Table of Contents
1
UI - 11370490
AU - Mendenhall NP
TI -
Breast-conserving therapy for early-stage breast cancer.
SO - Hematol Oncol Clin North Am 2001 Apr;15(2):219-42
AD - Department of Radiation Oncology, University of Florida College of
Medicine, Gainesville, Florida, USA. mendenan@shands.ufl.edu
In most other organs (extremities, bladder, rectum, larynx, or eye), the
acceptance of organ-conserving therapy into standard oncologic practice
has required only the demonstration of feasibility and efficacy--not
equivalency with the radical surgical alternative. BCT was not generally
accepted as standard oncologic practice until the maturation of numerous
prospective randomized trials that universally demonstrated equivalence
in disease control outcomes and survival with mastectomy. In fact, the
acceptance of BCT as standard therapy in many parts of the United States
actually lagged more than a decade behind sentinel publications
documenting proof of equivalency with mastectomy. Even today,
investigators continue to search for a subset of breast cancer patients
who will have better disease control with radical surgery. BCT stands as
not only the best-studied example of organ-conserving therapy but one of
the most rigorously tested therapies in all of medicine.
Breast-conserving therapy requires a multidisciplinary approach with
close coordination among team members from diagnosis through
surveillance following treatment. The surgeon must be willing to assess
and re-excise margins, to mark the tumor bed with clips, and to use
sentinel node biopsy in appropriate patients. The radiation oncologist
must be willing to use CT planning, paying close attention not only to
coverage of target tissues but to avoidance of critical normal tissues.
The medical oncologist must work closely with the surgeon and radiation
oncologist to determine the optimal sequencing of therapies and
selection of systemic agents. All must recognize special circumstances
where genetic counselling may be beneficial, psychosocial support may be
needed, or BCT may not be the best choice for patients. When used
appropriately, BCT produces maximal disease control and quality of life
while minimizing iatrogenic functional, cosmetic, and psychologic
sequelae in patients with early-stage breast cancer. BCT serves as a
model for the optimal combination of surgery and radiation in
organ-preserving cancer therapy.
2
UI - 11452820
AU - Odantini R; Mazzitelli R; Bellia SR; Di Pietro A; al Sayyad S; Capua A
TI -
[Intraoperative electron radiotherapy (IOERT) in the QUART sequence: a
phase I study]
SO - Chir Ital 2001 May-Jun;53(3):349-54
AD - Unita Operativa di Radioterapia Oncologica, Azienda Ospedaliera
Bianchi-Melacrino-Morelli, Reggio Calabria.
We evaluated the tolerance of a single dose of 800-1500 cGy, delivered
with an electron beam from an IOERT-dedicated linear accelerator to the
tumour bed in patients with breast cancer undergoing conservative
treatment, instead of the traditional boost. We enrolled 27 patients
(cT1-2, cN0). The first 6 received a dose of 800 cGy, 6 1000 cGy, 10
1200 cGy and 5 1500 cGy. External beam radiation therapy (EBRT) with a
conventional schedule, 4000 cGy total dose, was performed after wound
healing. The median gap between IOERT and EBRT was 8 weeks. Three
patients with adverse prognostic factors undergoing chemotherapy,
including doxorubicin or taxanes, received EBRT after completion of
chemotherapy. One patient with a prosthesis implant had yielding of the
surgical scar 8 months after IOERT (after 4 cycles of doxorubicin and 4
cycles of CMF complicated by frequent mastitis). Another patient with a
large serum collection in the axilla manifested delayed scar formation.
In the others no significant increase in healing time or surgery-related
morbidity was observed. Another 4 patients developed mastitis. The
cosmetic outcome was good in 26/27 patients. This treatment is well
tolerated at all IOERT doses delivered. In the follow-up, to date, there
have been no local relapses.
3
UI - 11474944
AU - Partridge M; Aldridge S; Donovan E; Evans PM
TI -
An intercomparison of IMRT delivery techniques: a case study for breast
treatment.
SO - Phys Med Biol 2001 Jul;46(7):N175-185
AD - Joint Department of Physics, The Institute of Cancer Research and The
Royal Marsden NHS Trust, Sutton, UK. m.partridge@physics.org
Intensity-modulated radiotherapy beams can be delivered using a
multileaf collimator by one of two methods: either by superposition of a
series of multiple-static fields, or by moving the collimators while the
beam is on to produce 'dynamically' modulated beams. The leaf
trajectories in this dynamic mode are given by a series of linear steps
between control points defining each collimator position at known
intervals throughout an exposure. The complexity of the resulting
modulation is limited in the first case by the number of fields
superposed and in the second case by the number of control points
defined. Results are presented for an experimental study that
investigates the effect of changing both the number of fields for the
multiple-static technique, and the number of control points for a
dynamic 'close-in' technique. All deliveries studied are clinical
intensity-modulated breast fields. The effect of using a universal wedge
in conjunction with the multileaf collimator is also studied, together
with a comparison of the relative efficiency, time taken and the
absolute dosimetric accuracy of the various delivery options. It is
shown that all delivery techniques produce equivalent dose distributions
when using 15 control points, with 10 control points being sufficient to
produce an adequate breast compensator distribution. Except for the case
of a four-control-point dynamic delivery, the universal wedge makes no
significant difference to the dose distribution. However, it makes the
delivery less efficient. The close-in interpreter consistently produces
deliveries that are more efficient than the more conventional
sliding-window technique and faster than the multiple-static-field
technique. Finally the close-in technique is compared to the more
'standard' leaf-sweep technique and shown to be equivalent.
