PURPOSE: To report interim cosmetic results and toxicity from a prospective study evaluating accelerated partial-breast irradiation (APBI) administered using a highly conformal external beam approach. METHODS AND MATERIALS: We enrolled breast cancer patients in an institutional review board-approved prospective study of APBI using beamlet intensity-modulated radiotherapy (IMRT) at deep-inspiration breath-hold. Patients received 38.5 Gy in 3.85 Gy fractions twice daily. Dosimetric parameters in patients who maintained acceptable cosmesis were compared with those in patients developing unacceptable cosmesis in follow-up, using t-tests. RESULTS: Thirty-four patients were enrolled; 2 were excluded from analysis because of fair baseline cosmesis. With a median follow-up of 2.5 years, new unacceptable cosmesis developed in 7 patients, leading to early study closure. We compared patients with new unacceptable cosmesis with those with consistently acceptable cosmesis. Retrospective analysis demonstrated that all but one plan adhered to the dosimetric requirements of the national APBI trial. The mean proportion of a whole-breast reference volume receiving 19.25 Gy (V50) was lower in patients with acceptable cosmesis than in those with unacceptable cosmesis (34.6% vs. 46.1%; p = 0.02). The mean percentage of this reference volume receiving 38.5 Gy (V100) was also lower in patients with acceptable cosmesis (15.5% vs. 23.0%; p = 0.02). CONCLUSIONS: The hypofractionated schedule and parameters commonly used for external beam APBI and prescribed by the ongoing national trial may be suboptimal, at least when highly conformal techniques such as IMRT with management of breathing motion are used. The V50 and V100 of the breast reference volume seem correlated with cosmetic outcome, and stricter limits may be appropriate in this setting.
PURPOSE: To report interim cosmetic results and toxicity from a prospective study evaluating accelerated partial-breast irradiation (APBI) administered using a highly conformal external beam approach. METHODS AND MATERIALS: We enrolled breast cancerpatients in an institutional review board-approved prospective study of APBI using beamlet intensity-modulated radiotherapy (IMRT) at deep-inspiration breath-hold. Patients received 38.5 Gy in 3.85 Gy fractions twice daily. Dosimetric parameters in patients who maintained acceptable cosmesis were compared with those in patients developing unacceptable cosmesis in follow-up, using t-tests. RESULTS: Thirty-four patients were enrolled; 2 were excluded from analysis because of fair baseline cosmesis. With a median follow-up of 2.5 years, new unacceptable cosmesis developed in 7 patients, leading to early study closure. We compared patients with new unacceptable cosmesis with those with consistently acceptable cosmesis. Retrospective analysis demonstrated that all but one plan adhered to the dosimetric requirements of the national APBI trial. The mean proportion of a whole-breast reference volume receiving 19.25 Gy (V50) was lower in patients with acceptable cosmesis than in those with unacceptable cosmesis (34.6% vs. 46.1%; p = 0.02). The mean percentage of this reference volume receiving 38.5 Gy (V100) was also lower in patients with acceptable cosmesis (15.5% vs. 23.0%; p = 0.02). CONCLUSIONS: The hypofractionated schedule and parameters commonly used for external beam APBI and prescribed by the ongoing national trial may be suboptimal, at least when highly conformal techniques such as IMRT with management of breathing motion are used. The V50 and V100 of the breast reference volume seem correlated with cosmetic outcome, and stricter limits may be appropriate in this setting.
Authors: Daniel W Weed; Di Yan; Alvaro A Martinez; Frank A Vicini; T J Wilkinson; John Wong Journal: Int J Radiat Oncol Biol Phys Date: 2004-10-01 Impact factor: 7.038
Authors: M Clarke; R Collins; S Darby; C Davies; P Elphinstone; V Evans; J Godwin; R Gray; C Hicks; S James; E MacKinnon; P McGale; T McHugh; R Peto; C Taylor; Y Wang Journal: Lancet Date: 2005-12-17 Impact factor: 79.321
Authors: Timothy Whelan; Robert MacKenzie; Jim Julian; Mark Levine; Wendy Shelley; Laval Grimard; Barbara Lada; Himu Lukka; Francisco Perera; Anthony Fyles; Ethan Laukkanen; Sunil Gulavita; Veronique Benk; Barbara Szechtman Journal: J Natl Cancer Inst Date: 2002-08-07 Impact factor: 13.506
Authors: Silvia C Formenti; Minh Tam Truong; Judith D Goldberg; Vandana Mukhi; Barry Rosenstein; Daniel Roses; Richard Shapiro; Amber Guth; J Keith Dewyngaert Journal: Int J Radiat Oncol Biol Phys Date: 2004-10-01 Impact factor: 7.038
Authors: T Morimoto; K Okazaki; K Komaki; M Sasa; T Mori; H Tsuzuki; Y Kamamura; H Miki; Y Monden Journal: J Surg Oncol Date: 1993-02 Impact factor: 3.454
Authors: Csaba Polgár; Zoltán Sulyok; János Fodor; Zsolt Orosz; Tibor Major; Zoltán Takácsi-Nagy; László C Mangel; András Somogyi; Miklós Kásler; György Németh Journal: J Surg Oncol Date: 2002-07 Impact factor: 3.454
Authors: R M Clark; P B McCulloch; M N Levine; M Lipa; R H Wilkinson; L J Mahoney; V R Basrur; B D Nair; R S McDermot; C S Wong Journal: J Natl Cancer Inst Date: 1992-05-06 Impact factor: 13.506
Authors: Adam A Garsa; Daniel J Ferraro; Todd Dewees; Julie A Margenthaler; Michael Naughton; Rebecca Aft; William E Gillanders; Timothy Eberlein; Melissa A Matesa; Imran Zoberi Journal: Brachytherapy Date: 2012-06-20 Impact factor: 2.362
Authors: F Sedlmayer; M L Sautter-Bihl; W Budach; J Dunst; P Feyer; R Fietkau; W Haase; W Harms; C Rödel; R Souchon; F Wenz; R Sauer Journal: Strahlenther Onkol Date: 2013-03 Impact factor: 3.621
Authors: Cedric X Yu; Xinyu Shao; Jin Zhang; William Regine; Mike Zheng; Ying S Yu; Jianchun Deng; Zhengcheng Duan Journal: Med Phys Date: 2013-05 Impact factor: 4.071
Authors: Krishan R Jethwa; Sean S Park; Karthik Gonuguntla; Stephanie M Wick; Laura A Vallow; Christopher L Deufel; Thomas J Whitaker; Keith M Furutani; Kathryn J Ruddy; Kimberly S Corbin; Tina J Hieken; Robert W Mutter Journal: Int J Radiat Oncol Biol Phys Date: 2018-12-21 Impact factor: 7.038