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Sample records for breast irradiation consensus

  1. Outcomes After Accelerated Partial Breast Irradiation in Patients With ASTRO Consensus Statement Cautionary Features

    International Nuclear Information System (INIS)

    Purpose: To evaluate outcomes among women with American Society for Radiation Oncology (ASTRO) consensus statement cautionary features treated with brachytherapy-based accelerated partial breast irradiation (APBI). Methods and Materials: Between March 2001 and June 2006, 322 consecutive patients were treated with high-dose-rate (HDR) APBI at the University of Wisconsin. A total of 136 patients were identified who met the ASTRO cautionary criteria. Thirty-eight (27.9%) patients possessed multiple cautionary factors. All patients received 32 to 34 Gy in 8 to 10 twice-daily fractions using multicatheter (93.4%) or Mammosite balloon (6.6%) brachytherapy. Results: With a median follow-up of 60 months, there were 5 ipsilateral breast tumor recurrences (IBTR), three local, and two loco-regional. The 5-year actuarial rate of IBTR was 4.8% ± 4.1%. The 5-year disease-free survival was 89.6%, with a cause-specific survival and overall survival of 97.6% and 95.3%, respectively. There were no IBTRs among 32 patients with ductal carcinoma in situ (DCIS) vs. 6.1% for patients with invasive carcinoma (p = 0.24). Among 104 patients with Stage I or II invasive carcinoma, the IBTR rate for patients considered cautionary because of age alone was 0% vs. 12.7% in those deemed cautionary due to histopathologic factors (p = 0.018). Conclusions: Overall, we observed few local recurrences among patients with cautionary features. Women with DCIS and patients 50 to 59 years of age with Stage I/II disease who otherwise meet the criteria for suitability appear to be at a low risk of IBTR. Patients with tumor-related cautionary features will benefit from careful patient selection.

  2. [3rd Hungarian Breast Cancer Consensus Conference - Radiotherapy Guidelines].

    Science.gov (United States)

    Polgár, Csaba; Kahán, Zsuzsanna; Csejtei, András; Gábor, Gabriella; Landherr, László; Mangel, László; Mayer, Árpád; Fodor, János

    2016-09-01

    The radiotherapy expert panel revised and updated the radiotherapy (RT) guidelines accepted in 2009 at the 2nd Hungarian Breast Cancer Consensus Conference based on new scientific evidence. Radiotherapy of the conserved breast is indicated in ductal carcinoma in situ (St. 0), as RT decreases the risk of local recurrence by 60%. In early stage (St. I-II) invasive breast cancer RT remains a standard treatment following breast conserving surgery. However, in elderly (≥70 years) patients with stage I, hormone receptor positive tumour hormonal therapy without RT can be considered. Hypofractionated (15×2.67 Gy) whole breast irradiation and for selected cases accelerated partial breast irradiation are validated treatment alternatives of conventional (25×2 Gy) whole breast irradiation. Following mastectomy RT significantly decreases the risk of locoregional recurrence and improves overall survival of patients having 1 to 3 (pN1a) or ≥4 (pN2a, pN3a) positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes axillary dissection can be omitted and substituted with axillary RT. After neoadjuvant chemotherapy (NAC) followed by breast conserving surgery whole breast irradiation is mandatory, while after NAC followed by mastectomy locoregional RT should be given in cases of initial stage III-IV and ypN1 axillary status. PMID:27579722

  3. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs

  4. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: morrowm@mskcc.org [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-03-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  5. Evaluation of Current Consensus Statement Recommendations for Accelerated Partial Breast Irradiation: A Pooled Analysis of William Beaumont Hospital and American Society of Breast Surgeon MammoSite Registry Trial Data

    International Nuclear Information System (INIS)

    Purpose: To determine whether the American Society for Radiation Oncology (ASTRO) Consensus Statement (CS) recommendations for accelerated partial breast irradiation (APBI) are associated with significantly different outcomes in a pooled analysis from William Beaumont Hospital (WBH) and the American Society of Breast Surgeons (ASBrS) MammoSite® Registry Trial. Methods and Materials: APBI was used to treat 2127 cases of early-stage breast cancer (WBH, n=678; ASBrS, n=1449). Three forms of APBI were used at WBH (interstitial, n=221; balloon-based, n=255; or 3-dimensional conformal radiation therapy, n=206), whereas all Registry Trial patients received balloon-based brachytherapy. Patients were divided according to the ASTRO CS into suitable (n=661, 36.5%), cautionary (n=850, 46.9%), and unsuitable (n=302, 16.7%) categories. Tumor characteristics and clinical outcomes were analyzed according to CS group. Results: The median age was 65 years (range, 32-94 years), and the median tumor size was 10.0 mm (range, 0-45 mm). The median follow-up time was 60.6 months. The WBH cohort had more node-positive disease (6.9% vs 2.6%, P<.01) and cautionary patients (49.5% vs 41.8%, P=.06). The 5-year actuarial ipsilateral breast tumor recurrence (IBTR), regional nodal failure (RNF), and distant metastasis (DM) for the whole cohort were 2.8%, 0.6%, 1.6%. The rate of IBTR was not statistically higher between suitable (2.5%), cautionary (3.3%), or unsuitable (4.6%) patients (P=.20). The nonsignificant increase in IBTR for the cautionary and unsuitable categories was due to increased elsewhere failures and new primaries (P=.04), not tumor bed recurrence (P=.93). Conclusions: Excellent outcomes after breast-conserving surgery and APBI were seen in our pooled analysis. The current ASTRO CS guidelines did not adequately differentiate patients at an increased risk of IBTR or tumor bed failure in this large patient cohort

  6. Accelerated partial breast irradiation

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Whole breast radiotherapy afier tumor lumpectomy is based on the premise that that the breast cancer recurrence rate is reduced through the elimination of residual cancer foci in the remaining tissue immediately adjacent to the lumpectomy site and occult multicentric areas of in situ or infiltrating cancer in remote areas of the breast. The relevance of remote foci to ipsilateral breast failure rates after breast conserving treatment is debatable, because 65%~100% of recurrences develop in the same quadrant as the initial tumor. This has led several investigators to question whether radiotherapy must be administered to the entire breast.

  7. [3rd Hungarian Breast Cancer Consensus Conference - Surgery Guidelines].

    Science.gov (United States)

    Lázár, György; Bursics, Attila; Farsang, Zoltán; Harsányi, László; Kósa, Csaba; Maráz, Róbert; Mátrai, Zoltán; Paszt, Attila; Pavlovics, Gábor; Tamás, Róbert

    2016-09-01

    Therapy for breast cancer today is characterised by ever more precise diagnostic methods and ever more effective oncological treatments, a trend which will certainly continue in the future. Breast preservation and the application of oncoplastic principles are increasingly popular. A sentinel lymph node biopsy in the surgical treatment of the axilla is primary, with the indication for axillary block dissection (ABD) narrowing and radiation therapy becoming an alternative to ABD in certain cases. This publication summarises our recommendations on the surgical treatment of breast cancer based on the content of the 2nd Breast Cancer Consensus Conference and considering the latest international studies and professional recommendations. PMID:27579720

  8. [Normofractionated breast irradiation in breast cancer. Indications and benefits].

    Science.gov (United States)

    Fourquet, A; Krhili, S-L; Campana, F; Chilles, A; Kirova, Y-M

    2016-10-01

    Whole-breast normofractionated irradiation following breast-conserving surgery is the reference treatment. It delivers a dose of 50Gy in 25 fractions of 2Gy to the reference point, and, in some patients, an additional dose of 16Gy in 8 fractions of 2Gy in the tumor bed. Long-term results and toxicity of this irradiation scheme was prospectively evaluated in several randomised trials and meta-analyses, in invasive cancers as well as in ductal carcinoma in situ. The average 10-year rate of in breast recurrences was 6 % in these trials, with limited cardiac and pulmonary toxicity and limited rate of severe fibrosis. Identification of risk factors of recurrences may help to design new irradiation schemes adapted to tumor biology. The new irradiation schemes must be rigorously evaluated in the long-term in the frame of prospective clinical trials, in order to validate them as new standards of treatment. PMID:27592268

  9. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

    International Nuclear Information System (INIS)

    Background and purpose: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. Material and methods: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. Results: Borders of the CTV encompassing a 5 mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. Conclusion: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency

  10. Accelerated Partial Breast Irradiation with Intensity-Modulated Radiotherapy Is Feasible for Chinese Breast Cancer Patients

    OpenAIRE

    He, Zhenyu; Wu, Sangang; Zhou, Juan; Li, Fengyan; Sun, Jiayan; Lin, Qin; Lin, Huanxin; Guan, Xunxing

    2014-01-01

    Purpose Several accelerated partial breast irradiation (APBI) techniques are being investigated in patients with early-stage breast cancer. The present study evaluated the feasibility, early toxicity, initial efficacy, and cosmetic outcomes of accelerated partial breast intensity-modulated radiotherapy (IMRT) for Chinese female patients with early-stage breast cancer after breast-conserving surgery. Methods A total of 38 patients met the inclusion criteria and an accelerated partial breast in...

  11. A consensus prognostic gene expression classifier for ER positive breast cancer

    OpenAIRE

    Teschendorff, Andrew E.; Naderi, Ali; Barbosa-Morais, Nuno L.; Pinder, Sarah E; Ellis, Ian O.; Aparicio, Sam; Brenton, James D.; Caldas, Carlos

    2006-01-01

    Background A consensus prognostic gene expression classifier is still elusive in heterogeneous diseases such as breast cancer. Results Here we perform a combined analysis of three major breast cancer microarray data sets to hone in on a universally valid prognostic molecular classifier in estrogen receptor (ER) positive tumors. Using a recently developed robust measure of prognostic separation, we further validate the prognostic classifier in three external independent cohorts, confirming the...

  12. Identifying gaps in the locoregional management of early breast cancer: highlights from the kyoto consensus conference.

    OpenAIRE

    Toi, Masakazu; Winer, Eric P.; INAMOTO, TAKASHI; BENSON, JOHN R.; Forbes, John F.; Mitsumori, Michihide; Robertson, John F. R.; Sasano, Hironobu; von Minckwitz, Gunter; Yamauchi, Akira; KLIMBERG, V. SUZANNE

    2011-01-01

    A consensus conference was held to investigate issues related to the local management of early breast cancer. Here, we highlight the major topics discussed at the conference and propose ideas for future studies. Regarding axillary management, we examined three major issues. First, we discussed whether the use of axillary reverse mapping could clarify the lymphatic system of breast and whether the ipsilateral arm might help avoid lymphedema. Second, the use of an indocyanine green fluorescent ...

  13. Adjuvant bisphosphonates in early breast cancer: consensus guidance for clinical practice from a European Panel.

    Science.gov (United States)

    Hadji, P; Coleman, R E; Wilson, C; Powles, T J; Clézardin, P; Aapro, M; Costa, L; Body, J-J; Markopoulos, C; Santini, D; Diel, I; Di Leo, A; Cameron, D; Dodwell, D; Smith, I; Gnant, M; Gray, R; Harbeck, N; Thurlimann, B; Untch, M; Cortes, J; Martin, M; Albert, U-S; Conte, P-F; Ejlertsen, B; Bergh, J; Kaufmann, M; Holen, I

    2016-03-01

    Bisphosphonates have been studied in randomised trials in early breast cancer to investigate their ability to prevent cancer treatment-induced bone loss (CTIBL) and reduce the risk of disease recurrence and metastasis. Treatment benefits have been reported but bisphosphonates do not currently have regulatory approval for either of these potential indications. This consensus paper provides a review of the evidence and offers guidance to breast cancer clinicians on the use of bisphosphonates in early breast cancer. Using the nominal group methodology for consensus, a systematic review of the literature was augmented by a workshop held in October 2014 for breast cancer and bone specialists to present and debate the available pre-clinical and clinical evidence for the use of adjuvant bisphosphonates. This was followed by a questionnaire to all members of the writing committee to identify areas of consensus. The panel recommended that bisphosphonates should be considered as part of routine clinical practice for the prevention of CTIBL in all patients with a T score of 18,000 patients supports clinically significant benefits of bisphosphonates on the development of bone metastases and breast cancer mortality in post-menopausal women or those receiving ovarian suppression therapy. Therefore, the panel recommends that bisphosphonates (either intravenous zoledronic acid or oral clodronate) are considered as part of the adjuvant breast cancer treatment in this population and the potential benefits and risks discussed with relevant patients. PMID:26681681

  14. Accelerated partial breast irradiation:advances and controversies

    Institute of Scientific and Technical Information of China (English)

    Mani Akhtari; Bin S Teh

    2016-01-01

    The management of localized breast cancer has changed dramatically over the past three to four decades. Breast-conserving therapy, which involved lumpectomy followed by adjuvant irradiation, is now widely considered the standard of care in women with early-stage breast cancer. Accelerated partial breast irradiation (APBI), which involves focal irradiation of the lumpectomy cavity over a short period of time, has developed over the past two decades as an alternative to whole breast irradiation (WBI). Multiple APBI modalities have been developed including brachytherapy, external beam irradiation, and intraoperative irradiation. These new techniques have provided early-stage breast can-cer patients with shorter treatment duration and more focused irradiation, delivering very high biological doses to the region at a high risk of failures over a much shorter treatment course as compared with conventional radiotherapy. However, the advantages of APBI over conventional radiotherapy are controversial, including a higher risk of compli-cations reported in retrospective literature and shorter follow-up duration in the intraoperative APBI trials. Neverthe-less, APBI presents a valuable alternative to WBI for a selected population of women with early-stage breast cancer.

  15. Breast cancer subtype predictors revisited: from consensus to concordance?

    OpenAIRE

    MJ. Sontrop, Herman; JT. Reinders, Marcel; D. Moerland, Perry

    2016-01-01

    Background At the molecular level breast cancer comprises a heterogeneous set of subtypes associated with clear differences in gene expression and clinical outcomes. Single sample predictors (SSPs) are built via a two-stage approach consisting of clustering and subtype predictor construction based on the cluster labels of individual cases. SSPs have been criticized because their subtype assignments for the same samples were only moderately concordant (Cohen’s κ0.8). Interestingly, for a given...

  16. Breast cancers and leukaemias after irradiation. Cancers du sein et leucemies apres irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Vathaire, F. de (Centre de Lutte Contre le Cancer Gustave-Roussy, 94 - Villejuif (France))

    1994-01-01

    The influence of new data or recent re-analysis concerning the risks of breast cancer and leukaemia after irradiation is summarized in this article. The risk of breast cancer, particularly after irradiation during childhood, seems to be more important than estimated previously. Because the pattern of risk after irradiation seems to be multiplicative and since breast cancer is very frequent among western populations, these new findings may have important consequences in public health. Despite leukaemias have been known for a long time to be a radioinduced tumour, very little information is available about the effects of age at irradiation and dose rate. (author). 9 refs., 2 tabs.

  17. Irradiation techniques for the breast cancer treatment

    International Nuclear Information System (INIS)

    The radiotherapy is a cancer treatment way based on the radiation employment. It acts on the tumor, destroying the wicked cells and impeding that this it grows and reproduce. With the radiotherapy the probability of cure of some types of cancer; among them the one of breast, it increases. The investigations in oncology have allowed to develop new technologies with which is possible, for example, to locate the tumors accurately and to adapt the irradiation fields to their form. This has allowed to improve the treatments since it can destroy the tumor applying an intense radiation dose without producing irreversible damages to other organs and healthy tissues of the body. In the underdeveloped countries or in development as Mexico, and almost all those of Latin America, it is not still possible to have several of these technologies in the main oncological centers of the country by their high cost. It is expected that their cost go lowering and that its going to develop technologies more cheap so that they can be applied in more general way to the population that suffers of this suffering. (Author)

  18. Hypoplasty of the breast due to x-ray irradiation

    International Nuclear Information System (INIS)

    We treated five women with hypoplasty of the breast induced by radiation. Only one of these women underwent mammaplasty with the use of a latissimus dorsi muscle flap and prosthesis. Hypoplasty of the breast is considered a result of imprudent utilization of x-ray irradiation of young patients with benign skin diseases. To prevent underdevelopment and hypoplasty, attention must be directed to the risk involved in radiation therapy for benign diseases

  19. Bronchiolitis obliterans organizing pneumonia after irradiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kitagawa, Satoshi; Aoshima, Masahiro; Ohmagari, Norio; Tada, Hiroshi; Chohnabayashi, Naohiko; Suzuki, Kohyu [Saint Luke' s International Hospital, Tokyo (Japan)

    2003-02-01

    We report three cases of bronchiolitis obliterans organizing pneumonia (BOOP) that developed after irradiation therapy following breast cancer. All patients presented with cough and fever for 3 to 10 months after the completion of irradiation. Chest radiographs and computed tomography (CT) in all three patients demonstrated a consolidation outside the irradiated fields. Their laboratory data revealed increased C-reactive protein and increased erythrocyte sedimentation rates. Transbronchial lung biopsy was performed in all patients, and plugs of granulation tissue in the bronchioles and interstitial infiltration by mononuclear cells were found. Corticosteroid treatment resulted in rapid clinical improvement. BOOP was diagnosed from the histological and clinical findings. Although the etiology of BOOP still remains unknown, there may be a subgroup of such patients in whom the BOOP is induced by irradiation for breast cancer. These cases were assumed to be in a series of reported cases of BOOP primed by radiotherapy. (author)

  20. Recommendations from GEC ESTRO Breast Cancer Working Group (I): Target definition and target delineation for accelerated or boost Partial Breast Irradiation using multicatheter interstitial brachytherapy after breast conserving closed cavity surgery

    International Nuclear Information System (INIS)

    Objective: The aim was to develop a delineation guideline for target definition for APBI or boost by consensus of the Breast Working Group of GEC-ESTRO. Proposed recommendations: Appropriate delineation of CTV (PTV) with low inter- and intra-observer variability in clinical practice is complex and needs various steps as: (1) Detailed knowledge of primary surgical procedure, of all details of pathology, as well as of preoperative imaging. (2) Definition of tumour localization before breast conserving surgery inside the breast and translation of this information in the postoperative CT imaging data set. (3) Calculation of the size of total safety margins. The size should be at least 2 cm. (4) Definition of the target. (5) Delineation of the target according to defined rules. Conclusion: Providing guidelines based on the consensus of a group of experts should make it possible to achieve a reproducible and consistent definition of CTV (PTV) for Accelerated Partial Breast Irradiation (APBI) or boost irradiation after breast conserving closed cavity surgery, and helps to define it after selected cases of oncoplastic surgery

  1. Identifying gaps in the locoregional management of early breast cancer: highlights from the Kyoto Consensus Conference.

    Science.gov (United States)

    Toi, Masakazu; Winer, Eric P; Inamoto, Takashi; Benson, John R; Forbes, John F; Mitsumori, Michihide; Robertson, John F R; Sasano, Hironobu; von Minckwitz, Gunter; Yamauchi, Akira; Klimberg, V Suzanne

    2011-10-01

    A consensus conference was held to investigate issues related to the local management of early breast cancer. Here, we highlight the major topics discussed at the conference and propose ideas for future studies. Regarding axillary management, we examined three major issues. First, we discussed whether the use of axillary reverse mapping could clarify the lymphatic system of breast and whether the ipsilateral arm might help avoid lymphedema. Second, the use of an indocyanine green fluorescent navigation system was discussed for intraoperative lymphatic mapping. These new issues should be examined further in practice. Finally, some agreement was reached on the importance of "four-node diagnosis" to aid in the diagnostic accuracy of sentinel nodes. Regarding breast treatment, there was general agreement that the clinical value of surgical margins in predicting local failure was dependent on the tumor's intrinsic biology and subtypes. For patients treated with preoperative chemotherapy, less extensive excision may be feasible in those who respond to systemic therapy in an acceptable manner. Most trials of preoperative chemotherapy lack outcome data on local recurrence. Therefore, there is a need for such data for overview analysis. We also agreed that radiation after mastectomy may be beneficial in node-positive cases where more than four nodes are involved. Throughout the discussions for both invasive and noninvasive disease, the investigation of nomograms was justified for major issues in the decision-making process, such as the presence or absence of microinvasion and the involvement of nonsentinel nodes in sentinel node-positive patients.

  2. Breast cancer and irradiation: a review

    International Nuclear Information System (INIS)

    Breast cancer, the most frequent in females, can be induced by many physical and chemical agents. The contribution on ionizing radiation has been clearly demonstrated both by animal experiments on rats and epidemiologic surveys on populations of women submitted to medical exposure or on Japanese atomic bomb survivors. The mean risk per dose unit (rad) is estimated at about 6 per year and per 106 females. It can vary widely with the age at the time of exposure and other internal (mainly hormonal) or external (diet for instance) factors. For radiation protection purposes, breast is a high risk tissue, which explains the high risk factor adopted by ICRP for this tissue

  3. Breast cancer: Postoperative irradiation and management of locally advanced disease

    International Nuclear Information System (INIS)

    Purpose/Objective: This course will review current indications for postoperative irradiation, present a videotape demonstration of a simulation technique for comprehensive chest wall/nodal irradiation, and discuss multimodality approaches to the difficult problem of locally advanced breast cancer. As part of an expanding role for the radiation oncologist in the treatment of all stages of breast cancer, recent data has inspired a reevaluation of chest wall and nodal irradiation following mastectomy. A decade ago, adjuvant irradiation was considered by many oncologists to be of no survival advantage or perhaps even harmful. Studies leading to this conclusion will be reviewed with special attention to the inadequacies and flawed constructs which biased these studies against adjuvant chest wall/nodal irradiation. The Fischer hypothesis or 'new paradigm' will be challenged. Can improvement in local control result in improved survival? If the goal of treatment is simply to reduce local-regional recurrence, a three-field technique covering the chest wall and supraclavicular nodes may suffice. But if the goal is an improvement in survival based on the treatment of all locoregional sites which may not be sterilized by chemotherapy and mastectomy, a more complex set of fields is required. Based on this premise, we designed a 5-field technique of comprehensive chest wall and nodal irradiation. Simulation of these fields will be demonstrated on videotape. Treatment strategies for both non-inflammatory and inflammatory non-metastatic breast cancer will be presented. Current recommendations include various combinations of chemohormonotherapy, radiation therapy, and mastectomy, but controversies abound regarding the proper sequencing of these modalities, whether breast conservation therapy can be offered to patients who have a dramatic response to systemic therapy, and whether or not any one of these treatment modalities can be dropped under specific clinical scenarios

  4. Breast cancer: Postoperative irradiation and management of locally advanced disease

    International Nuclear Information System (INIS)

    Purpose/Objective: This course will review current indications for postoperative irradiation, present a videotape demonstration of a simulation technique for comprehensive chest wall/nodal irradiation, and discuss multimodality approaches to the difficult problem of locally advanced breast cancer. As part of an expanding role for the radiation oncologist in the treatment of all stages of breast cancer, recent data has inspired a reevaluation of chest wall and nodal irradiation following mastectomy. A decade ago, adjuvant irradiation was considered by many oncologists to be of no survival advantage or perhaps even harmful. Studies leading to this conclusion will be reviewed with special attention to the inadequacies and flawed constructs which biased these studies against adjuvant chest wall/nodal irradiation. The Fischer hypothesis or 'new paradigm' will be challenged. Can improvement in local control result in improved survival? If the goal of treatment is simply to reduce local-regional recurrence, a three-field technique covering the chest wall and supraclavicular nodes may suffice. But if the goal is an improvement in survival based on the treatment of all locoregional sites which may not be sterilized by chemotherapy and mastectomy, a more complex set of fields is required. Based on this premise, we designed a 5-field technique of comprehensive chest wall and nodal irradiation. Simulation of these fields will be demonstrated on videotape. Treatment strategies for both non-inflammatory and inflammatory non-metastatic breast cancer will be presented. Current recommendations include various combinations of chemohormonotherapy, radiation therapy, and mastectomy, but Controversies abound regarding the proper sequencing of these modalities, whether breast conservation therapy can be offered to patients who have a dramatic response to systemic therapy, and whether or not any one of these treatment modalities can be dropped under specific clinical scenarios

  5. Pathophysiology of irradiated skin and breast

    International Nuclear Information System (INIS)

    The evolution, time course, and dose response of gross and histologic changes associated with the acute and late changes of the skin are noted and a composite pathophysiologic operational model given. This model focuses the selection of the observations to be 'scored' to assess the tolerance and cosmetic response of the skin and breast to different dose and combined therapy studies

  6. Interdisciplinary consensus on the uses and technique of MR-guided vacuum-assisted breast biopsy (VAB): Results of a European consensus meeting

    International Nuclear Information System (INIS)

    Purpose: Quality assurance of MR-guided vacuum-assisted breast biopsy (VAB). Method: A consensus was achieved based on the existing literature and experience of an interdisciplinary group comprising European specialists in breast imaging and VAB. Results: Full imaging work-up must be completed according to existing standards before an indication for MR-guided VAB is established. The procedure should be reserved for lesions demonstrable by MRI alone. Acquisition of >24 cores (11-Gauge) should be routinely attempted, with the intention of sufficiently removing small lesions for accurate diagnosis. Following biopsy the patient should be re-imaged to demonstrate the biopsy site and its proximity to the lesion and hence the likely accuracy of the sampling. All patients should be discussed in a regular interdisciplinary conference and a documented consensus reached regarding patient management. Regular audit and review of all MR-guided VAB results and subsequent follow-up are recommended. Conclusion: This consensus includes protocols for the indication, performance parameters, interdisciplinary interpretation therapeutic recommendation, documentation and follow-up of MR-guided VAB. It does not replace official recommendations for percutaneous biopsy.

  7. Accelerated partial breast irradiation. Techniques and clinical implementation. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Wazer, David E. [Tufts Medical Center, Boston, MA (United States). Dept. of Radiation Oncology; Arthur, Douglas W. [Virginia Commonwealth Univ., Richmond, VA (United States). Dept. of Radiation Oncology; Vicini, Frank, A. (eds.) [William Beaumont Hospital, Royal Oak, MI (United States). Dept. of Radiation Oncology

    2009-07-01

    Accelerated partial breast irradiation (APBI) is being rapidly introduced into the clinical management of early breast cancer. APBI, in fact, encompasses a number of different techniques and approaches that include brachytherapy, intraoperative, and external beam techniques. There is currently no single source that describes these techniques and their clinical implementation. This text is a concise handbook designed to assist the clinician in the implementation of APBI. This includes a review of the principles that underlie APBI, a practical and detailed description of each technique for APBI, a review of current clinical results of APBI, and a review of the incidence and management of treatment related complications. (orig.)

