Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
Annals of Surgical Oncology
Erschienen in:

18.03.2021 | Breast Oncology

A Phase II Trial of Once Weekly Hypofractionated Breast Irradiation for Early Stage Breast Cancer

verfasst von: Harriet Eldredge-Hindy, MD, Jianmin Pan, PhD, Shesh N. Rai, PhD, Leonid B. Reshko, MD, Anthony Dragun, MD, Elizabeth C. Riley, MD, Kelly M. McMasters, MD, PhD, Nicolas Ajkay, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To report an interim analysis of a phase II trial of once weekly, hypofractionated breast irradiation (WH-WBI) following breast conserving surgery (BCS).

Methods

Patients had stage 0-II breast cancer treated with breast BCS with negative margins. WH-WBI was 28.5 or 30Gy delivered to the whole breast using tangential beams with no elective coverage of lymph nodes. The primary endpoint was ipsilateral breast tumor recurrence (IBTR). Secondary endpoints were distant disease-free survival (DDFS), recurrence free survival (RFS), overall survival (OS), adverse events and cosmesis.

Results

From 2011 to 2015, 158 patients received WH-WBI. Median follow up was 4.4 years (range 0.2-8.1). Stage distribution was DCIS 22%; invasive pN0 68%; invasive pN1 10%. 80 patients received 30 Gy and 78 received 28.5 Gy with median follow up times of 5.6 and 3.7 years, respectively. There were 5 IBTR events, all in the 30 Gy group. The 5- and 7- year risks of IBRT for all patients were 2.2% (95% CI 0.6-5.8) and 6.0% (95% CI 1.1-17.2), respectively. The 7-year rates of DDFS, RFS, and OS were 96.3%, 91.5% and 89.8%, respectively. Improvement in IBTR-free time was seen in DCIS, lobular histology, low grade tumors, Her2 negative tumors and 28.5 Gy dose (all p < 0.0001).

