The Impact of Frailty Screening on Radiation Treatment Modification.

BACKGROUND: Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. METHODS: Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. RESULTS: Of 161 patients; 69.4% were male, the median age was 75 years (range 65-91), and the prevailing performance status (PS) was 0-1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. CONCLUSIONS: CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.

Nomogram for the personalisation of radiotherapy treatments in breast cancer patients.

INTRODUCTION: Numerous prospective studies have shown that the incorporation of genomic assays into clinical practice significantly impacts the choice of adjuvant treatments for patients with early-stage breast cancer. However, the same evidence does not exist for the treatment of locoregional recurrences. HYPOTHESIS AND OBJECTIVES: The main objective of this work was to identify the clinicopathological, molecular, and genetic parameters that allow patients to be more precisely categorised into risk groups, in order to create a locoregional recurrence riskclassification tool, the PersonalRT27. MATERIAL AND METHODS: To create PersonalRT27, we retrospective assessed the variables of patients with early breast cancer (stages I or II) who had undergone the OncotypeDx ® and MammaPrint ® genetic tests. These variables and factors included in the tests were categorised and weighted to obtain scores between 1 and 5 pointsto represent a lower or higher risk of relapse, respectively, based on these factors and as determined by the researchers. RESULTS: The mean follow-up time was 60.5 months (range 25-96 months); locoregional progression-free survival at the time of the analysis was 98.4%, and overall survival was 97.5%, of which 0.6% of the deaths had been cancer specific. The area under the curve for the PersonalRT27 was 0.76 (95% CI [0.70, 0.81]), sensitivity was 78%, and the specificity was 58.9%. We used these factors to create an inhospital web-based nomogram. CONCLUSIONS: The PersonalRT27 is a novel tool that integrates clinical-pathological, molecular, and genetic parameters. External and independent validation will be required to implement its clinical use.

OPTimizing Irradiation through Molecular Assessment of Lymph node (OPTIMAL): a randomized open label trial.

BACKGROUND: Conservative surgery followed by breast and nodal irradiation is the standard loco-regional early breast cancer (BC) treatment for patients with four or more involved lymph nodes. However, the treatment strategy when fewer nodes are involved remains unclear, especially when lymphadenectomy has not been performed. Sensitive nodal status assessment molecular techniques as the One-Step Nucleic Acid Amplification (OSNA) assay can contribute to the definition and standardization of the treatment strategy. Therefore, the OPTIMAL study aims to demonstrate the feasibility of incidental irradiation of axillary nodes in patients with early-stage BC and limited involvement of the SLN. METHODS: BC patients who underwent conservative surgery and whose SLN total tumour load assessed with OSNA ranged between 250-15,000 copies/µL will be eligible. Patients will be randomized to receive irradiation on the breast, tumour bed, axillary and supraclavicular lymph node areas (intentional arm) or only on the breast and tumour bed (incidental arm). All areas, including the internal mammary chain, will be contoured. The mean, median, D5% and D95% doses received in all volumes will be calculated. The primary endpoint is the non-inferiority of the incidental irradiation of axillary nodes compared to the intentional irradiation in terms of 5-year disease free survival. Secondary endpoints comprise the comparison of acute and chronic toxicity and loco-regional and distant disease recurrence rates. DISCUSSION: Standardizing the treatment and diagnosis of BC patients with few nodes affected is crucial due to the lack of consensus. Hence, the quantitative score for the metastatic burden of SLN provided by OSNA can contribute by improving the discrimination of which BC patients with limited nodal involvement can benefit from incidental radiation as an adjuvant treatment strategy. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02335957; https://clinicaltrials.gov/ct2/show/NCT02335957.

Contribution of hypoxia-measuring molecular imaging techniques to radiotherapy planning and treatment.

Hypoxia is related to poor prognosis because it is associated to chemo- and radioresistance. During recent years the evolution of imaging methods like PET/CT and MRI has meant the appearance of new perspectives with direct implications in radiation therapy. We discuss previous experiences in staging, planning and in the follow-up process with these techniques for measuring tumour hypoxia.

[Single fraction boost with high dose rate interstitial brachytherapy in conservative treatment of breast carcinoma]. / Sobreimpresión en fracción única con braquiterapia intersticial de alta tasa en el tratamiento conservador del carcinoma de mama.

INTRODUCTION: We evaluated the effectiveness of interstitial high dose rate brachytherapy as a single fraction boost to the surgical bed in patients with breast cancer undergoing conservative treatment. The comparison was with the alternative of electron boost. MATERIALS AND METHODS: Between April 1999 and December 2000, we conducted a prospective study of 84 patients with infiltrative breast carcinoma treated with conservative surgery, with free margins. This was followed by external radiotherapy to the breast of up to 46 Gy and one application of brachytherapy with needles inserted into the surgical bed, and administering 7 Gy to 90% with high dose rate (HDR). RESULTS: With a mean follow-up of 43 months, only one patient had therapeutic failure in the implant area, and local control was 98.5%. Another patient had a 2nd tumour in a different quadrant and 3 developed metastasis. Survival at 5 years was 98.7%. Acute toxicity was minimal, with excellent or good cosmetic appearance in 95%. CONCLUSIONS: Brachytherapy with high dose rate as single fraction boost in conservative treatment of breast carcinoma is simple, fast, well tolerated, with excellent local control, good cosmetic appearance, and with minimal late-onset toxicity.

Sobreimpresión en fracción única con braquiterapia intersticial de alta tasa en el tratamiento conservador del carcinoma de mama / Single fraction boost with high dose rate interstitial brachytherapy in conservative treatment of breast carcinoma

Introducción. Evaluamos la eficacia de la sobreimpresión del lecho quirúrgico con braquiterapia intersticial de alta tasa de dosis, en fracción única en pacientes con cáncer de mama, tratadas con tratamiento conservador, como alternativa a la sobreimpresión con electrones. Material y métodos. Entre abril de 1999 y diciembre de 2000, hemos realizado un estudio prospectivo sobre 84 pacientes con carcinoma infiltrante de mama sometidas a cirugía conservadora, con márgenes libres, seguida de radioterapia externa sobre la mama hasta 46 Gy y una aplicación de braquiterapia con agujas en el lecho quirúrgico, dando 7 Gy al 90% con alta tasa. Resultados. Con un seguimiento medio de 43 meses, sólo una paciente ha recaído en zona de implante siendo el control local del 98,5%. Otra paciente presentó un segundo tumor en un cuadrante distinto y tres desarrollaron metástasis. La supervivencia a 5 años es del 98,7%. La toxicidad aguda ha sido mínima, con estética excelente o buena en el 95%. Conclusiones. La braquiterapia con alta tasa en fracción única, como sobreimpresión en el tratamiento conservador del cáncer de mama, es bien tolerada, sencilla y rápida, consiguiendo un control local excelente, con buen resultado estético y una mínima toxicidad tardía

Introduction. We evaluated the effectiveness of interstitial high dose rate brachytherapy as a single fraction boost to the surgical bed in patients with breast cancer undergoing conservative treatment. The comparison was with the alternative of electron boost. Materials and methods. Between April 1999 and December 2000, we conducted a prospective study of 84 patients with infiltrative breast carcinoma treated with conservative surgery, with free margins. This was followed by external radiotherapy to the breast of up to 46 Gy and one application of brachytherapy with needles inserted into the surgical bed, and administering 7 Gy to 90% with high dose rate (HDR). Results. With a mean follow-up of 43 months, only one patient had therapeutic failure in the implant area, and local control was 98.5%. Another patient had a 2nd tumour in a different quadrant and 3 developed metastasis. Survival at 5 years was 98.7%. Acute toxicity was minimal, with excellent or good cosmetic appearance in 95%. Conclusions. Brachytherapy with high dose rate as single fraction boost in conservative treatment of breast carcinoma is simple, fast, well tolerated, with excellent local control, good cosmetic appearance, and with minimal late-onset toxicity