  8. Factors Associated With the Development of Breast Cancer-Related Lymphedema After Whole-Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag; Wilkinson, John Ben; Baschnagel, Andrew [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Ghilezan, Mihai [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); William Beaumont School of Medicine, Oakland University, Royal Oak, MI (United States); Riutta, Justin; Dekhne, Nayana; Balaraman, Savitha [Beaumont Cancer Institute, William Beaumont Hospital, Royal Oak, MI (United States); William Beaumont School of Medicine, Oakland University, Royal Oak, MI (United States); Mitchell, Christina; Wallace, Michelle [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank, E-mail: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Beaumont Cancer Institute, William Beaumont Hospital, Royal Oak, MI (United States); William Beaumont School of Medicine, Oakland University, Royal Oak, MI (United States)

    2012-07-15

    Purpose: To determine the rates of breast cancer-related lymphedema (BCRL) in patients undergoing whole-breast irradiation as part of breast-conserving therapy (BCT) and to identify clinical, pathologic, and treatment factors associated with its development. Methods and Materials: A total of 1,861 patients with breast cancer were treated at William Beaumont Hospital with whole-breast irradiation as part of their BCT from January 1980 to February 2006, with 1,497 patients available for analysis. Determination of BCRL was based on clinical assessment. Differences in clinical, pathologic, and treatment characteristics between patients with BCRL and those without BCRL were evaluated, and the actuarial rates of BCRL by regional irradiation technique were determined. Results: The actuarial rate of any BCRL was 7.4% for the entire cohort and 9.9%, 14.7%, and 8.3% for patients receiving a supraclavicular field, posterior axillary boost, and internal mammary irradiation, respectively. BCRL was more likely to develop in patients with advanced nodal status (11.4% vs. 6.3%, p = 0.001), those who had a greater number of lymph nodes removed (14 nodes) (9.5% vs. 6.0%, p = 0.01), those who had extracapsular extension (13.4% vs. 6.9%, p = 0.009), those with Grade II/III disease (10.8% vs. 2.9%, p < 0.001), and those who received adjuvant chemotherapy (10.5% vs. 6.7%, p = 0.02). Regional irradiation showed small increases in the rates of BCRL (p = not significant). Conclusions: These results suggest that clinically detectable BCRL will develop after traditional BCT in up to 10% of patients. High-risk subgroups include patients with advanced nodal status, those with more nodes removed, and those who receive chemotherapy, with patients receiving regional irradiation showing a trend toward increased rates.

  9. Factors Associated With the Development of Breast Cancer–Related Lymphedema After Whole-Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose: To determine the rates of breast cancer–related lymphedema (BCRL) in patients undergoing whole-breast irradiation as part of breast-conserving therapy (BCT) and to identify clinical, pathologic, and treatment factors associated with its development. Methods and Materials: A total of 1,861 patients with breast cancer were treated at William Beaumont Hospital with whole-breast irradiation as part of their BCT from January 1980 to February 2006, with 1,497 patients available for analysis. Determination of BCRL was based on clinical assessment. Differences in clinical, pathologic, and treatment characteristics between patients with BCRL and those without BCRL were evaluated, and the actuarial rates of BCRL by regional irradiation technique were determined. Results: The actuarial rate of any BCRL was 7.4% for the entire cohort and 9.9%, 14.7%, and 8.3% for patients receiving a supraclavicular field, posterior axillary boost, and internal mammary irradiation, respectively. BCRL was more likely to develop in patients with advanced nodal status (11.4% vs. 6.3%, p = 0.001), those who had a greater number of lymph nodes removed (14 nodes) (9.5% vs. 6.0%, p = 0.01), those who had extracapsular extension (13.4% vs. 6.9%, p = 0.009), those with Grade II/III disease (10.8% vs. 2.9%, p < 0.001), and those who received adjuvant chemotherapy (10.5% vs. 6.7%, p = 0.02). Regional irradiation showed small increases in the rates of BCRL (p = not significant). Conclusions: These results suggest that clinically detectable BCRL will develop after traditional BCT in up to 10% of patients. High-risk subgroups include patients with advanced nodal status, those with more nodes removed, and those who receive chemotherapy, with patients receiving regional irradiation showing a trend toward increased rates.

  10. Skin toxicity during hypo fractionated breast irradiation in patient with early breast cancer

    International Nuclear Information System (INIS)

    Radiotherapy is an important component in the treatment of breast cancer. (1) Many women with an early stage of breast cancer are candidates for a breast conservation therapy, which combines both conservative surgery and radiotherapy. (2) According to the data from some series, an estimated 90% of the patients treated with radiotherapy for breast cancer will develop a degree of radiation-induced dermatitis. (3) The severity of the skin reactions during and following the breast irradiation is influenced by both treatment-related and patient-related factors. The treatment - related factors include the fraction size (the dose delivered with each treatment), the total dose delivered, the volume of tissue treated, the type of radiation (4) and the addition of chemotherapy. (5) The patient-related factors include breast size, smoking, axillary lymphocele drainage before treatment, age, and infection of the surgical wound. (6) A hypo fractionation radiotherapy is alternative for a standard fractionation radiotherapy for women with early stage of breast cancer after conservative surgery. The aim of the study was to analyse the acute skin reactions during a hypo fractionated radiotherapy in patients with early breast cancer at our institution. Materials and methods: Twenty patients with early stage of breast cancer (Stadium I and II) and conservative surgery (quadrantectomy of breast with ipsilateral axillary dissection) were analysed. The patients were treated with 6MV x rays on LINAC, using tangential fields with 2.65Gy per fraction and the total dose prescribed to target volume was 42,4 Gy. These patients were observed for acute skin toxicity during the second week and at the end of the treatment. We evaluated dryness, epilation, pigmentation, changes and eritema, dry desquamation (clinically characterized by scaling and pruritus) and moist desquamation (characterized by serious oozing and exposure of the dermis). By using the radiation therapy oncology group’s (RTOG

  11. [Hypofractionated whole breast irradiation (WBRT): Results and indications].

    Science.gov (United States)

    Cutuli, B

    2016-10-01

    Breast irradiation after breast-conserving surgery is essential for maximizing local control and overall survival. The increase of breast cancer (BC) incidence, constraints of classical five weeks (w) radiation regimens and scarcity of radiotherapy units have led to test short hypofractionated WBRT schemes. One pilot study and three prospective randomized trials have tested various hypofractionated regimens of WBRT. About 7000 patients were included and follow-up ranged from 5 to 12 years. The conclusion of these trials is similar, showing local control and toxicity equivalent to these of the standard regimens. Three schemes are now clearly validated: 42.5Gy/16fr/3w, 40Gy/15fr/3w, or 42Gy/13fr/5w. However, the majority of included patients had favorable prognostic factors, were treated to the breast only and the boost dose, when indicated, was delivered with a standard fractionation. Therefore, we recommend the regimens preferentially in patients treated to the breast only, and without nodal involvement. These studies did not evaluate the addition of a boost dose with a hypofractionated scheme. If a boost is to be given, a standard fractionation should be used. Particular care should be taken to avoid heterogeneities leading to high fraction doses to organs at risk (lung and heart). PMID:27614516

  12. Bilateral breast cancer treated with breast-conserving surgery and definitive irradiation

    International Nuclear Information System (INIS)

    Objective: To assess whether patients with early stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complication rates, and cosmetic outcomes. Material and Methods: We reviewed 55 cases of patients with synchronous or sequential bilateral breast cancer treated with definitive irradiation following breast-conserving surgery at our institution from 1977 to 1992. Analysis of cases was limited to women who were AJCC clinical Stage 0, I, and II. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, AJCC stage, pathologic axillary lymph nodes status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Analysis regarding matching technique, cosmetic outcome, and complication rate was also performed. The 5- and 10-year overall survival (OS), no evidence of disease (NED) survival, relapse-free survival (RFS), and local control rates were evaluated. Twelve women (22%) presented with synchronous bilateral carcinoma, and 43 women (78%) had sequential bilateral carcinoma. Of the 12 patients with synchronous cancer, 5 received adjuvant chemotherapy, 2 received Tamoxifen, and 1 received both adjuvant therapies. Of the 43 patients with sequential cancer, 6 received chemotherapy, 1 received Tamoxifen, and 1 received both adjuvant therapies for the first cancer treatment; seven received chemotherapy and 6 received Tamoxifen for the second cancer treatment. Results: The median age at the time of treatment of the first cancer was 56 years (range 26-86 years). For the 12 patients with synchronous cancer, the median follow-up was 48 months (range 9-164). For the 43 patients with sequential cancer, the median follow-up was 112 months (range 52-188 months) after the first cancer, and 59 months (range 11-153 months) after the second. The median dose delivered was 64 Gy (range 42-72 Gy) using a combination of

  13. A case report on bilateral partial breast irradiation using SAVI

    Energy Technology Data Exchange (ETDEWEB)

    Gloi, Aime M., E-mail: agloi@stvgb.org [Radiation Oncology, St. Vincent Hospital, Green Bay, WI (United States); Buchanan, Robert [Southeast Alabama Medical Center, Radiation Oncology Department, Dothan, AL 36301 (United States); Nuskind, Jeff; Zuge, Corrie; Goettler, Anndrea [Radiation Oncology, St. Vincent Hospital, Green Bay, WI (United States)

    2012-07-01

    To assess dosimetric parameters in a case study where bilateral accelerated partial breast irradiation (APBI) is delivered using a strut-adjusted volume implant (SAVI) device. A 59-year-old female received APBI in both breasts over 5 days, with fractions of 3.4 Gy twice daily. A Vac-lok system was used for immobilization, and a C-arm was used for daily imaging. We generated dose-volume histograms (DVHs) for the brachytherapy plans to derive several important biologic factors. We calculated the normal tissue complication probability (NTCP), equivalent uniform dose (EUD), and tumor control probability (TCP) using the Lyman-Kutcher-Burman model parameters {alpha} = 0.3 Gy{sup -1}, {alpha}/{beta} = 4 Gy, n = 0.1, and m = 0.3. In addition, we assessed the dose homogeneity index (DHI), overdose index, and dose nonuniformity ratio. D95 was >95% and V150 was <50 mL for both breasts. The DHIs were 0.469 and 0.512 for the left and right breasts, respectively. The EUDs (normalized to 3.4 Gy b.i.d.) were 33.53 and 29.10 Gy. The TCPs were estimated at 99.2% and 99.9%, whereas the NTCP values were 4.2% and 2.57%. In this clinical case, we were able to quantify the dosimetric parameters of an APBI treatment performed with a SAVI device.

  14. [Pathological diagnosis, work-up and reporting of breast cancer. Recommendations of the 3rd Hungarian Consensus Conference on Breast Cancer].

    Science.gov (United States)

    Cserni, Gábor; Kulka, Janina; Francz, Monika; Járay, Balázs; Kálmán, Endre; Kovács, Ilona; Krenács, Tibor; Udvarhelyi, Nóra; Vass, László

    2016-09-01

    There have been relevant changes in the diagnosis and treatment of breast cancer to implement the updating of the 2010 recommendations made during the 2nd national consensus conference on the disease. Following a wide interdisciplinary consultation, the present recommendations have been finalized after their public discussion at the 3rd Hungarian Consensus Conference on Breast Cancer. The recommendations cover non-operative and intraoperative diagnostics, the work-up of operative specimens, the determination of prognostic and predictive markers and the content of the cytology and histology reports. Furthermore, it touches some special issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, some relevant points about the future. PMID:27579721

  15. Three-dimensional conformal partial breast external-beam irradiation after conservative surgery of the breast

    International Nuclear Information System (INIS)

    Objective: To explore the methods, dosimetric features and short-term effects of partial breast irradiation carried out by three-dimensional external-beam irradiation (3DCPBI) assisted by active breathing control (ABC). Methods: Computed tomography (CT) simulation assisted by active breathing control (ABC) was carried out for each patient and intended to get CT images in condition of 75% deepest inspiration named moderate deep inspiration breath hold (mDIBH). The extent labeled by the silver slips located in the cavity was delineated as gross target volume (GTV), GTV plus the margin of 15 mm was defined as planning target volume (PTV). 6 MV X-ray was selected as the radiation source and noncoplanar radiation with four three-dimensional conformal fields was used, the described dose was 34 Gy/10f/5d. The volume of GTV, PTV, the affected whole breast, and the percentage of PTV accounted for the affected whole breast, the percentages of PTV included by 100%, 95% and 90% isodose curve, the percentage of volume of the affected breast irradiated by 34.0, 27.2, 20.4, 13.6 and 6.8 Gy , and Dmean, D5, V20 of the lungs and heart were calculated respectively. Acute radiation skin response was recorded and the cosmetic effect of the breast after radiotherapy were appraised, with the local tumor control and survival rate followed. Results: The mean of volume ratio of PTV and affected whole breast was 14.88%; the mean of the volume covered by 90% isodose curve accounted for 92.54% of the PTV; the volume irradiated by 34 Gy (100% of described dose) accounted for 17.23% (mean) of the whole breast and 6.8 Gy (20% of described dose) for 46.11%, in other words, the volume covered by 20% of described dose was less than 50% of the whole breast. The Dmean, D5, V20 for the affected lateral lung were 1.97, 9.25 Gy and 1.58%, it was 0.20, 0.87 Gy, and 0% for the unaffected lateral lung. The Dmean, D5, V20 for the heart was 0.65 Gy, 2.82 Gy, and 0.85%. Zero grade of acute radiation skin

  16. Leiomyosarcoma arising in irradiated region after breast-conserving surgery: a case report

    OpenAIRE

    Hayashi, Satoshi; KITADA, MASAHIRO; Matsuda, Yoshinari; Ishibashi, Kei; Takahashi, Nana

    2015-01-01

    Background Radiation therapy (RT) is considered a risk factor for the development of sarcoma in patients with breast cancer. However, there are few reports regarding post-irradiation sarcoma (PIS). Case presentation The patient was a 59-year-old woman who presented with a chief complaint of induration in the lower outer quadrant of the left breast. She underwent breast-conserving surgery (BCS) for breast cancer located in the left upper inner region and received endocrine therapy following RT...

  17. Early-stage bilateral breast cancer treated with breast-conserving surgery and definitive irradiation: the university of Pennsylvania experience

    International Nuclear Information System (INIS)

    Purpose: To determine whether patients with early-stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complications, and cosmesis. Methods and Materials: During the period 1977-1992, 55 women with Stage 0, I, or II concurrent (n = 12) or sequential (n = 43) bilateral breast cancer were treated with definitive irradiation following breast-conserving surgery. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, pathologic axillary lymph node status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Curves for survival, local control, and regional control were determined. Cosmetic outcome, complication rates, and matching technique were analyzed. The median total radiation dose delivered was 64 Gy (range 42-72) using tangential whole-breast irradiation followed by an electron or iridium implant boost. The tangential fields were matched with no overlap in 40 patients (73%); there was overlap on skin of up to 4 cm in 14 patients (25%); and the matching technique was unknown in 1 patient (2%). The median follow-up for the 12 women with concurrent bilateral breast cancer was 4.0 years. The median follow-up for the other 43 women with sequential cancer was 9.3 and 4.9 years, respectively, after the first and second cancers. Results: For the overall group of 55 patients, the 5- and 10-year overall survival rates were 96% and 94%, respectively, after treatment of the first cancer, and 96% and 92%, respectively, after treatment of the second cancer. The 5- and 10-year actuarial relapse-free survival rates were 90% and 75%, respectively, after treatment of the first cancer, and 83% and 72%, respectively, after treatment of the second cancer. For the 110 treated breast cancers, the 5- and 10-year actuarial local failure rates were 5% and 15%, respectively. Complication rates were: 28% breast edema, 8

  18. Dosimetric comparison of 3DCRT versus IMRT in whole breast irradiation of early stage breast cancer

    Directory of Open Access Journals (Sweden)

    Mudasir Ashraf

    2014-08-01

    Full Text Available Purpose: The counseling regarding the treatment option is an important objective in the management of early stages breast cancer. In this study, we attempt to compare and analyze the dosimetric aspects of 3DRT over IMRT in the whole breast radiotherapy.Methods and Materials:  Both right and left sided computed tomography simulations of 14 women with early stage breast cancer were used for our retrospective study to compare the 3DCRT and IMRT. The dose prescribed was 50 Gy in 25 fractions to the whole breast PTV. The PTV was defined by adding unequal margins to the directional safety margin status of each lumpectomy cavity (i.e., medial, lateral, superior, inferior and deep margins measured from the tumor front after the examination of the surgical specimen: 2, 1.5, and 1 cm for resection margins < 1 cm, 1-2 cm, and > 2cm, respectively. And than modified so that it was no longer closer than 3mm to the skin surface and was no deep than the lung –chest interface. The prescribed dose delivered in 5 fractions per week schedule. Treatment plans were compared for target minimum dose, maximum dose, mean dose, conformity index, heterogeneity index and doses to organs at risk were compared and analysed.Results: The target coverage was achieved with 90% prescription to the 95% of the PTV. Conformity to the PTV was significantly higher with 3DCRT technique than IMRT. 3DCRT technique seems better in sparing critical organs parameters like lung V20 and Mean, heart, V25, Maximum, both lungs V20, Mean and Dose to the Normal Healthy tissue.Conclusion: We conclude from our study that treatment technique selection for whole Breast irradiation is an important factor in sparing the adjacent normal structures and in determining the associated risk. 3DCRT produces better conformity and heterogeneity indices of the target volume, also reduces dose to OARs the 3DCRT reduces the risk of radiation induced heart diseases

  19. Search for the lowest irradiation dose from literatures on radiation-induced breast cancer

    International Nuclear Information System (INIS)

    A survey of past case reports concerning radiation-induced breast cancer was carried out in order to find the lowest irradiation dose. The search of literature published since 1951 revealed 10 cases of radiation-induced breast cancer. Only 5 cases had precise descriptions of the irradiation dose. The lowest irradiation dose was estimated at 1470 rads in the case of external X-ray irradiation for tuberous angioma. All of cases of radiation-induced breast cancer had received radiation for the treatment of nonmalignant tumors, such as pulmonary tuberculosis, mastitis, and tuberous angioma. There also were three statistical studies. The first concerned atomic bomb survivors, the second, pulmoanry tuberculous patients subjected to frequent fluoroscopies, and the third, patients of acute post partum mastitis. These statistical studies had revealed a significant increase in the incidence of breast cancer in the irradiated group, but there was little information about the lowest irradiation dose. It was noticed that radiation-induced breast cancer was more numerous in the upper inner quadrant of the breast. Most histopathological findings of radiation-induced breast cancer involved duct cell carcinoma. The latent period was about 15 years. (Evans, J.)

  20. International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment

    OpenAIRE

    S Dawood; Merajver, S. D.; Viens, P.; Vermeulen, P B; Swain, S. M.; Buchholz, T. A.; Dirix, L Y; Levine, P. H.; Lucci, A.; Krishnamurthy, S.; Robertson, F. M.; Woodward, W. A.; W. T. Yang; Ueno, N T; Cristofanilli, M

    2010-01-01

    Background: Inflammatory breast cancer (IBC) represents the most aggressive presentation of breast cancer. Women diagnosed with IBC typically have a poorer prognosis compared with those diagnosed with non-IBC tumors. Recommendations and guidelines published to date on the diagnosis, management, and follow-up of women with breast cancer have focused primarily on non-IBC tumors. Establishing a minimum standard for clinical diagnosis and treatment of IBC is needed.

  1. Partial breast irradiation for early breast cancer: 3-year results of the German-Austrian phase II-trial

    International Nuclear Information System (INIS)

    Purpose: to evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. Materials and methods: from 11/2000 to 11/2004, 240 women with early stage breast cancer participated in a protocol of tumor bed irradiation alone using pulsed dose rate (PDR) or high dose rate (HDR) interstitial multi-catheter implants (partial breast irradiation). Perioperative morbidity, acute and late toxicity as well as cosmetic outcome were assessed. Of the first 51 patients treated in this multicenter trial, we present interim findings after a median follow-up of 36 months. Results: perioperative Morbidity: Bacterial infection of the implant: 2% (1/51). Acute toxicity: radiodermatitis grade 1: 4% (2/51). Late toxicity: breast pain grade 1: 8% (4/51), grade 2: 2% (1/51); dyspigmentation grade 1: 8% (4/51); fibrosis grade 1: 4% (2/51), grade 2: 8% (4/51); telangiectasia grade 1: 10% (5/51), grade 2: 4% (2/51). Cosmetic results: Excellent and good in 94% (48/51) of the patients. Conclusion: this analysis indicates that accelerated partial breast irradiation with 192-iridium interstitial multicatheter PDR-/HDR-implants (partial breast irradiation) is feasible with low perioperative morbidity, low acute and mild late toxicity at a median follow-up of 36 months. The cosmetic result is not significantly affected. (orig.)

  2. Toxicological evaluation of chicken-breast meat with high-dose irradiation

    International Nuclear Information System (INIS)

    In this paper, toxicity and safety of high-dose irradiated chicken-breast meat were evaluated. For assays of acute toxicity, genetic toxicity, and sub-chronic toxicity, ames test, mice bone marrow erythrocyte micronucleus, and mice sperm abnormality were performed. The results showed that, in the acute oral toxicity tests, median lethal dose (more than 10 000 mg kg-1) in male and female ICR mice showed no toxicological signs. For subacute 30-d oral toxicology of irradiated chicken-breast meat with dose of 10, 15 and 25 kGy in both male and female SD rats, no noticeable toxicological effects were observed. It is concluded that chicken-breast meat with high-dose irradiation has no acute toxicity and no genotoxicity, nor harmful effects on the animal body at the tested dosage range. Therefore, high-dose irradiated chicken-breast meat is safe for pet consumption

  3. Assessment of cardiac exposure in left-tangential breast irradiation; evaluation de l'irradiation cardiaque lors de l'irradiation tangentielle du sein gauche

    Energy Technology Data Exchange (ETDEWEB)

    Vees, H. [Department of Radiation Oncology, University of Bern, Inselspital, Bern (Switzerland); Department of Radiation Oncology, Hopital de Sion, avenue de Grand-Champsec 80, Sion 1951 (Switzerland); Bigler, R.; Gruber, G. [Department of Radiation Oncology, University of Bern, Inselspital, Bern (Switzerland); Bieri, S. [Department of Radiation Oncology, Hopital de Sion, avenue de Grand-Champsec 80, Sion 1951 (Switzerland)

    2011-12-15

    Purpose. - To assess the value of treatment-planning related parameters namely, the breast volume; the distance of the inferior field border to diaphragm; and the cardio-thoracic ratio for left-tangential breast irradiation. Patients and methods. - Treatment plans of 27 consecutively left-sided breast cancer patients after breast conserving surgery were evaluated for several parameters concerning heart-irradiation. We measured the heart distance respective to the cardio-thoracic ratio and the distance of the inferior field border to diaphragm, as well as the breast volume in correlation with the irradiated heart volume. Results. - The mean heart and left breast volumes were 504 cm{sup 3} and 672.8 cm{sup 3}, respectively. The mean heart diameter was 13.4 cm; the mean cardio-thoracic ratio 0.51 and the mean distance of the inferior field border to diaphragm was 1.4 cm. Cardio-thoracic ratio (p = 0.01), breast volume (p = 0.0002), distance of the inferior field border to diaphragm (p = 0.02) and central lung distance (p = 0.02) were significantly correlated with the measured heart distance. A significant correlation was also found between cardio-thoracic ratio, breast volume and distance of the inferior field border to diaphragm with the irradiated heart volume measured by V10, V20 and V40. Conclusion. - The verification of parameters like cardio-thoracic ratio, distance of the inferior field border to diaphragm and breast volume in left-sided breast cancer patients may help in determining which patients could benefit from more complex planning techniques such as intensity-modulated radiotherapy to reduced risk of late cardiac injury. (authors)

  4. Bronchiolitis obliterans organizing pneumonia after tangential beam irradiation to the breast. Discrimination from radiation pneumonitis

    Energy Technology Data Exchange (ETDEWEB)

    Nambu, Atsushi; Ozawa, Katsura; Kanazawa, Masaki; Miyata, Kazuyuki [Kofu Municipal Hospital (Japan); Araki, Tsutomu; Ohki, Zennosuke [Yamanashi Medical Coll., Tamaho (Japan)

    2002-06-01

    We report a case of bronchiolitis obliterans organizing pneumonia (BOOP) secondary to tangential beam irradiation to the breast, which occurred seven months after the completion of radiotherapy. Although radiation pneumonitis is an alternative consideration, BOOP could be differentiated from it by its relatively late onset and extensive distribution, which did not respect the radiation field. This disease should always be kept in mind in patients with a history of tangential beam irradiation to the breast. (author)

  5. Determination of exit skin dose for 192Ir intracavitary accelerated partial breast irradiation with thermoluminescent dosimeters

    OpenAIRE

    Raffi, Julie A.; Stephen D. Davis; Hammer, Cliff G.; Micka, John A.; Kunugi, Keith A.; Musgrove, Jana E.; Winston, John W.; Ricci-Ott, Terresa J.; DeWerd, Larry A.

    2010-01-01

    Purpose: Intracavitary accelerated partial breast irradiation (APBI) has become a popular treatment for early stage breast cancer in recent years due to its shortened course of treatment and simplified treatment planning compared to traditional external beam breast conservation therapy. However, the exit dose to the skin is a major concern and can be a limiting factor for these treatments. Most treatment planning systems (TPSs) currently used for high dose-rate (HDR) 192Ir brachytherapy overe...

  6. Setup accuracy for prone and supine whole breast irradiation

    International Nuclear Information System (INIS)

    To evaluate cone-beam computed tomography (CBCT) based setup accuracy and margins for prone and supine whole breast irradiation (WBI). Setup accuracy was evaluated on 3559 CBCT scans of 242 patients treated with WBI and uncertainty margins were calculated using the van Herk formula. Uni- and multivariate analysis on individual margins was performed for age, body mass index (BMI) and cup size. The population-based margin in vertical (VE), lateral (LA) and longitudinal (LO) directions was 10.4/9.4/9.4 mm for the 103 supine and 10.5/22.4/13.7 mm for the 139 prone treated patients, being significantly (p < 0.01) different for the LA and LO directions. Multivariate analysis identified a significant (p < 0.05) correlation between BMI and the LO margin in supine position and the VE/LA margin in prone position. In this series, setup accuracy is significantly worse in prone compared to supine position for the LA and LO directions. However, without proper image-guidance, uncertainty margins of about 1 cm are also necessary for supine WBI. For patients with a higher BMI, larger margins are required. (orig.)

  7. Pathology of breast cancer in women irradiated for acute postpartum mastitis

    International Nuclear Information System (INIS)

    The gross and microscopic pathology of breast cancers in women irradiated for acute postpartum mastitis was compared to the breast cancers found in the sisters of the irradiated women. In considering the lesions in the two populations, the size, location, histologic type, histologic grade, inflammatory response, lymphatic and blood vascular invasion, nipple involvement, axillary lymph node metastases, and menopausal status at the time of diagnosis were statistically indistinguishable. The only parameter that was different in the two populations was the desmoplastic response to the malignant lesion. The control population had more marked fibrosis within the cancers compared with the irradiated women

  8. Generation of breast cancer stem cells by steroid hormones in irradiated human mammary cell lines.

    Directory of Open Access Journals (Sweden)

    Guillaume Vares

    Full Text Available Exposure to ionizing radiation was shown to result in an increased risk of breast cancer. There is strong evidence that steroid hormones influence radiosensitivity and breast cancer risk. Tumors may be initiated by a small subpopulation of cancer stem cells (CSCs. In order to assess whether the modulation of radiation-induced breast cancer risk by steroid hormones could involve CSCs, we measured by flow cytometry the proportion of CSCs in irradiated breast cancer cell lines after progesterone and estrogen treatment. Progesterone stimulated the expansion of the CSC compartment both in progesterone receptor (PR-positive breast cancer cells and in PR-negative normal cells. In MCF10A normal epithelial PR-negative cells, progesterone-treatment and irradiation triggered cancer and stemness-associated microRNA regulations (such as the downregulation of miR-22 and miR-29c expression, which resulted in increased proportions of radiation-resistant tumor-initiating CSCs.

  9. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer

    NARCIS (Netherlands)

    Offersen, B.V.; Boersma, L.J.; Kirkove, C.; Hol, S.; Aznar, M.C.; Sola, A. Biete; Kirova, Y.M.; Pignol, J.P.; Remouchamps, V.; Verhoeven, K.; Weltens, C.; Arenas, M.; Gabrys, D.; Kopek, N.; Krause, M.; Lundstedt, D.; Marinko, T.; Montero, A.; Yarnold, J.; Poortmans, P.M.P.

    2015-01-01

    BACKGROUND AND PURPOSE: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. T

  10. Classification System for Identifying Women at Risk for Altered Partial Breast Irradiation Recommendations After Breast Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kowalchik, Kristin V. [Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida (United States); Vallow, Laura A., E-mail: vallow.laura@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida (United States); McDonough, Michelle [Department of Radiology, Mayo Clinic, Jacksonville, Florida (United States); Thomas, Colleen S.; Heckman, Michael G. [Section of Biostatistics, Mayo Clinic, Jacksonville, Florida (United States); Peterson, Jennifer L. [Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida (United States); Adkisson, Cameron D. [Department of General Surgery, Mayo Clinic, Jacksonville, Florida (United States); Serago, Christopher [Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida (United States); McLaughlin, Sarah A. [Department of General Surgery, Mayo Clinic, Jacksonville, Florida (United States)

    2013-09-01

    Purpose: To study the utility of preoperative breast MRI for partial breast irradiation (PBI) patient selection, using multivariable analysis of significant risk factors to create a classification rule. Methods and Materials: Between 2002 and 2009, 712 women with newly diagnosed breast cancer underwent preoperative bilateral breast MRI at Mayo Clinic Florida. Of this cohort, 566 were retrospectively deemed eligible for PBI according to the National Surgical Adjuvant Breast and Bowel Project Protocol B-39 inclusion criteria using physical examination, mammogram, and/or ultrasound. Magnetic resonance images were then reviewed to determine their impact on patient eligibility. The patient and tumor characteristics were evaluated to determine risk factors for altered PBI eligibility after MRI and to create a classification rule. Results: Of the 566 patients initially eligible for PBI, 141 (25%) were found ineligible because of pathologically proven MRI findings. Magnetic resonance imaging detected additional ipsilateral breast cancer in 118 (21%). Of these, 62 (11%) had more extensive disease than originally noted before MRI, and 64 (11%) had multicentric disease. Contralateral breast cancer was detected in 28 (5%). Four characteristics were found to be significantly associated with PBI ineligibility after MRI on multivariable analysis: premenopausal status (P=.021), detection by palpation (P<.001), first-degree relative with a history of breast cancer (P=.033), and lobular histology (P=.002). Risk factors were assigned a score of 0-2. The risk of altered PBI eligibility from MRI based on number of risk factors was 0:18%; 1:22%; 2:42%; 3:65%. Conclusions: Preoperative bilateral breast MRI altered the PBI recommendations for 25% of women. Women who may undergo PBI should be considered for breast MRI, especially those with lobular histology or with 2 or more of the following risk factors: premenopausal, detection by palpation, and first-degree relative with a history of

  11. Classification System for Identifying Women at Risk for Altered Partial Breast Irradiation Recommendations After Breast Magnetic Resonance Imaging

    International Nuclear Information System (INIS)

    Purpose: To study the utility of preoperative breast MRI for partial breast irradiation (PBI) patient selection, using multivariable analysis of significant risk factors to create a classification rule. Methods and Materials: Between 2002 and 2009, 712 women with newly diagnosed breast cancer underwent preoperative bilateral breast MRI at Mayo Clinic Florida. Of this cohort, 566 were retrospectively deemed eligible for PBI according to the National Surgical Adjuvant Breast and Bowel Project Protocol B-39 inclusion criteria using physical examination, mammogram, and/or ultrasound. Magnetic resonance images were then reviewed to determine their impact on patient eligibility. The patient and tumor characteristics were evaluated to determine risk factors for altered PBI eligibility after MRI and to create a classification rule. Results: Of the 566 patients initially eligible for PBI, 141 (25%) were found ineligible because of pathologically proven MRI findings. Magnetic resonance imaging detected additional ipsilateral breast cancer in 118 (21%). Of these, 62 (11%) had more extensive disease than originally noted before MRI, and 64 (11%) had multicentric disease. Contralateral breast cancer was detected in 28 (5%). Four characteristics were found to be significantly associated with PBI ineligibility after MRI on multivariable analysis: premenopausal status (P=.021), detection by palpation (P<.001), first-degree relative with a history of breast cancer (P=.033), and lobular histology (P=.002). Risk factors were assigned a score of 0-2. The risk of altered PBI eligibility from MRI based on number of risk factors was 0:18%; 1:22%; 2:42%; 3:65%. Conclusions: Preoperative bilateral breast MRI altered the PBI recommendations for 25% of women. Women who may undergo PBI should be considered for breast MRI, especially those with lobular histology or with 2 or more of the following risk factors: premenopausal, detection by palpation, and first-degree relative with a history of

  12. Breast-conserving therapy with partial or whole breast irradiation: Ten-year results of the Budapest randomized trial

    International Nuclear Information System (INIS)

    Background and purpose: To report the long-term results of a single-institution randomized study comparing the results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI). Patients and methods: Between 1998 and 2004, 258 selected women with pT1 pN0-1mi M0, grade 1–2, non-lobular breast cancer without the presence of extensive intraductal component and resected with negative margins were randomized after BCS to receive 50 Gy WBI (n = 130) or PBI (n = 128). The latter consisted of either 7 × 5.2 Gy high-dose-rate (HDR) multi-catheter brachytherapy (BT; n = 88) or 50 Gy electron beam (EB) irradiation (n = 40). Primary endpoint was local recurrence (LR) as a first event. Secondary endpoints were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and cosmetic results. Results: After a median follow up of 10.2 years, the ten-year actuarial rate of LR was 5.9% and 5.1% in PBI and WBI arms, respectively (p = 0.77). There was no significant difference in the ten-year probability of OS (80% vs 82%), CSS (94% vs 92%), and DFS (85% vs 84%), either. The rate of excellent-good cosmetic result was 81% in the PBI, and 63% in the control group (p < 0.01). Conclusions: Partial breast irradiation delivered by interstitial HDR BT or EB for a selected group of early-stage breast cancer patients produces similar ten-year results to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with HDR BT implants compared with the outcome after WBI

  13. Contralateral breast doses depending on treatment set-up positions for left-sided breast tangential irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Joo, Chan Seong; Park, Su Yeon; Kim, Jong Sik; Choi, Byeong Gi; Chung, Yoon Sun; Park, Won [Dept. of Radiation Oncology, Samsung Seoul Hospital, Seoul (Korea, Republic of)

    2015-12-15

    To evaluate Contralateral Breast Doses with Supine and Prone Positions for tangential Irradiation techniques for left-sided breast Cancer We performed measurements for contralateral doses using Human Phantom at each other three plans (conventional technique, Field-in-Field, IMRT, with prescription of 50 Gy/25fx). For the measurement of contralateral doses we used Glass dosimeters on the 4 points of Human Phantom surface (0 mm, 10 mm, 30 mm, 50 mm). For the position check at every measurements, we had taken portal images using EPID and denoted the incident points on the human phantom for checking the constancy of incident points. The contralateral doses in supine position showed a little higher doses than those in prone position. In the planning study, contralateral doses in the prone position increased mean doses of 1.2% to 1.8% at each positions while those in the supine positions showed mean dose decreases of 0.8% to 0.9%. The measurements using glass dosimeters resulted in dose increases (mean: 2.7%, maximum: 4% of the prescribed dose) in the prone position. In addition, the delivery techniques of Field-in-field and IMRT showed mean doses of 3% higher than conventional technique. We evaluated contralateral breast doses depending on different positions of supine and prone for tangential irradiations. For the phantom simulation of set-up variation effects on contralateral dose evaluation, although we used humanoid phantom for planning and measurements comparisons, it would be more or less worse set-up constancy in a real patient. Therefore, more careful selection of determination of patient set-up for the breast tangential irradiation, especially in the left-sided breast, should be considered for unwanted dose increases to left lung and heart. In conclusion, intensive patient monitoring and improved patient set-up verification efforts should be necessary for the application of prone position for tangential irradiation of left-sided breast cancer.

  14. Investigation of irradiation conditions for recurrent breast cancer in JRR-4

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, H., E-mail: horiguchi.hironori@jaea.go.jp [Department of Research Reactor and Tandem Accelerator, Japan Atomic Energy Agency, Tokai, Ibaraki (Japan); Nakamura, T. [Department of Research Reactor and Tandem Accelerator, Japan Atomic Energy Agency, Tokai, Ibaraki (Japan); Kumada, H. [Proton Medical Research Centre, University of Tsukuba, Tsukuba, Ibaraki (Japan); Yanagie, H. [Department of Nuclear Engineering and management, Graduate School of Tokyo, Tokyo (Japan)] [Cooperative Unit of Medicine and Engineering, University of Tokyo Hospital, Tokyo (Japan); Suzuki, M. [Particle Radiation Oncology Research Center, Kyoto University, Osaka (Japan); Sagawa, H. [Department of Research Reactor and Tandem Accelerator, Japan Atomic Energy Agency, Tokai, Ibaraki (Japan)

    2011-12-15

    Clinical trials of boron neutron capture therapy (BNCT) for recurrent breast cancers are considered at Japan Research Reactor No. 4 (JRR-4). In this study, the irradiation technique for a total mastectomy patient with recurrent cancer was optimized by dosimetric calculations using JAEA computational dosimetry system (JCDS). The evaluation was performed using an en face technique and a tangents technique with thermal neutron beam mode at JRR-4. The results revealed that equivalent doses of lung, heart, liver and skin were similar in each irradiation technique due to the isotropic scattering of thermal neutrons in the body. On the other hand, the irradiation time with the tangents technique was a few times longer than with the en face technique. We concluded that the en face technique was an optimal irradiation technique for recurrent breast cancers using thermal neutron beam mode in terms of shorter irradiation time and easier patient positioning.

  15. Breast cancer radiotherapy: controversies and prospectives

    Institute of Scientific and Technical Information of China (English)

    YU Jin-ming; WANG Yong-sheng

    2008-01-01

    @@ Despite consensus on breast cancer radiotherapy, there are still some controversies over post-mastectomy radiotherapy (PMRT) in patients with 1-3 positive lymph nodes, accelerated partial breast irradiation (APBI), appropriate sequence of radiotherapy, chemotherapy and hormonal treatment, and radiotherapy after preoperative systemic therapy.

  16. External beam accelerated partial breast irradiation (EB-APBI yields favorable outcomes in patients with prior breast augmentation

    Directory of Open Access Journals (Sweden)

    Rachel Yi-Feng Lei

    2014-06-01

    Full Text Available Purpose: To report outcomes in breast cancer patients with prior breast augmentation treated with external beam accelerated partial breast irradiation (EB-APBI utilizing intensity modulated radiotherapy (IMRT or 3-dimensional conformal radiotherapy (3D-CRT, both with image-guided radiotherapy (IGRT.Methods and Materials: 16 stage 0/I breast cancer patients with previous elective bilateral augmentation were treated post-lumpectomy on institutional EB-APBI trials (01185132 and 01185145 on clinicaltrials.gov. Patients received 38.5 Gy in 10 fractions over 5 consecutive days. Breast/chest wall pain and cosmesis were rated by patient; cosmesis was additionally evaluated by physician per RTOG criteria.Results: The median follow-up from APBI completion was 18.0 months (range, 1.2-58.6. Little to no change in cosmesis or pain from baseline was reported. Cosmetic outcomes at last follow-up were judged by patients as excellent/good in 93.8% (15/16, and by physicians as excellent/good in 100% (16/16. Eight patients (50.0% reported no breast/chest wall pain, and the remaining 8 patients (50.0% reported mild pain. All patients remain disease free at last follow-up. The median ipsilateral breast, planning target volume (PTV, and implant volumes were 614 cc, 57 cc, and 333 cc. The median ratios of PTV/ipsilateral breast volume (implant excluded and PTV/total volume (implant included were 9% and 6%. Conclusions: These 16 breast cancer cases with prior bilateral breast augmentation treated with external beam APBI demonstrate favorable clinical outcomes. Further exploration of external beam APBI as a treatment option for this patient po

  17. Loco regional failure pattern after lumpectomy and breast irradiation in 4185 patients with T1 and T2 breast cancer. Implications for nodal irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Livi, Lorenzo; Paiar, Fabiola; Simontacchi, Gabriele [Univ. of Florence (Italy). Dept. of Radiation Oncology] (and others)

    2006-07-15

    The aim of this study is to determinate incidence and risk factors for loco regional failure (LRR) (breast, supraclavicular, axillary and internal mammary nodes) and indications for nodal irradiation. From January 1980 to December 2001, 4185 patients with T1-T2 breast cancer were treated with conservative surgery and whole breast radiotherapy without nodal irradiation at the Univ. of Florence. The median age was 55 years (range 19-86). All patients were followed for a median of eight years (range 3 months to 20 years). Multivariate analysis showed as independent prognostic factors for isolated nodal relapse (NR) the presence of more than three positive lymph nodes (PAN) (p=0.001), angiolymphatic invasion (p=0.002) and pT2 (p=0.02). However, only 4.8% of patients with more than three PAN developed NR as the only site of recurrence. Having one to three PAN was not associated with an increased risk of NR. We believe that it is not necessary to prescribe nodal irradiation to patients with negative or one to three PAN. Regarding patients with more than three PAN, the number of isolated NR is also small to routinely justify a node irradiation.

  18. Angiosarcoma of the skin overlying an irradiated breast; Brief communication

    Energy Technology Data Exchange (ETDEWEB)

    Badwe, R.A.; Hanby, A.M.; Fentiman, I.S.; Chaudary, M.A. (Guy' s Hospital, London (United Kingdom))

    1991-09-01

    A case of angiosarcoma of the breast which developed 6 1/2 years after treatment for carcinoma of the same breast is reported. As a result of radiotherapy the breast manifested signs of chronic lymphedema prior to development of angiosarcoma. Although the aetiology in this case is uncertain, there was a past history of childhood naevus regressing spontaneously. Angiosarcoma is a well known complication following radiotherapy and lymphedema , and is likely to be seen more frequently as conservation treatment is used more commonly for patients with early breast cancer. (author). 15 refs.; 2 figs.

  19. Radiation recall secondary to adjuvant docetaxel after balloon-catheter based accelerated partial breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Nathan W. [Summer Intern, Mayo Clinic Arizona, Scottsdale, AZ (United States); Wong, William W., E-mail: wong.william@mayo.ed [Department of Radiation Oncology, Mayo Clinic Arizona, 13400 E. Shea Boulevard, Scottsdale, AZ 85259 (United States); Karlin, Nina J. [Division of Oncology, Mayo Clinic Arizona, Scottsdale, AZ (United States); Gray, Richard J. [Department of Surgery, Mayo Clinic Arizona, Scottsdale, AZ (United States)

    2010-08-15

    For early stage breast cancer, wide local excision and post-operative whole breast irradiation is a standard treatment. If adjuvant chemotherapy is recommended, radiation is usually given after completion of chemotherapy. In recent years, accelerated partial breast irradiation (APBI) with balloon-cathetered based brachytherapy has become an option for selected patients. For these patients, adjuvant chemotherapy would have to be administered after radiation. The sequence of treatment with radiation followed by chemotherapy results in increased risk of radiation recall reaction (RRD) in these patients. Docetaxel is becoming a more commonly used drug as adjuvant treatment for breast cancer. Here we report a case of docetaxel induced RRD after APBI with balloon-cathetered based brachytherapy. Such reaction would have an adverse impact on the cosmetic outcome and quality of life of the patient. For patients who develop an intense skin reaction after the administration of docetaxel following APBI, RRD should be considered in the differential diagnosis.

  20. Breast-Conserving Treatment With Partial or Whole Breast Irradiation for Low-Risk Invasive Breast Carcinoma-5-Year Results of a Randomized Trial

    International Nuclear Information System (INIS)

    Purpose: To report the 5-year results of a randomized study comparing the survival and cosmetic results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI). Methods and Materials: Between 1998 and 2004, 258 selected patients with T1 N0-1mi, Grade 1-2, nonlobular breast cancer without presence of extensive intraductal component and resected with negative margins were randomized after breast-conserving surgery to receive 50 Gy/25 fractions WBI (n = 130) or PBI (n = 128). The latter consisted of either 7 x 5.2 Gy high-dose-rate (HDR) multicatheter brachytherapy (BT; n = 88) or 50 Gy/25 fractions electron beam (EB) irradiation (n = 40). Results: At a median follow-up of 66 months, the 5-year actuarial rate of local recurrence was 4.7% and 3.4% in the PBI and WBI arms, respectively (p = 0.50). There was no significant difference in the 5-year probability of overall survival (94.6% vs. 91.8%), cancer-specific survival (98.3% vs. 96.0%), and disease-free survival (88.3% vs. 90.3%). The rate of excellent to good cosmetic result was 77.6% in the PBI group (81.2% after HDR BT; 70.0% after EB) and 62.9% in the control group (52.2% after telecobalt; 65.6% after 6-9-MV photons; pWBI/PBI = 0.009). Conclusions: Partial breast irradiation using interstitial HDR implants or EB to deliver radiation to the tumor bed alone for a selected group of early-stage breast cancer patients produces 5-year results similar to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with carefully designed HDR multicatheter implants compared with the outcome after WBI

  1. Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Shin Hyung; Kim, Jae Chul; Lee, Jeong Eun; Park, In Kyu [Dept.of Radiation Oncology, Kyungpook National University Hospital, Daegu(Korea, Republic of)

    2015-03-15

    To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

  2. Setup accuracy for prone and supine whole breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Mulliez, Thomas; Vercauteren, Tom; Greveling, Annick van; Speleers, Bruno; Neve, Wilfried de; Veldeman, Liv [University Hospital Ghent, Department of Radiotherapy, Ghent (Belgium); Gulyban, Akos [University Hospital Ghent, Department of Radiotherapy, Ghent (Belgium); University Hospital Liege, Department of Radiotherapy, Liege (Belgium)

    2016-04-15

    To evaluate cone-beam computed tomography (CBCT) based setup accuracy and margins for prone and supine whole breast irradiation (WBI). Setup accuracy was evaluated on 3559 CBCT scans of 242 patients treated with WBI and uncertainty margins were calculated using the van Herk formula. Uni- and multivariate analysis on individual margins was performed for age, body mass index (BMI) and cup size. The population-based margin in vertical (VE), lateral (LA) and longitudinal (LO) directions was 10.4/9.4/9.4 mm for the 103 supine and 10.5/22.4/13.7 mm for the 139 prone treated patients, being significantly (p < 0.01) different for the LA and LO directions. Multivariate analysis identified a significant (p < 0.05) correlation between BMI and the LO margin in supine position and the VE/LA margin in prone position. In this series, setup accuracy is significantly worse in prone compared to supine position for the LA and LO directions. However, without proper image-guidance, uncertainty margins of about 1 cm are also necessary for supine WBI. For patients with a higher BMI, larger margins are required. (orig.) [German] Ziel der Arbeit war es, die interfraktionelle Repositionierungsgenauigkeit in Bauchlage (BL) versus Rueckenlage (RL) bei Ganzbrustbestrahlung (GBB) mittels Cone-Beam-CT (CBCT) zu bestimmen, um die notwendigen PTV-Sicherheitsabstaende zu definieren. Die Repositionierungsgenauigkeit wurde basierend an 3559 CBCT-Scans von 242 mit GBB behandelten Patienten ausgewertet. Die PTV-Sicherheitsabstaende wurden unter Verwendung der ''van-Herk''-Formel berechnet. Uni- und multivariable Analysen wurden fuer Sicherheitsabstaende in jede Richtung auf Basis von Alter, Body-Mass-Index (BMI) und Koerbchengroesse durchgefuehrt. Die basierend auf den taeglichen CBCT-Verschiebungen berechneten PTV-Sicherheitsabstaende betrugen in anteroposteriorer (AP), lateraler (LT oder links-rechts) und kraniokaudaler (CC) Richtung 10,4/9,4/9,4 mm fuer die RL (103 Patienten) und

  3. Partial breast irradiation with interstitial high dose-rate brachytherapy: acute and late toxicities and cosmetic results

    International Nuclear Information System (INIS)

    Accelerated partial breast irradiation aims at decreasing the overall treatment time and reducing toxicity. The study we report is for early stage breast cancer and is a multicentre clinical investigation of partial breast irradiation achieved by interstitial high dose-rate (HDR) brachytherapy with intraoperative placement of catheters. We have been able to conclude from the initial data that an interstitial perioperative brachytherapy implant is a feasible method of treatment with good tolerance and good cosmetic results. (author)

  4. Accelerated partial breast irradiation using robotic radiotherapy: a dosimetric comparison with tomotherapy and three-dimensional conformal radiotherapy

    OpenAIRE

    Rault, Erwann; Lacornerie, Thomas; Dang, Hong-Phuong; Crop, Frederik; Lartigau, Eric; Reynaert, Nick; Pasquier, David

    2016-01-01

    Background Accelerated partial breast irradiation (APBI) is a new breast treatment modality aiming to reduce treatment time using hypo fractionation. Compared to conventional whole breast irradiation that takes 5 to 6 weeks, APBI is reported to induce worse cosmetic outcomes both when using three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). These late normal tissue effects may be attributed to the dose volume effect because a large portion of the no...

  5. Impact of the Number of Cautionary and/or Unsuitable Risk Factors on Outcomes After Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose: To examine clinical outcomes of accelerated partial-breast irradiation (APBI) stratified by the number of American Society for Radiation Oncology consensus statement cautionary/unsuitable risk factors (RFs) present. Methods and Materials: A total of 692 patients were treated with APBI at a single institution between April 1993 and January 2012 using interstitial (n=195), balloon (n=292), and 3-dimensional conformal radiation therapy (n=205) techniques. Clinical outcomes were evaluated by risk group and number of RFs. Results: Median follow-up was 5.2 years (range, 0-18.3 years). Most patients were classified as suitable (n=240, 34%) or cautionary (n=343, 50%) risk, whereas 16% (n=109) were unsuitable. In patients with increasing total RFs (1 RF, 2 RF, 3+ RF), higher rates of grade 3 histology (10% vs 18% vs 32%, P<.001), estrogen receptor negativity (0 vs 12% vs 29%, P<.001), close/positive margins (0 vs 6% vs 17%, P<.001), and use of adjuvant chemotherapy (3% vs 12% vs 33%, P<.001) were noted. When pooling cautionary and unsuitable patients, increased ipsilateral breast tumor recurrence/regional recurrence was most notable for patients with 3 or more combined RFs versus 2 or fewer combined RFs (P<.001). Conclusions: Patients with 3 or more cautionary or unsuitable RFs may be at risk for higher local, regional, and distant recurrence after breast-conserving therapy using APBI. Patients with 2 or fewer total RFs have 98% locoregional control at 5 years. Inclusion of total number of RFs in future risk stratification schemes for APBI may be warranted

  6. Impact of the Number of Cautionary and/or Unsuitable Risk Factors on Outcomes After Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Wobb, Jessica; Wilkinson, J. Ben [Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Shah, Chirag [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Mitchell, Christina; Wallace, Michelle; Ye, Hong; Stromberg, Jannifer; Grills, Inga [Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Chen, Peter Y., E-mail: PChen@beaumont.edu [Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States)

    2013-09-01

    Purpose: To examine clinical outcomes of accelerated partial-breast irradiation (APBI) stratified by the number of American Society for Radiation Oncology consensus statement cautionary/unsuitable risk factors (RFs) present. Methods and Materials: A total of 692 patients were treated with APBI at a single institution between April 1993 and January 2012 using interstitial (n=195), balloon (n=292), and 3-dimensional conformal radiation therapy (n=205) techniques. Clinical outcomes were evaluated by risk group and number of RFs. Results: Median follow-up was 5.2 years (range, 0-18.3 years). Most patients were classified as suitable (n=240, 34%) or cautionary (n=343, 50%) risk, whereas 16% (n=109) were unsuitable. In patients with increasing total RFs (1 RF, 2 RF, 3+ RF), higher rates of grade 3 histology (10% vs 18% vs 32%, P<.001), estrogen receptor negativity (0 vs 12% vs 29%, P<.001), close/positive margins (0 vs 6% vs 17%, P<.001), and use of adjuvant chemotherapy (3% vs 12% vs 33%, P<.001) were noted. When pooling cautionary and unsuitable patients, increased ipsilateral breast tumor recurrence/regional recurrence was most notable for patients with 3 or more combined RFs versus 2 or fewer combined RFs (P<.001). Conclusions: Patients with 3 or more cautionary or unsuitable RFs may be at risk for higher local, regional, and distant recurrence after breast-conserving therapy using APBI. Patients with 2 or fewer total RFs have 98% locoregional control at 5 years. Inclusion of total number of RFs in future risk stratification schemes for APBI may be warranted.