Conclusions

Disease-specific outcomes after WH-WBI are favorable and parallel those seen with conventional radiation techniques for stage 0-II breast cancer.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRef
2.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRef
3.
Blichert-Toft M, Rose C, Andersen JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogra 1992;11:12–5.
4.
Arriagada R, Le MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer: Patterns of failure with 15 years of follow-up data. Insitut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996;14:1558–64.
5.
Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: The National Cancer Institute Randomized trial. Cancer. 2003;98:697–702.PubMedCrossRef
6.
Van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2002;92:1143–50.CrossRef
7.
Ganz PA, Coscarelli Schag CA, Lee JJ, et al. Breast Conservation versus mastectomy: is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer. 1992;69:1729–38.PubMedCrossRef
8.
Janni W, Rjosk D, Dimpfl T, et al. Quality of life influenced by primary surgical treatment for stage I-III breast cancer—Long them follow-up of a matched pair analysis. Ann Surg Oncol. 2001;8:542–8.PubMed
9.
Curran D, van Dongen JP, Aaronson NK, et al. Quality of life of early-stage breast cancer patients treated with radical mastecotmy or breast-conserving procedures: results of EORTC trial 10801. Eur J Cancer. 1998;34:307–14.PubMedCrossRef
10.
Jagsi R, Li Y, Morrow M, et al. Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a surgery of breast cancer survivors. Ann Surg. 2015;261:1198–206.PubMedCrossRef
11.
Kunkler IH, Williams LJ, Jack WJ, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomized controlled trial. Lancet Oncol. 2015;16:266–73.PubMedCrossRef
12.
Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: Long-tern follow-up of CALGB 93943. J Clin Oncol. 2013;31:2382–7.PubMedPubMedCentralCrossRef
13.
McCormick B, Winter K, Hudis C, et al. RTOG 9804: A prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33:709–15.PubMedPubMedCentralCrossRef
14.
Solin LJ, Gray R, Hughes LL, et al. Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J Clin Oncol. 2015;33:3938–44.PubMedPubMedCentralCrossRef
15.
Freedman RA, He Y, Winer EP, et al. Trends in racial and age disparities in definitive local therapy of early-stage breast cancer. J Clin Oncol. 2009;27:713–9.PubMedCrossRef
16.
Smith GL, Shih YC, Xu Y, et al. Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer. 2010;116:734–41.PubMedCrossRef
17.
Hampton T. Studies address racial and geographic disparities in breast cancer treatment. JAMA. 2008;300:1641.PubMedCrossRef
18.
Haggstrom DA, Quale C, Smith-Bindman R. Differences in the quality of breast cancer care among vulnerable populations. Cancer. 2005;104:2347–58.PubMedCrossRef
19.
Hershman DL, Buono D, McBride RB, et al. Surgeon characteristics and receipt of adjuvant radiotherapy in women with breast cancer. J Natl Cancer Inst. 2008;100:199–206.PubMedCrossRef
20.
Schroen AT, Brenin DR, Kelly MD, et al. Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. J Clin Oncol. 2005;23:7074–80.PubMedCrossRef
21.
Gold HT, Do HT, Dick AW. Correlates and effect of suboptimal radiotherapy in women with ductal carcinoma in situ or early invasive breast cancer. Cancer. 2008;113:3108–15.PubMedCrossRef
22.
Jagsi R, Abrahamse P, Morrow M, et al. Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer. J Clin Oncol. 2010;28:2396–403.PubMedPubMedCentralCrossRef
23.
Buchholz TA, Theriault RL, Niland JC, et al. The use of radiation as a component of breast conservation therapy in National Comprehensive Cancer Network Centers. J Clin Oncol. 2006;24:361–9.PubMedCrossRef
24.
Chagpar AB, McMasters KM, Scoggins CR, et al. The use of radiation therapy after breast-conserving surgery in hormonally treated breast cancer patients is dependent on patient age, geographic region, and surgeon specialty. Am J Surg. 2008;195:793–8.PubMedCrossRef
25.
Bickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol. 2006;24:1357–62.PubMedCrossRef
26.
Anderson RT, Kimmick GG, Camacho F, et al. Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women. Am J Manag Care. 2008;14:644–52.PubMed
27.
Dragun AE, Huang B, Tucker TC, et al. Disparities in the application of adjuvant radiotherapy after breast conserving surgery for early stage breast cancer: impact on overall survival. Cancer. 2011;117:2590–8.PubMedCrossRef
28.
Dragun AE, Quillo AR, Riley EC, et al. A phase 2 trial of once-weekly hypofractionated breast irradiation: first report of acute toxicity, feasibility and patient satisfaction. Int J Radiat Oncol Biol Phys. 2013;85:e123–8.PubMedCrossRef
29.
Dragun AE, Ajkay NJ, Riley EC, et al. First results of a phase 2 trial of once-weekly hypofractionated breast irradiation (WHBI) for early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2017;98:595–602.PubMedCrossRef
30.
Vicini FA, Cecchini RS, White JR, et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomized, phase 3, equivalence trial. Lancet. 2019;394:2155–64.PubMedPubMedCentralCrossRef
31.
Acharya S, Hsieh S, Michalski JM, et al. Distance to radiation facility and treatment choice in early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2016;94:691–9.PubMedCrossRef
32.
Punglia RS, Weeks JC, Neville BA, et al. Effect of distance to radiation treatment facility on use of the radiation therapy after mastectomy in elderly women. Int J Radiat Oncol Biol Phys. 2006;66:56–63.PubMedCrossRef
33.
Voti L, Richardson LC, Reis IM, et al. Treatment of local breast carcinoma in Florida: the role of the distance to radiation therapy facilities. Cancer. 2006;106:201–7.PubMedCrossRef
34.
Celaya MO, Rees JR, Gibson JJ, et al. Travel distance and season of diagnosis affect treatment choices for women with early-stage breast cancer in a predominantly rural population (United States). Cancer Causes Control. 2006;17:851–6.PubMedCrossRef
35.
Boscoe FP, Johnson CJ, Hendry KA, et al. Geographic proximity to treatment for early stage breast cancer and the likelihood of mastectomy. Breast. 2011;20:324–8.PubMedCrossRef
36.
Lautner M, Lin H, Shen Y, et al. Disparities in the use of breast-conserving therapy among patients with early-stage breast cancer. JAMA Surg. 2015;150:778–86.PubMedPubMedCentralCrossRef
37.
The FAST Trialists group. First results of the randomized UK FAST trial or radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015). Radiother Oncol. 2011;100:93–100.CrossRef
38.
DeSantis CE, Ma J, Goding Sauer A, et al. Breast cancer statistics 2017, racial disparity in mortality by state. CA Cancer J Clin. 2017;67:439–47.PubMedCrossRef
39.
Owen JR, Ashton A, Bliss JM, et al. Effect of radiotherapy fraction size on tumor control in patients with early-stage breast cancer after local tumor excision: long-term results of a randomized trial.
40.
Haviland JS, Owen JR, Dewar JA, et al. The UK standardization of breast radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomized controlled trials. Lancet Oncol. 2013;14:1086–94.PubMedCrossRef
41.
Brunt AM, Haviland JS, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicenter, non-inferiority, randomized, phase 3 trial. Lancet. 2020;395:1613–26.CrossRef
42.
Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.PubMedCrossRef
43.
Hickey BE, James ML, Lehman M, et al. Fraction size in radiation therapy for breast conservation in early breast cancer. Cochrane Database Syst Rev 2016; 7: CD003860.
44.
Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Prac Radiat Oncol. 2018;8:145–52.CrossRef
45.
Brunt AM, Haviland J, Sydenham M, et al. Ten-year results of FAST: A randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer. J Clin Oncol. 2020;38:3261–72.PubMedCrossRefPubMedCentral
46.
Brunt AM, Wheatley D, Yarnold J, et al. Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3-week regimen delivered in the UK FAST-Forward Trial. Radiother Oncol. 2016;120:114–8.PubMedPubMedCentralCrossRef
47.
Gupta Ap, Khan AJ, Yegya-Raman N, et al. 5-year results of a prospective phase 2 trial evaluating 3-week hypofractionated whole breast radiation therapy inclusive of a sequential boost. Int J Radiat Oncol Biol Phys 2019;105:267–74.
48.
Dellas K, Vonthein R, Zimmer J, et al. Hypofractionation with simultaneous integrated boost for early breast cancer: results of the German multicenter phase II trial (ARO-2010-01). Strahlenther Onkol. 2014;190:646–53.PubMedCrossRef
49.
Formenti SC, Gidea-Addeo D, Goldberg JD, et al. Phase I-II trial of prone accelerated intensity modulated radiation therapy to the breast to optimally spare normal tissue. J Clin Oncol. 2007;25:2236–42.PubMedCrossRef
50.
Chen G, White J, Vicini FA, et al. A dosimetric planning study for hypofractionated whole breast irradiation with concurrent boost (RTOG1005) for early breast cancer. Int J Radiat Oncol Biol Phys. 2011;81(2):S248–9.CrossRef
51.
Eldredge-Hindy H, Gaskins J, Dragun A, et al. Patient-reported outcomes and cosmesis after once-weekly hypofractionated breast irradiation in medically underserved patients. Int J Radiat Oncol Biol Phys. 2020;107:934–42.PubMedCrossRef
52.
Mak KS, Chen Y, Catalano PJ, et al. Dosimetric inhomogeneity predicts for long-term breast pain after breast-conserving therapy. Int J Radiati Oncol Biol Phys. 2015;93:1087–95.CrossRef
53.
Meattini I, Marrazzo L, Saieva C, et al. Accelerate partial-breast irradiation compared with whole-breast irradiation for early breast cancer: Long-term results of the randomized phase III APBI-IMRT-Florence trial. J Clin Oncol. 2020;38:4175–83.PubMedCrossRef
54.
Smith GL, Xu Y, Buchholz TA, et al. Association between treatment with brachytherapy vs. whole-breast irradiation and subsequent mastectomy, complications, and survival among older wome with invasive breast cancer. JAMA 2012:307:1827–37
55.
Foley KL, Kimmick G, Camacho F, et al. Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy. Breast Cancer Res Treat. 2007;101:207–14.PubMedCrossRef
56.
McCarthy EP, Ngo LH, Roetzheim RG, et al. Disparities in breast cancer treatment and survival for women with disabilities. Ann Intern Med. 2006;145:637–45.PubMedPubMedCentralCrossRef
57.
Yood MU, Owusu C, Buist DS, et al. Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg. 2008;206:66–75.PubMedCrossRef
Metadaten
Titel
A Phase II Trial of Once Weekly Hypofractionated Breast Irradiation for Early Stage Breast Cancer
verfasst von
Harriet Eldredge-Hindy, MD
Jianmin Pan, PhD
Shesh N. Rai, PhD
Leonid B. Reshko, MD
Anthony Dragun, MD
Elizabeth C. Riley, MD
Kelly M. McMasters, MD, PhD
Nicolas Ajkay, MD
Publikationsdatum
18.03.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-09777-3

