Douglas W Arthur1, Kathryn A Winter2, Henry M Kuerer3, Bruce G Haffty4, Laurie W Cuttino5, Dorin A Todor5, Nicole L Simone6, Shelly B Hayes7, Wendy A Woodward8, Beryl McCormick9, Randi J Cohen10, Walter M Sahijdak11, Daniel J Canaday12, Doris R Brown13, Adam D Currey14, Christine M Fisher15, Reshma Jagsi16, Julia White17. 1. Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia. Electronic address: douglas.arthur@vcuhealth.org. 2. NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania. 3. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. 5. Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia. 6. Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 7. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. 8. Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 9. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 10. Department of Radiation Oncology, University of Maryland Medical System, Baltimore, Maryland. 11. Department of Radiation Oncology, Michigan Cancer Research Consortium Community Clinical Oncology Program, Ann Arbor, Michigan. 12. Cape Cod Hospital, Hyannis, Massachusetts. 13. Department of Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina. 14. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 15. Department of Radiation Oncology, University of Colorado Denver, Denver, Colorado. 16. Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan. 17. Department of Radiation Oncology, Ohio State University, Columbus, Ohio.
Abstract
PURPOSE: To determine the associated toxicity, tolerance, and safety of partial-breast reirradiation. METHODS AND MATERIALS: Eligibility criteria included in-breast recurrence occurring >1 year after whole-breast irradiation, <3 cm, unifocal, and resected with negative margins. Partial-breast reirradiation was targeted to the surgical cavity plus 1.5 cm; a prescription dose of 45 Gy in 1.5 Gy twice daily for 30 treatments was used. The primary objective was to evaluate the rate of grade ≥3 treatment-related skin, fibrosis, and/or breast pain adverse events (AEs), occurring ≤1 year from re-treatment completion. A rate of ≥13% for these AEs in a cohort of 55 patients was determined to be unacceptable (86% power, 1-sided α = 0.07). RESULTS: Between 2010 and 2013, 65 patients were accrued, and the first 55 eligible and with 1 year follow-up were analyzed. Median age was 68 years. Twenty-two patients had ductal carcinoma in situ, and 33 had invasive disease: 19 ≤1 cm, 13 >1 to ≤2 cm, and 1 >2 cm. All patients were clinically node negative. Systemic therapy was delivered in 51%. All treatment plans underwent quality review for contouring accuracy and dosimetric compliance. All treatment plans scored acceptable for tumor volume contouring and tumor volume dose-volume analysis. Only 4 (7%) scored unacceptable for organs at risk contouring and organs at risk dose-volume analysis. Treatment-related skin, fibrosis, and/or breast pain AEs were recorded as grade 1 in 64% and grade 2 in 7%, with only 1 (<2%) grade ≥3 and identified as grade 3 fibrosis of deep connective tissue. CONCLUSION: Partial-breast reirradiation with 3-dimensional conformal radiation therapy after second lumpectomy for patients experiencing in-breast failures after whole-breast irradiation is safe and feasible, with acceptable treatment quality achieved. Skin, fibrosis, and breast pain toxicity was acceptable, and grade 3 toxicity was rare.
PURPOSE: To determine the associated toxicity, tolerance, and safety of partial-breast reirradiation. METHODS AND MATERIALS: Eligibility criteria included in-breast recurrence occurring >1 year after whole-breast irradiation, <3 cm, unifocal, and resected with negative margins. Partial-breast reirradiation was targeted to the surgical cavity plus 1.5 cm; a prescription dose of 45 Gy in 1.5 Gy twice daily for 30 treatments was used. The primary objective was to evaluate the rate of grade ≥3 treatment-related skin, fibrosis, and/or breast pain adverse events (AEs), occurring ≤1 year from re-treatment completion. A rate of ≥13% for these AEs in a cohort of 55 patients was determined to be unacceptable (86% power, 1-sided α = 0.07). RESULTS: Between 2010 and 2013, 65 patients were accrued, and the first 55 eligible and with 1 year follow-up were analyzed. Median age was 68 years. Twenty-two patients had ductal carcinoma in situ, and 33 had invasive disease: 19 ≤1 cm, 13 >1 to ≤2 cm, and 1 >2 cm. All patients were clinically node negative. Systemic therapy was delivered in 51%. All treatment plans underwent quality review for contouring accuracy and dosimetric compliance. All treatment plans scored acceptable for tumor volume contouring and tumor volume dose-volume analysis. Only 4 (7%) scored unacceptable for organs at risk contouring and organs at risk dose-volume analysis. Treatment-related skin, fibrosis, and/or breast pain AEs were recorded as grade 1 in 64% and grade 2 in 7%, with only 1 (<2%) grade ≥3 and identified as grade 3 fibrosis of deep connective tissue. CONCLUSION: Partial-breast reirradiation with 3-dimensional conformal radiation therapy after second lumpectomy for patients experiencing in-breast failures after whole-breast irradiation is safe and feasible, with acceptable treatment quality achieved. Skin, fibrosis, and breast pain toxicity was acceptable, and grade 3 toxicity was rare.
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