  7. Microbiological and sensory evaluation of the shelf-life of irradiated chicken breast meat

    International Nuclear Information System (INIS)

    Kraft paper boxes containing 10 expanded polystyrene trays with 200g skinless deboned chicken breast each were irradiated with 60Co source of a Nordion JS7500 irradiator. The trays were previously wrapped with polyethylene film. The samples were exposed to 1.5; 3.0 and 7.0 kGy doses in the static mode at 0º and 180º in relation to the irradiation beam. Set of 18 alanine+paraffin dosimeters per treatment were distributed inside the boxes for evaluation of irradiation dose homogeneity. A separeted dose calibration curve was obtained by irradiating in the range of 1 to 10kGy. After the irradiation, the chicken breasts were stored at 5±1ºC for 39 days and were analysed microbiologically in total psychrotrophic aerobic bacteria, total mesophilic aerobic bacteria, molds and yeasts, Pseudomonas spp, Enterobacteriaceae, lactic bacteria counts and E.coli during the storage period. The results revealed a linear behaviour of the alanine+paraffin dosimeters in the range of 1 to 10kGy irradiation. In regard to the microbiological aspect, compared to the shelf-life of 5 days for the controls, there were a increasing of 1.75; 4.40 e 7.0 times shelf-life for chicken breasts irradiated with 1.5; 3.0 and 7.0kGy, respectively. There was an increasing change of the smell of burnt as the irradiation doses increased. Thus, 3kGy dose was considered as the ideal dose to assure a longer shelf-life to the product, without perceptible changes in the aspect

  8. Intensity Modulated Accelerated Partial Breast Irradiation Before Surgery in Treating Older Patients With Hormone Responsive Stage 0-I Breast Cancer

    Science.gov (United States)

    2016-05-04

    Ductal Breast Carcinoma in Situ; Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Ductal Breast Carcinoma With Predominant Intraductal Component; Lobular Breast Carcinoma in Situ; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Progesterone Receptor-positive Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Tubular Ductal Breast Carcinoma

  9. An evaluation of the accuracy of semi-permanent skin marks for breast cancer irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Probst, H. [Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield S10 2BP (United Kingdom)]. E-mail: h.probst@shu.ac.uk; Dodwell, D. [Cookridge Hospital Leeds (United Kingdom); Gray, J.C. [University of Newcastle (United Kingdom); Holmes, M. [Leeds Metropolitan University (United Kingdom)

    2006-08-15

    A randomised trial was designed to investigate the accuracy of semi-permanent ink marks versus permanent tattoos for early stage breast cancer irradiation. No significant difference in random and systematic errors was identified between the two groups. On multivariate analysis no specific patient characteristic had a major influence on the systematic errors identified.

  10. Should inhomogeneity corrections be applied during treatment planning of tangential breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Mijnheer, B.J.; Heukelom, S.; Lanson, J.H. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands)); Battum, L.J. van; Bree, N.A.M. van (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands) Dr. Daniel Den Hoed Cancer Centre, Rotterdam (Netherlands). Department of Clinical Physics); Tienhoven, G. van (Amsterdam Univ. (Netherlands). Academisch Ziekenhuis)

    1991-12-01

    Due to the inclusion of lung tissue in the treatment volume, some parts of the breast will get a higher dose during tangential breast irradiation because of the lower lung density. Data on the accuracy of dose calculation algorithms, investigated by phantom measurements, determinations of the geometry and density of the actual lung in the patient and results of in vivo dose measurements, are presented. From this information it can be concluded that a lung correction varying between about 3 and 7% is needed but its magnitude is slightly overpredicted in a number of commercial treatment planning systems. Because this increase in dose is already in a high dose region, it is recommended that inhomogeneity corrections should be applied during tangential breast irradiation. (author). 20 refs.; 4 tabs.

  11. Potential Reduction of Contralateral Second Breast-Cancer Risks by Prophylactic Mammary Irradiation: Validation in a Breast-Cancer-Prone Mouse Model

    OpenAIRE

    Igor Shuryak; Lubomir B Smilenov; Kleiman, Norman J.; Brenner, David J.

    2013-01-01

    BACKGROUND: Long-term breast-cancer survivors have a highly elevated risk (1 in 6 at 20 years) of contralateral second breast cancer. This high risk is associated with the presence of multiple pre-malignant cell clones in the contralateral breast at the time of primary breast cancer diagnosis. Mechanistic analyses suggest that a moderate dose of X-rays to the contralateral breast can kill these pre-malignant clones such that, at an appropriate Prophylactic Mammary Irradiation (PMI) dose, the ...

  12. Epidemiologic study on carcinoma of the breast following irradiation for benign conditions in infancy and childhood

    International Nuclear Information System (INIS)

    To investigate the relationship of irradiation during infancy and childhood to the subsequent development of carcinoma of the breast, 996 eligible patients were studied at Evanston Hospital, Evanston, Illinois, and Northwestern Memorial Hospital, Chicago. This was a case-control study, with those in the control group being selected from concurrent hospital admissions for nonmalignant surgical conditions. A second group consisting of those with benign biopsy results was also studied. The Mantel-Haenszel method of analysis, controlling for age and race, was used to estimate the approximate relative risk of carcinoma of the breast in the irradiated group compared with that for the nonirradiated group. The type of radiation history included radiotherapy for mastitis or enlarged thymus (nine patients), irradiation of the head and neck (69 patients), diagnostic fluoroscopies (ten patients) and miscellaneous irradiation (52 patients) for bursitis, eczema or keloid. Based upon the data obtained from the results of this study and its analysis, we conclude that there is little evidence of increased risk of carcinoma of the breast after irradiation about the head, neck and chest areas for benign conditions in the population being studied herein. Such a risk, if indeed it exists at all for this population, is estimated to be about 10 per cent

  13. Epidemiologic study on carcinoma of the breast following irradiation for benign conditions in infancy and childhood

    Energy Technology Data Exchange (ETDEWEB)

    Oviedo, M.A.; Chmiel, J.S.; Curb, J.D.; Kautz, J.A.; Haenszel, W.; Scanlon, E.F.

    1983-07-01

    To investigate the relationship of irradiation during infancy and childhood to the subsequent development of carcinoma of the breast, 996 eligible patients were studied at Evanston Hospital, Evanston, Illinois, and Northwestern Memorial Hospital, Chicago. This was a case-control study, with those in the control group being selected from concurrent hospital admissions for nonmalignant surgical conditions. A second group consisting of those with benign biopsy results was also studied. The Mantel-Haenszel method of analysis, controlling for age and race, was used to estimate the approximate relative risk of carcinoma of the breast in the irradiated group compared with that for the nonirradiated group. The type of radiation history included radiotherapy for mastitis or enlarged thymus (nine patients), irradiation of the head and neck (69 patients), diagnostic fluoroscopies (ten patients) and miscellaneous irradiation (52 patients) for bursitis, eczema or keloid. Based upon the data obtained from the results of this study and its analysis, we conclude that there is little evidence of increased risk of carcinoma of the breast after irradiation about the head, neck and chest areas for benign conditions in the population being studied herein. Such a risk, if indeed it exists at all for this population, is estimated to be about 10 per cent.

  14. 早期乳腺癌部分乳腺加速放疗%Accelerated partial breast irradiation for early breast cancer

    Institute of Scientific and Technical Information of China (English)

    张秋宁; 王小虎

    2011-01-01

    随着乳腺癌术后复发模式的研究进展,部分乳腺照射方法 成为乳腺癌放疗的热点.组织间插植、球囊近距离治疗、术中放疗及三维适形放疗和调强放疗等部分乳腺加速放疗已进入临床研究.其局部控制率和安全性与全乳腺照射比较相当,同时具有治疗周期短、方便患者等优势.部分乳腺加速放疗在部分患者有望代替全乳腺放疗,成为早期乳腺癌保乳术后放疗的标准治疗之一.%With a view to patterns of local recurrence after breast conserving surgery, whole breast irradiation(WBI) after surgery is controversial and partial-breast irradiation(PBI) came up. Many clinical trials related with accelerated partial-breast irradiation using a variety of radiotherapeutic techniques such as interstitial brachytherapy (IBT), MammoSite Radiation Therapy System, intraoperative radiotherapy(IORT), threedimensional conformal radiotherapy(3-DCRT)and intensity modulated radiation therapy(IMRT) in selected patients have been carried out. Accelerated partial-breast irradiation that provides faster, more convenient treat-ment demonstrates local control rate and safety comparable to that of whole breast irradiation. Partial breast irradiation may be an alternative way to whole breast radiotherapy and will be one of the standard treatments in women with early breast cancer seeking breast conservation.

  15. Dosimetric comparison of partial and whole breast external beam irradiation in the treatment of early stage breast cancer.

    Science.gov (United States)

    Kim, Yongbok; Parda, David S; Trombetta, Mark G; Colonias, Athanasios; Werts, E Day; Miller, Linda; Miften, Moyed

    2007-12-01

    A dosimetric comparison was performed on external-beam three-dimensional conformal partial breast irradiation (PBI) and whole breast irradiation (WBI) plans for patients enrolled in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 protocol at our institution. Twenty-four consecutive patients were treated with either PBI (12 patients) or WBI (12 patients). In the PBI arm, the lumpectomy cavity was treated to a total dose of 38.5 Gy at 3.85 Gy per fraction twice daily using a four-field noncoplanar beam setup. A minimum 6 h interval was required between fractions. In the WBI arm, the whole breast including the entirety of the lumpectomy cavity was treated to a total dose of 50.4 Gy at 1.8 Gy per fraction daily using opposed tangential beams. The lumpectomy cavity volume, planning target volume for evaluation (PTV_EVAL), and critical structure volumes were contoured for both the PBI and WBI patients. Dosimetric parameters, dose volume histograms (DVHs), and generalized equivalent uniform dose (gEUD) for target and critical structures were compared. Dosimetric results show the PBI plans, compared to the WBI plans, have smaller hot spots in the PTV_EVAL (maximum dose: 104.2% versus 110.9%) and reduced dose to the ipsilateral breast (V50: 48.6% versus 92.1% and V100: 10.2% versus 50.5%), contralateral breast (V3: 0.16% versus 2.04%), ipsilateral lung (V30: 5.8% versus 12.7%), and thyroid (maximum dose: 0.5% versus 2.0%) with p values < or = 0.01. However, similar dose coverage of the PTV_EVAL (98% for PBI and 99% for WBI, on average) was observed and the dose difference for other critical structures was clinically insignificant in both arms. The gEUD data analysis showed the reduction of dose to the ipsilateral breast and lung, contralateral breast and thyroid. In addition, preliminary dermatologic adverse event assessment data suggested reduced skin toxicity for patients treated with the PBI technique.

  16. Effect of high-dose irradiation on quality characteristics of ready-to-eat chicken breast

    International Nuclear Information System (INIS)

    High-dose (higher than 30 kGy) irradiation has been used to sterilize specific-purposed foods for safe and long-term storage. The objective of this study was to investigate the effect of high-dose irradiation on the quality characteristics of ready-to-eat chicken breast in comparison with those of the low-dose irradiation. Ready-to-eat chicken breast was manufactured, vacuum-packaged, and irradiated at 0, 5, and 40 kGy. The populations of total aerobic bacteria were 4.75 and 2.26 Log CFU/g in the samples irradiated at 0 and 5 kGy, respectively. However, no viable cells were detected in the samples irradiated at 40 kGy. On day 10, bacteria were not detected in the samples irradiated at 40 kGy but the number of bacteria in the samples irradiated at 5 kGy was increased. The pH at day 0 was higher in the samples irradiated at 40 kGy than those at 0 and 5 kGy. The 2-thiobarbituric acid reactive substance (TBARS) values of the samples were not significantly different on day 0. However, on day 10, the TBARS value was significantly higher in the samples irradiated at 40 kGy than those at 0 and 5 kGy. There was no difference in the sensory scores of the samples, except for off-flavor, which was stronger in samples irradiated at 5 and 40 kGy than control. However, no difference in off-flavor between the irradiated ones was observed. After 10 days of storage, only the samples irradiated at 40 kGy showed higher off-flavor score. SPME-GC–MS analysis revealed that 5 kGy of irradiation produced 2-methylbutanal and 3-methylbutanal, which were not present in the control, whereas 40 kGy of irradiation produced hexane, heptane, pentanal, dimethly disulfide, heptanal, and nonanal, which were not detected in the control or the samples irradiated at 5 kGy. However, the amount of compounds such as allyl sulfide and diallyl disulfide decreased significantly in the samples irradiated at 5 kGy and 40 kGy. - Highlights: ► Comparison of high (40 kGy) and low-dose irradiation (5 kGy) on

  17. Tailoring therapies--improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015.

    Science.gov (United States)

    Coates, A S; Winer, E P; Goldhirsch, A; Gelber, R D; Gnant, M; Piccart-Gebhart, M; Thürlimann, B; Senn, H-J

    2015-08-01

    The 14th St Gallen International Breast Cancer Conference (2015) reviewed substantial new evidence on locoregional and systemic therapies for early breast cancer. Further experience has supported the adequacy of tumor margins defined as 'no ink on invasive tumor or DCIS' and the safety of omitting axillary dissection in specific cohorts. Radiotherapy trials support irradiation of regional nodes in node-positive disease. Considering subdivisions within luminal disease, the Panel was more concerned with indications for the use of specific therapies, rather than surrogate identification of intrinsic subtypes as measured by multiparameter molecular tests. For the treatment of HER2-positive disease in patients with node-negative cancers up to 1 cm, the Panel endorsed a simplified regimen comprising paclitaxel and trastuzumab without anthracycline as adjuvant therapy. For premenopausal patients with endocrine responsive disease, the Panel endorsed the role of ovarian function suppression with either tamoxifen or exemestane for patients at higher risk. The Panel noted the value of an LHRH agonist given during chemotherapy for premenopausal women with ER-negative disease in protecting against premature ovarian failure and preserving fertility. The Panel noted increasing evidence for the prognostic value of commonly used multiparameter molecular markers, some of which also carried prognostic information for late relapse. The Panel noted that the results of such tests, where available, were frequently used to assist decisions about the inclusion of cytotoxic chemotherapy in the treatment of patients with luminal disease, but noted that threshold values had not been established for this purpose for any of these tests. Multiparameter molecular assays are expensive and therefore unavailable in much of the world. The majority of new breast cancer cases and breast cancer deaths now occur in less developed regions of the world. In these areas, less expensive pathology tests may

  18. Stereotactic Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Rationale, Feasibility, and Early Experience Using the CyberKnife Radiosurgery Delivery Platform

    OpenAIRE

    Obayomi-Davies, Olusola; Kole, Thomas P.; Oppong, Bridget; Rudra, Sonali; Makariou, Erini V.; Lloyd D Campbell; Hozaifa M Anjum; Sean P Collins; Unger, Keith; WILLEY, SHAWNA; Tousimis, Eleni; Collins, Brian T.

    2016-01-01

    Purpose The efficacy of accelerated partial breast irradiation (APBI) utilizing brachytherapy or conventional external beam radiation has been studied in early-stage breast cancer treated with breast-conserving surgery. Data regarding stereotactic treatment approaches are emerging. The CyberKnife linear accelerator enables excellent dose conformality to target structures while adjusting for target and patient motion. We report our institutional experience on the technical feasibility and rati...

  19. Stereotactic Accelerated Partial Breast Irradiation (SAPBI) for Early Stage Breast Cancer: Rationale, Feasibility and Early Experience using the CyberKnife Radiosurgery Delivery Platform

    OpenAIRE

    Olusola eOBAYOMI-DAVIES; Kole, Thomas P.; Bridget eOppong; Sonali eRudra; Erini eMakariou; Lloyd D Campbell; Hozaifa M Anjum; Sean P Collins; Keith eUnger; Willey, Shawna C.; Eleni A Tousimis; Brian Timothy Collins

    2016-01-01

    Purpose: The efficacy of accelerated partial breast irradiation (APBI) utilizing brachytherapy or conventional external beam radiation has been studied in early stage breast cancer treated with breast conserving surgery. Data regarding stereotactic treatment approaches are emerging. The CyberKnife linear accelerator enables excellent dose conformality to target structures while adjusting for target and patient motion. We report our institutional experience on the technical feasibility and rat...

  20. Evaluation of dose to cardiac structures during breast irradiation

    DEFF Research Database (Denmark)

    Aznar, M C; Korreman, S-S; Pedersen, A N;

    2011-01-01

    OBJECTIVE: Adjuvant radiotherapy for breast cancer can lead to late cardiac complications. The highest radiation doses are likely to be to the anterior portion of the heart, including the left anterior descending coronary artery (LAD). The purpose of this work was to assess the radiation doses de...

  1. Identifying Patients Who May Be Candidates for a Clinical Trial of Salvage Accelerated Partial Breast Irradiation after Previous Whole Breast Irradiation

    Directory of Open Access Journals (Sweden)

    Linna Li

    2012-01-01

    Full Text Available Background and Objectives. Accelerated partial breast irradiation (APBI has been proposed as an alternative to salvage mastectomy for patients with ipsilateral breast tumor recurrence (IBTR after prior breast conservation. We studied factors that are associated with a more favorable local recurrence profile that could make certain patients eligible for APBI. Methods. Between 1980 and 2005, 157 Stage 0–II breast cancer patients had an IBTR treated by mastectomy. Clinical and pathological features were analyzed to identify factors associated with favorable IBTR defined as unifocal DCIS or T1 ≤ 2 cm, without skin involvement, and >2 year interval from initial treatment. Results. Median followup was 140 months and time to recurrence was 73 months. Clinical stage distribution at recurrence was DCIS in 32 pts (20%, T1 in 90 pts (57%, T2 in 14 pts (9%, T3 in 4 pts (3%, and T4 in 9 pts (6%. IBTR was classified as favorable in 71%. Clinical stage of IBTR predicted for pathologic stage –95% of patients with clinical T1 IBTR had pathologic T1 disease at salvage mastectomy . Conclusions. Clinical stage at presentation strongly correlated with pathologic stage at mastectomy. More than 70% of recurrences were favorable and may be appropriate candidates for salvage APBI trials.

  2. Effect of irradiation dose and irradiation temperature on the thiamin content of raw and cooked chicken breast meat

    International Nuclear Information System (INIS)

    The usefulness of ionising radiation for the elimination of pathogenic bacteria in poultry meat has been well documented as have the effects of this processing treatment on the nutritional status of the food, in particular, the vitamins. Unfortunately, much of the earlier research carried out on the effect of irradiation on vitamins was carried out in solution or in model systems at doses much greater than those used commercially thereby resulting in considerable destruction of these compounds. Thus, those opposed to the process of food irradiation labelled the treated food as nutritionally poor. However, in reality, due to the complexity of food systems the effects of irradiation on vitamins are generally not as marked and many processes, for example cooking, cause the same degree of change to the vitamins. Thiamin (vitamin B1) is the most radiation sensitive of the water-soluble vitamins and is therefore a good indicator of the effect of irradiation treatment. In this study the effects of irradiation at either 4°C or −20°C followed by cooking on the thiamin content of chicken breast meat was determined. Results showed that whilst both irradiation and cooking resulted in a decrease in thiamin concentration, the losses incurred were unlikely to be of nutritional significance and could be further minimised by irradiating the chicken meat at a low temperature. Thiamin analyses were carried out using high-performance liquid chromatography since this technique is faster and more selective than the chemical or microbiological methods more commonly employed. Total thiamin, both free and combined form, was determined following acid and enzyme hydrolysis. © 1998 Society of Chemical Industry

  3. Effects of recombinant epidermal growth factor receptor antisense adenovirus combined with irradiation on breast cancer cells

    International Nuclear Information System (INIS)

    Objective: To investigate the effects of a recombinant antisense adenovirus for epidermal growth factor receptor (EGFR) combined with irradiation on breast cancer cells. Methods: Human EGFR cDNA fragment was subcloned in the opposite orientation to the cytomegaloviral promoter and inserted into a E1/E3-deleted type 5 adenoviral vector to obtain AdE5 construct which expresses EGFR antisense RNA. Combined with γ-ray irradiation, its effects on clonogenicity and cell cycle phase distribution were studied in a human breast cancer line MDA-MB-23. Results: EGFR protein expression was dramatically inhibited in MDA-MB-231 cells after AdE5 infection. The post-irradiation clonogenicity was reduced by AdE5 in a viral and irradiation dose-dependent manner. Further cytometric analysis showed that AdE5 infection at a MOI of 300 pfu/cell induced a cell cycle progression from radio-resistant G0 + G1 phases to radiosensitive G2 + M phases, resulting in a synergistic effect after combination of these two treatments. Conclusions: The transduction of EGFR antisense RNA by adenoviral vector is effective for antisense strategy targeting EGFR, and increases the cell-killing effect of ionizing radiation on breast cancer cells.(authors)

  4. Accelerated partial breast irradiation using once-daily fractionation: analysis of 312 cases with four years median follow-up

    Directory of Open Access Journals (Sweden)

    Shaikh Arif Y

    2012-02-01

    Full Text Available Abstract Background There are limited data on accelerated partial breast irradiation (APBI using external beam techniques. Moreover, there are recent reports of increased fibrosis and unacceptable cosmesis with APBI using external beam with BID fractionation. We adopted a once daily regimen of APBI with fractionation similar to that shown to be effective in a Canadian randomized trial of whole breast irradiation. It is unclear whether patients with DCIS or invasive lobular carcinoma (ILC are suitable for APBI. Methods The retrospective cohort included 310 patients with 312 tumors of T1-T2N0-N1micM0 invasive ductal carcinoma (IDC, ILC, or Tis (DCIS treated with APBI via external beam. Most patients were treated using IMRT with 16 daily fractions of 270 cGy to a dose of 4320 cGy. The target volume included the lumpectomy cavity plus 1.0 cm to account for microscopic disease and an additional 0.5 to 1.0 cm for setup uncertainty and breathing motion. Ipsilateral breast failure (IBF was pathologically confirmed as a local failure (LF or an elsewhere failure (EF. Results Median follow-up was 49 months. Among the 312 cases, 213 were IDC, 31 ILC, and 68 DCIS. Median tumor size was 1.0 cm. There were 9 IBFs (2.9% including 5 LFs and 4 EFs. The IBF rates among patients with IDC, ILC, and DCIS were 2.4%, 3.2%, and 4.4%, respectively, with no significant difference between histologies. When patients were analyzed by the ASTRO APBI consensus statement risk groups, 32% of treated cases were considered suitable, 50% cautionary, and 18% unsuitable. The IBF rates among suitable, cautionary, and unsuitable patients were 4.0%, 2.6%, and 1.8%, respectively, with no significant difference between risk groups. Acute skin reactions were rare and long-term cosmetic outcome was very good to excellent. Conclusions External beam APBI with once daily fractionation has a low rate of IBF consistent with other published APBI studies. The ASTRO risk stratification did not

  5. Prospective Multicenter Trial Evaluating Balloon-Catheter Partial-Breast Irradiation for Ductal Carcinoma in Situ

    Energy Technology Data Exchange (ETDEWEB)

    Abbott, Andrea M.; Portschy, Pamela R. [Division of Surgical Oncology, University of Minnesota, Minneapolis, Minnesota (United States); Lee, Chung [Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota (United States); Le, Chap T. [Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota (United States); Han, Linda K. [Department of Surgery, Indiana University, Indianapolis, Indiana (United States); Washington, Tara [Vantage Oncology, Redhawk and Wildomar Centers California, Wildomar, California (United States); Kinney, Michael [Center for Advanced Breast Care, Arlington Heights, Illinois (United States); Bretzke, Margit [Surgical Specialists of Minnesota, Minneapolis, Minnesota (United States); Tuttle, Todd M., E-mail: tuttl006@umn.edu [Division of Surgical Oncology, University of Minnesota, Minneapolis, Minnesota (United States)

    2013-11-01

    Purpose: To determine outcomes of accelerated partial-breast irradiation (APBI) with MammoSite in the treatment of ductal carcinoma in situ (DCIS) after breast-conserving surgery. Methods and Materials: We conducted a prospective, multicenter trial between 2003 and 2009. Inclusion criteria included age >18 years, core needle biopsy diagnosis of DCIS, and no prior breast cancer history. Patients underwent breast-conserving surgery plus MammoSite placement. Radiation was given twice daily for 5 days for a total of 34 Gy. Patients were evaluated for development of toxicities, cosmetic outcome, and ipsilateral breast tumor recurrence (IBTR). Results: A total of 41 patients (42 breasts) completed treatment in the study, with a median follow up of 5.3 years. Overall, 28 patients (68.3%) experienced an adverse event. Skin changes and pain were the most common adverse events. Cosmetic outcome at 6 months was judged excellent/good by 100% of physicians and by 96.8% of patients. At 12 months, 86.7% of physicians and 92.3% of patients rated the cosmetic outcome as excellent/good. Overall, 4 patients (9.8%) developed an IBTR (all DCIS), with a 5-year actuarial rate of 11.3%. All IBTRs were outside the treatment field. Among patients with IBTRs, the mean time to recurrence was 3.2 years. Conclusions: Accelerated partial-breast irradiation using MammoSite seems to provide a safe and cosmetically acceptable outcome; however, the 9.8% IBTR rate with median follow-up of 5.3 years is concerning. Prospective randomized trials are necessary before routine use of APBI for DCIS can be recommended.

