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Abramson Cancer CenterNCI CANCERLIT® Search: Radiotherapy for Breast Cancer - July 2002
National Cancer Institute®
Last Modified: July 1, 2002
- Predictive factors for skin telangiectasia following post-mastectomy electron beam irradiation.
- Low heart risk after radiation therapy for breast cancer.
- Timing of radiotherapy in breast cancer conserving treatment.
- [Is there an indication for additional local irradiation in conserving treatment of breast cancer patients aged 60 and over?]
- A novel technique of upper extremity revascularization: the retrohumeral approach.
- Surgical technique of intraoperative radiotherapy in conservative treatment of limited-stage breast cancer.
- Postmastectomy radiation in patients with four or more positive nodes.
- Postoperative radiotherapy following mastectomy for high-risk breast cancer. A randomised trial.
- Acute and subacute toxicity associated with concurrent adjuvant radiation therapy and paclitaxel in primary breast cancer therapy.
- Lumpectomy and breast radiotherapy in breast cancer patients with a family history of breast cancer, ovarian cancer, or both.
- In vitro radiosensitivity measured in lymphocytes and fibroblasts by colony formation and comet assay: comparison with clinical acute
- Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: five-year results of a phase I-II study and initial
- Adjuvant radiotherapy in breast cancer. Are there factors that allow selection of patients who do not require adjuvant radiotherapy following
- Device delivers local radiation after breast-lump removal.
- Adenoid cystic breast cancer.
- Radiotherapy for early stage favourable breast cancers.
- Radiation-induced angiosarcoma of the breast: case report and self-criticism of therapeutic approach.
- Use of image processing techniques to assess effect of disodium pamidronate in conjunction with radiotherapy in patients with bone
- Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy.
- Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation.
- Intensity modulated versus non-intensity modulated radiotherapy in the treatment of the left breast and upper internal mammary lymph node
- Critical appraisal of treatment techniques based on conventional photon beams, intensity modulated photon beams and proton beams for therapy of
- The use of a compensator library to reduce dose inhomogeneity in tangential radiotherapy of the breast.
- Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity
- Cardiac and pulmonary doses and complication probabilities in standard and conformal tangential irradiation in conservative management of
- Predictors for pneumonitis during locoregional radiotherapy in high-risk patients with breast carcinoma treated with high-dose chemotherapy and
Table of Contents
1
UI - 12036838
AU - Huang EY; Chen HC; Wang CJ; Sun LM; Hsu HC
TI -
Predictive factors for skin telangiectasia following post-mastectomy
electron beam irradiation.
SO - Br J Radiol 2002 May;75(893):444-7
AD - Department of Radiation Oncology, Kaohsiung Chang Gung Memorial
Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan.
This study evaluated the predictive factors associated with skin
telangiectasia following post-mastectomy electron beam irradiation of
the chest wall and regional lymph nodes in patients with breast cancer.
cancer received electron beam irradiation following modified radical
mastectomy. Doses of 50-50.4 Gy per 25-28 fractions were given to the
chest wall (with bolus), the internal mammary nodes, the supraclavicular
nodes and the axillary lymph nodes using a 12 MeV or 15 MeV single
portal electron beam. 19 patients received an additional 10-16 Gy boost
to the surgical scar using a 9 MeV electron beam. Univariate and
multivariate analyses for the development of skin telangiectasia showed
5- and 7-year actuarial rates of telangiectasia to be 59% and 72%,
respectively. In univariate analysis, an additional surgical scar boost
(p=0.023) as well as no treatment interruption (p=0.028) were associated
with a significantly increased risk of skin telangiectasia. In
multivariate analysis, the only significant independent factor for the
development of skin telangiectasia was surgical scar boost (p=0.026); no
treatment interruption showed a trend but did not achieve significance
(p=0.051). Thus, patients given an additional boost to the surgical scar
are more likely to develop skin telangiectasia. Shorter treatment
courses may result in a higher probability of skin telangiectasia
following electron beam irradiation.
2
UI - 12079825
AU - Anonymous
TI -
Low heart risk after radiation therapy for breast cancer.
SO - Harv Heart Lett 2002 Jun;12(10):7
3
UI - 12027411
AU - Ruo Redda MG; Verna R; Guarneri A; Sannazzari GL
TI -
Timing of radiotherapy in breast cancer conserving treatment.
SO - Cancer Treat Rev 2002 Feb;28(1):5-10
AD - Department of Radiation Oncology, University of Turin, San Giovanni
Batista Hospital, Via Genova 3, 10126 Turin, Italy.
The optimal timing and sequencing of adjuvant radiotherapy and
chemotherapy after breast-conserving surgery for early invasive breast
cancer is controversial. Several studies demonstrated that postoperative
radiation therapy significantly reduces the incidence of breast
recurrences. For patients who do not need systemic treatment, the
interval between surgery and the start of radiotherapy should not exceed
eight weeks. For node-positive and high-risk patients receiving
breast-conserving treatment, adjuvant chemotherapy should be
administered prior to radiotherapy, but the delay of radiation should
not exceed 20-24 weeks. Side effects and complications of radiotherapy
can be expected to increase when chemotherapy is administered
concurrently. In particular, antracycline-based chemotherapy regimens
increase the damage to heart muscle and coronary arteries: to avoid the
risk of ischemic cardiovascular disease, radiotherapy must be performed
after the end of systemic treatment. Copyright 2002 Published by
Elsevier Science Ltd.
4
UI - 11901938
AU - Noordijk EM; Creutzberg CL
TI -
[Is there an indication for additional local irradiation in conserving
treatment of breast cancer patients aged 60 and over?]
SO - Ned Tijdschr Geneeskd 2002 Mar 2;146(9):395-8
AD - Leids Universitair Medisch Centrum, afd. Klinische Oncologie, Postbus
9600, 2300 RC Leiden. e.m.noordijk@lumc.nl
Recent results from the European Organisation for Research and Treatment
of Cancer (EORTC) trial of additional irradiation in patients with
breast cancer, show that after breast-conserving surgery and
radiotherapy (50 Gy) of the whole breast, an additional dose of 16 Gy on
the tumour bed significantly reduces the local recurrence rate from 7.3%
to 4.3%. A relative reduction was seen in all age groups but was most
significant in patients aged 40 years and below (19.5% versus 10.2%). In
women aged 60 years and over, the local recurrence rate after
radiotherapy of 50 Gy (without the additional radiation dose) is already
very low (4.0%). Therefore it is questionable whether an additional dose
of 16 Gy (reducing the recurrence rate to 2.5%) is still justified as a
standard treatment in this age group.
5
UI - 12042742
AU - Marone L; Nigri G; LaMuraglia GM
TI -
A novel technique of upper extremity revascularization: the retrohumeral
approach.
SO - J Vasc Surg 2002 Jun;35(6):1277-9
AD - Division of Vascular Surgery, Department of Surgery, Massachusetts
General Hospital, Boston, MA 02114, USA.
Although the standard approach for inflow to the brachial artery is
directly from the subclavian or the carotid artery, unusual scenarios
exist when this direct route is not accessible. We present a case of a
patient after right radical mastectomy and radiation therapy for breast
cancer with severe ischemic symptoms of the dominant right upper
extremity. Angiography revealed an occluded right subclavian artery with
a paucity of distal collaterals across the right shoulder. A reversed
vein graft was constructed from the right common carotid artery to the
right brachial artery and was tunneled with a retrohumeral approach to
avoid the previously operated and irradiated field. The patient has
remained asymptomatic with a patent graft at 2 years.
6
UI - 12049547
AU - Intra M; Gatti G; Luini A; Galimberti V; Veronesi P; Zurrida S; Frasson
TI -
A; Ciocca M; Orecchia R; Veronesi U
Surgical technique of intraoperative radiotherapy in conservative
treatment of limited-stage breast cancer.
SO - Arch Surg 2002 Jun;137(6):737-40
AD - Breast Division, University of Milan, Italy. mattia.intra@ieo.it
At the European Institute of Oncology, Milan, Italy, we have focused our
interest on the use of intraoperative radiation therapy (IORT) in
limited-stage breast cancer that is conservatively treated. A new
technique to perform IORT was applied in 185 patients from July 1, 1999,
to October 31, 2001. As the surgeon plays a crucial role in this
procedure in selecting the patients, performing the breast resection,
preparing the gland as a target to receive IORT, delivering the
radiation directly to the mammary gland via a dedicated applicator, and,
finally, reconstructing the breast, each phase of the surgical technique
has been completely standardized and is described herein. The use of
IORT in the conservative treatment of breast cancer could allow the
course of external fractionated-dose radiation therapy to be completely
avoided; IORT dramatically reduces radiation exposure of the skin, lung,
and subcutaneous tissues and avoids the irradiation of the contralateral
breast, which contributes to a very low incidence of radiation-induced
sequelae. In our experience, IORT for limited-stage breast carcinoma is
easy to perform and only briefly prolongs the duration of the surgical
procedure.
7
UI - 12079136
AU - Timothy SK; Teng S; Stolier AJ; Bolton JS; Fuhrman GM
TI -
Postmastectomy radiation in patients with four or more positive nodes.
SO - Am Surg 2002 Jun;68(6):539-44; discussion 544-5
AD - Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
70121, USA.
Postmastectomy radiotherapy (PMR), a local therapeutic modality, is
recommended to treat breast cancer patients with multiple involved
axillary lymph nodes (a marker of increased systemic risk). Bothered by
this conceptually flawed treatment approach we evaluated the impact of
PMR on the treatment of women with four or more involved axillary lymph
nodes. We identified 1164 patients treated from 1982 through 1999 with
mastectomy. We reviewed the records of the 223 who demonstrated four or
more positive axillary lymph nodes. Of these 128 were treated by
mastectomy only and 95 by PMR. The mastectomy-only group demonstrated a
mean tumor size of 3.5 cm, a median of seven axillary nodes involved,
and a median of 24.9 nodes harvested. The PMR group had a mean tumor
size of 4.3 cm with nine positive nodes out of a median total of 23.3
harvested. The difference in mean tumor size was statistically
significant (P = 0.01). The locoregional recurrence (10.9% vs 12.6%),
distant recurrence rates (42.2% vs 35.8%), and 5-year survival (51% vs
55%) were not statistically different between the mastectomy-only group
versus the PMR group, respectively. Adding PMR to breast cancer
treatment demonstrated no improvement in outcome. Despite limitations of
this retrospective study the results strongly support evaluation of PMR
by a high-quality randomized prospective trial.
8
UI - 12008199
AU - Morgan DA; Berridge J; Blamey RW
TI -
Postoperative radiotherapy following mastectomy for high-risk breast
cancer. A randomised trial.
SO - Eur J Cancer 2002 May;38(8):1107-10
AD - Department of Clinical Oncology, Nottingham City Hospital, NG5 1PB,
Nottingham, UK. david.morgan@nottingham.ac.uk
Grade III, node-positive breast cancer carries a high risk of
loco-regional relapse after simple mastectomy. A randomised trial was
conducted to assess whether this would be significantly reduced by
postoperative radiotherapy. Between 1985 and 1991, 76 patients who had
undergone a simple mastectomy and axillary sampling, and whose tumours
had been found to be grade III and node-positive, were randomised to
receive postoperative radiotherapy to the chest wall and axilla or no
further loco-regional treatment. Radiotherapy was delivered with 8 MV
X-rays to the axilla and supraclavicular fossa and with 8 MeV electrons
to the chest wall, to a dose of 45 Gy in 15 fractions over 3 weeks. All
patients have been followed-up until death, or for a minimum of 10
years. All loco-regional recurrences occurred within the first 4 years
after mastectomy. There were 26 such events in the 40 patients
randomised to the 'watch' policy (65%), as opposed to 9 out of 36 (25%)
who received radiotherapy (P<0.01). Ten-year survival was 39% in the
radiotherapy arm as opposed to 25% in the no radiotherapy arm.
