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Abramson Cancer Center
NCI CANCERLIT® Search: Radiotherapy for Breast Cancer - August 2002
National Cancer Institute®
Last Modified: August 1, 2002
- Radiotherapy for early breast cancer.
- Electron conformal radiotherapy using bolus and intensity modulation.
- Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers' experience.
- Preliminary results of a phase I/II study of HDR brachytherapy alone for T1/T2 breast cancer.
- Breast imaging and the conservative treatment of breast cancer.
- [Is extra local radiation still indicated in breast cancer patients who are older than 60 years after breast conserving surgery?]
- Lack of effect of a bisphosphonate (pamidronate disodium) infusion on subsequent skeletal uptake of Sm-153 EDTMP.
- Microscopic residual disease is a risk factor in the primary treatment of breast cancer.
- Is radiotherapy needed after breast conservation for small invasive breast cancers?
- The novel technique of delivering targeted intraoperative radiotherapy (Targit) for early breast cancer.
- Is less more? Lessons in radiation schedules in breast cancer.
- Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer.
- Montana Supreme Court upholds rejection of physician's claims. Hughes v. Pullman.
- Locoregional treatment outcomes for inoperable anthracycline-resistant breast cancer.
- Radiotherapy after high-dose chemotherapy and peripheral blood stem cell support in high-risk breast cancer.
- An evidence-based estimate of appropriate radiotherapy utilization rate for breast cancer.
- Variation in the manganese superoxide dismutase gene (SOD2) is not a major cause of radiotherapy complications in breast cancer patients.
- Radiation treatment for breast cancer. Recent advances.
- Monitor unit calculation for tangential breast treatments: verification in an anthropomorphic phantom.
- Breast cancer in pregnancy.
- Radiation-induced brachial plexopathy in women treated for carcinoma of the breast.
Table of Contents
1
UI - 12076497
AU - Early Breast Cancer Trialists' Collaborative Group
TI -
Radiotherapy for early breast cancer.
SO - Cochrane Database Syst Rev 2002;(2):CD003647
AD - Clinical Trial Service Unit, Harkness Building, Radcliffe Infirmary,
Woodstock Road, Oxford, UK, OX2 6HE. mike.clarke@ctsu.ox.ac.uk
BACKGROUND: The long-term effects of radiotherapy on mortality from
breast cancer and other causes remain uncertain. OBJECTIVES: In this
report the Early Breast Cancer Trialists' Collaborative Group present
their systematic overview of treatment with radiotherapy. SEARCH
STRATEGY: Trial identification procedures for the EBCTCG overviews have
been described elsewhere. See under "EBCTCG" in the Breast Cancer Group
module. SELECTION CRITERIA: A meta-analysis was done of 10-year and
20-year results from 40 unconfounded randomised trials of radiotherapy
for early breast cancer. Radiotherapy fields generally included not only
chest wall (or breast) but also axillary, supraclavicular, and internal
mammary nodes. DATA COLLECTION AND ANALYSIS: Data collection involved
central review of individual patient data on recurrence and
cause-specific mortality from 20,000 women. MAIN RESULTS: A reduction of
approximately two-thirds in local recurrence was seen in all trials,
largely independent of the type of patient or type of radiotherapy (8.8%
vs 27.2% local recurrence by year 10). Hence, to assess effects on
breast cancer mortality of substantially better local control, results
from all trials were combined. Breast cancer mortality was reduced
(2p=0.0001) but other, particularly vascular, mortality was increased
(2p=0.0003), and overall 20-year survival was 37.1% with radiotherapy
versus 35.9% control (2p=0.06). There was little effect on early deaths,
but logrank analyses of later deaths indicate that, on average after
year 2, radiotherapy reduced annual mortality rates from breast cancer
by 13.2% (SE 2.5) but increased those from other causes by 21.2% (SE
5.4). Nodal status, age, and decade of follow-up strongly affected the
ratio of breast cancer mortality to other mortality, and hence affected
the ratio of absolute benefit to absolute hazard from these proportional
changes in mortality. REVIEWER'S CONCLUSIONS: Radiotherapy regimens able
to produce the two-thirds reduction in local recurrence seen in these
trials, but without long-term hazard, would be expected to produce an
absolute increase in 20-year survival of about 2-4% (except for women at
particularly low risk of local recurrence). The average hazard seen in
these trials would, however, reduce this 20-year survival benefit in
young women and reverse it in older women.