4
UI - 11527290
AU - Dodwell D; Horgan K
TI -
Breast cancer: locoregional control and survival.
SO - Clin Oncol (R Coll Radiol) 2001;13(3):172-3
AD - Breast Unit, Leeds Cancer Centre, Leeds General Infirmary, UK.
5
UI - 11595118
AU - Sartor CI
TI -
Postmastectomy radiotherapy in women with breast cancer metastatic to
one to three axillary lymph nodes.
SO - Curr Oncol Rep 2001 Nov;3(6):497-505
AD - Department of Radiation Oncology and Lineberger Comprehensive Cancer
Center, University of North Carolina School of Medicine, Chapel Hill, NC
27599, USA. sartor@radonc.unc.edu
The influence of postmastectomy radiotherapy on survival has long been
debated. Early randomized trials established a clear role for adjuvant
postmastectomy chest wall radiotherapy (PMCWRT) in reducing locoregional
recurrence (LRR), and PMCWRT became standard therapy for patients at
high risk of LRR: those with T3 or T4 tumors and four or more involved
lymph nodes. However, without effective systemic therapy, distant
metastases limited any effect of improved local control on overall
outcome, and radiotherapy showed no benefit in survival. In fact, early
meta-analyses showed a negative impact of radiotherapy on survival. As
data and techniques matured, a favorable influence of PMCWRT on breast
cancer-specific mortality emerged but was offset by a
radiotherapy-related increase in vascular mortality. Improvements in
radiotherapy delivery to increase efficacy and reduce toxicity,
restriction of PMCWRT to patients at intermediate or high risk of LRR
after mastectomy, and improved distant control of disease with systemic
therapy are expected to bring the greatest likelihood of a survival
advantage from locoregional control. Three randomized trials with
sufficient follow-up meet these criteria. All demonstrate significant
improvement in overall survival with PMCWRT. However, the trials were
not designed to specifically address the benefit of PMCWRT in patients
at intermediate risk of LRR (those with T1 or T2 tumors and one to three
involved lymph nodes). These findings have been discussed in a host of
publications and conferences in light of historical negative results.
This review focuses on the recent data on PMCWRT in patients with one to
three involved nodes.
6
UI - 11597808
AU - Schlembach PJ; Buchholz TA; Ross MI; Kirsner SM; Salas GJ; Strom EA;
TI -
McNeese MD; Perkins GH; Hunt KK
Relationship of sentinel and axillary level I-II lymph nodes to
tangential fields used in breast irradiation.
SO - Int J Radiat Oncol Biol Phys 2001 Nov 1;51(3):671-8
AD - Department of Radiation Oncology, University of Texas M. D. Anderson
Cancer Center, Houston, TX 77030, USA.
PURPOSE: To evaluate the volume of nodal irradiation associated with
breast-conserving therapy, we defined the anatomic relationship of
sentinel lymph nodes and axillary level I and II lymph nodes in patients
receiving tangential breast irradiation. METHODS AND MATERIALS: A
retrospective analysis of 65 simulation fields in women with breast
cancer treated with sentinel lymph node surgery and 39 women in whom
radiopaque clips demarcated the extent of axillary lymph node dissection
was performed. We measured the relationship of the surgical clips to the
anatomic landmarks and calculated the percentage of prescribed dose
delivered to the sentinel lymph node region. RESULTS: A cranial field
edge 2.0 cm below the humeral head the sentinel lymph node region was
included or at the field edge in 95% of the cases and the entire extent
of axillary I and II dissection in 43% of the axillary dissection cases.
In the remaining 57%, this field border encompassed an average of 80% of
cranial/caudal extent of axillary level I and II dissection. In 98.5% of
the cases, all sentinel lymph nodes were anterior to the deep field edge
and 71% were anterior to the chest wall-interface, whereas 61% of the
axillary dissection cohort had extension deep to the chest wall-lung
interface. If the deep field edge had been set 2 cm below the chest
wall-lung interface, the entire axillary dissection would have been
included in 82% of the cases, and the entire sentinel lymph node would
have been covered with a 0.5-cm margin. The median dose to the sentinel
lymph node region was 98% of the prescribed dose. CONCLUSIONS: By
extending the cranial border to 2 cm below the humeral head and 2 cm
deep to the chest wall-lung interface, the radiotherapy fields used to
treat the breast can include the sentinel lymph node region and most of
axillary levels I and II.
7
UI - 11597809
AU - Fowble B; Hanlon A; Freedman G; Nicolaou N; Anderson P
TI -
Second cancers after conservative surgery and radiation for stages I-II
breast cancer: identifying a subset of women at increased risk.
SO - Int J Radiat Oncol Biol Phys 2001 Nov 1;51(3):679-90
AD - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia,
PA 19111, USA.
PURPOSE: To assess the risk and patterns of second malignancy in a group
of women treated with conservative surgery and radiation in a relatively
contemporary manner for early-stage invasive breast cancer, and to
identify a subgroup of these women at increased risk for a second
cancer. METHODS AND MATERIALS: From 1978 to 1994, 1,253 women with
unilateral Stage I-II breast cancer underwent wide excision, axillary
dissection, and radiation. The median follow-up was 8.9 years, with 446
patients followed for >or= 10 years. The median age was 55 years.