  6. Prospective Multicenter Trial Evaluating Balloon-Catheter Partial-Breast Irradiation for Ductal Carcinoma in Situ

    International Nuclear Information System (INIS)

    Purpose: To determine outcomes of accelerated partial-breast irradiation (APBI) with MammoSite in the treatment of ductal carcinoma in situ (DCIS) after breast-conserving surgery. Methods and Materials: We conducted a prospective, multicenter trial between 2003 and 2009. Inclusion criteria included age >18 years, core needle biopsy diagnosis of DCIS, and no prior breast cancer history. Patients underwent breast-conserving surgery plus MammoSite placement. Radiation was given twice daily for 5 days for a total of 34 Gy. Patients were evaluated for development of toxicities, cosmetic outcome, and ipsilateral breast tumor recurrence (IBTR). Results: A total of 41 patients (42 breasts) completed treatment in the study, with a median follow up of 5.3 years. Overall, 28 patients (68.3%) experienced an adverse event. Skin changes and pain were the most common adverse events. Cosmetic outcome at 6 months was judged excellent/good by 100% of physicians and by 96.8% of patients. At 12 months, 86.7% of physicians and 92.3% of patients rated the cosmetic outcome as excellent/good. Overall, 4 patients (9.8%) developed an IBTR (all DCIS), with a 5-year actuarial rate of 11.3%. All IBTRs were outside the treatment field. Among patients with IBTRs, the mean time to recurrence was 3.2 years. Conclusions: Accelerated partial-breast irradiation using MammoSite seems to provide a safe and cosmetically acceptable outcome; however, the 9.8% IBTR rate with median follow-up of 5.3 years is concerning. Prospective randomized trials are necessary before routine use of APBI for DCIS can be recommended

  7. Target volume definition and target conformal irradiation technique for breast cancer patients.

    Science.gov (United States)

    Kiricuta, I C; Götz, U; Schwab, F; Fehn, M; Neumann, H H

    2000-01-01

    The aim of this study was to present the target volume and irradiation technique in the most complex situation where the breast or chest wall and the locoregional lymphatics (mammaria interna lymph nodes, axillary and supraclavicular lymph nodes) have to be irradiated. The study comprised 125 breast cancer patients treated with curative intent after primary surgery in the last two years at our institute. In 62 cases the target volume included the breast or chest wall and the locoregional lymphatics, which were treated using our irradiation technique. The target conformal irradiation technique is a multiple non-opposed beams one isocenter technique developed to protect the heart and lungs. This technique, consisting of several rotation beams modulated with wedge filters and individual lung absorbers as well as additional fixed beams, was used in our study to apply a homogeneous dose of 46 to 56 Gy to the target volume; the irradiation technique was optimized by means of dose-volume histograms. After pre-localization, the patients underwent computerized tomographic scanning, with sections at 1.0 cm intervals. Contouring of target volume and organs at risk was carried out with a MULTIDATA workstation for regions of interest (mammaria interna and/or axillary and/or supraclavicular lymphatics and the breast or chest wall) as well as the organs at risk, such as heart and lung parenchyma. Planning target volume coverage was examined by three-dimensional isodose visualization for all CT axial sections for each patient. To determine the incidence of acute or late side effects on the lung parenchyma, conventional chest x-rays and CT studies were carried out at 1 month, 3 months and 6 months after completion of radiotherapy. Dose-volume histogram analysis revealed that this irradiation technique permits the application of a homogeneous dose to the target volume, conforming to the ICRU norms. The maximum dose applied to the ipsilateral lung parenchyma was less than 50-70% of

  8. Efficiency and prognosis of whole brain irradiation combined with precise radiotherapy on triple-negative breast cancer

    OpenAIRE

    Xinhong Wu; Bo Luo; Shaozhong Wei; Yan Luo; Yaojun Feng; Juan Xu; Wei Wei

    2013-01-01

    Aim: To investigate the treatment efficiency of whole brain irradiation combined with precise radiotherapy on triple-negative (TN) phenotype breast cancer patients with brain metastases and their survival times. Materials and Methods : A total of 112 metastatic breast cancer patients treated with whole brain irradiation and intensity modulated radiotherapy (IMRT) or 3D conformal radiotherapy (3DCRT) were analyzed. Thirty-seven patients were of TN phenotype. Objective response rates were co...

  9. Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients

    International Nuclear Information System (INIS)

    Purpose: To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress. Methods and Materials: Between January 1997 and April 1998, 111 women (33-84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis. Results: The internal subject-related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: ≤58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful. Conclusion: Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff

  10. Dosimetric comparison of three dimensional conformal radiation therapy versus intensity modulated radiation therapy in accelerated partial breast irradiation

    OpenAIRE

    Moorthy, S; H S Elhateer; SKD Majumdar; Mohammed, S; Patnaik, R; Narayanamurty

    2016-01-01

    Aim of Study: Breast conserving surgery (BCS) is the standard treatment for stage I and II breast cancer. Multiple studies have shown that recurrences after lumpectomy occur mainly in or near the tumor bed. Use of accelerated partial breast irradiation (APBI) allows for significant reduction in the overall treatment time that results in increasing patient compliance and decreasing healthcare costs. We conducted a treatment planning study to evaluate the role of intensity modulated radiation t...

  11. Phase II investigation: partial breast irradiation with high-dose brachytherapy using intratissue multicatheter implant

    International Nuclear Information System (INIS)

    Local control, side-effects, and cosmetic results were analyzed in patients with early-stage breast cancer after organpreserving surgery and adjuvant partial accelerated irradiation of the breast using high dose rate brachytherapy and intratissue multicatheter implant. The patients over 50 with solitary tumors < 3 cm invasive ductal carcinoma, differentiation grade I-III, resection R0, N0 (axillary dissection or investigation of signal lymph node) were included in the study. The irradiation was performed twice a day with a 6-hour interval at a single dose of 4 Gy. Total focal dose of 32 Gy was delivered with 8 fractions. With a mean observation period of 31 months (13-46), a local relapse was diagnosed in one patient (1.7 %). Cosmetic results were assessed as good and excellent. Immediate complications of the treatment were minimal. The method can be indicated in a selected group of patients and cannot be a standard of treatment at present.

  12. Feasibility, efficacy and cosmetic effect of three-dimensional conformal external bean partial breast irradiation for the selected early stage breast cancer patients after breast-conserving surgery

    International Nuclear Information System (INIS)

    Objective: To explore the feasibility, efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients. Methods: From June 2003 to December 2010, Forty-four early stage breast cancer patients underwent underwent EB-PBI after breast-conserving surgery. Twenty patients had CT simulation scan in moderate deep inspiration breathing hold, and twenty-four patients in free breathing. EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT) with four non-coplanar beams. The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients, twice per day at an interval of at least six hours, in five consecutive days. Results: The number of patients with follow up time of 2, 3 and 5 years were 39, 31 and 16, Grade 1 acute radiation-induced dermatitis was observed in 17 patients (39%) at three months. Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95% cases at two years after radiotherapy. The 2-, 3- and 5- year local control rates were 100%, 99% and 94%, respectively. The 2-, 3-, and 5-year survival rates were all 100% and no metastases occurred. Conclusions: EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery. The cosmetic effect, local control rate and long-term survival rate are satisfactory, and acute radiation toxicity is very low. (authors)

  13. Accelerated partial breast irradiation using intensity-modulated radiotherapy technique compared to whole breast irradiation for patients aged 70 years or older: subgroup analysis from a randomized phase 3 trial

    OpenAIRE

    Meattini, Icro; Saieva, Calogero; Marrazzo, Livia; Di Brina, Lucia; Pallotta, Stefania; Mangoni, Monica; Meacci, Fiammetta; Bendinelli, Benedetta; Francolini, Giulio; Desideri, Isacco; De Luca Cardillo, Carla; Scotti, Vieri; Furfaro, Ilaria Francesca; Rossi, Francesca; Greto, Daniela

    2015-01-01

    The purpose of this study was to report the efficacy and the safety profile on the subset of selected early breast cancer (BC) patients aged 70 years or older from a single-center phase 3 trial comparing whole breast irradiation (WBI) to accelerated partial breast irradiation (APBI) using intensity-modulated radiation therapy technique. Between 2005 and 2013, 520 patients aged more than 40 years old were enrolled and randomly assigned to receive either WBI or APBI in a 1:1 ratio. Eligible pat...

  14. Accelerated partial breast irradiation using 3D conformal radiotherapy: initial clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Gatti, M.; Madeddu, A.; Malinverni, G.; Delmastro, E.; Bona, C.; Gabriele, P. [IRCC-Radiotherapy, Candiolo, TO (Italy); Baiotto, B.; Stasi, M. [IRCC-Medical Physics, Candiolo, TO (Italy); Ponzone, R.; Siatis, D. [IRCC-Surgery, Candiolo, TO (Italy)

    2006-11-15

    Accelerated partial breast irradiation using 3D-C.R.T. is technically sophisticate but feasible and acute toxicity to date has been minimal. A C.T.V.-to-P.T.V. margin of 10 mm seems to provide coverage for analyzed patients. However, more patients and additional studies will be needed to validate the accuracy of this margin, and longer follow-up will be needed to assess acute and chronic toxicity, tumor control, and cosmetic results. (author)

  15. Time Interval From Breast-Conserving Surgery to Breast Irradiation in Early Stage Node-Negative Breast Cancer: 17-Year Follow-Up Results and Patterns of Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Vujovic, Olga, E-mail: olga.vujovic@lhsc.on.ca [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Cherian, Anil [Station Health Centre, Royal Air Force Lossiemouth, Moray (United Kingdom); Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Stitt, Larry [Department of Biometry, London Regional Cancer Program, London, Ontario (Canada); Perera, Francisco [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada)

    2015-02-01

    Purpose: A retrospectivechart review was conducted to determine whether the time interval from breast-conserving surgery to breast irradiation (surgery-radiation therapy interval) in early stage node-negative breast cancer had any detrimental effects on recurrence rates. Methods and Materials: There were 566 patients with T1 to T3, N0 breast cancer treated with breast-conserving surgery and breast irradiation and without adjuvant systemic treatment between 1985 and 1992. The surgery-to-radiation therapy intervals used for analysis were 0 to 8 weeks (201 patients), >8 to 12 weeks (233 patients), >12 to 16 weeks (91 patients), and >16 weeks (41 patients). Kaplan-Meier estimates of time to local recurrence, disease-free survival, distant disease-free survival, cause-specific survival, and overall survival rates were calculated. Results: Median follow-up was 17.4 years. Patients in all 4 time intervals were similar in terms of characteristics and pathologic features. There were no statistically significant differences among the 4 time groups in local recurrence (P=.67) or disease-free survival (P=.82). The local recurrence rates at 5, 10, and 15 years were 4.9%, 11.5%, and 15.0%, respectively. The distant disease relapse rates at 5, 10, and 15 years were 10.6%, 15.4%, and 18.5%, respectively. The disease-free failure rates at 5, 10, and 15 years were 20%, 32.3%, and 39.8%, respectively. Cause-specific survival rates at 5, 10, and 15 years were 92%, 84.6%, and 79.8%, respectively. The overall survival rates at 5, 10, and 15 years were 89.3%, 79.2%, and 66.9%, respectively. Conclusions: Surgery-radiation therapy intervals up to 16 weeks from breast-conserving surgery are not associated with any increased risk of recurrence in early stage node-negative breast cancer. There is a steady local recurrence rate of 1% per year with adjuvant radiation alone.

  16. Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy

    International Nuclear Information System (INIS)

    Background and purpose: breast irradiation after lumpectomy is an integral component of breast-conserving therapy (BCT). As the prognosis is general good following BCT, late morbidity and cosmesis are important. The present study compares two different radiation schedules with respect to these two endpoints. Patients and methods: 129 breast cancer patients (pT1-2 pN0-1 cM0) were irradiated between 09/1992 and 08/1994 with either a 22-day fractionation schedule (2.5 Gy to 55 Gy, 4 x /week, n = 65) or with a conventional fractionation schedule (28 days, 2.0 Gy to 55 Gy, 5 x /week, n = 64), both without additional boost. The equivalent dose of 2-Gy fractions (EQD2) was 55 Gy and 62 Gy, respectively. Late toxicity, assessed according to the LENT-SOMA criteria, and cosmetic outcome, graded on a 5-point scale, were evaluated after a median of 86 months (range 72-94 months) in tumor-free breast cancer patients. Results: LENT-SOMA grade 2/3 toxicity (2.5 Gy vs. 2.0 Gy): breast pain (18% vs. 11%; p = 0.3), fibrosis (57% vs. 16%; p < 0.001), telangiectasia (22% vs. 3%; p = 0.002), atrophy (31% vs. 3%; p < 0.001). Medication to breast pain was taken by 8% versus 9% of patients. Cosmesis was very good/good/acceptable in 75% versus 93% (2.5 Gy vs. 2.0 Gy; p = 0.006). Conclusion: late morbidity was significantly frequent and cosmesis was significantly worse after hypofractionated radiotherapy (2.5 Gy to 55 Gy). However, morbidity was not associated with major implications on daily life. (orig.)

  17. Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fehlauer, F.; Tribius, S.; Alberti, W.; Rades, D. [Dept. of Radiation Oncology, Univ. Medical Clinic Hamburg-Eppendorf, Hamburg (Germany)

    2005-10-01

    Background and purpose: breast irradiation after lumpectomy is an integral component of breast-conserving therapy (BCT). As the prognosis is general good following BCT, late morbidity and cosmesis are important. The present study compares two different radiation schedules with respect to these two endpoints. Patients and methods: 129 breast cancer patients (pT1-2 pN0-1 cM0) were irradiated between 09/1992 and 08/1994 with either a 22-day fractionation schedule (2.5 Gy to 55 Gy, 4 x /week, n = 65) or with a conventional fractionation schedule (28 days, 2.0 Gy to 55 Gy, 5 x /week, n = 64), both without additional boost. The equivalent dose of 2-Gy fractions (EQD2) was 55 Gy and 62 Gy, respectively. Late toxicity, assessed according to the LENT-SOMA criteria, and cosmetic outcome, graded on a 5-point scale, were evaluated after a median of 86 months (range 72-94 months) in tumor-free breast cancer patients. Results: LENT-SOMA grade 2/3 toxicity (2.5 Gy vs. 2.0 Gy): breast pain (18% vs. 11%; p = 0.3), fibrosis (57% vs. 16%; p < 0.001), telangiectasia (22% vs. 3%; p = 0.002), atrophy (31% vs. 3%; p < 0.001). Medication to breast pain was taken by 8% versus 9% of patients. Cosmesis was very good/good/acceptable in 75% versus 93% (2.5 Gy vs. 2.0 Gy; p = 0.006). Conclusion: late morbidity was significantly frequent and cosmesis was significantly worse after hypofractionated radiotherapy (2.5 Gy to 55 Gy). However, morbidity was not associated with major implications on daily life. (orig.)

  18. Low-power laser irradiation did not stimulate breast cancer cells following ionizing radiation

    Science.gov (United States)

    Silva, C. R.; Camargo, C. F. M.; Cabral, F. V.; Ribeiro, M. S.

    2016-03-01

    Cancer has become a public health problem worldwide. Radiotherapy may be a treatment to a number of types of cancer, frequently using gamma-radiation with sources such as 137Cs and 60Co, with varying doses, dose rates, and exposure times to obtain a better as a stimulant for cell proliferation and tissue healing process. However, its effects on cancer cells are not yet well elucidated. The purpose of this work was to evaluate the effects of the LPL on breast cancer cultures after ionizing radiation. The breast cancer-MDA-MB-231 cells were gamma irradiated by a 60Co source, with dose of 2.5 Gy. After 24h, cells were submitted to LPL irradiation using a red laser emitting at λ= 660 nm, with output power of 40 mW and exposure time of 30 s and 60 s. The plates were uniformly irradiated, with energy of 1.2 J and 2.4 J, respectively. Cell viability was analyzed using the exclusion method with trypan blue. Our results show that breast cancer cells submitted to LPL after ionizing radiation remained 95 % viable. No statistically significant differences were observed between laser and control untreated cells, (P > 0.05). These findings suggest that LPL did not influenced cancer cells viability.

  19. Irradiation doses on thyroid gland during the postoperative irradiation for breast cancer

    Directory of Open Access Journals (Sweden)

    Mustafa Akın

    2014-01-01

    Conclusions: In majority of the node-positive breast cancer patients treated with 3D CRT, the thyroid gland was exposed to considerable doses. On the other hand, for 44% of the patients are at risk for developing thyroid function abnormalities which should be considered during the routine follow-up.

  20. Target volume delineation in external beam partial breast irradiation: less inter-observer variation with preoperative- compared to postoperative delineation

    NARCIS (Netherlands)

    Leij, F. van der; Elkhuizen, P.H.M.; Janssen, T.M.; Poortmans, P.M.P.; Sangen, M. van der; Scholten, A.N.; Vliet-Vroegindeweij, C. van; Boersma, L.J.

    2014-01-01

    The challenge of adequate target volume definition in external beam partial breast irradiation (PBI) could be overcome with preoperative irradiation, due to less inter-observer variation. We compared the target volume delineation for external beam PBI on preoperative versus postoperative CT scans of

  1. Papillary endothelial hyperplasia arising in the irradiated breast: A diagnostic dilemma.

    Science.gov (United States)

    Khazai, Laila; Chau, Alec; Hoover, Susan; Rosa, Marilin

    2016-07-01

    Papillary endothelial hyperplasia (PEH) is a benign proliferative lesion that may occur in any site of the body, but most commonly affects the skin and subcutaneous tissues. In the breast, PEH has been documented but is rare. PEH is notorious for being misdiagnosed as angiosarcoma due to its complex growth pattern, papillary processes and interlacing vascular channels. The occurrence of PEH years after breast irradiation constitutes a pathological and clinical diagnostic challenge because angiosarcoma is far more common in this setting. The most important features that differentiate papillary endothelial hyperplasia from angiosarcoma are its presentation as a round nodule without infiltrative borders, its localization inside a vessel or in association with thrombus, and the lack of significant cytologic atypia or areas of solid growth, even in the presence of a complex architecture. Clinical history and site of involvement (cutaneous versus parenchymal) are usually of help to establish a correct diagnosis. Herein, we describe two cases of PEH presenting in patients with history of breast carcinoma and breast radiation therapy. The clinical and morphological features as well as the differential diagnoses are discussed. To our knowledge, no other cases of PEH of the breast occurring in the post-radiation setting have been described in the literature. PMID:27157404

  2. Toxicity and cosmetic outcome of three-dimensional conformal radiotherapy for accelerated partial breast irradiation

    International Nuclear Information System (INIS)

    Full text of publication follows: Purpose.- To analyse the incidence and severity of acute and late normal tissue toxicity and cosmetic outcome using three - dimensional conformal radiotherapy to deliver accelerated partial breast irradiation. Patients and Methods.- 70 patients with stage I disease were treated with three-dimensional conformal radiotherapy for accelerated partial breast irradiation, in an approved protocol. The prescribed dose was 34 Gy in all patients delivered in 10 fractions over 5 consecutive days. On all CT scans gross tumor volume (GTV ) was defined around surgical clips. A 1.5 cm margin was added in order to account for clinical target volume (CTV) . A margin of 1 cm was added to CTI to define the planning target volume (PTV). The dose-volume constraints were followed in accordance with the specifications as dictated in the NSABP/RTOG protocol. After treatment, patients underwent a clinical and cosmetic evaluation every 3 months. Late toxicity was evaluated according to the RTOG grading schema. The cosmetic assessment was performed by the physicians using the controlateral untreated breast as the reference (Harvard scale). Results.- Median patient age was 66 years (range 51-80). Median follow-up was 15 months (range 6-46). Tumor size was 2 cm in 4(6%). The mean value of the ratio between the PTV and the whole ipsilateral breast volume was 38 % and the median percentage whole breast volume that received 95 % of prescribed dose was 34% (range 16%-55%). The rate of G1 and G2 acute skin toxicity was 28% and 2% respectively and the late toxicity was 17% (G1). G2 or greater toxicities were not observed. The most pronounced G1 late toxicity was subcutaneous fibrosis, developed in 3 patients. The cosmetic outcome was excellent in 83% and good in 17%. Conclusion.- Accelerated partial breast irradiation using three-dimensional conformal radiotherapy is technically feasible with very low acute and late toxicity. Long-term results are needed to assess

  3. Toxicity and cosmetic outcome of three-dimensional conformal radiotherapy for accelerated partial breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Gatti, M.; Bresciani, S.; Ponzone, R.; Panaia, R.; Salatino, A.; Stasi, M.; Gabriele, P. [IRCC, Candiolo (Italy)

    2011-10-15

    Full text of publication follows: Purpose.- To analyse the incidence and severity of acute and late normal tissue toxicity and cosmetic outcome using three - dimensional conformal radiotherapy to deliver accelerated partial breast irradiation. Patients and Methods.- 70 patients with stage I disease were treated with three-dimensional conformal radiotherapy for accelerated partial breast irradiation, in an approved protocol. The prescribed dose was 34 Gy in all patients delivered in 10 fractions over 5 consecutive days. On all CT scans gross tumor volume (GTV ) was defined around surgical clips. A 1.5 cm margin was added in order to account for clinical target volume (CTV) . A margin of 1 cm was added to CTI to define the planning target volume (PTV). The dose-volume constraints were followed in accordance with the specifications as dictated in the NSABP/RTOG protocol. After treatment, patients underwent a clinical and cosmetic evaluation every 3 months. Late toxicity was evaluated according to the RTOG grading schema. The cosmetic assessment was performed by the physicians using the controlateral untreated breast as the reference (Harvard scale). Results.- Median patient age was 66 years (range 51-80). Median follow-up was 15 months (range 6-46). Tumor size was < 10 mm in 33 patients (53%) and > 2 cm in 4(6%). The mean value of the ratio between the PTV and the whole ipsilateral breast volume was 38 % and the median percentage whole breast volume that received 95 % of prescribed dose was 34% (range 16%-55%). The rate of G1 and G2 acute skin toxicity was 28% and 2% respectively and the late toxicity was 17% (G1). G2 or greater toxicities were not observed. The most pronounced G1 late toxicity was subcutaneous fibrosis, developed in 3 patients. The cosmetic outcome was excellent in 83% and good in 17%. Conclusion.- Accelerated partial breast irradiation using three-dimensional conformal radiotherapy is technically feasible with very low acute and late toxicity. Long

  4. The effect of thoracic irradiation for cancer of the breast on ventilation, perfusion and pulmonary permeability

    International Nuclear Information System (INIS)

    Regional and overall lung function was studied in 14 women during a one-year follow-up after postmastectomy irradiation for cancer of the breast. The dose was 40 Gy in the chest wall and 20-40 Gy in the apex of the lung. Immediately after irradiation there was a slight increase in pulmonary clearance of 99TCm-DTPA compared to baseline values. This increase, however, was not restricted to the field of irradiation. Three months after irradiation there were regional defects in the ventilation and perfusion scintigrams in 11 of the patients. At the same time there was a greater decrease in total lung capacity, vital capacity and diffusion capacity for CO than in ventilation and perfusion. One year after irradiation the lung function impairment had only insignificantly regressed. It is concluded that local lung irradiation may cause persistent regional and generalized lung function impairment. The early increase in pulmonary clearance of 99Tcm-DTPA could not be used as a predictor of subsequent lung function impairment. (orig.)

  5. The Role of Preoperative Bilateral Breast Magnetic Resonance Imaging in Patient Selection for Partial Breast Irradiation in Ductal Carcinoma In Situ

    Directory of Open Access Journals (Sweden)

    Kristin V. Kowalchik

    2012-01-01

    Full Text Available Purpose. Women with ductal carcinoma in situ (DCIS are often candidates for breast-conserving therapy, and one option for radiation treatment is partial breast irradiation (PBI. This study evaluates the use of preoperative breast magnetic resonance imaging (MRI for PBI selection in DCIS patients. Methods. Between 2002 and 2009, 136 women with newly diagnosed DCIS underwent a preoperative bilateral breast MRI at Mayo Clinic in Florida. One hundred seventeen women were deemed eligible for PBI by the NSABP B-39 (National Surgical Adjuvant Breast and Bowel Project, Protocol B-39 inclusion criteria using physical examination, mammogram, and/or ultrasound. MRIs were reviewed for their impact on patient eligibility, and findings were pathologically confirmed. Results. Of the 117 patients, 23 (20% were found ineligible because of pathologically proven MRI findings. MRI detected additional ipsilateral breast cancer in 21 (18% patients. Of these women, 15 (13% had more extensive disease than originally noted before MRI, and 6 (5% had multicentric disease in the ipsilateral breast. In addition, contralateral breast cancer was detected in 4 (4%. Conclusions. Preoperative breast MRI altered the PBI recommendations for 20% of women. Bilateral breast MRI should be an integral part of the preoperative evaluation of all patients with DCIS being considered for PBI.

  6. Update on DCIS Outcomes from the American Society of Breast Surgeons Accelerated Partial Breast Irradiation Registry Trial

    Science.gov (United States)

    Jeruss, Jacqueline S.; Kuerer, Henry M.; Beitsch, Peter D.; Vicini, Frank A.; Keisch, Martin

    2010-01-01

    Background Since the initial reports on use of MammoSite accelerated partial breast irradiation (APBI) for treatment of ductal carcinoma in situ (DCIS), additional follow-up data were collected. We hypothesized that APBI delivered via MammoSite would continue to be well tolerated, associated with a good cosmetic outcome, and carry a low risk for recurrence in patients with DCIS. Materials and Methods From 2002–2004, 194 patients with DCIS were enrolled in a registry trial to assess the MammoSite. Follow-up data were available for all 194 patients. Median follow-up was 54.4 months; 63 patients had at least 5 years of follow-up. Data obtained included patient-, tumor-, and treatment-related factors, and recurrence incidence. Results Of the 194 patients, 87 (45%) had the MammoSite placed at lumpectomy; 107 patients (55%) had the device placed postlumpectomy. In the first year of followup, 16 patients developed a breast infection, though the method of device placement was not associated with infection risk. Also, 46 patients developed a seroma that was associated with applicator placement at the time of lumpectomy (P = 0.001). For patients with at least 5 years of follow-up, 92% had favorable cosmetic results. There were 6 patients (3.1%) who had an ipsilateral breast recurrence, with 1 (0.5%) experiencing recurrence in the breast and axilla, for a 5-year actuarial local recurrence rate of 3.39%. Conclusions During an extended follow-up period, APBI delivered via MammoSite continued to be well tolerated for patients with DCIS. Use of this device may make lumpectomy possible for patients who would otherwise choose mastectomy because of barriers associated with standard radiation therapy. PMID:20577822

  7. Selective Nodal Irradiation for Head and Neck Cancer Using Intensity-Modulated Radiotherapy: Application of RTOG Consensus Guidelines in Routine Clinical Practice

    International Nuclear Information System (INIS)

    Purpose: We have been using intensity-modulated radiotherapy (IMRT) for selective neck irradiation. This article presents an analysis of patterns of failure and their dosimetric correlation. Methods and Materials: Between October 2003 and January 2008, 83 patients with head-and-neck cancer were treated with IMRT. Nodal levels were contoured as per the Radiation Therapy Oncology Group (RTOG) consensus guidelines. Results: There were 32 relapses with 23 local relapses (21 local relapses alone and 2 local and regional relapses, simultaneously), 9 regional relapses (including 2 simultaneous local and regional relapses), and 5 distant relapses, of which 2 patients had local relapses. At 2 and 3 years, the locoregional relapse-free survival rates were was 68.3% and 60.8%, respectively, while the overall survival rates were 84.1% and 81.7%, respectively. Subgroup analyses revealed significant differences in locoregional relapse-free survival rates for total treatment times of 53 days, a volume of CTV1PTV (i.e., the volume prescribed 70 Gy) 177 cc, a V100 for CTV1PTV of 91%, and a minimum dose to CTV1PTV of 54 Gy. There were no failures in the elective nodal volume, substantiating both the nodal selection criteria and the RTOG consensus guidelines for delineation of neck node levels. Conclusions: IMRT for head-neck cancer is feasible, using elective nodal selection criteria along with RTOG consensus guidelines for the radiological boundaries of levels of neck nodes.

  8. A Phase 2 Trial of Once-Weekly Hypofractionated Breast Irradiation: First Report of Acute Toxicity, Feasibility, and Patient Satisfaction

    International Nuclear Information System (INIS)

    Purpose: To report on early results of a single-institution phase 2 trial of a 5-fraction, once-weekly radiation therapy regimen for patients undergoing breast-conserving surgery (BCS). Methods and Materials: Patients who underwent BCS for American Joint Committee on Cancer stage 0, I, or II breast cancer with negative surgical margins were eligible to receive whole breast radiation therapy to a dose of 30 Gy in 5 weekly fractions of 6 Gy with or without an additional boost. Elective nodal irradiation was not permitted. There were no restrictions on breast size or the use of cytotoxic chemotherapy for otherwise eligible patients. Patients were assessed at baseline, treatment completion, and at first posttreatment follow-up to assess acute toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and quality of life (European Organization for Research and Treatment of Cancer QLQ-BR23). Results: Between January and September 2011, 42 eligible patients underwent weekly hypofractionated breast irradiation immediately following BCS (69.0%) or at the conclusion of cytotoxic chemotherapy (31.0%). The rates of grade ≥2 radiation-induced dermatitis, pain, fatigue, and breast edema were 19.0%, 11.9%, 9.5%, and 2.4%, respectively. Only 1 grade 3 toxicity—pain requiring a course of narcotic analgesics—was observed. One patient developed a superficial cellulitis (grade 2), which resolved with the use of oral antibiotics. Patient-reported moderate-to-major breast symptoms (pain, swelling, and skin problems), all decreased from baseline through 1 month, whereas breast sensitivity remained stable over the study period. Conclusions: The tolerance of weekly hypofractionated breast irradiation compares well with recent reports of daily hypofractionated whole-breast irradiation schedules. The regimen appears feasible and cost-effective. Additional follow-up with continued accrual is needed to assess late toxicity, cosmesis, and disease-specific outcomes

  9. A Phase 2 Trial of Once-Weekly Hypofractionated Breast Irradiation: First Report of Acute Toxicity, Feasibility, and Patient Satisfaction

    Energy Technology Data Exchange (ETDEWEB)

    Dragun, Anthony E., E-mail: aedrag01@louisville.edu [Department of Radiation Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); Quillo, Amy R. [Department of Surgical Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); Riley, Elizabeth C. [Department of Medical Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); Roberts, Teresa L.; Hunter, Allison M. [Department of Radiation Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); Rai, Shesh N. [Department of Biostatistics and Epidemiology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); Callender, Glenda G. [Department of Surgical Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); Jain, Dharamvir [Department of Medical Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); McMasters, Kelly M. [Department of Surgical Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States); Spanos, William J. [Department of Radiation Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, Kentucky (United States)

    2013-03-01

    Purpose: To report on early results of a single-institution phase 2 trial of a 5-fraction, once-weekly radiation therapy regimen for patients undergoing breast-conserving surgery (BCS). Methods and Materials: Patients who underwent BCS for American Joint Committee on Cancer stage 0, I, or II breast cancer with negative surgical margins were eligible to receive whole breast radiation therapy to a dose of 30 Gy in 5 weekly fractions of 6 Gy with or without an additional boost. Elective nodal irradiation was not permitted. There were no restrictions on breast size or the use of cytotoxic chemotherapy for otherwise eligible patients. Patients were assessed at baseline, treatment completion, and at first posttreatment follow-up to assess acute toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and quality of life (European Organization for Research and Treatment of Cancer QLQ-BR23). Results: Between January and September 2011, 42 eligible patients underwent weekly hypofractionated breast irradiation immediately following BCS (69.0%) or at the conclusion of cytotoxic chemotherapy (31.0%). The rates of grade ≥2 radiation-induced dermatitis, pain, fatigue, and breast edema were 19.0%, 11.9%, 9.5%, and 2.4%, respectively. Only 1 grade 3 toxicity—pain requiring a course of narcotic analgesics—was observed. One patient developed a superficial cellulitis (grade 2), which resolved with the use of oral antibiotics. Patient-reported moderate-to-major breast symptoms (pain, swelling, and skin problems), all decreased from baseline through 1 month, whereas breast sensitivity remained stable over the study period. Conclusions: The tolerance of weekly hypofractionated breast irradiation compares well with recent reports of daily hypofractionated whole-breast irradiation schedules. The regimen appears feasible and cost-effective. Additional follow-up with continued accrual is needed to assess late toxicity, cosmesis, and disease-specific outcomes.

  10. Irradiation of left breast and cardiac risk: fundamentals for a prospective study; Irradiation du sein gauche et risque cardiaque: bases pour une etude prospective

    Energy Technology Data Exchange (ETDEWEB)

    Untereiner, M.; Frederick, B.; Burie, D.; Philippi, S.; Joseph, S.; Harzee, L.; Hoziel, D.; Eschenbrenner, A.; Meyer, P. [Centre Francois-Baclesse, Esch-sur-Alzette (Luxembourg); Gibeau, L.; Laurent-Daniel, F.; Libert, S.; Fressancourt, C. [Centre Gray, 59 - Maubeuge (France)

    2010-10-15

    As the delineation of the anterior interventricular artery and of the heart is to be taken into account during irradiations of the left beast, in order to limit cardiotoxicity, the authors discuss the results of previous studies which highlighted this risk, and notably in a retrospective assessment of dose-volume histograms of the anterior interventricular artery and of the heart which concerned 162 left breast irradiations. This last study allowed cardiac tolerance thresholds to be defined. Short communication

  11. A multi-centre investigation towards reaching a consensus on the immunohistochemical detection of ERbeta in archival formalin-fixed paraffin embedded human breast tissue.

    Science.gov (United States)

    Carder, Pauline J; Murphy, Claire E; Dervan, Peter; Kennedy, Maria; McCann, Amanda; Saunders, Philippa T K; Shaaban, Abeer M; Foster, Christopher S; Witton, Caroline J; Bartlett, John M S; Walker, Rosemary A; Speirs, Valerie

    2005-08-01

    Estrogen receptor (ER) alpha is a well-established independent prognostic factor in breast cancer whose presence determines the clinical implications of adjuvant endocrine therapy. A second receptor, ERb has been described, and a number of studies have examined its expression in breast tissue. However elucidation of the role played by ERb has been hampered by published immunohistochemical studies employing a variety of protocols and scoring systems such that inter-laboratory comparisons are difficult. Here we present a multi-centre study designed to critically evaluate inter-laboratory differences in methodology. Six UK and Irish centres participated in this study. A small series of breast cancers were stained using centre-specific laboratory protocols and scored using both centrespecific and standard scoring protocols. There was generally poor agreement as to what constituted a positive or negative case when centre-specific scoring systems were used with less than half of all cases in agreement. Concordance was improved when a standard scoring system was used but varied according to threshold for positivity employed and primary antibody. Our results emphasise the need for further studies addressing the role of ERb to be based on a wider consensus on criteria for positivity. Ideally this should be based on calibration against clinical outcome.

  12. Evaluation of the Flash effect in breast irradiation using TomoDirect. An investigational study

    International Nuclear Information System (INIS)

    Flash is a specified function in TomoDirect that enables beam expansion by opening additional leaves to the target. This study assessed the theoretical dose distribution resulting from Flash in breast irradiation using TomoDirect. A cylindrical phantom that enabled dose distribution of the breast was used for verifying the effect of planning target volume (PTV) contouring and Flash. A total of 18 Gy in 10 fractions were prescribed to the PTV. Five PTVs were then created by Contracting this contour by 0, 1, 2, 3, 4 and 5 mm, giving PTV-x. Flash ±x is defined by opening x (number) of the leaves. The Flash effect in the air was compared with each set-up error of 5, 10 and 15 mm, respectively. The minimum PTV dose from PTV-1 to PTV-3 increased from 13.88 Gy to 15.86 Gy. In contrast, Dmin in PTV-4 and PTV-5 was 17.80 Gy in 98.88% of the prescription dose. Without Flash, when 5-, 10- and 15-mm set-up errors applied in the PTV, relative doses of 87.88, 23.73 and 7.94% were observed, respectively. However, in Flash 3, which was equal to the usual air margin of 1.875 cm, a relative dose of 104.24% ± 0.30% was observed, irrespective of set-up errors (5 mm to 15 mm). Flash opening is useful for countervailing set-up errors in breast cancer patients who receive breast irradiation with TomoDirect. (author)

  13. Toxicity and cosmesis outcomes after single fraction partial breast irradiation in early stage breast cancer

    Directory of Open Access Journals (Sweden)

    Pinnarò Paola

    2011-11-01

    Full Text Available Abstract Background To report the clinical outcome after a Single Shot 3D-CRT PBI (SSPBI in breast cancer patients after conservative surgery (ClinicalTrials.gov Identifier: NCT01316328. Methods A dose of 18Gy (in the first 4 patients and 21Gy (in the remaining 60 patients was prescribed in a single session and delivered to the index area (i.e. the area of breast including the primary tumor bed and the surrounding tissue using 3D-CRT with patients in prone position. Acute and late toxicity was assessed using the National Cancer Institute's CTC for Adverse Events. Cosmesis was defined based on modified Harvard criteria. Differences between dosimetric or clinical parameters of patients with/without G2 or more late toxicity or unsatisfactory (poor or fair cosmetic outcome were evaluated with the Mann-Whitney test. Odds ratios and 95% confidence interval were calculated for cosmesis and fibrosis. Univariate and multivariate analyses(UVA/MVA were used to determine covariates associated with an increase in fibrosis or fat necrosis rate. Results Sixty four patients were enrolled. With a median follow-up of 3 years, G2 and G3 subcutaneous fibrosis was detected in 20(31% and in 8(13% patients, and ≥G2 fat necrosis was observed in 2(3% patients. Good to excellent, fair and poor cosmesis was observed in 38(59%, 23(36% and 3(5% patients, respectively. Based on UVA, the breast volume receiving more than 21Gy (V21Gy was found to be a predictor of the ≥G1 or ≥G2 fibrosis/fat necrosis. Based on MVA, V21Gy was confirmed as a predictor for ≥G1 fibrosis/fat necrosis, the results correlated as a trend for ≥G2. Cosmesis was correlated with whole breast (WB mean dose (p = 0.030. Conclusion Our choice of a single dose of 21Gy significantly increased the treatment related toxicity. However, this should not discourage novel SSPBI approaches with lower equivalent doses.

  14. Internal mammary chain irradiation in breast cancer: State of the art

    International Nuclear Information System (INIS)

    Radiation therapy has a major role in the management of infiltrative breast cancers. However, there is no consensus for the prophylactic treatment of the internal mammary chain (IMC), with strategies that show strong differences according to centers and physicians. Indications for internal mammary chain radiotherapy are debated, since this treatment significantly increases the dose delivered to the heart and leads to potential technical difficulties. Important prospective data recently suggested that internal mammary chain radiotherapy would not be necessary, even in cases of internal or central tumor locations, or in patients with positive axillary lymph nodes. Although these data warrant confirmation by two other prospective trials, there is evidence that the indications for internal mammary chain radiotherapy should be careful and that high quality techniques should be used for decreasing the dose delivered to the heart. This review of literature presents the state of art on the radiotherapy of internal mammary chain, with special focus on the indications, techniques, and potential toxicity. (authors)

  15. Accelerated Partial Breast Irradiation: 5-Year Results of the German-Austrian Multicenter Phase II Trial Using Interstitial Multicatheter Brachytherapy Alone After Breast-Conserving Surgery

    International Nuclear Information System (INIS)

    Purpose: To evaluate the impact of accelerated partial breast irradiation on local control, side effects, and cosmesis using multicatheter interstitial brachytherapy as the sole method for the adjuvant local treatment of patients with low-risk breast cancer. Methods and Materials: 274 patients with low-risk breast cancer were treated on protocol. Patients were eligible for the study if the tumor size was 35 years, hormone receptors were positive, and histologic grades were 1 or 2. Of the 274 patients, 175 (64%) received pulse-dose-rate brachytherapy (Dref = 50 Gy). and 99 (36%) received high-dose-rate brachytherapy (Dref = 32.0 Gy). Results: Median follow-up was 63 months (range, 9-103). Only 8 of 274 (2.9%) patients developed an ipsilateral in-breast tumor recurrence at the time of analysis. The 5-year actuarial local recurrence-free survival probability was 98%. The 5- year overall and disease-free survival probabilities of all patients were 97% and 96%, respectively. Contralateral in-breast malignancies were detected in 2 of 274 (0.7%) patients, and distant metastases occurred in 6 of 274 (2.2%). Late side effects ≥Grade 3 (i.e., breast tissue fibrosis and telangiectasia) occurred in 1 patient (0.4%, 95%CI:0.0-2.0%) and 6 patients (2.2%, 95%CI:0.8-4.7%), respectively. Cosmetic results were good to excellent in 245 of 274 patients (90%). Conclusions: The long-term results of this prospective Phase II trial confirm that the efficacy of accelerated partial breast irradiation using multicatheter brachytherapy is comparable with that of whole breast irradiation and that late side effects are negligible.

  16. Measurement of mean cardiac dose for various breast irradiation techniques and corresponding risk of major cardiovascular event.

    Directory of Open Access Journals (Sweden)

    Tomas Rodrigo Merino Lara

    2014-10-01

    Full Text Available After breast conserving surgery, early stage breast cancer patients are currently treated with a wide range of radiation techniques including whole breast irradiation (WBI, accelerated partial breast irradiation (APBI using high dose rate (HDR brachytherapy, or 3D conformal radiotherapy (3D-CRT. This study compares the mean heart’s doses for a left breast irradiated with different breast techniques.An anthropomorphic Rando phantom was modified with gelatin-based breast of different sizes and tumors located medially or laterally. The breasts were treated with WBI, 3D-CRT or HDR APBI. The heart’s mean doses were measured with Gafchromic films and controlled with optically stimulated luminescent dosimeters (OSLDs. Following the model reported by Darby (16, major cardiac were estimated assuming a linear risk increase with the mean dose to the heart of 7.4% per gray.Whole breast irradiation lead to the highest mean heart dose (2.99 Gy compared to 3D-CRT APBI, (0.51 Gy, multicatheter (1.58 Gy and balloon HDR (2.17 Gy for a medially located tumor. This translated into long-term coronary event increases of 22%, 3.8%, 11.7%, and 16% respectively. The sensitivity analysis showed that the tumor location had almost no effect on the mean heart dose for 3D-CRT APBI and a minimal impact for HDR APBI. For WBI large breast size and set-up errors lead to sharp increases of the mean heart dose. Its value reached 10.79 Gy for women with large breast and a set-up error of 1.5 cm. Such a high value could increase the risk of having long-term coronary events by 80%.Comparison among different irradiation techniques demonstrates that 3D-CRT APBI appears the safest one with less probability of having cardiovascular events in the future. A sensitivity analysis showed that WBI is the most challenging technique for patients with large breasts or when significant set-up errors are anticipated. In those cases additional heart shielding techniques are required.

  17. Dietary omega-3 fatty acids and ionizing irradiation on human breast cancer xenograft growth and angiogenesis

    OpenAIRE

    Cameron Ivan L; Short Nicholas; Sun LuZhe; Hardman W Elaine

    2005-01-01

    Abstract Background The effects of an omega-3 (n-3) fatty acid enriched diet alone and in combination with gamma irradiation (IR) therapy in nude mice bearing a human MDA-MB231 breast cancer xenograft were tested. The cancer cells were injected into the mammary fat pad of young female mice. Six weeks later, mice were randomly divided into two diet groups: 1) mice with 10% corn oil (rich in omega 6 fatty acids) in their food, 2) mice consuming a 10% fat diet that was enriched in n-3 fatty acid...

  18. DEGRO practical guidelines for radiotherapy of breast cancer II. Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Municipal Hospital Karlsruhe (Germany); Souchon, R. [Allgemeines Krankenhaus Hagen (Germany); Budach, W. [Univ. Hospital Duesseldorf (Germany); Sedlmayer, F. [Univ. Hospital, Salzburger Landeskliniken, Salzburg (Austria); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Harms, W. [St. Clara Hospital, Basel (Switzerland); Haase, W. [St.-Vincentius-Kliniken, Karlsruhe (Germany); Dunst, J. [Univ. Hospital Schleswig-Holstein, Luebeck (Germany); Wenz, F. [Univ. Hospital Mannheim (Germany); Sauer, R. [Univ. Hospital Erlangen (Germany)

    2008-07-15

    Background and purpose: the aim of the present paper is to update the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society for Radiooncology (DEGRO). These recommendations were complementing the S3 guidelines of the German Cancer Society (DKG) elaborated in 2004. The present DEGRO recommendations are based on a revision of the DKG guidelines provided by an interdisciplinary panel and published in February 2008. Methods: the DEGRO expert panel (authors of the present manuscript) performed a comprehensive survey of the literature. Data from lately published meta-analyses, recent randomized trials and guidelines of international breast cancer societies, yielding new aspects compared to 2006, provided the basis for defining recommendations referring to the criteria of evidence-based medicine. In addition to the more general statements of the DKG, this paper emphasizes specific radiooncologic issues relating to radiotherapy after mastectomy (PMRT), locally advanced disease, irradiation of the lymphatic pathways, and sequencing of local and systemic treatment. Technique, targeting, and dose are described in detail. Results: PMRT significantly reduces local recurrence rates in patients with T3/T4 tumors and/or positive axillary lymph nodes (12.9% with and 40.6% without PMRT in patients with four or more positive nodes). The more local control is improved, the more substantially it translates into increased survival. In node-positive women the absolute reduction in 15-year breast cancer mortality is 5.4%. Data referring to the benefit of lymphatic irradiation are conflicting. However, radiotherapy of the supraclavicular area is recommended when four or more nodes are positive and otherwise considered individually. Evidence concerning timing and sequencing of local and systemic treatment is sparse; therefore, treatment decisions should depend on the dominating risk of recurrence. Conclusion: there

  19. Safety and toxicology assessment of chicken breast for high-dose irradiation

    International Nuclear Information System (INIS)

    Feeding wholesomeness tests of irradiated chicken breast were studied by using acute oral toxicology, Ames, micronucleus of born marrow cell, sperm shape abnormality in mice and 30 d feeding test. The LD50 of all the rats and mice were more than 10 g/kg · BW, which means that the pet foods belonged to actually non-toxic grade; ames test, and the tests of micronucleus of born marrow cell, sampan shape abnormality in mice were all negative results; 30 d feeding test in rats demonstrated that it had no distinctive effects on routine blood, body weight and biochemical index. It is concluded that pet foods irradiated up to 25 kGy high dose were no safety and toxicology problems. (authors)

  20. Multi-modality fusion of CT, 3D ultrasound, and tracked strain images for breast irradiation planning

    Science.gov (United States)

    Foroughi, Pezhman; Csoma, Csaba; Rivaz, Hassan; Fichtinger, Gabor; Zellars, Richard; Hager, Gregory; Boctor, Emad

    2009-02-01

    Breast irradiation significantly reduces the risk of recurrence of cancer. There is growing evidence suggesting that irradiation of only the involved area of the breast, partial breast irradiation (PBI), is as effective as whole breast irradiation. Benefits of PBI include shortened treatment time, and perhaps fewer side effects as less tissue is treated. However, these benefits cannot be realized without precise and accurate localization of the lumpectomy cavity. Several studies have shown that accurate delineation of the cavity in CT scans is very challenging and the delineated volumes differ dramatically over time and among users. In this paper, we propose utilizing 3D ultrasound (3D-US) and tracked strain images as complementary modalities to reduce uncertainties associated with current CT planning workflow. We present the early version of an integrated system that fuses 3D-US and real-time strain images. For the first time, we employ tracking information to reduce the noise in calculation of strain image by choosing the properly compressed frames and to position the strain image within the ultrasound volume. Using this system, we provide the tools to retrieve additional information from 3D-US and strain image alongside the CT scan. We have preliminarily evaluated our proposed system in a step-by-step fashion using a breast phantom and clinical experiments.

  1. Partial breast irradiation for locally recurrent breast cancer within a second breast conserving treatment: Alternative to mastectomy? Results from a prospective trial

    International Nuclear Information System (INIS)

    Purpose: To assess the outcome of multi-catheter pulse dose rate (PDR) brachytherapy of re-irradiation for local ipsilateral breast tumour recurrence (IBTR) in regard to local control, survival, morbidity and quality of life (QoL). Patients and methods: Between 1999 and 2006, 39 patients were included with histologically confirmed IBTR, Karnofsky index ⩾80% and refusal of mastectomy. Exclusion criteria were multicentric invasive growth pattern, unclear surgical margins, distant metastasis and a postoperative breast not suitable for interstitial brachytherapy. Primary endpoint was local tumour control. Morbidity, cosmetic outcome and QoL were assessed in 24/39 patients. Results: The five year actuarial local control rate was 93% after a mean follow up of 57 (±30) months with two second local relapses. Overall survival and disease free survival, both at 5 years, were 87% and 77%, respectively. Late side effects Grade 1–2 were observed in 20/24 patients after a mean follow-up of 30 (±18) months. Late side effects ⩾Grade 3 occurred in 4/24 patients. Cosmetic outcome was excellent to fair in 76% of women. Overall QoL was comparable to a healthy control group. Mean scores of scales and items of QLQ-BR23 were comparable to primary breast conserving therapy. Conclusions: Accelerated PDR-brachytherapy following breast conserving surgery (BCS) for local IBTR results in local tumour control comparable to mastectomy. Morbidity is moderate; the cosmetic outcome is good and hardly any impairment on QoL is observed.

  2. The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review

    International Nuclear Information System (INIS)

    Despite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique. An electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed. Ten studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease. DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy

  3. The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Smyth, Lloyd M, E-mail: lloyd.smyth@epworth.org.au [Epworth Radiation Oncology, Level 4, The Epworth Centre, Richmond, Victoria (Australia); Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, School of Biomedical Sciences, Nursing and Health Sciences, Monash University, Clayton, Victoria (Australia); Knight, Kellie A [Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, School of Biomedical Sciences, Nursing and Health Sciences, Monash University, Clayton, Victoria (Australia); Aarons, Yolanda K; Wasiak, Jason [Epworth Radiation Oncology, Level 4, The Epworth Centre, Richmond, Victoria (Australia)

    2015-03-15

    Despite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique. An electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed. Ten studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease. DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.

  4. Guidelines for Follow-Up of Women at High Risk for Inherited Breast Cancer: Consensus Statement from the Biomed 2 Demonstration Programme on Inherited Breast Cancer

    Directory of Open Access Journals (Sweden)

    P. Møller

    1999-01-01

    Full Text Available Protocols for activity aiming at early diagnosis and treatment of inherited breast or breast-ovarian cancer have been reported. Available reports on outcome of such programmes are considered here. It is concluded that the ongoing activities should continue with minor modifications. Direct evidence of a survival benefit from breast and ovarian screening is not yet available. On the basis of expert opinion and preliminary results from intervention programmes indicating good detection rates for early breast cancers and 5-year survival concordant with early diagnosis, we propose that women at high risk for inherited breast cancer be offered genetic counselling, education in ‘breast awareness’ and annual mammography and clinical expert examination from around 30 years of age. Mammography every second year may be sufficient from 60 years on. BRCA1 mutation carriers may benefit from more frequent examinations and cancer risk may be reduced by oophorectomy before 40–50 years of age. We strongly advocate that all activities should be organized as multicentre studies subjected to continuous evaluation to measure the effects of the interventions on long-term mortality, to match management options more precisely to individual risks and to prepare the ground for studies on chemoprevention.