2
UI - 12095572
AU - Kudchadker RJ; Hogstrom KR; Garden AS; McNeese MD; Boyd RA; Antolak JA
TI -
Electron conformal radiotherapy using bolus and intensity modulation.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 15;53(4):1023-37
AD - Department of Radiation Physics, M.D. Anderson Cancer Center, University
of Texas, Houston, TX 77030, USA. rkudchad@mdanderson.org
PURPOSE: Conformal electron beam therapy can be delivered using shaped
bolus, which varies the penetration of the electrons across the incident
beam so that the 90% isodose surface conforms to the distal surface of
the planning target volume (PTV). Previous use of this modality has
shown that the irregular proximal surface of the bolus causes the dose
heterogeneity in the PTV to increase from 10%, the typical dose spread
of a flat-water surface to approximately 20%. The present work evaluates
the ability to restore dose homogeneity by varying the incident electron
intensity. METHODS AND MATERIALS: Three patients, one each with chest
wall, thorax, and head-and-neck cancer, were planned using electron
conformal therapy with bolus, with and without intensity modulation.
Resulting dose distributions and dose-volume histograms were compared
with non-intensity-modulated bolus plans. RESULTS: In all cases, the
DeltaD(90%-10%) for the PTV was reduced; for example, for the
head-and-neck case, the DeltaD(90%-10%) for the PTV was reduced from
14.9% to 9.2%. This reduction in dose spread is a direct result of
intensity modulation. CONCLUSIONS: The results showed that
intensity-modulated electron beams could significantly improve the dose
homogeneity in the PTV for patients treated with electron conformal
therapy using shaped bolus.
3
UI - 12095552
AU - Cutuli B; Cohen-Solal-le Nir C; de Lafontan B; Mignotte H; Fichet V; Fay
TI -
R; Servent V; Giard S; Charra-Brunaud C; Lemanski C; Auvray H; Jacquot
S; Charpentier JC
Breast-conserving therapy for ductal carcinoma in situ of the breast:
the French Cancer Centers' experience.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 15;53(4):868-79
AD - Department of Radiation Oncology, Paul Strauss Center Strasbourg and
Polyclinique de Courlancy, Reims, France. b.cutuli@wanadoo.fr
PURPOSE: To assess the long-term outcome for women with ductal carcinoma
in situ of the breast treated in current clinical practice by
conservative surgery with or without definitive breast irradiation.
METHODS AND MATERIALS: We analyzed 705 cases of ductal carcinoma in situ
treated between 1985 and 1995 in nine French regional cancer centers;
515 underwent conservative surgery and radiotherapy (CS+RT) and 190 CS
alone. The median follow-up was 7 years. RESULTS: The 7-year crude local
recurrence (LR) rate was 12.6% (95% confidence interval [CI] 9.4-15.8)
and 32.4% (95% CI 25-39.7) for the CS+RT and CS groups, respectively (p
<0.0001). The respective 10-year results were 18.2% (95% CI 13.3-23) and
43.8% (95% CI 30-57.7). A total of 125 LRs occurred, 66 and 59 in the
CS+RT and CS groups, respectively. Invasive or microinvasive LRs
occurred in 60.6% and 52% of the cases in the same respective groups.
The median time to LR development was 55 and 41 months. Nine (1.7%) and
6 (3.1%) nodal recurrences occurred in the CS+RT and CS groups,
respectively. Distant metastases occurred in 1.4% and 3% of the
respective groups. Patient age and excision quality (final margin
status) were both significantly associated with LR risk in the CS+RT
group: the LR rate was 29%, 13%, and 8% among women aged < or =40,
41-60, and > or =61 years (p <0.001). Even in the case of complete
excision, we observed a 24% rate of LR (6 of 25) in women <40 years.
Patients with negative, positive, or uncertain margins had a 7-year
crude LR rate of 9.7%, 25.2%, and 12.2%, respectively (p = 0.008). RT
reduced the LR rate in all subgroups, especially in those with
comedocarcinoma (17% vs. 59% in the CS+RT and CS groups, respectively, p
<0.0001) and mixed cribriform/papillary tumors (9% vs. 31%, p <0.0001).
In the multivariate Cox regression model, young age and positive margins
remained significant in the CS+RT group (p = 0.00012 and p = 0.016).
Finally, the relative LR risk in the CS+RT group compared with the CS
group was 0.35 (95% CI 0.25-0.51, p = 0.0001). Subsequent contralateral
breast cancer occurred in 7.1% and 7.5% of the patients in the CS+RT and
CS groups, respectively. CONCLUSION: Despite the absence of
randomization, our results are extremely consistent with the updated
National Surgical Adjuvant Breast Project B17 and European Organization
for Research and Treatment of Cancer 10853 trials. We also noted that
the LR risk was very high in women <40 years and/or in the case of
incomplete excision.
