National Cancer Institute®
Last Modified: August 1, 2002
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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.
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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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