  5. Chloroquine Engages the Immune System to Eradicate Irradiated Breast Tumors in Mice

    International Nuclear Information System (INIS)

    Purpose: This study used chloroquine to direct radiation-induced tumor cell death pathways to harness the antitumor activity of the immune system. Methods and Materials: Chloroquine given immediately after tumor irradiation increased the cure rate of MCaK breast cancer in C3H mice. Chloroquine blocked radiation-induced autophagy and drove MCaK cells into a more rapid apoptotic and more immunogenic form of cell death. Results: Chloroquine treatment made irradiated tumor vaccines superior at inducing strong interferon gamma-associated immune responses in vivo and protecting mice from further tumor challenge. In vitro, chloroquine slowed antigen uptake and degradation by dendritic cells, although T-cell stimulation was unaffected. Conclusions: This study illustrates a novel approach to improve the efficacy of breast cancer radiation therapy by blocking endosomal pathways, which enhances radiation-induced cell death within the field and drives antitumor immunity to assist therapeutic cure. The study illuminates and merges seemingly disparate concepts regarding the importance of autophagy in cancer therapy

  6. Chloroquine Engages the Immune System to Eradicate Irradiated Breast Tumors in Mice

    Energy Technology Data Exchange (ETDEWEB)

    Ratikan, Josephine Anna [Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California (United States); Sayre, James William [Public Health Biostatistics/Radiology at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California (United States); Schaue, Dörthe, E-mail: dschaue@mednet.ucla.edu [Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California (United States)

    2013-11-15

    Purpose: This study used chloroquine to direct radiation-induced tumor cell death pathways to harness the antitumor activity of the immune system. Methods and Materials: Chloroquine given immediately after tumor irradiation increased the cure rate of MCaK breast cancer in C3H mice. Chloroquine blocked radiation-induced autophagy and drove MCaK cells into a more rapid apoptotic and more immunogenic form of cell death. Results: Chloroquine treatment made irradiated tumor vaccines superior at inducing strong interferon gamma-associated immune responses in vivo and protecting mice from further tumor challenge. In vitro, chloroquine slowed antigen uptake and degradation by dendritic cells, although T-cell stimulation was unaffected. Conclusions: This study illustrates a novel approach to improve the efficacy of breast cancer radiation therapy by blocking endosomal pathways, which enhances radiation-induced cell death within the field and drives antitumor immunity to assist therapeutic cure. The study illuminates and merges seemingly disparate concepts regarding the importance of autophagy in cancer therapy.

  7. MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications

    International Nuclear Information System (INIS)

    Aim: To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications. Materials and methods: One hundred and forty patients (total of 144 implants) were evaluated by MRI; 80 (group 1) had undergone RT, whereas the remaining 60 patients (group 2) underwent mastectomy with implant reconstruction without RT. Two radiologists evaluated MRI images searching for implant rupture signs, sub-capsular seromas, capsular contracture, soft-tissue oedema, peri-implant fluid collections. Implant ruptures were classified as severe complications; seromas and capsular contractures as moderate complications; oedema and fluid collections as mild complications. The prevalence of MRI findings in the two groups was calculated and compared by unpaired t-test. Cohen's kappa statistics was used to assess interobserver agreement. Results: Sixty-nine out of 144 (48%) implants presented pathological findings at MRI with complication rates of 47.5 and 48.4 for groups 1 and 2, respectively. Two (5%) severe complications, 10 (26%) moderate complications, and 26 (69%) mild complications occurred in group 1 and surgical treatment was performed in 10 cases. Two (6%) severe complications, seven (23%) moderate complications, and 22 (71%) mild complications occurred in group 2 and surgical treatment was performed in eight cases. No significant difference between the two groups was found (p>0.1). Almost perfect agreement between the two radiologists was found for MRI image detection (k=0.86). Conclusion: RT does not seem to cause a significant effect on breast implants in terms of complication rate in patients undergoing implant-based breast reconstruction. One-stage immediate implant-based breast reconstruction performed at the same time as mastectomy could be proposed. -- Highlights: •RT could increase complication rates of implant-based breast reconstruction (IBR). •No general consensus

  8. Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT)

    International Nuclear Information System (INIS)

    Purpose: We present a novel three-dimensional conformal radiation therapy (3D-CRT) technique to treat the lumpectomy cavity, plus a 1.5-cm margin, in patients with early-stage breast cancer and study its clinical feasibility. Methods and Materials: A 3D-CRT technique for partial-breast irradiation was developed using archived CT scans from 7 patients who underwent an active breathing control study. The clinical feasibility of this technique was then assessed in 9 patients who were prospectively enrolled on an Investigational Review Board-approved protocol of partial-breast irradiation. The prescribed dose was 34 Gy in 5 patients and 38.5 Gy in 4 patients, delivered in 10 fractions twice daily over 5 consecutive days. The impact of both breathing motion and patient setup uncertainty on clinical target volume (CTV) coverage was studied, and an appropriate CTV-to-PTV (planning target volume) margin was calculated. Results: By adding a CTV-to-PTV 'breathing-only' margin of 5 mm, 98%-100% of the CTV remained covered by the 95% isodose surface at the extremes of normal inhalation and normal exhalation. The 'total' CTV-to-PTV margin employed to accommodate organ motion and setup error (10 mm) was found to be sufficient to accommodate the observed uncertainty in the delivery precision. Patient tolerance was excellent, and acute toxicity was minimal. No skin changes were noted during treatment, and at the initial 4-8-week follow-up visit, only mild localized hyperpigmentation and/or erythema was observed. No instances of symptomatic radiation pneumonitis have occurred. Conclusions: Accelerated partial-breast irradiation using 3D-CRT is technically feasible, and acute toxicity to date has been minimal. A CTV-to-PTV margin of 10 mm seems to provide coverage for most patients. However, more patients and additional studies will be needed to validate the accuracy of this margin, and longer follow-up will be needed to assess acute and chronic toxicity, tumor control, and cosmetic

  9. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation

    International Nuclear Information System (INIS)

    Background and purpose: Cardiac disease has been related to heart dose after left-sided breast radiotherapy. This trial evaluates the heart sparing ability and feasibility of deep inspiration breath hold (DIBH) in the prone position for left-sided whole breast irradiation (WBI). Materials and methods: Twelve patients underwent CT-simulation in supine shallow breathing (SB), supine DIBH, prone SB and prone DIBH. A validation cohort of 38 patients received prone SB and prone DIBH CT-scans; the last 30 patients were accepted for prone DIBH treatment. WBI was planned with a prescription dose of 40.05 Gy. Results: DIBH was able to reduce (p < 0.001) heart dose in both positions, with results for prone DIBH at least as favorable as for supine DIBH. Mean heart dose was lowered from 2.2 Gy for prone SB to 1.3 Gy for prone DIBH (p < 0.001), while preserving the lung sparing ability of prone positioning. Moreover prone DIBH nearly consistently reduced mean heart dose to less then 2 Gy, regardless of breast volume. All patients were able to perform the simulation procedure, 28/30 patients were treated with prone DIBH. Conclusions: This trial demonstrates the ability and feasibility of prone DIBH to acquire optimal heart and lung sparing for left-sided WBI

  10. Planning Hybrid Intensity Modulated Radiation Therapy for Whole-breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Farace, Paolo, E-mail: paolofarace@gmail.com [Medical Physics Department, Regional Oncological Hospital, Cagliari (Italy); Zucca, Sergio; Solla, Ignazio; Fadda, Giuseppina; Durzu, Silvia; Porru, Sergio; Meleddu, Gianfranco [Medical Physics Department, Regional Oncological Hospital, Cagliari (Italy); Deidda, Maria Assunta; Possanzini, Marco; Orru, Sivia; Lay, Giancarlo [Radiotherapy Department, Regional Oncological Hospital, Cagliari (Italy)

    2012-09-01

    Purpose: To test tangential and not-tangential hybrid intensity modulated radiation therapy (IMRT) for whole-breast irradiation. Methods and Materials: Seventy-eight (36 right-, 42 left-) breast patients were randomly selected. Hybrid IMRT was performed by direct aperture optimization. A semiautomated method for planning hybrid IMRT was implemented using Pinnacle scripts. A plan optimization volume (POV), defined as the portion of the planning target volume covered by the open beams, was used as the target objective during inverse planning. Treatment goals were to prescribe a minimum dose of 47.5 Gy to greater than 90% of the POV and to minimize the POV and/or normal tissue receiving a dose greater than 107%. When treatment goals were not achieved by using a 4-field technique (2 conventional open plus 2 IMRT tangents), a 6-field technique was applied, adding 2 non tangential (anterior-oblique) IMRT beams. Results: Using scripts, manual procedures were minimized (choice of optimal beam angle, setting monitor units for open tangentials, and POV definition). Treatment goals were achieved by using the 4-field technique in 61 of 78 (78%) patients. The 6-field technique was applied in the remaining 17 of 78 (22%) patients, allowing for significantly better achievement of goals, at the expense of an increase of low-dose ({approx}5 Gy) distribution in the contralateral tissue, heart, and lungs but with no significant increase of higher doses ({approx}20 Gy) in heart and lungs. The mean monitor unit contribution to IMRT beams was significantly greater (18.7% vs 9.9%) in the group of patients who required 6-field procedure. Conclusions: Because hybrid IMRT can be performed semiautomatically, it can be planned for a large number of patients with little impact on human or departmental resources, promoting it as the standard practice for whole-breast irradiation.

  11. Fractionation for Whole Breast Irradiation: An American Society for Radiation Oncology (ASTRO) Evidence-Based Guideline

    International Nuclear Information System (INIS)

    Purpose: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. Methods and Materials: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. Results: The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within ±7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI. Conclusion: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.

  12. The Suitability of Absorbable Mesh Insertion for Oncoplastic Breast Surgery in Patients with Breast Cancer Scheduled to Be Irradiated

    OpenAIRE

    Kim, Taehyun; Cho, Heunglae

    2013-01-01

    Purpose The objective of this study was to investigate the influence of radiotherapy on the cosmetic outcome after immediate breast reconstruction using an absorbable mesh in breast cancer. Methods From July 2008 to July 2009, 35 breast cancer patients who received immediate breast reconstruction with absorbable mesh insertion at the time of breast conserving surgery followed by radiotherapy were retrospectively studied. Results In 91% of cases there was an excellent or good cosmetic outcome ...

  13. Stereotactic Accelerated Partial Breast Irradiation (SAPBI for Early Stage Breast Cancer: Rationale, Feasibility and Early Experience using the CyberKnife Radiosurgery Delivery Platform

    Directory of Open Access Journals (Sweden)

    Olusola eOBAYOMI-DAVIES

    2016-05-01

    Full Text Available Purpose: The efficacy of accelerated partial breast irradiation (APBI utilizing brachytherapy or conventional external beam radiation has been studied in early stage breast cancer treated with breast conserving surgery. Data regarding stereotactic treatment approaches are emerging. The CyberKnife linear accelerator enables excellent dose conformality to target structures while adjusting for target and patient motion. We report our institutional experience on the technical feasibility and rationale for SAPBI delivery using the CyberKnife radiosurgery system.Methods: Ten patients completed CyberKnife SAPBI in 2013 at Georgetown University Hospital. Four gold fiducials were implanted around the lumpectomy cavity prior to treatment under ultrasound guidance. The synchrony system tracked intrafraction motion of the fiducials. The clinical target volume (CTV was defined on contrast enhanced CT scans using surgical clips and post-operative changes. A 5 mm expansion was added to create the planning treatment volume (PTV. A total dose of 30 Gy was delivered to the PTV in 5 consecutive fractions. Target and critical structure doses were assessed as per the National Surgical Adjuvant Breast and Bowel Project B-39 study.Results: At least 3 fiducials were tracked in 100% of cases. The Mean treated PTV was 70 cm3 and the mean prescription isodose line was 80%. Mean dose to target volumes and constraints are as follows: 100% of the PTV received the prescription dose (PTV30. The volume of the ipsilateral breast receiving 30 Gy (V30 and above 15 Gy (V>15 was 14% and 31% respectively. The ipsilateral lung volume receiving 9 Gy (V9 was 3% and the contralateral lung volume receiving 1.5 Gy (V1.5 was 8%. For left sided breast cancers, the volume of heart receiving 1.5 Gy (V1.5 was 31%. Maximum skin dose was 36 Gy. At a median follow up of 1.3 years, all patients have experienced excellent/good breast cosmesis outcomes, and no breast events have been recorded

  14. Diseases of the brachial plexus after surgery and irradiation of breast cancer

    International Nuclear Information System (INIS)

    The authors evaluated retrospectively the medical records of 1028 female and two male patients operated upon and post-irradiated because of a breast cancer. Thirty-nine among the female patients suffered from a plexus disease. When considering the reasons for the formation of this disease, one must not only suppose that the operation method and the influence of the dose is at its origin, but the hyperemization and hyperhydration which may develop in the early postoperative phase or due to hormonal action have to be taken into consideration, too. The following conclusions were drawn for patients submitted to radical operations: 1. The irradiations should not be started much earlier than twenty days after the operation. 2. The dose calculation and beginning of irradiations should be controlled very carefully for patients aged below 45 and/or patients presenting an oedema of the arm. 3. No maximum doses are administered to patients treated by hormonal and/or pharmacological therapy (not more than 42 to 45 Gy). (orig.)

  15. Diseases of the brachial plexus after surgery and irradiation of breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hering, K.G.; Mitrovic, D.

    1981-02-01

    The authors evaluated retrospectively the medical records of 1028 female and two male patients operated upon and post-irradiated because of a breast cancer. Thirty-nine among the female patients suffered from a plexus disease. When considering the reasons for the formation of this disease, one must not only suppose that the operation method and the influence of the dose is at its origin, but the hyperemization and hyperhydration which may develop in the early postoperative phase or due to hormonal action have to be taken into consideration, too. The following conclusions were drawn for patients submitted to radical operations: 1. The irradiations should not be started much earlier than twenty days after the operation. 2. The dose calculation and beginning of irradiations should be controlled very carefully for patients aged below 45 and/or patients presenting an oedema of the arm. 3. No maximum doses are administered to patients treated by hormonal and/or pharmacological therapy (not more than 42 to 45 Gy).

  16. Alternated Prone and Supine Whole-Breast Irradiation Using IMRT: Setup Precision, Respiratory Movement and Treatment Time

    International Nuclear Information System (INIS)

    Purpose: The objective of this study was to compare setup precision, respiration-related breast movement and treatment time between prone and supine positions for whole-breast irradiation. Methods and Materials: Ten patients with early-stage breast carcinoma after breast-conserving surgery were treated with prone and supine whole breast-irradiation in a daily alternating schedule. Setup precision was monitored using cone-beam computed tomography (CBCT) imaging. Respiration-related breast movement in the vertical direction was assessed by magnetic sensors. The time needed for patient setup and for the CBCT procedure, the beam time, and the length of the whole treatment slot were also recorded. Results: Random and systematic errors were not significantly different between positions in individual patients for each of the three axes (left-right, longitudinal, and vertical). Respiration-related movement was smaller in prone position, but about 80% of observations showed amplitudes <1 mm in both positions. Treatment slots were longer in prone position (21.2 ± 2.5 min) than in supine position (19.4 ± 0.8 min; p = 0.044). Conclusion: Comparison of setup precision between prone and supine position in the same patient showed no significant differences in random and systematic errors. Respiratory movement was smaller in prone position. The longer treatment slots in prone position can probably be attributed to the higher repositioning need.

  17. Accelerated Partial Breast Irradiation With Interstitial Implants: Risk Factors Associated With Increased Local Recurrence

    International Nuclear Information System (INIS)

    Purpose: To analyze patient, disease, and treatment-related factors regarding their impact on local control after interstitial multicatheter accelerated partial breast irradiation (APBI). Methods and Materials: Between November 2000 and April 2005, 274 patients with early breast cancer were recruited for the German-Austrian APBI Phase II trial ( (ClinicalTrials.gov) identifier: NCT00392184). In all, 64% (175/274) of the patients received pulsed-dose-rate (PDR) brachytherapy and 36% (99/274) received high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3 to 4 days. Results: The median follow-up time was 64 months (range, 9-110). The actuarial 5-year local recurrence free survival rate (5-year LRFS) was 97.7%. Comparing patients with an age <50 years (49/274) vs. ≥50 years (225/274), the 5-year LRFS resulted in 92.5% and 98.9% (exact p = 0.030; 99% confidence interval, 0.029-0.032), respectively. Antihormonal treatment (AHT) was not applied in 9% (24/274) of the study population. The 5-year LRFS was 99% and 84.9% (exact p = 0.0087; 99% confidence interval, 0.0079-0.0094) in favor of the patients who received AHT. Lobular histology (45/274) was not associated with worse local control compared with all other histologies (229/274). The 5-year LRFS rates were 97.6% and 97.8%, respectively. Conclusions: Local control at 5 years is excellent and comparable to therapeutic successes reported from corresponding whole-breast irradiation trials. Our data indicate that patients <50 years of age ought to be excluded from APBI protocols, and that patients with hormone-sensitive breast cancer should definitely receive adjuvant AHT when interstitial multicatheter APBI is performed. Lobular histology need not be an exclusion criterion for future APBI trials.

  18. Predictors of Local Recurrence Following Accelerated Partial Breast Irradiation: A Pooled Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag; Wilkinson, John Ben [Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Lyden, Maureen [Biostat Inc., Tampa, Florida (United States); Beitsch, Peter [Dallas Breast Center, Dallas, Texas (United States); Vicini, Frank A., E-mail: fvicini@pol.net [Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States)

    2012-04-01

    Purpose: To analyze a pooled set of nearly 2,000 patients treated on the American Society of Breast Surgeons (ASBS) Mammosite Registry Trial and at William Beaumont Hospital (WBH) to identify factors associated with local recurrence following accelerated partial breast irradiation (APBI). Methods and Materials: A total of 1,961 women underwent partial breast irradiation between April 1993 and November 2010 as part of the ASBS Registry Trial or at WBH. Rates of ipsilateral breast tumor recurrence (IBTR), regional recurrence (RR), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS) were analyzed for each group and for the pooled cohort. Clinical, pathologic, and treatment-related variables were analyzed including age, tumor stage/size, estrogen receptor status, surgical margins, and lymph node status to determine their association with IBTR. Results: The two groups weres similar, but WBH patients were more frequently node positive, had positive margins, and were less likely to be within the American Society for Radiation Oncology-unsuitable group. At 5 years, the rates of IBTR, RR, DM, DFS, CSS, and OS for the pooled group of patients were 2.9%, 0.5%, 2.4%, 89.1%, 98.5%, and 91.8%, respectively. The 5-year rate of true recurrence/marginal miss was 0.8%. Univariate analysis of IBTR found that negative estrogen receptor status (odds ratio [OR], 2.83, 95% confidence interval 1.55-5.13, p = 0.0007) was the only factor significantly associated with IBTR, while a trend was seen for age less than 50 (OR 1.80, 95% confidence interval 0.90-3.58, p = 0.10). Conclusions: Excellent 5-year outcomes were seen following APBI in over 1,900 patients. Estrogen receptor negativity was the only factor associated with IBTR, while a trend for age less than 50 was noted. Significant differences in factors associated with IBTR were noted between cohorts, suggesting that factors driving IBTR may be predicated based on the risk

  19. Axillary irradiation omitting axillary dissection in breast cancer: is there a role for shoulder-sparing proton therapy?

    Science.gov (United States)

    Farace, P; Deidda, M A; Amichetti, M

    2015-10-01

    The recent EORTC 10981-22023 AMAROS trial showed that axillary radiotherapy and axillary lymph node dissection provide comparable local control and reduced lymphoedema in the irradiated group. However, no significant differences between the two groups in range of motion and quality of life were reported. It has been acknowledged that axillary irradiation could have induced some toxicity, particularly shoulder function impairment. In fact, conventional breast irradiation by tangential beams has to be modified to achieve full-dose coverage of the axillary nodes, including in the treatment field a larger portion of the shoulder structures. In this scenario, alternative irradiation techniques were discussed. Compared with modern photon techniques, axillary irradiation by proton therapy has the potential for sparing the shoulder without detrimental increase of the medium-to-low doses to the other normal tissues. PMID:26153903

  20. Refrigerated poultry breast fillets packed in modified atmosphere and irradiated: bacteriological evaluation, shelf life and sensory acceptance

    Directory of Open Access Journals (Sweden)

    Samira Pirola Santos Mantilla

    2012-12-01

    Full Text Available In the present study the effects on shelf life and sensory acceptance of gamma-irradiated refrigerated poultry breast fillets subjected to modified atmosphere packaging (80% CO2/20% N2 or vacuum were investigated. After irradiation with 2 kGy, sensory acceptance tests and monitoring of bacterial growth were performed in order to determine the sanitary quality of the samples. It has been found that irradiation, used in combination with modified atmosphere packaging, can double the shelf life of refrigerated poultry breast fillets by reducing the populations of aerobic mesophilic and psychrotrophic bacteria, enterobacteria, coliforms, Listeria spp. and Aeromonas spp., without significantly modifying its color or its overall appearance, the lactic acid bacteria being the most resistant to exposure to radiation and carbon dioxide.

  1. Use of ER/PR/HER2 subtypes in conjunction with the 2007 St Gallen Consensus Statement for early breast cancer

    Directory of Open Access Journals (Sweden)

    Parise Carol

    2010-05-01

    Full Text Available Abstract Background The 2007 St Gallen international expert consensus statement describes three risk categories and provides recommendations for treatment of early breast cancer. The set of recommendations on how to best treat primary breast cancer is recognized and used by clinicians worldwide. We now examine the variability of five-year survival of the 2007 St Gallen Risk Classifications utilizing the ER/PR/HER2 subtypes. Methods Using the population-based California Cancer Registry, 114,786 incident cases of Stages 1-3 invasive breast cancer diagnosed between 2000 and 2006 were identified. Cases were assigned to Low, Intermediate, or High Risk categories. Five-year-relative survival was computed for the three St Gallen risk categories and for the ER/PR/HER2 subtypes for further differentiation. Results and Discussion There were 9,124 (13% cases classified as Low Risk, 44,234 (65% cases as Intermediate Risk, and 14,340 (21% as High Risk. Within the Intermediate Risk group, 33,735 (76% were node-negative (Intermediate Risk 2 and 10,499 (24% were node-positive (Intermediate Risk 3. For the High Risk group, 6,149 (43% had 1 to 3 positive axillary lymph nodes (High Risk 4 and 8,191 (57% had four or more positive lymph nodes (High Risk 5. Using five-year relative survival as the principal criterion, we found the following: a There was very little difference between the Low Risk and Intermediate Risk categories; b Use of the ER/PR/HER2 subtypes within the Intermediate and High Risk categories separated each into a group with better five-year survival (ER-positive and a group with worse survival (ER-negative, irrespective of HER2-status; c The heterogeneity of the High Risk category was most evident when one examined the ER/PR/HER2 subtypes with four or more positive axillary lymph nodes; (d HER2-positivity did not always translate to worse survival, as noted when one compared the triple positive subtype (ER+/PR+/HER2+ to the triple negative subtype

  2. Potential reduction of contralateral second breast-cancer risks by prophylactic mammary irradiation: validation in a breast-cancer-prone mouse model.

    Directory of Open Access Journals (Sweden)

    Igor Shuryak

    Full Text Available BACKGROUND: Long-term breast-cancer survivors have a highly elevated risk (1 in 6 at 20 years of contralateral second breast cancer. This high risk is associated with the presence of multiple pre-malignant cell clones in the contralateral breast at the time of primary breast cancer diagnosis. Mechanistic analyses suggest that a moderate dose of X-rays to the contralateral breast can kill these pre-malignant clones such that, at an appropriate Prophylactic Mammary Irradiation (PMI dose, the long-term contralateral breast cancer risk in breast cancer survivors would be considerably decreased. AIMS: To test the predicted relationship between PMI dose and cancer risk in mammary glands that have a high risk of developing malignancies. METHODS: We tested the PMI concept using MMTV-PyVT mammary-tumor-prone mice. Mammary glands on one side of each mouse were irradiated with X-rays, while those on the other side were shielded from radiation. The unshielded mammary glands received doses of 0, 4, 8, 12 and 16 Gy in 4-Gy fractions. RESULTS: In high-risk mammary glands exposed to radiation doses designed for PMI (12 and 16 Gy, tumor incidence rates were respectively decreased by a factor of 2.2 (95% CI, 1.1-5.0 at 12 Gy, and a factor of 3.1 (95% CI, 1.3-8.3 at 16 Gy, compared to those in the shielded glands that were exposed to very low radiation doses. The same pattern was seen for PMI-exposed mammary glands relative to zero-dose controls. CONCLUSIONS: The pattern of cancer risk reduction by PMI was consistent with mechanistic predictions. Contralateral breast PMI may thus have promise as a spatially targeted breast-conserving option for reducing the current high risk of contralateral second breast cancers. For estrogen-receptor positive primary tumors, PMI might optimally be used concomitantly with systemically delivered chemopreventive drugs such as tamoxifen or aromatase inhibitors, while for estrogen-receptor negative tumors, PMI might be used alone.