4
UI - 12095554
AU - Wazer DE; Berle L; Graham R; Chung M; Rothschild J; Graves T; Cady B;
TI -
Ulin K; Ruthazer R; DiPetrillo TA
Preliminary results of a phase I/II study of HDR brachytherapy alone for
T1/T2 breast cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 15;53(4):889-97
AD - Department of Radiation Oncology, New England Medical Center, Tufts
University School of Medicine, Boston, MA 02111, USA.
Dwazer@lifespan.org
PURPOSE: To investigate the feasibility, toxicity, cosmetic outcome, and
local control of high-dose-rate (HDR) brachytherapy alone without whole
breast external beam irradiation for early-stage breast carcinoma.
diagnosed with a total of 33 AJCC Stage I/II breast carcinomas underwent
surgical breast excision and postoperative irradiation using HDR
brachytherapy interstitial implantation as part of a multi-institutional
clinical Phase I/II protocol. Eligible patients included those with T1,
T2, N0, N1 (< or =3 nodes positive), and M0 tumors of nonlobular
histologic features with negative surgical margins, no extracapsular
lymph node extension, and a negative postexcision mammogram.
Brachytherapy catheters were placed at the initial excision, reexcision,
or either sentinel or full-axillary sampling. Direct visualization,
surgical clips, and ultrasound and/or CT scan assisted in the
delineation of the target volume, defined as the excision cavity plus a
2-cm margin. High-activity 192Ir (3-10 Ci) was used to deliver 340
cGy/fraction, 2 fractions/d, for 5 consecutive days, to a total dose of
34 Gy to the target volume. Source position and dwell times were
calculated using standard volume optimization techniques. RESULTS: The
median follow-up of all patients was 33 months, and the mean patient age
was 63 years. The mean tumor size was 1.3 cm, and 55% had an extensive
intraductal component. Three patients had positive axillary nodes. Two
patients experienced moderate perioperative pain that required narcotic
analgesics. No peri- or postoperative infections occurred. No wound
healing problems and no significant skin reactions related to the
implant developed. The Radiation Therapy Oncology Group late radiation
morbidity scoring scheme was applied to the entire 33-case cohort. In
the assessment of the skin, 30 cases were Grade 0-1 and 3 cases were
Grade 2. Subcutaneous toxicity was scored as 11 patients with Grade 0, 3
with Grade 1, 8 with Grade 2, 3 with Grade 3, and 8 with Grade 4.
Clinically evident fat necrosis occurred in 8 patients at a median of
7.5 months after HDR brachytherapy completion. The only variables
significantly associated with Grade 3-4 toxicity were the number of
source dwell positions and the volume of tissue encompassed by the
prescription isodose shell. The global cosmetic scores after a minimum
of 18 months' follow-up were 0 cases with poor, 4 with fair, 5 with
good, and 24 with excellent scores. One case of ipsilateral breast tumor
recurrence was diagnosed 23 months after HDR brachytherapy, for a 4-year
actuarial recurrence rate of 3%. This failure appeared to be a new
primary tumor, because it was histologically distinct from the initial
tumor and was located 9 cm from the initial tumor bed and 3 cm from the
edge of the implant volume. CONCLUSION: Radiotherapy of the tumor bed
alone with HDR interstitial brachytherapy is associated with a 33%
incidence of Grade 3-4 s.c. toxicity, but with generally favorable
overall cosmetic results. The risk of toxicity appears to be primarily
related to the implant volume. With limited follow-up, the incidence of
ipsilateral breast tumor recurrence was low.
5
UI - 12117189
AU - Dershaw DD
TI -
Breast imaging and the conservative treatment of breast cancer.
SO - Radiol Clin North Am 2002 May;40(3):501-16
AD - Department of Radiology, Memorial Sloan-Kettering Cancer Center, New
York, NY 10021, USA. dershawd@mskcc.org
Breast conservation, where appropriate, offers effective treatment for
breast cancer while preserving the breast. The increased use of
mammographic screening has led to increased detection of small, curable
breast cancers that are amenable to breast-conserving surgery.
Mammography and other imaging modalities, such as sonography and MRI,
assist in the determination of the appropriateness of breast
conservation and in the differentiation of recurrence from benign
sequelae of treatment.
6
UI - 12014245
AU - van Tienhoven G
TI -
[Is extra local radiation still indicated in breast cancer patients who
are older than 60 years after breast conserving surgery?]
SO - Ned Tijdschr Geneeskd 2002 Apr 27;146(17):824; discussion 824
7
UI - 12045435
AU - Marcus CS; Saeed S; Mlikotic A; Mishkin F; Pham HL; Javellana T;
TI -
Diestelhorst S; Minami C
Lack of effect of a bisphosphonate (pamidronate disodium) infusion on
subsequent skeletal uptake of Sm-153 EDTMP.
SO - Clin Nucl Med 2002 Jun;27(6):427-30
AD - Division of Nuclear Medicine, Department of Radiology, Harbor-UCLA
Medical Center, Torrance, California, USA.
Patients who are candidates for samarium-153
ethylenediaminetetramethylenephosphonic acid (Sm-153 EDTMP) therapy
often receive monthly infusions of pamidronate disodium or other
bisphosphonates. Because both drugs are related compounds that
concentrate in bone, it was advisable to determine whether previous
bisphosphonate administration has blocked subsequent uptake of Sm-153
EDTMP. The authors compared skeletal uptake of Sm-153 EDTMP before and 1
to 4 days after pamidronate infusion in three patients with breast
cancer metastatic to bone. In two of the patients, they continued to
compare Sm-153 EDTMP uptake at approximately 1, 2, 3, and 4 weeks after
pamidronate infusion. There was no difference in skeletal uptake of
Sm-153 EDTMP before or at any time after pamidronate infusion.
Pamidronate infusion did not interfere with skeletal uptake of Sm-153
EDTMP.
8
UI - 12122786
AU - Schuck A; Konemann S; Heinen K; Rube CE; Hesselmann S; Reinartz G;
TI -
Schuller P; Micke O; Schafer U; Willich N
Microscopic residual disease is a risk factor in the primary treatment
of breast cancer.
SO - Strahlenther Onkol 2002 Jun;178(6):307-13
AD - Department of Radiotherapy of the University of Muenster, Germany.
schuck@uni-muenster.de
OBJECTIVES: In the primary treatment of breast cancer, postoperative
radiotherapy is performed in high-risk patients after mastectomy and in
patients who received breast conserving surgery. In a retrospective
analysis, our mono-institutional results of postoperative irradiation
have been evaluated. PATIENTS AND METHODS: Between 1992 and 1996, 500
patients have been irradiated after surgery for primary breast cancer.
Of these, 489 patients had no initial metastases. 89 patients with
loco-regional disease had a mastectomy, 400 patients were irradiated
after breast conserving surgery. Radiotherapy at the chest wall was
performed with 50 Gy and 2 Gy fractions. After microscopically
incomplete resection, an electron boost of 10 Gy was given. The
ipsilateral lymph nodes were irradiated with 50 Gy when there was
extensive lymph node involvement or invasion of tumor in the axillary
fat tissue. RESULTS: The 5-year local control rate after mastectomy was
97.4% and 91.2% after breast conserving surgery. The only statistically
significant risk factor for local failure was microscopically incomplete
resection. The corresponding 5-year local control rates for
microscopically incomplete and complete resections were 76.4% and 92.7%
(p = 0.01). The risk of local relapse was increased with both marginal
invasive and marginal DCIS-tissue. 86.6% of local relapses were in the
same quadrant. CONCLUSIONS: High-risk patients after mastectomy and
patients with breast conserving surgery achieve a high local control
rate with postoperative irradiation. After microscopically incomplete
resection, there is an increased risk for local relapse.
9
UI - 12099645
AU - Athow AC; Gattuso JM; Perry N; Wells C; Dutt N; Bahsir GM; Mair G;
TI -
Carpenter R
Is radiotherapy needed after breast conservation for small invasive
breast cancers?
SO - Eur J Surg Oncol 2002 Jun;28(4):379-82
AD - St Bartholomew's Hospital, West Smithfield, London, UK.
AIMS: The purpose of this study was to determine the rate of local
recurrence in patients with small invasive breast cancers (<1 cm) who
had been treated with breast-conserving surgery either with (group 1) or
without (group 2) adjuvant radiotherapy. METHODS: This is a
retrospective study of 110 patients with an invasive breast cancer less
than 1 cm in size, treated in our centre by breast-conserving surgery.
Parameters examined included age at and mode of presentation,
histopathological features, adjuvant therapy, length of follow-up and
outcome in terms of local recurrence rate and death. RESULTS: In group 1
there were 59 women of median age 57 (38-80) years. The median tumour
size was 9 (1-10) mm and median follow-up was 74 (15-110) months. There
were no local recurrences. In group 2 the median age at presentation was
59 (48-81) years. The median tumour size was 7 (2-10) mm and median
follow-up was 47 (14-93) months. There were three non-breast-cancer
related deaths and three local recurrences (6%). CONCLUSIONS: A local
recurrence rate of 6% at almost 4 years median follow-up suggests that
it may be possible to avoid adjuvant radiotherapy in a subgroup of
largely screen-detected, node-negative patients with invasive tumours
less than 1 cm, in whom adequate local excision is performed. Further
follow-up is required to substantiate this. Copyright 2002 Elsevier
Science Ltd. All rights reserved.