Sixty-eight percent had T1 tumors and 74% were axillary-node negative.
Radiation was directed to the breast only in 78%. Adjuvant therapy
consisted of chemotherapy in 19%, tamoxifen in 19%, and both in 8%.
Factors analyzed for their association with the cumulative incidence of
all second malignancies, contralateral breast cancer, and non-breast
cancer malignancy were: age, menopausal status, race, family history,
obesity, smoking, tumor size, location, histology, pathologic nodal
status, region(s) treated with radiation, and the use and type of
adjuvant therapy. RESULTS: One hundred seventy-six women developed a
second malignancy (87 contralateral breast cancers at a median interval
of 5.8 years, and 98 non-breast cancer malignancies at a median interval
of 7.2 years). Nine women had both a contralateral breast cancer and
non-breast cancer second malignancy. The 5- and 10-year cumulative
incidences of a second malignancy were 5% and 16% for all cancers, 3%
and 7% for contralateral breast cancer, 3% and 8%, for all second
non-breast cancer malignancies, and 1% and 5%, respectively, for second
non-breast cancer malignancies, excluding skin cancers. Patient age was
a significant factor for contralateral breast cancer and non-breast
cancer second malignancy. Young age was associated with an increased
risk of contralateral breast cancer, while older age was associated with
an increased the risk of a second non-breast cancer second malignancy. A
positive family history increased the risk of contralateral breast
cancer, but not non-breast cancer malignancies. The risk of a
contralateral breast cancer increased as the number of affected
relatives increased. Tamoxifen resulted in a nonsignificant decrease in
contralateral breast cancer and an increase in non-breast cancer second
malignancies. The 5-and 10-year cumulative incidences for leukemia and
lung cancer were 0.08% and 0.2%, and 0.8% and 1%, respectively. There
was no significant effect of chemotherapy or the regions treated with
radiation on contralateral breast cancer or non-breast cancer second
malignancy. The most common types of second non-breast cancer
malignancies were skin cancers, followed by gynecologic malignancies
(endometrial), and gastrointestinal malignancies (colorectal and
pancreas). CONCLUSION: The 10-years cumulative incidence of a second
cancer in this study was 16%. Young age and family history predicted for
an increased risk of contralateral breast cancer, and older age
predicted for an increased risk of non-breast cancer malignancy. The
majority of patients treated with conservative surgery and radiation
with or without adjuvant systemic therapy will not develop a second
cancer. Long-term follow-up is important to document the risk and
patterns of second cancer, and knowledge of this risk and the patterns
will influence surveillance and prevention strategies.
8
UI - 11597810
AU - Geinitz H; Zimmermann FB; Stoll P; Thamm R; Kaffenberger W; Ansorg K;
TI -
Keller M; Busch R; van Beuningen D; Molls M
Fatigue, serum cytokine levels, and blood cell counts during
radiotherapy of patients with breast cancer.
SO - Int J Radiat Oncol Biol Phys 2001 Nov 1;51(3):691-8
AD - Klinik und Poliklinik fur Strahlentherapie und Radiologische Onkologie,
Technische Universitat Munchen, Munchen, Germany.
hans.geinitz@lrz.tu-muenchen.de
PURPOSE: To assess the level of fatigue during the course of adjuvant
radiotherapy (RT) of breast cancer patients and its relation to anxiety,
depression, serum cytokines, and blood count levels. METHODS AND
MATERIALS: Forty-one patients who received adjuvant RT after
breast-conserving surgery were prospectively studied. All patients
underwent RT without concomitant chemotherapy. Patients rated their
fatigue with two standardized self-assessment instruments, the Fatigue
Assessment Questionnaire and a visual analog scale on fatigue intensity,
before RT, during weeks 1-5 of RT, and 2 months after RT completion. In
addition, the anxiety and depression levels were assessed with the
Hospital Anxiety and Depression Scale. A differential blood cell count
and the serum levels of the cytokines interleukin (IL)-1beta, IL-6, and
tumor necrosis factor-alpha were determined in parallel to the fatigue
assessments. RESULTS: Fatigue intensity as assessed with the visual
analog scale increased (p <0.001) until treatment week 4 and remained
elevated until week 5. Two months after RT, the values had fallen to the
pretreatment levels. Fatigue measured with the Fatigue Assessment
Questionnaire did not increase significantly during treatment, but the
subscores on physical (p = 0.035) and cognitive (p = 0.015) fatigue were
elevated during treatment weeks 4 and 5. Affective fatigue did not
change significantly. Anxiety, as rated with the Hospital Anxiety and
Depression Scale, declined during RT (p = 0.002), but the Hospital
Anxiety and Depression Scale depression score did not change
significantly. IL-1beta, IL-6, and tumor necrosis factor-alpha levels
did not change during therapy and did not correlate with fatigue.
Peripheral blood cell levels declined significantly during therapy and
were still low 2 months after treatment. Until treatment week 5,
lymphocytes were reduced to almost 50% of their initial values.
Hemoglobin levels did not correlate with fatigue. CONCLUSIONS: We
observed an increase in fatigue during adjuvant RT of patients with
breast cancer. Fatigue returned to pretreatment levels 2 months after
treatment. No evidence was found that anxiety, depression, serum levels
of IL-1beta, IL-6, tumor necrosis factor-alpha, or declining hemoglobin
levels were responsible for the treatment-induced fatigue.
9
UI - 11641016
AU - McCormick B; Strom E; Craighead PS; Kuske R; Hudis C; Ley J; Margolis L;
TI -
Meyerwitz B; Morris E; Petrek J; Pierce L; Pisansky T; Rabinovitch R;
Sneige N; Vicini F; Unger D; Winter K; Radiation Therapy Oncology Group
Radiation Therapy Oncology Group. Research Plan 2002-2006. Breast Cancer
Working Group.
SO - Int J Radiat Oncol Biol Phys 2001;51(3 Suppl 2):56-7
10
UI - 11673682
AU - Zellars R; Frassica D
TI -
Radiation therapy in the management of breast cancer: an annual review
of selected publications.
SO - Curr Opin Oncol 2001 Nov;13(6):431-5
AD - Johns Hopkins Oncology Center, Lutherville, Maryland 21093, USA.
Radiation oncology is essential in the management of breast cancer. Each
year the scientific literature is replete with evidence of radiation's
role in the treatment of this disease. The goal of this article is to
motivate the reader to discuss and critically review some of these
publications. The authors have made a subjective selection of clinical
publications addressing radiation and breast cancer from the past 13
months. Articles were chosen on the basis of their ability to influence
both current and future therapy. Some readers will no doubt disagree
with our choices; however, if this disappointment generates discussion
and review of these and other articles, we have achieved our goal.
11
UI - 11677099
AU - Bartelink H
TI -
Commentary on the paper "A preliminary report of intraoperative
radiotherapy (IORT) in limited-stage breast cancers that are
conservatively treated". A critical review of an innovative approach.
SO - Eur J Cancer 2001 Nov;37(17):2143-6
AD - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The
Netherlands. hbart@nki.nl
12
UI - 11677104
AU - Veronesi U; Orecchia R; Luini A; Gatti G; Intra M; Zurrida S; Ivaldi G;
TI -
Tosi G; Ciocca M; Tosoni A; De Lucia F
A preliminary report of intraoperative radiotherapy (IORT) in
limited-stage breast cancers that are conservatively treated.
SO - Eur J Cancer 2001 Nov;37(17):2178-83
AD - Radiotherapy Division, Istituto Europeo di Oncologia, University of
Milan, Via G. Ripamonti 435, 20141 Milan, Italy. umberto.veronesi@ieo.it
Local recurrences after breast conserving surgery occur mostly in the
quadrant harbouring the primary carcinoma. The main objective of
postoperative radiotherapy should be the sterilisation of residual
cancer cells in the operative area, while irradiation of the whole
breast may be avoided. We have developed a new technique of
intra-operative radiotherapy (IORT) of a breast quadrant after the
removal of the primary carcinoma. A mobile linear accelerator (linac)
with a robotic arm is utilised delivering electron beams able to produce
energies from 3 to 9 MeV. Through a perspex applicator, the radiation is
delivered directly to the mammary gland and to spare the skin from the
radiation, the skin margins are stretched out of the radiation field. To
protect the thoracic wall, an aluminium-lead disc is placed between the
gland and the pectoralis muscle. Different dose levels were tested from
10 to 21 Gy without important side-effects. We estimated that a single
fraction of 21 Gy is equivalent to 60 Gy delivered in 30 fractions at 2
Gy/fraction. Seventeen patients received a dose of IORT of 10 to 15 Gy
as an anticipated boost to external radiotherapy, while 86 patients
received a dose of 17-19-21 Gy intra-operatively as their whole
treatment. The follow-up time of the 101 patients varied from 1 to 17
months (mean follow-up time was 8 months). The IORT treatment was very
well accepted by all of our patients, either due to the rapidity of the
radiation course in cases where IORT was given as the whole treatment or
to the shortening of the subsequent external radiotherapy in cases where
IORT was given as an anticipated boost. We believe that single dose IORT
after breast resection for small mammary carcinomas may be an excellent
alternative to the traditional postoperative radiotherapy. However, a
longer follow-up is needed for a better evaluation of the possible late
side-effects.
13
UI - 11680014
AU - Dunst J; Steil B; Furch S; Fach A; Lautenschlager C; Diestelhorst A;
TI -
Lampe D; Kolbl H; Richter C
Prognostic significance of local recurrence in breast cancer after
postmastectomy radiotherapy.
SO - Strahlenther Onkol 2001 Oct;177(10):504-10
AD - Department of Radiotherapy, Martin-Luther-University Halle-Wittenberg,
Germany. juergen.dunst@medizin.uni-halle.de
PURPOSE: We have retrospectively analyzed the impact of local recurrence
in patients with adjuvant radiation therapy after mastectomy for breast
959 patients were irradiated after mastectomy for breast cancer. The age
ranged from 34 to 79 years, the median follow-up was 3.1 years (range:
0.3-12.2 years). 368 (38%) were pre- and 591 (62%) postmenopausal. 35%
had T3-4 tumors, 62% had axillary lymph node involvement, and 66%
received additional systemic hormonal and/or cytotoxic therapy.
Postmastectomy radiotherapy was administered in case of positive
axillary nodes and in high-risk pN0-patients. The chest wall and
lymphatics (axilla, parasternal and supraclavicular nodes) were
irradiated with an anterior photon field with 50 Gy and the chest wall
with an electron field with 44 Gy in 2-Gy fractions. RESULTS: The
overall survival was 70.5% after 5 and 59.8% after 10 years. 53 patients
(5.5%) developed a locoregional recurrence 2-96 months after treatment
(median 26 months). The local control rate was 92.7% after 5 and 86.4%
after 10 years. Axillary lymph node involvement was the most important
and (in a multivariate analysis the only) risk factor for local
recurrence (p = 0.0001). Patients with local control had a significantly
better 10-year distant-disease-free survival and overall survival as
compared to patients with local recurrence (44.5% vs 15.4%, p = 0.002
and 62.1% vs 34.8%, p = 0.004). Local recurrence increased the risk of
death by a factor of 1.7 and in a Cox regression model, axillary lymph
node status, T-category and local recurrence were significant prognostic
factors for overall survival. In patients with local recurrence, the
initial axillary lymph node status was the most important prognostic
factor for survival after local recurrence. The 3-year survival after
local relapse was 86% for patients with pN0 status vs 27% in with
positive axillary nodes (p = 0.025). CONCLUSIONS: Local recurrence after
treatment of breast cancer with mastectomy + radiotherapy +/- systemic
therapy is associated with a significantly higher risk of distant
metastases and death. In this analysis, local recurrence was a strong
and, besides lymph node status and T category, an independent risk
factor for survival. Minimizing the risk of local recurrence is
therefore an essential goal of a curative treatment concept.
14
UI - 11680015
AU - Horst E; Schuck A; Moustakis C; Schaefer U; Micke O; Kronholz HL;
TI -
Willich N
CT simulation in nodal positive breast cancer.
SO - Strahlenther Onkol 2001 Oct;177(10):511-6
AD - Department of Radiation Oncology, University of Munster, Germany.
horste@uni-muenster.de
BACKGROUND: A variety of solutions are used to match tangential fields
and opposed lymph node fields in irradiation of nodal positive breast
cancer. The choice is depending on the technical equipment which is
available and the clinical situation. The CT simulation of a
non-monoisocentric technique was evaluated in terms of accuracy and
reproducibility. PATIENTS, MATERIAL AND METHODS: The field match
parameters were adjusted virtually at CT simulation and were compared
with parameters derived mathematically. The coordinate transfer from the
CT simulator to the conventional simulator was analyzed in 25
consecutive patients. RESULTS: The angles adjusted virtually for a
geometrically exact coplanar field match corresponded with the angles
calculated for each set-up. The mean isocenter displacement was 5.7 mm
and the total uncertainty of the coordinate transfer was 6.7 mm (1 SD).
Limitations in the patient set-up became obvious because of the steep
arm abduction necessary to fit the 70 cm CT gantry aperture. Required
modifications of the arm position and coordinate transfer errors led to
a significant shift of the marked matchline of > 1.0 cm in eight of 25
patients (32%). CONCLUSION: The virtual CT simulation allows a precise
and graphic definition of the field match parameters. However,
modifications of the virtual set-up basically due to technical
limitations were required in a total of 32% of cases, so that a hybrid
technique was adapted at present that combines virtual adjustment of the
ideal field alignment parameters with conventional simulation.
15
UI - 11680022
AU - Sack H
TI -
[Risk factors for local recurrence and distant metastases after breast
conserving therapy of ductal carcinoma in situ]
SO - Strahlenther Onkol 2001 Oct;177(10):557
16
UI - 11680023
AU - Ott O; Strnad V
TI -
[Only interstitial brachytherapy of the tumor bed as an alternative to
teletherapy in selected breast cancer patients]
SO - Strahlenther Onkol 2001 Oct;177(10):558-9
17
UI - 11688159
AU - van Buuren F; Kelbel C; Tan KH; Bohm E; Lorenz J
TI -
[Contralateral pulmonary infiltrates after percutaneous thorax
irradiation in a 61-year old female patient with breast carcinoma]
SO - Internist (Berl) 2001 Oct;42(10):1418-21
AD - Abteilung fur Pneumologie, Intensivmedizin, Infektiologie und
Schlafmedizin, Kreiskrankenhaus Ludenscheid.
18
UI - 11693749
AU - Beckman JA; Thakore A; Kalinowski BH; Harris JR; Creager MA
TI -
Radiation therapy impairs endothelium-dependent vasodilation in humans.
SO - J Am Coll Cardiol 2001 Mar 1;37(3):761-5
AD - Department of Medicine, Brigham and Women's Hospital, Boston,
Massachusetts 02115, USA.
OBJECTIVES: The objective of this study was to test the hypothesis that
external-beam radiation induces a chronic impairment of
endothelium-dependent vasodilation. BACKGROUND: Radiation therapy is
used commonly in the treatment of cancer and is associated with an
increased incidence of adverse vascular events related to the field of
radiation, including stroke and myocardial infarction. As endothelial
injury is central to the pathogenesis of vascular diseases, we
hypothesized that radiotherapy induces arterial endothelial dysfunction.
METHODS: Sixteen women with unilateral breast cancer who underwent
standard external-beam radiation therapy to the breast and axilla >3
years before enrollment and ten healthy women were studied. Vascular
ultrasonography was used to image both the artery exposed to radiation
and the contralateral artery. Flow-mediated, endothelium-dependent
vasodilation and endothelium-independent vasodilation to nitroglycerin
of both axillary arteries were measured. RESULTS: Endothelium-dependent
vasodilation was significantly impaired in the irradiated axillary
arteries compared with the contralateral, nonirradiated arteries (-0.4
+/- 0.4% vs. 3.2 +/- 0.8% p < 0.001) and also compared with control
subjects' arteries (-0.4 +/- 0.4% vs. 2.5 +/- 0.6%, p < 0.001). In
contrast, endothelium-independent vasodilation was greater in the
arteries that received radiation compared with the contralateral
arteries (3.8 +/- 0.5% vs. 2.0 +/- 0.4%, p < 0.05) and also compared
with control arteries (3.8 +/- 0.5% vs. 2.5 +/- 0.4%, p < 0.05).
CONCLUSIONS: External beam radiation therapy impairs
endothelium-dependent vasodilation of conduit arteries, implicating a
decrease in the bioavailability of nitric oxide. These abnormalities may
contribute to the development of arterial occlusive disease and
associated clinical events.
19
UI - 11708024
AU - Yamasaki M; Yayoi E; Kishibuchi M; Nishi T; Yagyu T; Kawasaki K;
TI -
Ostapenko V; Nishide T
[A case of locally advanced breast cancer treated with hyperthermia in
combination with radiotherapy]
SO - Gan To Kagaku Ryoho 2001 Oct;28(11):1746-8
AD - Dept. of Surgery, Kaizuka City Hospital.
A 59-year-old woman was admitted to our hospital because of massive
bleeding from a right breast tumor. The breast tumor had existed for ten
years occupied the entire right breast (23 x 20 cm), its central part
forming an ulcer 17 x 15 cm in size. Radiotherapy to the right breast
and medication with tamoxifen were started, after which five courses of
CMF chemotherapy were given. The tumor decreased to 16 x 14 cm, and
hyperthermia to the right breast was performed for a total of 87
ulcer caused the necrosis, and was sloughed off about one month after
hyperthermia. No viable tumor cells were observed in a biopsy taken at 5
months after the start of treatment (40 sessions). A total of 87
hyperthermia sessions were performed, and the ulcer disappeared. For 15
months after the end of hyperthermia, the patient showed a continuous
CR. Hyperthermia in combination with radiotherapy or chemotherapy for
breast cancer may produce a remarkable effect as in the present case,
and may become one choice for medical treatment of locally advanced or
recurrent breast cancer.
20
UI - 11704339
AU - Perkins GH; McNeese MD; Antolak JA; Buchholz TA; Strom EA; Hogstrom KR
TI -
A custom three-dimensional electron bolus technique for optimization of
postmastectomy irradiation.
SO - Int J Radiat Oncol Biol Phys 2001 Nov 15;51(4):1142-51
AD - Department of Radiation Oncology, University of Texas M. D. Anderson
Cancer Center, Houston, TX, USA.
PURPOSE: Postmastectomy irradiation (PMI) is a technically complex
treatment requiring consideration of the primary tumor location,
possible risk of internal mammary node involvement, varying chest wall
thicknesses secondary to surgical defects or body habitus, and risk of
damaging normal underlying structures. In this report, we describe the
application of a customized three-dimensional (3D) electron bolus
technique for delivering PMI. METHODS AND MATERIALS: A customized
electron bolus was designed using a 3D planning system. Computed
tomography (CT) images of each patient were obtained in treatment
position and the volume to be treated was identified. The distal surface
of the wax bolus matched the skin surface, and the proximal surface was
designed to conform to the 90% isodose surface to the distal surface of
the planning target volume (PTV). Dose was calculated with a pencil-beam
algorithm correcting for patient heterogeneity. The bolus was then
fabricated from modeling wax using a computer-controlled milling device.
To aid in quality assurance, CT images with the bolus in place were
generated and the dose distribution was computed using these images.
RESULTS: This technique optimized the dose distribution while minimizing
irradiation of normal tissues. The use of a single anterior field
eliminated field junction sites. Two patients who benefited from this
option are described: one with altered chest wall geometry (congenital
pectus excavatum), and one with recurrent disease in the medial chest
wall and internal mammary chain (IMC) area. CONCLUSION: The use of
custom 3D electron bolus for PMI is an effective method for optimizing
dose delivery. The radiation dose distribution is highly conformal, dose
heterogeneity is reduced compared to standard techniques in certain
suboptimal settings, and excellent immediate outcome is obtained.
21
UI - 11704323
AU - Gaffney DK; Leavitt DD; Tsodikov A; Smith L; Watson G; Patton G; Gibbs
TI -
FA; Stewart JR
Electron arc irradiation of the postmastectomy chest wall with CT
treatment planning: 20-year experience.
SO - Int J Radiat Oncol Biol Phys 2001 Nov 15;51(4):994-1001
AD - Department of Radiation Oncology, Huntsman Cancer Institute, University
of Utah, Salt Lake City, UT 84132, USA. David.k.gaffney@hsc.utah.edu
PURPOSE: Since 1980, electron arc irradiation of the postmastectomy
chest wall has been the preferred radiotherapy technique at the
University of Utah for patients with advanced breast cancer. We report
the results of this technique in 156 consecutive Stage IIA-IIIB patients
treated from 1980 to 1998. METHODS: CT treatment planning was used in
all patients to identify chest wall thickness and internal mammary lymph
node depth. Computerized dosimetry was used to deliver total doses of 50
Gy in 5-1/2 weeks to the chest wall and the internal mammary lymph nodes
with electron arc therapy. Patients were assessed for local, regional,
and distant control of disease and for survival. Univariate and
multivariate proportional hazards were modeled using a hierarchical
nonproportional semiparametric model testing the following prognostic
factors: age, stage, tumor size, number of positive lymph nodes,
estrogen receptor status, and dose. End points evaluated included
disease-free survival, cause-specific survival, and overall survival.
RESULTS: Eighty-one percent of patients were at high risk for
local-regional failure because of > T2 primary tumor or > 3 positive
axillary lymph nodes. The median number of positive lymph nodes was 5,
and the median tumor size was 3.5 cm. Actuarial 10-year local-regional
control and overall survival were 95% and 52%, respectively. In
multivariate analysis, the only factor prognostic for disease-free
survival, cause-specific survival, and overall survival was the number
of positive lymph nodes (p < 0.001). The 10-year rates of local-regional
control for patients with 0, 1-3, 4-9, and > or = 10 involved lymph
nodes were 100%, 98%, 93%, and 89%, respectively. The only rates of
acute and chronic radiotherapy toxicity > or = 2 by RTOG/EORTC criteria
were skin related and observed in 44% and 10% for acute and late
reactions, respectively. CONCLUSION: These data demonstrate excellent
local-regional control rates with electron arc therapy of the
postmastectomy chest wall in patients with advanced breast cancer. Our
20-year experience with electron arc radiotherapy has demonstrated the
safety and efficacy of this technique. The advantage of this technique
is that the internal mammary lymph node chain can be easily encompassed
while the dose to heart and lung is minimized; it also obviates match
lines in areas of high risk.
22
UI - 11715307
AU - Dilhuydy JM; Bussieres E; Romestaing P
TI -
[Radiotherapy of the breast and chest wall: treatment volume]
SO - Cancer Radiother 2001 Oct;5(5):550-9
AD - Service de radiotherapie, institut Bergonie, 229, cours de l'Argonne,
33076 Bordeaux, France. dilhuydy_jm@bergonie.org
The radiotherapy of the breast or the chest wall is a complex technique.
The definition of the gross tumour volume and the clinical target volume
depends on clinical, anatomical and histological criteria. The volumes
are located by physical examination, mammography, echography and
tomodensitometry. The implantation of surgical clips in the lumpectomy
cavity is useful for the boost field. The planning target volume takes
into consideration movements of tissues during respiration and
variations in beam geometry characteristics. The organs at risk (heart,
lung) must be considered systematically. Technical contrivances are
necessary to modify and homogenize dose distribution. Conformational
irradiation allows an individually design treatment planning.
Intensity-modulated radiotherapy technique is a future advantageous
technique still under evaluation.
23
UI - 11712796
AU - Koukourakis MI; Yannakakis D
TI -
High dose daily amifostine and hypofractionated intensively accelerated
radiotherapy for locally advanced breast cancer. A phase I/II study and
report on early and late sequellae.
SO - Anticancer Res 2001 Jul-Aug;21(4B):2973-8
AD - Department of Radiotherapy and Oncology, Democritus University of
Thrace, Alexandroupolis, Greece. targ@her.forthnet.gr
Intrinsic radioresistance, tumor hypoxia and ability of cancer cells to
undergo rapid repopulation during radiotherapy are associated with
failure of radiotherapy. Tumors with low alpha/beta-ratio values or
hypoxic tumors unable to undergo re-oxygenation, are unlikely to be
eradicated with standard radiotherapy. Although the therapeutic efficacy
of accelerated regimens based on low-dose per fraction may be high since
they minimize the adverse role of rapid tumor repopulation, the cellular
compartment with low alpha/beta-ratio values (i.e. hypoxic cells)
remains a limiting factor. Accelerated hypofractionation, which may be
more effective in such tumors, cannot be safely applied unless normal
tissues are protected. In the present study we assessed the feasibility
of hypofractionated and accelerated radiotherapy supported by
cytoprotection (HypoARC) with high dose daily amifostine. Fifteen breast
cancer patients with locally advanced disease entered radiation-dose
escalation protocoL Twelve consecutive fractions of 3.5-4Gy (5
fractions/week) were given to the breast/chest wall, supraclavicular and
axillary area, within 17 days. A high dose of amifostine, at 1,000 mg
flat dose, was given 20 minutes before each radiotherapy fraction.
Amifostine administration was well- tolerated with minor side-effects
(vomiting in 6 out of 15 and hypotention in 2 out of 15 patients).
Radiation induced acute skin toxicity was negligible (grade 3 in 1 out
of 15 patients). Ten out of 15 patients survived more than 12 months and
7 out of 15 more than 18 months following HypoARC. None of these
patients showed any signs of late sequellae, such as lung and
myoskeletal fibrosis, or brachial plexopathy. Complete and partial
responses were obtained in 11 out of 15 (73%) and in 4 out of 15 (27%)
patients, respectively. High dose daily amifostine during
hypofractionated radiotherapy is feasible. HypoARC regimen is
well-tolerated, effective and has minimal acute and late toxicity to
normal breast, chest and axillary tissues.
24
UI - 11710885
AU - Su Y; Swift M
TI -
Outcomes of adjuvant radiation therapy for breast cancer in women with
ataxia-telangiectasia mutations.
SO - JAMA 2001 Nov 14;286(18):2233-4
25
UI - 11347561
AU - Freshwater MF
TI -
"Standard of care" for immediate breast reconstruction.
SO - Plast Reconstr Surg 2001 May;107(6):1612
26
UI - 11677460
AU - Baroni G; Troia A; Troia A; Orecchia R; Pedotti A
TI -
[Opto-electronic techniques and 3D body surface reconstruction for the
control of patient positioning in the radiotherapy of breast cancer]
SO - Radiol Med (Torino) 2001 Sep;102(3):168-77
AD - Dipartimento di Bioingegneria, Centro di Bioingegneria Fondazione Don
Carlo Gnocchi IRCCS ONLUS, Politecnico di Milano, Milan, Italy.
baroni@biomed.polimi.it
PURPOSE: In radiotherapy clinical practice, the currently existing gap
between the high degree of accuracy in treatment planning and, the
possibility of conforming the high-energy radiation beams on the one
hand, and the uncertain set-up of each irradiation session on the other
is a decisive factor for optimizing radiation treatment. Indeed there is
wide experimental evidence that the current methods used for patient
alignment and immobilization do not guarantee the necessary precision in
delivering therapy with respect to the specifications of the treatment
plan. The main reason for this is the lack of control systems that may
be applied systematically to provide quantitative real-time feedback on
the quality of patient repositioning and immobility during radiation
emission. MATERIAL AND METHODS: Opto-electronic techniques and body
surface registration methods were sygergisically used for the automatic
three-dimensional verification and correction of patient position at the
therapy unit. The method is based on radiotherapy applications of
real-time opto-electronic human motion analysis using passive markers to
control patient repositioning and to acquire and describe body surfaces
in three dimensions. The quantitative detection of the localization
error relies on the real-time detection of the position of an hybrid set
of control points, namely physical passive markers and laser light
markers, and their immediate comparison with a reference data set. The
data set consists of the reference positions of the passive markers and
a three-dimensional model of the body surface. The method was
experimentally tested at the Radiotherapy Division of the European
Institute of Oncology to control the repositioning of a phantom and of a
volunteer, with reference to the clinical realignment procedure applied
for breast cancer radiotherapy. RESULTS: The results confirm that the
technique represents a valuable method to detect and automatically
correct localization errors in the irradiation set-up. The use of the
information provided by the laser markers allows one to reduce the
potential inaccuracies in the manual relocation of the passive markers
on the subject's skin and guarantees that position control is based on a
redundant set of data describing the three-dimensional localization and
configuration of the irradiated body surface portion. The experimental
results show that the initial displacements of the controlled body area
were systematically reduced to median values below 1 millimeter and 1.2
millimeters for the phantom and the volunteer, respectively.
CONCLUSIONS: The synergistic use of opto-electronic technologies and
stereophotogrammetric techniques associated to surface registration
methods proved to provide an accurate description of the spatial
transformation between the reference position and the actual position of
the controlled body area. This allowed us to define an effective
procedure to correct the patients position and recover the quality of
the irradiation set-up, in agreement with the clinical requirements. The
reported results confirm that the dynamic sensing of the body surface by
opto-electronic technologies is a particularly promising technique that
allows to systematically achieve swift and accurate patient alignment,
thus ensuring that the treatment plan specifications are reproduced in
the reality of each irradiation session.
27
UI - 11728694
AU - Mose S; Budischewski KM; Rahn AN; Zander-Heinz AC; Bormeth S; Bottcher
TI -
HD
Influence of irradiation on therapy-associated psychological distress in
breast carcinoma patients.
SO - Int J Radiat Oncol Biol Phys 2001 Dec 1;51(5):1328-35
AD - Department of Radiation Oncology, Johann Wolfgang Goethe University,
Frankfurt/Main, Germany. S.Mose@vff.uni-frankfurt.de
PURPOSE: To confirm our assumptions regarding factors that apparently
cause psychological distress related to adjuvant radiotherapy in breast
cancer patients and to evaluate variables that can predict
were irradiated (56 Gy) after breast-conserving surgery. Patients were
given self-assessment questionnaires on the first and last day of
radiotherapy. Statistical analysis was performed using the structural
equation model LISREL, variance analysis, and regression analysis.
RESULTS: The internal subject-related factors (coping, radiation-related
anxiety, physical distress, psychological distress) reciprocally
influenced each other, whereas external radiotherapy-specific factors
(environmental influence, confidence in the medical staff) were causally
related to coping, anxiety, and distress. Fifty-three percent of the
women felt distressed because cancer affected the breast; 48% were
initially afraid of radiotherapy. For 36%, anxiety was not reduced
during treatment. Highly distressed women were identified by the
following parameters: < or =58 years; initial anxiety; they were
affected by having breast cancer, were negatively affected by
environmental factors, and did not find distraction helpful. CONCLUSION:
Despite considerable individual variability in breast cancer patients,
it seems possible to identify women who run a high risk of
therapy-associated distress. In these patients, psychosocial support is
necessary to reduce treatment-related anxiety and to stabilize
confidence in the medical staff.
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