Recruitment to the trial was closed in 1991, when a preliminary safety
analysis revealed the size of the effect of radiotherapy, and from then
on all node-positive patients with grade III tumours have routinely been
given this treatment. Further follow-up has confirmed this finding, as
borne out by these 10-year results, which shows that radiotherapy has a
significant impact on reducing loco-regional recurrence in patients at
high risk after mastectomy. There is an apparent survival benefit
although, because of the small numbers in this trial, this has not
reached statistical significance.
9
UI - 12047471
AU - Hanna YM; Baglan KL; Stromberg JS; Vicini FA; A Decker D
TI -
Acute and subacute toxicity associated with concurrent adjuvant
radiation therapy and paclitaxel in primary breast cancer therapy.
SO - Breast J 2002 May-Jun;8(3):149-53
AD - Department of Internal Medicine, William Beaumont Hospital, Royal Oak,
Michigan 48073, USA.
The purpose of this study was to describe the toxicity of concurrent
standard dose adjuvant radiation therapy (RT) and paclitaxel in a series
radiation and paclitaxel. There were 16 patients (80%) with American
Joint Committee on Cancer (AJCC) stage II disease and 4 with stage III
disease. Eighteen patients, 12 postmastectomy and 6 breast conservation,
were treated with definitive surgery followed by concurrent RT and
paclitaxel. Two received concurrent neoadjuvant radiation and
paclitaxel. All patients received a doxorubicin-containing combination
prior to radiation and paclitaxel. RT was delivered concurrently with
paclitaxel after the completion of all doxorubicin therapy, with all
patients receiving at least two cycles of paclitaxel (175 mg/m2) every 3
weeks during RT. Toxicity was graded weekly according to Radiation
Therapy Oncology Group criteria. Thirteen patients (65%) developed grade
2 or higher cutaneous toxicity. In the postmastectomy group, 6 of 12
patients (50%) developed grade 2 cutaneous toxicity, and 4 of 12
patients (33%) developed grade 3. RT was discontinued in 1 and placed on
hold in 3 of these patients. In the breast-conservation group, 2 of 6
patients (33%) developed grade 3 toxicity. In the neoadjuvant group, 1
of 2 patients (50%) developed grade 3 toxicity. Four patients (20%)
developed radiation pneumonitis, 2 of 12 (17%) in the postmastectomy
group and 2 of 6 (33%) in the breast conservation group, with 2
requiring hospitalization and 1 a diagnostic open-lung biopsy. In this
group of patients, standard dose concurrent radiation and paclitaxel
resulted in a high incidence of cutaneous and pulmonary toxicity.
Concurrent radiation and paclitaxel with these doses and schedule should
be approached cautiously until further studies documenting its safety
are completed.
10
UI - 12047472
AU - Leonard CE; Sedlacek S; Shapiro H; Hey D; Liang X; Howell K; Vernon B;
TI -
Ponce J; Smith L
Lumpectomy and breast radiotherapy in breast cancer patients with a
family history of breast cancer, ovarian cancer, or both.
SO - Breast J 2002 May-Jun;8(3):154-61
AD - Rocky Mountain Cancer Centers; Department of Radiation Oncology, Denver,
Colorado 80110, USA.
This article presents an outcomes review of breast cancer patients
identified from the cancer registries of four area hospitals. These
patients had family histories of breast cancer, ovarian carcinoma, or
both and were treated with conservative surgery and radiation to the
involved breast. Patients were as follows: group 1, one first-degree
relative ( n = 165, one synchronous bilateral breast cancer); group 2, >
or =2 first-degree relatives ( n = 21); group 3, one second-degree
relative ( n = 20); and group 4, > or =2 second-degree relatives ( n =
18). The total of patients and breast cancer events was 224 and 225,
respectively. Group 5 was a subgroup of 53 patients with a substantial
risk (>10%) of a BRCA1 or BRCA2 mutation. After a median follow-up of
3.9 years, 5 patients had local failure (2%), and 5 developed a
contralateral breast cancer (2%). There were no significant differences
in local failure rates between groups (p = 1.0): group 1, 5 of 166 (3%);
group 2, 0 of 21 (0%); group 3, 0 of 20 (0%); and group 4, 0 of 18 (0%).
Local failure for group 5 was 2% (1 of 53). Four of 143 patients (3%)
with a minimum 3 years of follow-up (median, 5.6 years) had local
failure, and 5 (4%) developed a contralateral breast cancer. A
univariate analysis was statistically significant for differentiation
only (well, 0 of 67; moderately, 1 of 57 [1.8%]; poor, 3 of 26 [11.5%],
p = 0.008). Overall survival for groups 1-4 did not differ
significantly. Although follow-up has been relatively short, we have not
found that breast cancer patients with various degrees of family
histories of breast/ovarian carcinoma have had a detrimental outcome
when treated with conservative therapy.
11
UI - 12079540
AU - Oppitz U; Schulte S; Stopper H; Baier K; Muller M; Wulf J; Schakowski R;
TI -
Flentje M
In vitro radiosensitivity measured in lymphocytes and fibroblasts by
colony formation and comet assay: comparison with clinical acute
reactions to radiotherapy in breast cancer patients.
SO - Int J Radiat Biol 2002 Jul;78(7):611-6
AD - Department of Radiation Therapy, University of Wurzburg,
Josef-Schneider-Str. 11, 97080 Wurzburg, Germany.
oppitz@strahlentherapie.uni-wuerzburg.de
PURPOSE: To compare colony-forming and comet assays on fibroblasts and
lymphocytes of 32 breast cancer patients irradiated after
breast-conserving operations and to correlate the results with acute
clinical radiation reactions in the skin. MATERIAL AND METHODS: Skin
fibroblasts were isolated and cultivated before radiotherapy and
lymphocytes were drawn prior to the first and directly after the final
external irradiation. The colony-forming assay was performed with
fibroblasts and the comet assay with lymphocytes and fibroblasts of
breast cancer patients according to standard protocols. The clinical
radiation reactions of the patients were graded according to the RTOG
system. RESULTS: No significant correlation (p =0.09) was detected
between clinical acute skin reactions and the in vitro clonogenic data
in fibroblasts. Results of the comet assay in lymphocytes, however,
showed a significant correlation (p <0.05) with the clinical data when
patients were divided into two groups with average and elevated acute
reactions. Apart from initial damage, fibroblasts did not show
significant differences between the two patient groups. Repeated comet
assays in lymphocytes of the same patient drawn before treatment and
before and after external radiotherapy demonstrated good reproducibility
of the test and no significant impact of preceding radiation treatment.
There was a good correlation (r =0.65) between the comet assay results
in fibroblasts and lymphocytes of the same individual. CONCLUSIONS: In
this cohort of patients, a significant correlation between the in vitro
results of the comet assay in lymphocytes and clinical acute reactions
was detected. The results of the comet assay and of fibroblast colony
formation did not correlate with in vitro radiosensitivity.
12
UI - 12115793
AU - Polgar C; Sulyok Z; Fodor J; Orosz Z; Major T; Takacsi-Nagy Z; Mangel
TI -
LC; Somogyi A; Kasler M; Nemeth G
Sole brachytherapy of the tumor bed after conservative surgery for T1
breast cancer: five-year results of a phase I-II study and initial
findings of a randomized phase III trial.
SO - J Surg Oncol 2002 Jul;80(3):121-8; discussion 129
AD - Department of Radiotherapy, National Institute of Oncology, Budapest,
Hungary. polgar@oncol.hu
BACKGROUND AND OBJECTIVES: The objectives of this study were to test the
feasibility of sole interstitial high-dose-rate brachytherapy (HDR-BT)
after breast-conserving surgery (BCS) for T1 breast cancer in a phase
I-II study, and to present the initial findings of a phase III trial
comparing the efficacy of tumor bed radiotherapy (TBRT) alone with
conventional whole breast radiotherapy (WBRT). METHODS: Forty-five
prospectively selected patients with T1 breast cancer undergoing BCS
were enrolled into a phase I-II study of TBRT alone, using interstitial
HDR implants. HDR-BT of 7 x 4.33 Gy (n = 8) and 7 x 5.2 Gy (n = 37) was
delivered to the tumor bed. Based on the results of this phase I-II
study, a further 126 patients were randomized to receive 50 Gy WBRT (n =
63) or TBRT alone (n = 63); the latter consisted of either 7 x 5.2 Gy
HDR-BT (n = 46) or 50-Gy wide-field electron irradiation (n = 17).
Breast cancer related events and side effects were assessed. RESULTS: In
the phase I-II study, at a median follow-up of 57 months, 2 (4.4%)
local, 3 (6.7%) axillary, and 3 (6.7%) distant failures were observed.
Two patients (4.4%) died of breast cancer. The 5-year probability of
cancer-specific, relapse-free and local recurrence-free survival was
90.0%, 85.9%, and 95.6%, respectively. The cosmetic results were judged
to be excellent in 44 of 45 patients (97.8%). Severe (higher than grade
2) skin sequelae or fibrosis was not found. Symptomatic fat necrosis
occurred in one patient (2.2%). In the phase III study, at a median
follow-up of 30 months, the locoregional tumor control was 100% in both
arms. The 3-year probability of cancer-specific and relapse-free
survival was 98.1% and 98.4% in the WBRT group and 100% and 94.4% in the
TBRT group, respectively (P = NS). There was no significant difference
between the two treatment arms regarding the incidence of radiation side
effects. CONCLUSIONS: Five-year results of our phase I-II study prove
that sole HDR-BT of the tumor bed with careful patient selection and
adequate quality assurance is a feasible alternative to WBRT. However,
long-term results of phase III trials are required to determine the
equivalence of TBRT alone, compared with WBRT in the management of
selected patients with early breast cancer. Copyright 2002 Wiley-Liss,
Inc.
13
UI - 12032441
AU - Loncaster J; Dodwell D
TI -
Adjuvant radiotherapy in breast cancer. Are there factors that allow
selection of patients who do not require adjuvant radiotherapy following
breast-conserving surgery for breast cancer?
SO - Minerva Med 2002 Apr;93(2):101-7
AD - Yorkshire Centre for Clinical Oncology, Cookridge Hospital, Leeds, UK.
Postoperative adjuvant radiotherapy is used to reduce local recurrences
following breast-conserving surgery for early breast cancer. This review
examines factors that may be used to select patients at low risk of
local failure following breast-conserving surgery alone.
14
UI - 12132509
AU - Anonymous
TI -
Device delivers local radiation after breast-lump removal.
SO - Health News 2002 Jul;8(7):8
15
UI - 12095593
AU - McClenathan JH; de la Roza G
TI -
Adenoid cystic breast cancer.
SO - Am J Surg 2002 Jun;183(6):646-9
AD - Department of Surgery, Kaiser Permanente Medical Center, 900 Kiely
Blvd., Santa Clara, CA 95051, USA. james.mcclenathan@ncal.kaiperm.org
BACKGROUND: Adenoid cystic carcinoma is a rare type of breast cancer
that is generally reported in individual case reports or as series from
major referral centers. To characterize early diagnostic criteria for
adenoid cystic carcinoma and to determine whether breast-preserving
surgery with radiotherapy is as effective as mastectomy for eradicating
the disease, we reviewed clinical records of a large series of patients
treated for adenoid cystic carcinoma of the breast at a large health
maintenance organization (HMO) that includes primary care facilities and
referral centers. METHODS: Using the data bank of the Northern
California Cancer Registry of the Kaiser Permanente Northern California
Region (KPNCR), we retrospectively reviewed medical records of patients
treated for adenoid cystic carcinoma of the breast. Follow-up also was
done for these patients. RESULTS: Adenoid cystic carcinoma of the breast
was diagnosed in 22 of 27,970 patients treated for breast cancer at
KPNCR from 1960 through 2000. All 22 patients were female and were
available for follow-up. Mean age of patients at diagnosis was 61 years
(range, 37 to 94 years). In 17 (77%) of the women, a lump in the breast
led to initial suspicion of a tumor; in 4 (23%) of the 22 patients,
mammography led to suspicion of a tumor. Median tumor size was 20 mm.