Weitere Artikel der Ausgabe 11/2021

An Improved Staging System for Locally Advanced Pancreatic Cancer: A Critical Need in the Multidisciplinary Era

  • Pancreatic Tumors

ASO Author Reflection: Demographic Conditions are the Major Determinants for Functional Outcome and Quality of Life in Lower Extremity Soft Tissue Sarcoma Patients

  • Open Access
  • ASO Author Reflections

Intraductal Papilloma of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance

  • Breast Oncology

Preceding Systemic Chemotherapy for Patients with Pancreatic Ductal Adenocarcinoma with Positive Peritoneal Cytology Provides Survival Benefit Compared with Up-Front Surgery

  • Pancreatic Tumors

Tumor-Nipple Distance of ≥ 1 cm Predicts Negative Nipple Pathology After Neoadjuvant Chemotherapy

  • Breast Oncology

Microvascular Invasion Status and Its Survival Impact in Hepatocellular Carcinoma Depend on Tissue Sampling Protocol

  • Hepatobiliary Tumors

Neu im Fachgebiet Chirurgie

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

US-Team empfiehlt Gastropexie nach Hiatushernien-Op.

Zur Vermeidung von Rezidiven nach Reparatur einer paraösophagealen Hiatushernie sollte einem US-Team zufolge der Magen bei der Op. routinemäßig an der Bauchwand fixiert werden. Das Ergebnis einer randomisierten Studie scheint dafür zu sprechen.

Mit Lidocain kommt der Darm nicht schneller in Schwung

Verzögertes Wiederanspringen der Darmfunktion ist ein Hauptfaktor dafür, wenn Patientinnen und Patienten nach einer Kolonresektion länger als geplant im Krankenhaus bleiben müssen. Ob man diesem Problem mit Lidocain vorbeugen kann, war Thema einer Studie.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise