Sophie C J Bosma1, Femke Leij1, Sandra Vreeswijk1, Michiel de Maaker2, Jelle Wesseling2, Marc van de Vijver3, Astrid Scholten1, Sofia Rivera4, Celine Bourgier5, Guillaume Auzac4, Theodoros Foukakis6, Tobias Lekberg6, Desiree Bongard7, Claudette Loo8, Emiel Rutgers9, Harry Bartelink1, Paula H M Elkhuizen10. 1. Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. 2. Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. 3. Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands. 4. Department of Radiation Oncology, Gustave Roussy, Villejuif, France. 5. Department of Radiation Oncology, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France. 6. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. 7. Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands. 8. Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. 9. Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. 10. Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: p.elkhuizen@nki.nl.
Abstract
PURPOSE: In this multicenter phase 2 feasibility study, we investigated the impact of preoperative accelerated partial breast irradiation (PAPBI) on local control, breast fibrosis, and cosmetic outcome. METHODS AND MATERIALS: Women aged >60 years with an invasive, unifocal (mammography and magnetic resonance imaging), nonlobular adenocarcinoma of the breast were treated with PAPBI. Six weeks after radiation therapy, a wide local excision was performed. Radiation therapy consisted of 10 × 4 Gy (2010-2013) or 5 × 6 Gy (after 2013) to the tumor (gross target volume) with a 25 mm margin (20 mm from gross target volume to clinical target volume, 5 mm planning target volume). RESULTS: One hundred thirty-three patients treated between 2010 and 2016 were analyzed with a median follow-up of 5.0 years (0.9-8.8 years). Seventy-eight (59%) patients were treated with 10 × 4 Gy in 2 weeks and 55 (41%) patients with 5 × 6 Gy in 1 week. Eighteen postoperative complications (14%) occurred in 15 patients (11%). The proportion of patients with no to mild fibrosis in the treated part of the breast at 2 years and later time points was around 90%. Cosmesis improved over time in several patients: excellent to good cosmetic score as rated by the physician was 68% at 6 months and 92% at 5 years. Seventy-seven percent (6 months) to 82% (5 years) of patients were "satisfied" or "very satisfied" with their cosmetic outcome. Three recurrences were detected in the biopsy track and 1 recurrence in the ipsilateral breast. CONCLUSIONS: PAPBI is a feasible method with a low postoperative complication rate, limited fibrosis, and good to excellent cosmetic outcome. The local recurrence rate was 3% at 5 years; however, no local recurrences were observed since removal of the needle biopsy track.
PURPOSE: In this multicenter phase 2 feasibility study, we investigated the impact of preoperative accelerated partial breast irradiation (PAPBI) on local control, breast fibrosis, and cosmetic outcome. METHODS AND MATERIALS: Women aged >60 years with an invasive, unifocal (mammography and magnetic resonance imaging), nonlobular adenocarcinoma of the breast were treated with PAPBI. Six weeks after radiation therapy, a wide local excision was performed. Radiation therapy consisted of 10 × 4 Gy (2010-2013) or 5 × 6 Gy (after 2013) to the tumor (gross target volume) with a 25 mm margin (20 mm from gross target volume to clinical target volume, 5 mm planning target volume). RESULTS: One hundred thirty-three patients treated between 2010 and 2016 were analyzed with a median follow-up of 5.0 years (0.9-8.8 years). Seventy-eight (59%) patients were treated with 10 × 4 Gy in 2 weeks and 55 (41%) patients with 5 × 6 Gy in 1 week. Eighteen postoperative complications (14%) occurred in 15 patients (11%). The proportion of patients with no to mild fibrosis in the treated part of the breast at 2 years and later time points was around 90%. Cosmesis improved over time in several patients: excellent to good cosmetic score as rated by the physician was 68% at 6 months and 92% at 5 years. Seventy-seven percent (6 months) to 82% (5 years) of patients were "satisfied" or "very satisfied" with their cosmetic outcome. Three recurrences were detected in the biopsy track and 1 recurrence in the ipsilateral breast. CONCLUSIONS:PAPBI is a feasible method with a low postoperative complication rate, limited fibrosis, and good to excellent cosmetic outcome. The local recurrence rate was 3% at 5 years; however, no local recurrences were observed since removal of the needle biopsy track.
Authors: Maureen L Groot Koerkamp; H J G Desirée van den Bongard; Marielle E P Philippens; Femke van der Leij; Stefano Mandija; Antonetta C Houweling Journal: Phys Imaging Radiat Oncol Date: 2022-07-05