Pain was a prominent symptom. Surgical management evolved from radical
and modified radical mastectomy to simple mastectomy or lumpectomy
during the study period, during which time 1 patient died of previous
ordinary ductal carcinoma of the contralateral breast, and 7 died of
unrelated disease. At follow-up, 12 of the 13 remaining patients were
free of disease; 1 patient died of the disease; and 1 patient remained
alive despite late occurrence of lymph node and pulmonary metastases.
CONCLUSIONS: Whether breast-preserving surgery with radiotherapy is as
effective as mastectomy for treating adenoid cystic carcinoma of the
breast has not been determined.
16
UI - 11870524
AU - Buchholz TA; Singletary SE
TI -
Radiotherapy for early stage favourable breast cancers.
SO - Br J Cancer 2002 Jan 21;86(2):309-11
17
UI - 12094424
AU - Anania G; Parodi PC; Sanna A; Rampino E; Marcotti E; Di Loreto C; Zuiani
TI -
C; Donini A
Radiation-induced angiosarcoma of the breast: case report and
self-criticism of therapeutic approach.
SO - Ann Chir 2002 May;127(5):388-91
AD - Departement of Surgery, Radiology and Anestesiology, Sezione di Clinica
Chirurgica, University of Ferrara, Corso Giovecca 203, 44100 Ferrara,
Italy.
Angiosarcoma (AS) of the breast is a rare and highly aggressive vascular
cancer. It presents as a primitive or radioinduced form. The case of a
46-year-old woman who underwent quadrantectomy of the breast plus
axillary lymph node dissection and radiotherapy postoperatively (QUART)
for ductal infiltrant carcinoma is reported in the following. Ten years
later, the patient underwent mastectomy with immediate reconstruction,
for local recurrence that was diagnosed as an AS of the breast at final
pathological examination. She did not receive any adjuvant treatment due
to local post-operative complications related to breast reconstruction.
We criticize our therapeutic approach and we recommend more attention
about local recurrence suggesting that tru-cut needle biopsy of local
recurrence of the breast after QUART, should be the correct diagnostic
approach.
18
UI - 12102162
AU - Kouloulias VE; Dardoufas CE; Kouvaris JR; Antypas CE; Sandilos PH;
TI -
Matsopoulos GK; Vlahos LJ
Use of image processing techniques to assess effect of disodium
pamidronate in conjunction with radiotherapy in patients with bone
metastases.
SO - Acta Oncol 2002;41(2):169-74
AD - Department of Radiology, Areteion University Hospital, Athens, Greece.
vkouloul@yahoo.com
The aim of this study was radiographically to monitor the effect of
disodium pamidronate on metastatic bone disease, using image-processing
techniques. Eighteen patients with osteolytic metastases from breast
cancer received an intravenous infusion of 180 mg disodium pamidronate
every 4 weeks for a period of 6 months. The first session of intravenous
infusions was given concurrently with external beam radiotherapy with a
6 MV linear accelerator (total dose 30 Gy in 10 fractions). Radiographs
of osteolytic lesions were obtained at every session of the treatment,
retaining the same settings for each modality. The analysis of the
attributes of the images was based on measuring the first-order
statistics of the gray-level histogram in terms of mean value (MVGLH)
and energy (EGLH). The measurements showed significant differences for
MVGLH and EGLH values (p < 0.05, Wilcoxon test). Analytically, there was
an 11.08% (95% CI = 10.21, 11.93) mean reduction of EGLH and an 11.63%
(95% CI = 10.96, 12.29) mean increase of MVGLH of the x-ray images,
before and after the combined treatment protocol. The changes in the
image-processing indices were also highly correlated with the reduction
of the patient's pain score. These findings indicate an important
increase in bone mass and bone formation, which the radiologists found
difficult to identify visually.
19
UI - 12062612
AU - DiBiase SJ; Komarnicky LT; Heron DE; Schwartz GF; Mansfield CM
TI -
Influence of radiation dose on positive surgical margins in women
undergoing breast conservation therapy.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):680-6
AD - Department of Radiation Oncology, University of Maryland Medical Center,
22 S. Greene Street, Baltimore, MD 21201, USA. sdibi001@umaryland.edu
PURPOSE: Positive surgical margins adversely influence local tumor
control in breast conservation therapy (BCT). However, reports have
conflicted regarding whether an increased radiation dose can overcome
this poor prognostic factor. In this study, we evaluated the influence
of an increased radiation dose on tumor control in women with positive
surgical margins undergoing BCT.METHODS AND MATERIALS: Between 1978 and
1994, 733 women with pathologic Stage I-II breast cancer and known
surgical margin status were treated at Thomas Jefferson University
Hospital with BCT. Of these 733 patients, 641 women had a minimal tumor
bed dose of 60 Gy and had documentation of their margin status; 509 had
negative surgical margins, and 132 had positive surgical margins before
definitive radiotherapy. Complete gross excision of the tumor and
axillary lymph node sampling was obtained in all patients. The median
radiation dose to the primary site was 65.0 Gy (range 60-76). Of the
women with positive margins (n = 132), the influence of higher doses of
radiotherapy was evaluated. The median follow-up time was 52
months.RESULTS: The local tumor control rate for patients with negative
margins at 5 and 10 years was 94% and 88%, respectively, compared with
85% and 67%, respectively, for those women with positive margins (p =
0.001). The disease-free survival rate for the negative margin group at
5 and 10 years was 91% and 82%, respectively, compared with 76% and 71%,
respectively, for the positive margin group (p = 0.001). The overall
survival rate of women with negative margins at 5 and 10 years was 95%
and 90%, respectively. By comparison, for women with positive surgical
margins, the overall survival rate at 5 and 10 years was 86% and 79%,
respectively (p = 0.008). A comparison of the positive and negative
margin groups revealed that an increased radiation dose (whether entered
as a dichotomous or a continuous variable) >65.0 Gy did not improve
local tumor control (p = 0.776). On Cox multivariate analysis, margin
status and menopausal status had prognostic significance for local tumor
control and DFS.CONCLUSION: Patients with positive surgical margins have
a higher risk of local tumor recurrence and worse survival when
undergoing BCT. Higher doses of radiation are unable to provide an
adequate level of local control in patients with positive margins.
20
UI - 12062613
AU - Deutsch M
TI -
Repeat high-dose external beam irradiation for in-breast tumor
recurrence after previous lumpectomy and whole breast irradiation.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):687-91
AD - Department of Radiation Oncology, University of Pittsburgh Medical
Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
deutschm@msx.upmc.edu
PURPOSE: To determine whether excision of an in-breast tumor recurrence
(IBTR) plus 5000 cGy in 25 fractions to the new operative area is both
tolerated and effective as treatment for an IBTR after previous
lumpectomy and whole breast irradiation.METHODS AND MATERIALS:
Thirty-nine women with an IBTR after lumpectomy and breast irradiation
for invasive carcinoma (n = 31) or ductal carcinoma in situ (n = 8) were
treated with excision of the IBTR and radiotherapy (RT), 5000 cGy in 25
fractions, to the operative area using electrons of appropriate energy.
The interval from completion of the first course of RT to diagnosis of
the IBTR ranged from 16 to 291 months (median 63).RESULTS: The repeat
course of RT to the new operative area was well tolerated in all
patients, and no late sequelae occurred other than skin pigmentation
changes. Eight patients, including 2 with suspicious bone scans at the
time of IBTR, developed distant metastases, and 7 died 21-71 months
(median 48) after retreatment. One patient was alive with distant
metastases at 27 months after retreatment. Four of the 8 patients who
developed distant metastases also had a second IBTR, and 3 died with
persistent disease in the breast. An additional 4 patients, for a total
of 8, had a second IBTR. Three were alive and free of disease after
mastectomy, and 1 was alive and free of disease after mastectomy and
additional RT for chest wall recurrence. An additional patient developed
recurrence in the axilla 9 months after reirradiation and was treated
with surgery; she died free of disease at 63 months. One patient
underwent mastectomy for suspected persistent disease 2 months after
completion of repeat RT; no evidence of recurrent tumor was found in the
removed breast. Thus, 30 women (76.9%) had an intact breast free of
tumor at death or at last follow-up 1-180 months (median 51.5) after
reirradiation. Using the Kaplan-Meier life table analysis, the estimated
overall and disease-free 5-year survival rate for the 39 patients was
77.9% and 68.5%, respectively.CONCLUSION: For select patients with an
IBTR after lumpectomy and breast irradiation, excision of the IBTR
followed by repeat external beam RT to the operative area may be an
acceptable alternative to mastectomy.
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The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
UI - 11937239
AU - Cho BC; Hurkmans CW; Damen EM; Zijp LJ; Mijnheer BJ
TI -
Intensity modulated versus non-intensity modulated radiotherapy in the
treatment of the left breast and upper internal mammary lymph node
chain: a comparative planning study.
SO - Radiother Oncol 2002 Feb;62(2):127-36
AD - Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van
Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The
Netherlands.
BACKGROUND AND PURPOSE: To compare and evaluate intensity modulated
(IMRT) and non-intensity modulated radiotherapy techniques in the
treatment of the left breast and upper internal mammary lymph node
chain. MATERIALS AND METHODS: The breast, upper internal mammary chain
(IMC), heart and lungs were delineated on a computed tomography
(CT)-scan for 12 patients. Three different treatment plans were created:
(1) tangential photon fields with oblique IMC electron-photon fields
with manually optimized beam weights and wedges, (2) wide split
tangential photon fields with a heart block and computer optimized wedge
angles, and (3) IMRT tangential photon fields. For the IMRT technique,
an inverse planning program (KonRad) generated the intensity profiles
and a clinical three-dimensional treatment planning system (U-MPlan)
optimized the segment weights. U-MPlan calculated the dose distribution
for all three techniques. The normal tissue complication probabilities
(NTCPs) for the organs at risk (ORs) were calculated for comparison.
RESULTS: The average root mean square deviation of the differential
dose-volume histogram of the breast planning target volume was 4.6, 3.9
and 3.5% and the average mean dose to the IMC was 97.2, 108.0 and 99.6%
for the oblique electron, wide split tangent and IMRT techniques,
respectively. The average NTCP for the ORs (i.e. heart and lungs) were
comparable between the oblique electron and IMRT techniques (
UI - 11937240
AU - Fogliata A; Bolsi A; Cozzi L
TI -
Critical appraisal of treatment techniques based on conventional photon
beams, intensity modulated photon beams and proton beams for therapy of
intact breast.
SO - Radiother Oncol 2002 Feb;62(2):137-45
AD - Radiation Oncology Department, Medical Physics Unit, Oncology Institute
of Southern Switzerland, c/o Ospedale S. Giovanni, 6504 Bellinzona,
Switzerland.
PURPOSE: To analyse different treatment techniques with conventional
photon beams, intensity modulated photon beams, and proton beams for
intact breast irradiation for patients in whom conventional irradiation
would cause potentially dangerous lung irradiation. MATERIALS AND
METHODS: Five breast cancer patients with highly concave breast tissue
volume around the lung were considered at planning level in order to
assess the suitability of different irradiation techniques.