10
UI - 12099658
AU - Vaidya JS; Baum M; Tobias JS; Morgan S; D'Souza D
TI -
The novel technique of delivering targeted intraoperative radiotherapy
(Targit) for early breast cancer.
SO - Eur J Surg Oncol 2002 Jun;28(4):447-54
AD - Department of Surgery, Royal Free and University College London Medical
School, 67-73 Riding House St, London, W1W 7EJ, UK. j.vaidya@ucl.ac.uk
AIM: We believe that conservative treatment of early breast cancer may
not require radiotherapy that encompasses the whole breast in all
patients. We have developed a novel therapeutic approach that allows
targeted intraoperative radiotherapy (Targit) to be safely and
accurately delivered in a standard operating theatre. We are currently
recruiting for a randomized trial testing whether Targit can replace the
whole 6 weeks of post-operative radiotherapy after breast conserving
surgery. METHODS: This paper describes the operative technique. It
employs a miniature electron-beam-driven X-ray source called INTRABEAM
(PeC) that emits soft X-rays (50 kV) from within the breast. The X-rays
are emitted from the tip of a 10 cm x 3.2 mm diameter probe, that is
enclosed in a spherical applicator (available in 2.5-5 cm diameter
sizes), which in turn is inserted in the tumour bed and intraoperative
radiotherapy is delivered in about 25 min. The prescribed dose is 5 and
20 Gy at 1 cm and 0.2 cm respectively, from the tumour bed. RESULTS: The
biologically effective dose is 7-53 Gy for alpha/beta=10 and 20-120 Gy
for alpha/beta=1.5. The quick attenuation of the radiation reduces the
damage to normal tissues and allows radiotherapy to be delivered in a
standard operating theatre. Tungsten impregnated rubber sheets, cut to
size, are placed on the chest wall to protect the heart/lungs and over
the wound to stop stray radiation. The skin dose is monitored with
thermoluminescent detectors (TLDs). After wide local excision of the
tumour and good haemostasis, a spherical applicator is inserted in the
tumour bed and the target breast tissues are wrapped around it with a
purse-string suture. Thus, true conformation of the target around the
applicator source is achieved in real time. CONCLUSION: As a tumour bed
boost, this technique has the potential to reduce local recurrence by
avoiding geographical misses and achieving excellent dosimetry. In
patients with low risk of local recurrence, it has the potential to
replace the full 6 weeks of post-operative radiotherapy with
considerable implications to patients and hospitals. Copyright 2002
Elsevier Science Ltd. All rights reserved.
11
UI - 12165629
AU - Sartor CI; Tepper JE
TI -
Is less more? Lessons in radiation schedules in breast cancer.
SO - J Natl Cancer Inst 2002 Aug 7;94(15):1114-5
12
UI - 12165639
AU - Whelan T; MacKenzie R; Julian J; Levine M; Shelley W; Grimard L; Lada B;
TI -
Lukka H; Perera F; Fyles A; Laukkanen E; Gulavita S; Benk V; Szechtman B
Randomized trial of breast irradiation schedules after lumpectomy for
women with lymph node-negative breast cancer.
SO - J Natl Cancer Inst 2002 Aug 7;94(15):1143-50
AD - T. Whelan, M. Levine, McMaster University, and Cancer Care Ontario (CCO)
Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada.
tim.whelan@hrcc.on.ca
BACKGROUND: Breast irradiation after lumpectomy is an integral component
of breast-conserving therapy that reduces the local recurrence of breast
cancer. Because an optimal fractionation schedule (radiation dose given
in a specified number of fractions or treatment sessions over a defined
time) for breast irradiation has not been uniformly accepted, we
examined whether a 22-day fractionation schedule was as effective as the
more traditional 35-day schedule in reducing recurrence. METHODS: Women
with invasive breast cancer who were treated by lumpectomy and had
pathologically clear resection margins and negative axillary lymph nodes
were randomly assigned to receive whole breast irradiation of 42.5 Gy in
16 fractions over 22 days (short arm) or whole breast irradiation of 50
Gy in 25 fractions over 35 days (long arm). The primary outcome was
local recurrence of invasive breast cancer in the treated breast.
Secondary outcomes included cosmetic outcome, assessed with the European
Organisation for Research and Treatment of Cancer (EORTC) Cosmetic
Rating System. All statistical tests were two-sided. RESULTS: From April
treatment, 622 to the short arm and 612 to the long arm. Median
follow-up was 69 months. Five-year local recurrence-free survival was
97.2% in the short arm and 96.8% in the long arm (absolute difference =
0.4%, 95% confidence interval [CI] = -1.5% to 2.4%). No difference in
disease-free or overall survival rates was detected between study arms.
The percentage of patients with an excellent or good global cosmetic
outcome at 3 years was 76.8% in the short arm and 77.0% in the long arm;
the corresponding data at 5 years were 76.8% and 77.4%, respectively
(absolute difference = -0.6%, 95% CI = -6.5% to 5.5%). CONCLUSION: The
more convenient 22-day fractionation schedule appears to be an
acceptable alternative to the 35-day schedule.
13
UI - 12154453
AU - Anonymous
TI -
Montana Supreme Court upholds rejection of physician's claims. Hughes v.
Pullman.
SO - Hosp Law Newsl 2002 Aug;19(10):1-3
14
UI - 12128124
AU - Huang E; McNeese MD; Strom EA; Perkins GH; Katz A; Hortobagyi GN; Valero
TI -
V; Kuerer HM; Singletary SE; Hunt KK; Buzdar AU; Buchholz TA
Locoregional treatment outcomes for inoperable anthracycline-resistant
breast cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Aug 1;53(5):1225-33
AD - Department of Radiation Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston, TX 77030, USA.
PURPOSE: To assess the therapeutic outcomes and treatment-related
morbidity of patients treated with radiation for inoperable breast
cancer resistant to anthracycline-containing primary chemotherapy.
METHODS AND MATERIALS: We analyzed the medical records of breast cancer
patients treated on five consecutive institutional trials who had been
designated as having inoperable locoregional disease after completion of
primary chemotherapy, without evidence of distant metastases at
diagnosis. The cohort for this analysis was 38 (4.4%) of 867 patients
enrolled in these trials. Kaplan-Meier statistics were used for survival
analysis, and prognostic factors were compared using log-rank tests. The
median follow-up of surviving patients was 6.1 years. RESULTS:
Thirty-two (84%) of the 38 patients were able to undergo mastectomy
after radiotherapy. For the whole group, the overall survival rate at 5
years was 46%, with a distant disease-free survival rate of 32%. The
5-year survival rate for patients who were inoperable because of primary
disease extent was 64% compared with 30% for those who were inoperable
because of nodal disease extent (p = 0.0266). The 5-year rate of
locoregional control was 73% for the surgically treated patients and 64%
for the overall group. Of the 32 who underwent mastectomy, the 5-year
rate of significant postoperative complications was 53%, with 4 (13%)
requiring subsequent hospitalization and additional surgical revision.
Preoperative radiation doses of >or=54 Gy were significantly associated
with the development of complications requiring surgical treatment (70%
vs. 9% for doses <54 Gy, p = 0.0257). CONCLUSION: Despite the poorer
prognosis of patients with inoperable disease after primary
chemotherapy, almost one-half remained alive at 5 years and one-third
were free of distant disease after multidisciplinary locoregional
management. These patients have high rates of locoregional recurrence
after preoperative radiotherapy and mastectomy, and the morbidity
associated with this approach may limit dose-escalation strategies.
Alternative therapeutic strategies such as novel systemic agents, use of
planned myocutaneous repair for closure, or radiation combined with
radiosensitizing agents, should be considered in this class of patients.
15
UI - 12128125
AU - Hoeller U; Heide J; Kroeger N; Krueger W; Jaenicke F; Alberti W
TI -
Radiotherapy after high-dose chemotherapy and peripheral blood stem cell
support in high-risk breast cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Aug 1;53(5):1234-9
AD - Department of Radiooncology, University Hospital Hamburg-Eppendorf,
Hamburg, Germany. hoeller@knk-berlin.de
PURPOSE: To assess the toxicity and efficacy of radiotherapy with
respect to locoregional control after adjuvant high-dose chemotherapy
for patients with breast cancer. At first, radiotherapy was withheld
because of toxicity concerns, but it was introduced in 1995 because of
reported high locoregional relapse rates. METHODS AND MATERIALS: Between
1992 and 1998, 40 patients with Stage II-III high-risk breast cancer
received adjuvant high-dose chemotherapy consisting of thiotepa,
mitoxantrone, and cyclophosphamide and peripheral blood stem cell
support after four cycles of induction chemotherapy. The chest wall or
breast, as well as the supraclavicular nodes, were irradiated with
electrons and photons to a median dose of 50.4 Gy in 20 patients. Six
additional patients received only supraclavicular irradiation to a
median dose of 50.4 Gy. Acute toxicity was scored clinically. Pulmonary
function tests were performed in 14 irradiated patients before high-dose
chemotherapy and 1.1-4.4 years (median 1.6) after irradiation. The
median follow-up time of living patients was 33 vs. 67 months in
irradiated (n = 26) and nonirradiated (n = 14) patients, respectively.
RESULTS: G2 and G3 hematologic toxicity occurred in 1 patient each. No
clinical pneumonitis or clinical impairment of lung function was
observed. After 1-2 years, the lung function tests showed only minor
changes in 4 patients. The 3-year locoregional control rate was 92% in
the irradiated patients vs. 58% in the nonirradiated patients (p =
0.049, actuarial analysis). CONCLUSION: In this series, adjuvant
radiotherapy after adjuvant chemotherapy for breast cancer appeared well
tolerated, with improved local regional control and without significant
side effects. Longer follow-up and more patient accrual, as well as
Phase III trials, are necessary for confirmation.
16
UI - 12128126
AU - Foroudi F; Tyldesley S; Walker H; Mackillop WJ
TI -
An evidence-based estimate of appropriate radiotherapy utilization rate
for breast cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Aug 1;53(5):1240-53
AD - Division of Cancer Care and Epidemiology, Queen's Cancer Research
Institute and Kingston Regional Cancer Centre, Kingston, Ontario,
Canada.
PURPOSE: Current estimates of the proportion of cancer patients who will
require radiotherapy (RT) are based almost entirely on expert opinion.
We sought to use an evidence-based approach to estimate the proportion
of incident cases of breast cancer that will require RT at any point in
the evolution of the illness. METHODS AND MATERIALS: We undertook a
systematic review of the literature to identify indications for RT for
breast cancer and to ascertain the level of evidence that supported each
indication. An epidemiologic approach was then used to estimate the
incidence of each indication for RT in a typical North American
population of breast cancer patients. The effect of sampling error on
the estimated appropriate rate of RT was calculated mathematically, and
the effect of systematic error was estimated by sensitivity analysis.
RESULTS: It was estimated that 66.4% +/- 4.8% of breast cancer patients
develop one or more indications for RT at some point in the course of
the illness. The plausible range for this rate was 56.3%-72.4% on
sensitivity analysis. Of all breast cancer patients, 57.3% +/- 4.7%
require RT in their initial treatment and 9.1% +/- 1.0% do so later for
recurrence or progression. The proportion of patients who ever require
RT is stage dependent: 39.8% +/- 1.1% in ductal carcinoma in situ; 68.6%
+/- 4.1% in Stage I invasive carcinoma; 81.5% +/- 2.3% in Stage II;
95.3% +/- 0.3% in Stage III; and 63.7% +/- 0.3% in Stage IV. CONCLUSION:
This method provides a rational starting point for the long-term
planning of RT services and for the audit of access to RT at the
population level. By completing such evaluations in the major cancer
sites, it will be possible to estimate the appropriate RT treatment rate
for the cancer population as a whole.
17
UI - 12063011
AU - Green H; Ross G; Peacock J; Owen R; Yarnold J; Houlston R
TI -
Variation in the manganese superoxide dismutase gene (SOD2) is not a
major cause of radiotherapy complications in breast cancer patients.
SO - Radiother Oncol 2002 May;63(2):213-6
AD - Section of Cancer Genetics, Institute of Cancer Research, Sutton,
Surrey, SM2 5NG, UK.
BACKGROUND AND PURPOSE: Small proportions of patients receiving
radiotherapy develop marked long-term radiation damage. It is thought
that this is due, at least in part, to intrinsic differences in cellular
radiosensitivity, but the underlying mechanism is unknown. Reactive
oxygen species are involved in cellular radiation damage, hence
inter-individual differences in free radical detoxification may be
related to radiosensitivity. Within mitochondria manganese superoxide
dismutase (MnSOD) provides a major defence against oxidative damage by
reactive oxygen species. MnSOD has been linked to expression of
malignant phenotype and apoptosis and polymorphic variation in the gene,
SOD2 to risk of breast cancer. MATERIALS AND METHODS: Forty-one breast
cancer patients developing marked changes in breast appearance after
radiotherapy and 39 patients who showed no clinically detectable
reaction after radiotherapy were analyzed for germline sequence
variation in SOD2. RESULTS: The Ala-9Val polymorphism was detected, but
no other sequence variants were detected in SOD2. Both alleles of the
Ala-9Val polymorphism were equally distributed between the two patient
groups. CONCLUSIONS: Sequence variation in SOD2 is not the major cause
of radiotherapy complications in women with breast cancer.
18
UI - 12113193
AU - Chow E
TI -
Radiation treatment for breast cancer. Recent advances.
SO - Can Fam Physician 2002 Jun;48():1065-9
AD - Toronto Sunnybrook Regional Cancer Centre, Department of Radiation
Oncology, 2075 Bayview Ave, Toronto, ON M4N 3N5.
OBJECTIVE: To review recent advances in radiation therapy in treatment
of breast cancer. QUALITY OF EVIDENCE: MEDLINE and CANCERLIT were
searched using the MeSH words breast cancer, ductal carcinoma in situ,
sentinel lymph node biopsy, and postmastectomy radiation. Randomized
studies have shown the efficacy of radiation treatment for ductal
carcinoma in situ (DCIS) and for invasive breast cancer. MAIN MESSAGE:
Lumpectomy followed by radiation is effective treatment for DCIS. In
early breast cancer, shorter radiation schedules are as efficacious for
local control and short-term cosmetic results as traditional
fractionation regimens. Sentinel lymph node biopsy is done in
specialized cancer centres; regional radiation is recommended for
patients with four or more positive axillary lymph nodes. Postmastectomy
radiation has been shown to have survival benefits for high-risk
premenopausal patients. Systemic metastases from breast cancer usually
respond satisfactorily to radiation. CONCLUSION: Radiation therapy
continues to have an important role in treatment of breast cancer. There
have been great advances in radiation therapy in the last decade, but
they have raised controversy. Further studies are needed to address the
controversies.
19
UI - 12132946
AU - Howlett SJ; Kron T
TI -
Monitor unit calculation for tangential breast treatments: verification
in an anthropomorphic phantom.
SO - J Appl Clin Med Phys 2002 Summer;3(3):235-40
AD - Department of Radiation Oncology, Newcastle Mater Hospital, Locked Bag
7, Hunter Region Mail Centre, 2310 NSW, Australia.
mdsjho@cc.newcastle.edu.au
This paper presents an anthropomorphic phantom study of dose delivered
to a specific point during tangential breast irradiation to verify
monitor unit calculations. Measurements were made using a 0.6 cc Farmer
type cylindrical ionization chamber in the phantom and compared to
calculations made on a three-dimensional radiotherapy treatment planning
system using single digitized contour through to multi slice CT data. A
large breast phantom was used for a single field size with a combination
of open and wedged fields for three different energies (4, 6, and 18
MV). Solid flat phantom measurements were also performed for comparison.
Results showed a lower calculated dose than the dose measured for a
fixed number of monitor units where the variations were within a range
of 0.8% to 4.5%. Differences were larger for the anthropomorphic phantom
than the flat phantom. We conclude that little accuracy is gained from
CT based monitor unit calculations compared to those based on digitised
contours for this breast treatment but that the dose distributions will
be affected. This type of test is recommended as one of a large set, in
the commissioning and testing procedures for treatment planning systems.
20
UI - 11892870
AU - Falkenberry SS
TI -
Breast cancer in pregnancy.
SO - Obstet Gynecol Clin North Am 2002 Mar;29(1):225-32, ix
AD - Department of Obstetrics and Gynecology, Brown University, Providence,
Rhode Island 02905, USA.
Breast cancer in pregnancy is likely to become more common because more
women have been waiting to bear children until they are in their 40s.
This article presents an overview of pregnancy-associated breast cancer
and a review of surgical, chemotherapeutical, and radiation principles
as they pertain to pregnancy.
21
UI - 11911514
AU - Fathers E; Thrush D; Huson SM; Norman A
TI -
Radiation-induced brachial plexopathy in women treated for carcinoma of
the breast.
SO - Clin Rehabil 2002 Mar;16(2):160-5
AD - Department of Neurology, Derriford Hospital, Plymouth, UK.
Edward.Fathers@btinternet.com
OBJECTIVES: To study the clinical presentation and natural history of
radiation-induced brachial plexopathy in 33 women treated for carcinoma
of the breast. METHODS: All of the patients were referred to a single
consultant neurologist. Details of surgical procedures, radiotherapy,
symptoms at presentation and follow-up and neurological findings were
recorded. Patients were reviewed at six or 12 monthly intervals for 2-19
years (median 9.5 years). Investigations included blood tests, chest
X-ray, bone scan, neurophysiological studies, computerized tomography
(CT) or magnetic resonance imaging (MRI) of the cervical spine and
cerebrospinal fluid examination. RESULTS: Symptoms began from six months
to 20 years after radiotherapy (median time 1.5 years). Progressive
weakness was universal and resulted in loss of any useful hand function
in all but three patients. The time taken to loss of useful hand
function ranged from six weeks to five years (median 1.25 years). Three
patterns of upper limb weakness were identified, distal limb weakness
only (13 patients), global limb weakness that was more marked distally
(11 patients), and completely flaccid arm (10 patients). Seventeen
patients required long-term morphine to palliate pain. A chemical
sympathectomy benefited three patients. CONCLUSIONS: Most patients
developed symptoms within three years, but late presentations 8-20 years
later were encountered. Symptoms were progressive in all patients,
though the rate did vary. Pain was common and persisted indefinitely in
all but one patient. Morphine was effective and should be used early and
in adequate doses. Chemical sympathectomy provided sustained relief in
three of six patients.
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.
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