. RESULTS: At four years, CO was significantly better in the standard boost group for all three scoring methods (satisfied CO ±65% vs 55%). A photon boost, high boost dose, poor cosmesis before radiation therapy, large boost volume and adjuvant chemotherapy significantly deteriorated CO. CONCLUSION: Important risk factors for worse CO were the use of a photon boost instead of an electron boost, a high boost dose, cosmesis at baseline, adjuvant chemotherapy and boost volume. These results can be used to define strategies aimed at improving CO.

Factors associated with patient-reported cosmetic outcome in the Young Boost Breast Trial.

PURPOSE: To investigate which factors are related to patient reported cosmetic outcome (PRCO) after breast conserving therapy. METHODS: From 2004 to 2011, 2421 cT1-2N0-2a breast cancer patients were randomised in the Young Boost Trial between a 16 and a 26Gy boost to the tumour bed. Cosmesis was scored subjectively by the patient and physician, and objectively using BCCT.core, at baseline, one and four years after treatment. Presence of fibrosis, QoL and rib pain at four years were also scored. Data were complete for 864 patients. The relation between the separate components was investigated using a proportional odds model. RESULTS: Of the 7 BCCT.core parameters, the distance from nipple to inframammary fold and the length of the breast contour were significantly related to the overall PRCO at four years. Patients with more fibrosis and poorer QoL scored their cosmesis worse, while rib pain was not related. The agreement between the different scores was low (kappa 0.26-0.42). CONCLUSION: The distance from nipple to inframammary fold, the length of the breast contour and the severity of fibrosis were the main factors related to patient-reported cosmetic outcome. Patients with better QoL scored their cosmesis better.

Field efficacy of furfural as a nematicide on turf.

A commercial formulation of furfural was recently launched in the United States as a turfgrass nematicide. Three field trials evaluated efficacy of this commercial formulation on dwarf bermudagrass putting greens infested primarily with Belonolaimus longicaudatus, Meloidogyne graminis, or both these nematodes, and in some cases with Mesocriconema ornatum or Helicotylenchus pseudorobustus. In all these trials, furfural improved turf health but did not reduce population densities of B. longicaudatus, M. graminis, or the other plant-parasitic nematodes present. In two additional field trials, efficacy of furfural at increasing depths in the soil profile (0 to 5 cm, 5 to 10 cm, and 10 to 15 cm) against B. longicaudatus on bermudagrass was evaluated. Reduction in population density of B. longicaudatus was observed in furfural-treated plots for depths below 5 cm on several dates during both trials. However, no differences in population densities of B. longicaudatus were observed between the furfural-treated plots and the untreated control for soil depth of 0 to 5 cm during either trial. These results indicate that furfural applications can improve health of nematode-infested turf and can reduce population density of plant-parasitic nematodes in turf systems. Although the degree to which turf improvement is directly caused by nematicidal effects is still unclear, furfural does appear to be a useful nematode management tool for turf.

Factors affecting furfural as a nematicide on turf.

Recently a furfural nematicide Multiguard Protect EC was launched for use on turfgrasses in the United States. A series of greenhouse experiments were conducted to determine the concentration and exposure time required for this formulation to irreversibly affect Belonolaimus longicaudatus, and to study factors that might affect the practicality of furfural use in turfgrass systems. One experiment exposed B. longicaudatus to increasing concentrations of furfural (0 to 990 ppm) in vitro for either 24 or 48 hr, followed by inoculation onto bermudagrass. A second experiment evaluated effects of exposure of B. longicaudatus to increasing concentrations of furfural in soil solution on bermudagrass with or without an organic thatch layer. A third experiment evaluated effects on B. longicaudatus of increasing concentrations of furfural applied as a spray treatment to creeping bentgrass. Results from the in vitro exposure experiment found decreasing numbers of B. longicaudatus with increasing furfural concentration beginning with the lowest concentration tested (270 ppm). Belonolaimus longicaudatus were virtually eliminated with furfural concentrations ≥ 720 ppm. Similarly, exposure to increasing concentration of furfural in soil solution resulted in increasing reduction in numbers of B. longicaudatus. Presence of thatch slightly reduced the population density of B. longicaudatus. Spray application of furfural only reduced numbers of B. longicaudatus at the two highest rates (3,600 and 4,950 ppm).

Comparison of Water Displacement and WinRHIZO Software for Plant Root Parameter Assessment.

Water-displacement and WinRHIZO root-scanning methods were compared for efficacy of root damage assessment. Results from both methods were similar and a highly significant relationship was found between the two methods in trial one (r2 = 0.9968, P < 0.0001) and trial two (r2 = 0.9988, P < 0.0001). Both protocols provide consistent root volume measurements; however, water displacement is preferred as an economical method if a quick evaluation of a large amount of roots is essential. For a more detailed root morphological and architectural analysis, WinRHIZO root scanning provides additional information about several root parameters that cannot be measured by simple water displacement.

Effects of Belonolaimus longicaudatus Management and Nitrogen Fertility on Turf Quality of Golf Course Fairways.

Field experiments evaluated the effects of nematicide and fertility on performance of 'Tifway 419' bermudagrass parasitized by the sting nematode (Belonolaimus longicaudatus). Plot treatments were nontreated or nematicide (1,3-dichloropropene) treated combined with different nitrogen (N) fertilizer levels. Effects of treatments on numbers of B. longicaudatus and turf performance were compared. Nematicide consistently reduced numbers of B. longicaudatus, but fertilizer level had no effect on B. longicaudatus. Turf performance of nematicide-treated plots was improved compared with nontreated plots during both experiments. Increasing N fertilizer level improved turf performance in nematicide-treated plots in some cases, but had no effect on turf performance in nontreated plots in either experiment. Results suggest that increasing N fertilizer levels may not improve turf performance at sites infested with B. longicaudatus unless nematode management tactics are effective in reducing nematode densities.

Influence of Belonolaimus longicaudatus on Nitrate Leaching in Turf.

Experiments were conducted to quantify the effects of the sting nematode (Belonolaimus longicaudatus) on root reductions and quantity of nitrate (NO(3) (-)) leached from 'Tifdwarf' bermudagrass in lysimeters. Forty lysimeters were planted with 'Tifdwarf' bermudagrass, of which 20 were inoculated with B. longicaudatus and 20 were noninoculated. Root length was compared between treatments at six, 12, and 18 weeks after initiation of the experiments. Turf was fertilized every three weeks, and leaching events were simulated at 21 and 42-day intervals in trial one and trial two, respectively. Leachate was collected, and the quantity of NO(3) (-) leached was compared between treatments. Root reductions were observed in lysimeters inoculated with B. longicaudatus at all evaluation dates. Quantity of NO(3) (-) leached was greater in inoculated lysimeters at the 18-week evaluation during both trials. This study indicates that nematode damage to turf roots limits root vigor and N uptake, thereby increasing nitrate leaching, adding to water quality concerns.