Three-dimensional dose distributions for conventional two-field
tangential photon treatment, two-field intensity modulated radiotherapy
(IMRT), three-field non-IMRT, three-field IMRT, and single-field proton
treatment were investigated, aiming at assessing the possibility to
reduce lung irradiation below risk levels. Analysis of dose-volume
histograms and related physical and biological parameters (significant
minimum, maximum and mean doses, conformity indexes and equivalent
uniform dose (EUD)) for planned target volume (PTV) and lung was carried
out. Dose plans were compared with the conventional two-field tangential
photon technique. RESULTS: PTV coverage was comparable for non-IMRT and
IMRT techniques (EUD from 47.1 to 49.4 Gy), and improved with
single-field proton treatment (EUD=49.8 Gy). Lung irradiation was
reduced, in terms of mean dose, with three-field (9.5 Gy) and proton
technique (3.5 Gy), with respect to the conventional two-field treatment
(12.9 Gy); also a reduction of the lung volume irradiated at high doses
was observed. Better results could be achieved with protons. In
addition, cardiac irradiation was also reduced with those techniques.
CONCLUSIONS: Geometrically difficult breast cancer patients could be
irradiated with a three-field non-IMRT technique thus reducing the dose
to the lung which is proposed as standard for this category of patients.
Intensity modulated techniques were only marginally more successful than
the corresponding non-IMRT treatments, while protons offer excellent
results.
UI - 11937241
AU - Wilks RJ; Bliss P
TI -
The use of a compensator library to reduce dose inhomogeneity in
tangential radiotherapy of the breast.
SO - Radiother Oncol 2002 Feb;62(2):147-57
AD - Radiotherapy Department, Torbay Hospital, Torquay TQ2 7AA, Devon, UK.
BACKGROUND AND PURPOSE: The dose variation throughout the volume of the
breast from tangential fields can exceed 20% for large breasts. This is
postulated to result in poor cosmesis [Radiother Oncol 16 (1989) 253],
particularly at the inframammary fold, where the dose is highest.
Compensators may be used to reduce this variation, but at the cost of
the time to manufacture each unique compensator for the individual
patients. This paper outlines the implementation and routine use of a
library of reusable compensators. MATERIALS AND METHODS: For the period
radiotherapy received treatment using breast compensators calculated
from multiple outlines measured using the Osiris system. The
compensators manufactured for the early patients were added to a library
for possible reuse by later patients. Of the 94 patients, 28 patients'
compensators formed the library and 66 subsequent patients have been
treated using compensators derived from the library. Selection of the
most appropriate library compensator was determined from the analysis of
the distribution of the calculated dose-volume histogram for the whole
breast, excluding lung, penumbra and build-up regions. Once the library
was complete, approximately 50% of all subsequent breast patients were
treated with compensators (46% from the library and 4% with individual
compensators). This represented a usage rate of 92% for the library
compensators for those patients requiring compensation. RESULTS: In all
cases the compensators reduced the variation in the dose distribution.
For example, the group treated with a library compensator demonstrated a
mean reduction from 29 to 9% for the volume of breast tissue receiving
more than 5% greater than the reference dose. If the same patients had
been treated using their own individual compensators, the corresponding
value would have been 7%. There is a small systematic, but negligible,
difference in the two populations of dose variation for individual
versus library compensators, but this difference (P=0.20) did not reach
the level of statistical significance of P=0.05). CONCLUSION: The method
of creation and selection of library compensators has proved to be
simple and reliable in practice. Every patient receiving radiotherapy
for breast cancer is currently investigated under full software control
to ascertain whether the use of a library compensator would be
advantageous.
UI - 11937243
AU - Hurkmans CW; Cho BC; Damen E; Zijp L; Mijnheer BJ
TI -
Reduction of cardiac and lung complication probabilities after breast
irradiation using conformal radiotherapy with or without intensity
modulation.
SO - Radiother Oncol 2002 Feb;62(2):163-71
AD - Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van
Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The
Netherlands.
PURPOSE: The main purpose of this work is to reduce the cardiac and lung
dose by applying conformal tangential beam irradiation of the intact
left breast with and without intensity modulation, instead of
rectangular tangential treatment fields. The extension of the
applicability of the maximum heart distance (MHD) to conformal
tangential fields as a simple patient selection criterion, identifying
patients for which rectangular and conformal tangential fields without
intensity modulation will result in unacceptable normal tissue
complication probability (NTCP) values for late cardiac mortality (e.g.
>2%), was also investigated. MATERIALS AND METHODS: Three-dimensional
treatment planning was performed for 17 left-sided breast cancer
patients. Three different tangential beam techniques were compared: (1)
optimized wedges without blocks, (2) optimized wedges with conformal
blocks and (3) intensity modulation. Plans were evaluated using
dose-volume histograms (DVHs) for the planning target volume (PTV), the
heart and the lungs. NTCPs for radiation pneumonitis and late cardiac
mortality were calculated using the DVH data. The MHD was measured for
all rectangular (MHD(rectangular)) and conformal (MHD(conformal))
treatment plans. RESULTS: For all patients, on average, part of the PTV
receiving a dose between 95 and 107% of the prescribed dose of 50Gy in
25 fractions of 2Gy was 90.8% (standard deviation (SD): 5.0%), 92.8%
(SD: 3.5%) and 92.8% (SD: 3.6%) for the intensity modulation radiation
therapy (IMRT), conformal and rectangular field treatment techniques,
respectively. The NTCP for radiation pneumonitis was 0.3% (SD: 0.1%),
0.4% (SD: 0.4%) and 0.5% (SD: 0.6%) for the IMRT, conformal and
rectangular field techniques, respectively. The NTCP for late cardiac
mortality was 5.9% (SD: 2.2%) for the rectangular field technique. This
value was reduced to 4.0% (SD: 2.3%) with the conformal technique. A
further reduction to 2.0% (SD: 1.1%) could be accomplished with the IMRT
technique. The NTCP for late cardiac mortality could be described as a
second order polynomial function of the MHD. This function could be
described with a high accuracy and was independent of the technique for
which the MHD was determined (r(2)=0.88). In order to achieve a NTCP
value for late cardiac mortality below 1, 2 or 3%, the MHD should be
equal to or smaller than 11, 17 or 23 mm, respectively. If such a
maximum complication probability cannot be accomplished, a treatment
using the IMRT technique should be considered. CONCLUSIONS: The use of
conformal tangential fields decreases the NTCP for late cardiac toxicity
on average by 30% compared to using rectangular fields, while the
tangential IMRT technique can further reduce this value by an additional
50%. The MHD can be used to estimate the NTCP for late cardiac mortality
if rectangular or conformal tangential treatment fields are used.
UI - 11937244
AU - Muren LP; Maurstad G; Hafslund R; Anker G; Dahl O
TI -
Cardiac and pulmonary doses and complication probabilities in standard
and conformal tangential irradiation in conservative management of
breast cancer.
SO - Radiother Oncol 2002 Feb;62(2):173-83
AD - Department of Radiophysics, Haukeland University Hospital, N-5021
Bergen, Norway.
BACKGROUND AND PURPOSE: The clinical benefit of irradiating the intact
breast after lumpectomy must be weighted against the risk of severe
toxicity. We present a study on cardiac and pulmonary dose-volume data
and the related complication probabilities of tangential breast
irradiation having the following objectives: (1) to quantify the sparing
of the organs at risk (ORs), the heart and the lung, achieved by
three-dimensional (3-D) conformal tangential irradiation (CTI) as
compared to standard tangential irradiation (STI); (2) to elucidate the
uncertainty in radiation tolerance data; and (3) to analyse the relation
between the amount of OR irradiated and the resulting morbidity risk.
MATERIAL AND METHODS: Computed tomography (CT)-based 3-D treatment plans
of 26 patients prescribed to CTI of the intact breast were applied.
Contour-based STI has been our routine treatment, and was reconstructed
for all patients. Dose-volume data and normal tissue complication
probability (NTCP) predictions from the probit and relative seriality
models with several cardiac and pulmonary tolerance parameterizations
were analysed and compared. RESULTS AND CONCLUSIONS: A significant
amount of normal tissues can be spared from radiation by using CT-based
CTI, resulting in a 50% reduction of the average excess cardiac
mortality risk in the left-sided cases. The risks for pericarditis and
pneumonitis were too low to reveal any clinically significant difference
between the treatments. For the STI set-up, a regression analysis showed
that the excess cardiac mortality risk increased when larger parts of
the heart were inside the fields. However, the different excess cardiac
mortality and pneumonitis tolerance parameters resulted in statistically
significant different NTCPs, which precluded the ability to accurately
predict absolute NTCPs after tangential breast irradiation. Despite this
uncertainty the different series of cardiac and pulmonary risk
predictions were in relatively good agreement when small volumes of the
ORs were irradiated. From the present data and without consideration of
patient or organ motion, it therefore appears that tangential breast
irradiation with less than 1 cm of the heart and 2-2.5 cm of the lung
included inside the treatment fields will cause at most 1 per thousand
risk for cardiac mortality and pulmonary morbidity. CT-based CTI should
be considered, in particular for the left-sided cases, if these
requirements cannot be met.
UI - 12115368
AU - Lind PA; Marks LB; Jamieson TA; Carter DL; Vredenburgh JJ; Folz RJ;
TI -
Prosnitz LR
Predictors for pneumonitis during locoregional radiotherapy in high-risk
patients with breast carcinoma treated with high-dose chemotherapy and
stem-cell rescue.
SO - Cancer 2002 Jun 1;94(11):2821-9
AD - Department of Radiation Oncology, Duke University Medical Center,
Durham, North Carolina, USA. Pehr.Lind@abc.se
BACKGROUND: To study the predictive value of serial pulmonary function
testing (PFT) for toxicity in patients who have received high-dose
chemotherapy (HDCT) and stem-cell rescue for breast carcinoma. These
patients are at risk of developing therapy-related pneumonitis (TRP)
during or after radiotherapy (RT). METHODS: Sixty-eight patients who
received induction chemotherapy (CT) and consolidation HDCT
(cyclophosphamide, cisplatin, carmustine) underwent serial PFTs before
induction CT, after HDCT, and before locoregional RT. The rate of TRP,
i.e., pulmonary complications of Grade 2 or higher (World Health
Organization classification), was studied during and 2 months after RT.
We analyzed the time-course of changes in the diffusing capacity of
carbon monoxide (DLCO) and forced expiratory volume at one second
(FEV(1)) and studied the differences between patients who developed TRP
and those who did not. RESULTS: The incidence of TRP was 46%. There were
marked reductions in DLCO and FEV(1) at the time of RT compared with
baseline (Wilcoxon signed rank test: P < 0.001). However, pre-RT PFT
values did not predict subsequent development of TRP. Instead, the ratio
of pre-RT DLCO to the minimum post- HDCT DLCO, i.e., trend of
improvement, predicted the development of TRP in patients (logistic
regression analysis: P = 0.048). At a cutoff level of 1, the positive
and negative predictive values for this ratio were 61% and 87%,
respectively. There was an association between this ratio and a longer
interval between HDCT and RT (Spearman rank correlation: P = 0.002).
CONCLUSIONS: The results suggest that the directional trend of DLCO
after HDCT, i.e., no recovery from nadir values, is a predictor for TRP.
TRP patients have a shorter median interval between HDCT and RT than
asymptomatic patients. To minimize the occurrence of TRP, one should
consider either delaying RT beyond 2 months following carmustine-based
HDCT to allow the PFTs to partly recover, or confirm apositive
directional trend for improvement of DLCO at the start of RT compared to
the post-HDCT nadir value. Copyright 2002 American Cancer Society.
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