  3. Correlation between atopic manifestation and lung toxicity following chest irradiation for breast cancer

    International Nuclear Information System (INIS)

    The purpose of this study was to identify the impact of atopic manifestations on the occurrence of the lung toxicity following chest irradiation for breast cancer. Collection of 1,173 patients who had undergone radiotherapy on their 1,177 chest walls or postsurgical mammary glands at 9 institutions including ours. They received treatment consecutively from December 1980 through October 2005, with which we formed the basis of this analysis. Patients with any of the following medical history were defined as having atopic manifestations (n=111): asthma, allergic rhinitis, atopic dermatitis, contact dermatitis, and allergy to food or drug. Of them, patients who were observed for at least 6 months or who suffered from lung toxicity at any time, were classified as Group A (n=85). On the other hand, patients in our institute who were observed for at least 6 months or who suffered from lung toxicity at any time regardless of atopic manifestations, were classified as Group B (n=113), and patients without any atopic manifestation were classified as Group C (n=92). Grade 3 or higher lung toxicity in National Cancer Institute, Common Toxicity Criteria for Adverse Events (NCI-CTCAE) (v 3.0), occurred in 8.2%, id est (i.e.) 7 cases, of Group A, 2.7% of Group B, and 1.1% of Group C (p=0.0293 Group C against Group A). Three cases were classified as classical pneumonitis, and the other 4 sporadic pneumonitis such as Cryptogenic Organizing Pneumonia and Chronic Eosinophilic Pneumonia. Both of the histologically proven COP and CEP patients showed atopic manifestations in our institute. The detail clinical features are described in the main text. Having atopic manifestations suggests that there may be risk of lung toxicity following chest irradiation for breast cancer. (author)

  4. Changes in local pulmonary injury up to 48 months after irradiation for lymphoma and breast cancer

    International Nuclear Information System (INIS)

    Purpose: To assess the recovery from early local pulmonary injury after irradiation and to determine whether regional differences exist. Methods: For 110 patients treated for breast cancer or malignant lymphoma, single photon emission computed tomography (SPECT) perfusion and ventilation scans and CT scans were made before, 3, 18, and 48 months after radiotherapy. Dose-effect relations for changes in local perfusion, ventilation, and density were determined for each individual patient using spatially correlated SPECT and CT data sets, for each follow-up period. Average dose-effect relations for both subgroups were determined, as well as dose-effect relations for different regions. Results: In general, partial improvement of local pulmonary injury was observed between 3 and 18 months for each of the three endpoints. After 18 months, no further improvement was seen. Patients with breast cancer and malignant lymphoma showed a similar improvement (except for the perfusion parameter), which was attributed to a recovery from the early radiation response and could not be explained by contraction effects of fibrosis of lung parenchyma. No regional differences in radiosensitivity 18 months after treatment were observed, except for the dorsal versus ventral region. This difference was attributed to a gravity-related effect in the measuring procedure. Conclusion: For all patients, a partial recovery from early local perfusion, ventilation, and density changes, was seen between 3 and 18 months after radiotherapy. After 18 months, local lung function did not further improve (lymphoma patients)

  5. Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience

    Directory of Open Access Journals (Sweden)

    Fabio Caviggioli

    2016-01-01

    Full Text Available Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of “Postmastectomy Pain Syndrome” (PMPS and had undergone mastectomy with axillary dissection (113 patients or quadrantectomy (96 patients. Both procedures were followed by radiotherapy. We performed fat grafting following Coleman’s procedure. Mean amount of adipose tissue injected was 52 cc (±8.9 cc per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7–13.5 months. In 120 treated patients we detected pain decrease (mean ± SD point reduction, 3.19 ± 2.86. Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean ± SD decrease of pain of 1.14 ± 2.72. Results showed that pain decreased significantly in patients treated (p<0.005, Wilcoxon rank-sum test. Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain.

  6. Changes in Pulmonary Function Up to 10 Years After Locoregional Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Erven, Katrien, E-mail: Katrien.erven@uzleuven.be [Department of Radiotherapy, University Hospital Gasthuisberg, Leuven (Belgium); Weltens, Caroline [Department of Radiotherapy, University Hospital Gasthuisberg, Leuven (Belgium); Nackaerts, Kristiaan [Department of Pulmonology, University Hospital Gasthuisberg, Leuven (Belgium); Fieuws, Steffen [I-BioStat, Catholic University Leuven and Hasselt University, Leuven (Belgium); Decramer, Marc [Department of Pulmonology, University Hospital Gasthuisberg, Leuven (Belgium); Lievens, Yolande [Department of Radiotherapy, University Hospital Gasthuisberg, Leuven (Belgium)

    2012-02-01

    Purpose: To evaluate the long-term impact of locoregional breast radiotherapy (RT) on pulmonary function tests (PFTs). Methods and Materials: This study included 75 women who underwent postoperative locoregional breast RT. PFTs were performed before RT and 3, 6, and 12 months and 8 to 10 years after RT. By use of univariate and multivariate analyses, the impact of treatment- and patient-related factors on late changes in PFTs was evaluated. Results: During the first year after RT, all PFTs significantly worsened at 3 to 6 months after RT (p < 0.05). At 12 months, forced vital capacity (FVC), vital capacity (VC), and forced expiratory volume in 1 second (FEV{sub 1}) recovered almost to baseline values, whereas total lung capacity (TLC) and diffusion capacity of carbon monoxide (DL{sub CO}) recovered only slightly and were still found to be decreased compared with baseline (p < 0.05). At 8 to 10 years after RT, mean reductions in FEV{sub 1} of 4% (p = 0.03) and in VC, DL{sub CO}, and TLC of 5%, 9%, and 11% (all p < 0.0001), respectively, were observed compared with pre-RT values. On multivariate analysis, tamoxifen use negatively affected TLC at 8 to 10 years after RT (p = 0.033), whereas right-sided irradiation was associated with a late reduction in FEV{sub 1} (p = 0.027). For FEV{sub 1} and DL{sub CO}, an early decrease was predictive for a late decrease (p = 0.003 and p = 0.0009, respectively). Conclusions: The time course of PFT changes after locoregional RT for breast cancer follows a biphasic pattern. An early reduction in PFTs at 3 to 6 months with a partial recovery at 12 months after RT is followed by a late, more important PFT reduction up to 8 to 10 years after RT. Tamoxifen use may have an impact on this late decline in PFTs.

  7. Dosimetric evaluation of incidental irradiation to the axilla during whole breast radiotherapy for patients with left-sided early breast cancer in the IMRT era.

    Science.gov (United States)

    Lee, Jayoung; Kim, Shin-Wook; Son, Seok Hyun

    2016-06-01

    The purpose of this study was to compare the dosimetric parameters for incidental irradiation to the axilla during whole breast radiotherapy (WBRT) with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). Twenty left breast cancer patients treated with WBRT after breast-conserving surgery (BCS) were enrolled in this study. Remnant breast tissue, 3 levels of the axilla, heart, and lung were delineated. We used 2 different radiotherapy methods: 3D-CRT with field-in-field technique and 7-field fixed-beam IMRT. The target coverage of IMRT was significantly better than that of 3D-CRT (Dmean: 49.72 ± 0.64 Gy vs 50.24 ± 0.66 Gy, P axillary irradiation was shown throughout each level of axilla by IMRT compared to 3D-CRT (Dmean for level I: 42.58 ± 5.31 Gy vs 14.49 ± 6.91 Gy, P positive sentinel lymph nodes and who do not undergo complete axillary lymph node dissection. PMID:27368030

  8. Effect of gamma irradiation on the B vitamins of pork chops and chicken breasts

    International Nuclear Information System (INIS)

    A study was made of the effect of low-dose gamma irradiation on the content of thiamine (B1), riboflavin (B2), niacin, pyridoxine (B6) and cobalamin (B12) in pork chops, and thiamine, riboflavin and niacin in chicken breasts. Over the range of dose and temperature studied (0.49-6.65 kGy from -20 to 200C) it was possible to derive a mathematical expression for predicting losses. A calculation was made of the effect of the loss of thiamine, riboflavin and niacin due to irradiation on overall loss of these vitamins in the American diet. Losses of riboflavin and niacin were of the order of a fraction of a per cent. The calculated loss at 1.0kGy of thiamine in cooked pork was only 1.5%. There were initial increases with radiation doses up to 2-4 kGy in measured concentrations of riboflavin and niacin in pork and chicken. Increases were highly significant, and of concern to the study of radiation effects and the chemical method of determination of these vitamins. (author)

  9. Bi-tangential hybrid IMRT for sparing the shoulder in whole breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Farace, P.; Deidda, M.A.; Iamundo de Curtis, I.; Deiana, E.; Farigu, R.; Lay, G.; Porru, S. [Regional Oncological Hospital, Cagliari (Italy). Dept. of Radio-Oncology

    2013-11-15

    Background and purpose: A bi-tangential technique is proposed to reduce undesired doses to the shoulder produced by standard tangential irradiation. Patients and methods: A total of 6 patients affected by shoulder pain and reduced functional capacity after whole-breast irradiation were retrospectively analysed. The standard tangential plan used for treatment was compared with (1) a single bi-tangential plan where, to spare the shoulder, the lateral open tangent was split into two half-beams at isocentre, with the superior portion rotated by 10-20 medially with respect to the standard lateral beam; (2) a double bi-tangential plan, where both the tangential open beams were split. The planning target volume (PTV) coverage and the dose to the portion of muscles and axilla included in the standard tangential beams were compared. Results: PTV95 % of standard plan (91.9 {+-} 3.8) was not significantly different from single bi-tangential plan (91.8 {+-} 3.4); a small but significant (p < 0.01) decrease was observed with the double bi-tangential plan (90.1 {+-} 3.7). A marked dose reduction to the muscle was produced by the single bi-tangential plan around 30-40 Gy. The application of the double bi-tangential technique further reduced the volume receiving around 20 Gy, but did not markedly affect the higher doses. The dose to the axilla was reduced both in the single and the double bi-tangential plans. Conclusion: The single bi-tangential technique would have been able to reduce the dose to shoulder and axilla, without compromising target coverage. This simple technique is valuable for irradiation after axillary lymph node dissection or in patients without dissection due to negative or low-volume sentinel lymph node disease. (orig.)

  10. Bi-tangential hybrid IMRT for sparing the shoulder in whole breast irradiation

    International Nuclear Information System (INIS)

    Background and purpose: A bi-tangential technique is proposed to reduce undesired doses to the shoulder produced by standard tangential irradiation. Patients and methods: A total of 6 patients affected by shoulder pain and reduced functional capacity after whole-breast irradiation were retrospectively analysed. The standard tangential plan used for treatment was compared with (1) a single bi-tangential plan where, to spare the shoulder, the lateral open tangent was split into two half-beams at isocentre, with the superior portion rotated by 10-20 medially with respect to the standard lateral beam; (2) a double bi-tangential plan, where both the tangential open beams were split. The planning target volume (PTV) coverage and the dose to the portion of muscles and axilla included in the standard tangential beams were compared. Results: PTV95 % of standard plan (91.9 ± 3.8) was not significantly different from single bi-tangential plan (91.8 ± 3.4); a small but significant (p < 0.01) decrease was observed with the double bi-tangential plan (90.1 ± 3.7). A marked dose reduction to the muscle was produced by the single bi-tangential plan around 30-40 Gy. The application of the double bi-tangential technique further reduced the volume receiving around 20 Gy, but did not markedly affect the higher doses. The dose to the axilla was reduced both in the single and the double bi-tangential plans. Conclusion: The single bi-tangential technique would have been able to reduce the dose to shoulder and axilla, without compromising target coverage. This simple technique is valuable for irradiation after axillary lymph node dissection or in patients without dissection due to negative or low-volume sentinel lymph node disease. (orig.)

  11. Breast conserving therapy with accelerated partial breast versus external beam whole breast irradiation: comparison of imaging sequela and complications in a matched population.

    Science.gov (United States)

    Monticciolo, Debra L; Biggs, Kelly; Gist, Ashley K; Sincleair, Spencer T; Hajdik, Rodney L; Nipper, Michael L; Schnitker, James B

    2011-01-01

    Our purpose was to evaluate and compare the imaging sequela and complications of accelerated partial breast irradiation (APBI) with those occurring in patients treated with standard external beam therapy. Patient selection included those who met the criteria for possible ABPI: age 45 or older; cancer stage T1N0M0 or ductal carcinoma in situ 3 cm or less, and negative surgical margins. One hundred and ninety seven had complete records and films available for review. Ninety-seven (49%) were treated with APBI (MammoSite) and 100(51%) were treated with external beam. Image findings for APBI versus external beam were: distortion 90(93%) versus 83(83%), seroma 67(69%) versus 7(7%), skin edema 52(54%) versus 47(47%), increased stroma 75(77%) versus 66(66%), calcifications 10(10%) versus 6(6%), and fat necrosis 12(12%) versus 6(6%). For APBI, skin and stromal edema was more commonly focal. At imaging, the seroma rate was statistically and significantly different between the two treatment modes (p < 0.0001). For patients treated with APBI, seroma formation was not related to balloon size and only weakly related to lumpectomy cavity size. The complication rate was significantly higher for those treated with APBI (36 versus 20%) and the types and treatment of complications differed. There were three recurrences among the APBI group and none among those treated with external beam radiation. PMID:21306469

  12. Randomized Trial of Pentoxifylline and Vitamin E vs Standard Follow-up After Breast Irradiation to Prevent Breast Fibrosis, Evaluated by Tissue Compliance Meter

    International Nuclear Information System (INIS)

    Purpose: To conduct a randomized clinical trial to determine whether the combination of pentoxifylline (PTX) and vitamin E given for 6 months after breast/chest wall irradiation effectively prevents radiation-induced fibrosis (RIF). Methods and Materials: Fifty-three breast cancer patients with localized disease were enrolled and randomized to treatment with oral PTX 400 mg 3 times daily and oral vitamin E 400 IU daily for 6 months after radiation (n=26), or standard follow up (n=27). Tissue compliance meter (TCM) measurements were obtained at 18 months to compare tissue compliance in the irradiated and untreated breast/chest wall in treated subjects and controls. Measurements were obtained at 2 mirror image sites on each breast/chest wall, and the average difference in tissue compliance was scored. Differences in TCM measurements were compared using a t test. Subjects were followed a minimum of 2 years for local recurrence, disease-free survival, and overall survival. Results: The mean difference in TCM measurements in the 2 groups was 0.88 mm, median of 1.00 mm (treated) and 2.10 mm, median of 2.4 mm (untreated). The difference between the 2 groups was significant (P=.0478). Overall survival (100% treated, 90.6% controls at 5 years) and disease-free survival (96.2% treated, 86.8% controls at 5 years) were not significantly different in the 2 groups. Conclusions: This study of postirradiation breast cancer patients treated with PTX/vitamin E or standard follow-up indicated a significant difference in radiation-induced fibrosis as measured by TCM. There was no observed impact on local control or survival within the first 2 years of follow-up. The treatment was safe and well tolerated. Pentoxifylline/vitamin E may be clinically useful in preventing fibrosis after radiation in high-risk patients

  13. Dosimetry evaluation of SAVI-based HDR brachytherapy for partial breast irradiation

    Directory of Open Access Journals (Sweden)

    Manoharan Sivasubramanian

    2010-01-01

    Full Text Available Accelerated partial breast irradiation (APBI with high dose rate (HDR brachytherapy offers an excellent compact course of radiation due to its limited number of fractions for early-stage carcinoma of breast. One of the recent devices is SAVI (strut-adjusted volume implant, which has 6, 8 or 10 peripheral source channels with one center channel. Each channel can be differentially loaded. This paper focuses on the treatment planning, dosimetry and quality assurance aspects of HDR brachytherapy implant with GammaMed Plus HDR afterloader unit. The accelerated PBI balloon devices normally inflate above 35 cc range, and hence these balloon type devices cannot be accommodated in small lumpectomy cavity sizes. CT images were obtained and 3-D dosimetric plans were done with Brachyvision planning system. The 3-D treatment planning and dosimetric data were evaluated with planning target volume (PTV_eval V90, V95, V150, V200 skin dose and minimum distance to skin. With the use of the SAVI 6-1 mini device, we were able to accomplish an excellent coverage - V90, V95, V150 and V200 to 98%, 95%, 37 cc (<50 cc volume and 16 cc (<20 cc volume, respectively. Maximum skin dose was between 73% and 90%, much below the prescribed dose of 34 Gy. The minimum skin distance achieved was 5 to 11 mm. The volume that received 50% of the prescribed radiation dose was found to be lower with SAVI. The multi-channel SAVI-based implants reduced the maximum skin dose to markedly lower levels as compared to other modalities, simultaneously achieving best dose coverage to target volume. Differential-source dwell-loading allows modulation of the radiation dose distribution in symmetric or asymmetric opening of the catheter shapes and is also advantageous in cavities close to chest wall.

  14. Potential of using cerium oxide nanoparticles for protecting healthy tissue during accelerated partial breast irradiation (APBI).

    Science.gov (United States)

    Ouyang, Zi; Mainali, Madan Kumar; Sinha, Neeharika; Strack, Guinevere; Altundal, Yucel; Hao, Yao; Winningham, Thomas Andrew; Sajo, Erno; Celli, Jonathan; Ngwa, Wilfred

    2016-04-01

    The purpose of this study is to investigate the feasibility of using cerium oxide nanoparticles (CONPs) as radical scavengers during accelerated partial breast irradiation (APBI) to protect normal tissue. We hypothesize that CONPs can be slowly released from the routinely used APBI balloon applicators-via a degradable coating-and protect the normal tissue on the border of the lumpectomy cavity over the duration of APBI. To assess the feasibility of this approach, we analytically calculated the initial concentration of CONPs required to protect normal breast tissue from reactive oxygen species (ROS) and the time required for the particles to diffuse to various distances from the lumpectomy wall. Given that cerium has a high atomic number, we took into account the possible inadvertent dose enhancement that could occur due to the photoelectric interactions with radiotherapy photons. To protect against a typical MammoSite treatment fraction of 3.4Gy, 5ng·g(-1) of CONPs is required to scavenge hydroxyl radicals and hydrogen peroxide. Using 2nm sized NPs, with an initial concentration of 1mg·g(-1), we found that 2-10days of diffusion is required to obtain desired concentrations of CONPs in regions 1-2cm away from the lumpectomy wall. The resultant dose enhancement factor (DEF) is less than 1.01 under such conditions. Our results predict that CONPs can be employed for radioprotection during APBI using a new design in which balloon applicators are coated with the NPs for sustained/controlled in-situ release from within the lumpectomy cavity. PMID:27053452

  15. Impact of residual and intrafractional errors on strategy of correction for image-guided accelerated partial breast irradiation

    OpenAIRE

    Guo Xiao-Mao; Yang Zhao-Zhi; Pan Zi-Qiang; Yu Xiao-Li; Chen Jia-Yi; Hu Wei-Gang; Cai Gang; Shao Zhi-Min; Jiang Guo-Liang

    2010-01-01

    Abstract Background The cone beam CT (CBCT) guided radiation can reduce the systematic and random setup errors as compared to the skin-mark setup. However, the residual and intrafractional (RAIF) errors are still unknown. The purpose of this paper is to investigate the magnitude of RAIF errors and correction action levels needed in cone beam computed tomography (CBCT) guided accelerated partial breast irradiation (APBI). Methods Ten patients were enrolled in the prospective study of CBCT guid...

  16. Accelerated partial-breast irradiation with interstitial implants. Analysis of factors affecting cosmetic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Ott, Oliver J.; Lotter, Michael; Fietkau, Rainer; Strnad, Vratislav [University Hospital Erlangen (Germany). Dept. of Radiation Oncology

    2009-03-15

    Purpose: To analyze patient-, disease-, and treatment-related factors for their impact on cosmetic outcome (CO) after interstitial multicatheter accelerated partial-breast irradiation (APBI). Patients and Methods: Between April 2001 and January 2005, 171 patients with early breast cancer were recruited in Erlangen for this subanalysis of the German-Austrian APBI phase II-trial. 58% (99/171) of the patients received pulsed-dose-rate (PDR), and 42% (72/171) high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3-4 days. Endpoint of this evaluation was the CO, graded as excellent, good, fair, or poor. Patients were divided in two groups with an excellent (n = 102) or nonexcellent (n = 69) cosmetic result. Various factors were analyzed for their impact on excellent CO. Results: The median follow-up time was 52 months (range: 21-91 months). Cosmetic results were rated as excellent in 59.6% (102/171), good in 29.8% (51/171), fair in 9.9% (17/171), and poor in 0.6% (1/171). The initial cosmetic status was significantly worse for the nonexcellent CO group (p = 0.000). The percentage of patients who received PDR brachytherapy APBI was higher in the nonexcellent CO group (68.1% vs. 51%; p = 0.026). Acute toxicity was higher in the nonexcellent CO group (24.6% vs. 12.7%; p = 0.045). Furthermore, the presence of any late toxicity was found to be associated with a worse cosmetic result (65.2% vs. 18.6%; p = 0.000). In detail, the appearance of skin hyperpigmentation (p = 0.034), breast tissue fibrosis (p = 0.000), and telangiectasia (p = 0.000) had a negative impact on CO. Conclusion: The initial, surgery-associated cosmetic status, brachytherapy modality, and the presence of acute and late toxicities were found to have an impact on overall CO. Our data have proven

  17. Impact of Lymph Node Status on Clinical Outcomes After Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag; Wilkinson, J. Ben; Shaitelman, Simona [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Grills, Inga S.; Chen, Peter Y. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Oakland University William Beaumont School of Medicine, Royal Oak, MI (United States); Dekhne, Nayana [Breast Care Center, Beaumont Health System, William Beaumont Hospital, Royal Oak, MI (United States); Jaiyesimi, Ishmael [Department of Medical Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Wallace, Michelle; Mitchell, Christina K. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A., E-mail: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Oakland University William Beaumont School of Medicine, Royal Oak, MI (United States)

    2012-03-01

    Purpose: To compare outcomes after accelerated partial breast irradiation (APBI) between node-negative and node-positive patients. Methods and Materials: A total of 534 patients with early-stage breast cancer received APBI including 39 node-positive (N+) cases. Clinical, pathologic, and treatment-related factors were compared between node-negative (N-) and N+ cohorts. Local recurrence (LR), regional recurrence (RR), axillary failure (AF), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS) were analyzed. Results: N+ patients were younger (p = 0.04), had larger tumors (p < 0.001), and were more likely to receive chemotherapy (p < 0.001). Mean follow-up was 7.8 years for N+ patients and 6.3 years for N- patients (p = 0.06). No differences were seen in 5-year actuarial rates of LR (2.2% vs. 2.6%, p = 0.86), AF (0% vs. 0%, p = 0.69), DFS (90.0% vs. 88.0%, p = 0.79), or OS (91.0 vs. 84.0%, p = 0.65) between the two groups, whereas higher rates of RR (0% vs. 6.1%, p < 0.001) and DM (2.2% vs. 8.9%, p = 0.005) were noted in N+ patients. A trend for improved CSS (p = 0.06), was seen in N- patients. Age, tumor size, receptor status, T-stage, chemotherapy, APBI technique, and nodal status (p = 0.86) were not associated with LR, while a trend for an association with LR was noted with close/positive margins, (p = 0.07), and failure to receive adjuvant hormonal therapy (p = 0.06). Conclusions: No differences were seen in the rates of LR or AF between N- and N+ patients after APBI. These results support the continued enrollment of node-positive patients in Phase III trials evaluating the efficacy of APBI including the National Surgical Adjuvant Breast and Bowel Project-B39/Radiation Therapy Oncology Group 0413.

  18. Accelerated partial-breast irradiation with interstitial implants. Analysis of factors affecting cosmetic outcome

    International Nuclear Information System (INIS)

    Purpose: To analyze patient-, disease-, and treatment-related factors for their impact on cosmetic outcome (CO) after interstitial multicatheter accelerated partial-breast irradiation (APBI). Patients and Methods: Between April 2001 and January 2005, 171 patients with early breast cancer were recruited in Erlangen for this subanalysis of the German-Austrian APBI phase II-trial. 58% (99/171) of the patients received pulsed-dose-rate (PDR), and 42% (72/171) high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3-4 days. Endpoint of this evaluation was the CO, graded as excellent, good, fair, or poor. Patients were divided in two groups with an excellent (n = 102) or nonexcellent (n = 69) cosmetic result. Various factors were analyzed for their impact on excellent CO. Results: The median follow-up time was 52 months (range: 21-91 months). Cosmetic results were rated as excellent in 59.6% (102/171), good in 29.8% (51/171), fair in 9.9% (17/171), and poor in 0.6% (1/171). The initial cosmetic status was significantly worse for the nonexcellent CO group (p = 0.000). The percentage of patients who received PDR brachytherapy APBI was higher in the nonexcellent CO group (68.1% vs. 51%; p = 0.026). Acute toxicity was higher in the nonexcellent CO group (24.6% vs. 12.7%; p = 0.045). Furthermore, the presence of any late toxicity was found to be associated with a worse cosmetic result (65.2% vs. 18.6%; p = 0.000). In detail, the appearance of skin hyperpigmentation (p 0.034), breast tissue fibrosis (p = 0.000), and telangiectasia (p = 0.000) had a negative impact on CO. Conclusion: The initial, surgery-associated cosmetic status, brachytherapy modality, and the presence of acute and late toxicities were found to have an impact on overall CO. Our data have proven that

  19. Tangential breast irradiation; Influence of technique of set-up on transfer errors and reproducibility

    Energy Technology Data Exchange (ETDEWEB)

    Mitine, C.; Dutreix, A.; Van der Schueren, E. (University Hospital St. Rafael, Leuven (Belgium). Department of Radiotherapy)

    1991-12-01

    Using conventional portal films, the influence of the technique of set-up on the transfer error from simulator to treatment couch and on the subsequent reproducibility was made for the irradiated volume in the treatment of breast cancer. A total number of 376 portal films have been performed on 14 patients. All patients were treated on a 6MV Linac supplied with an automatic verification system excluding, however, the couch parameters. Overall precision of treatment delivery is evaluated by the global analysis of discrepancies between the simulator films and different portal films. For the patient group lying on a inclined plane with (group 2) or without (group 1) fixed arm support, narrow gaussian distribution is obtained in the anteroposterior (AP) direction with a SD of 4 mm. In the craniocaudal (CC) direction, distribution frequency of the patients treated without fixed arm support is mich larger than in the other group: SD is respectively 15.5mm for the first and 5.5mm for the second one. Reproducibility of the series of set-ups of the 2 groups estimated by reference to the mean value are similar in the AP direction. SD within the series of portal films in CC direction is 5.8 mm for the 1st group and 3.7 for the second. Their comparison with the discrepancies of 15.5 and 5.5mm when assessing the deviation between the stimulated and portal films shows the importance of systematic errors. Localisation of the irradiation port can be improved by using support systems with fixed arm indicators. (author). 6 refs.; 1 tab.

  20. Inactivation of Cytomegalovirus in Breast Milk Using Ultraviolet-C Irradiation: Opportunities for a New Treatment Option in Breast Milk Banking.

    Science.gov (United States)

    Lloyd, Megan L; Hod, Nurul; Jayaraman, Jothsna; Marchant, Elizabeth A; Christen, Lukas; Chiang, Peter; Hartmann, Peter; Shellam, Geoffrey R; Simmer, Karen

    2016-01-01

    Pasteurized donor human milk is provided by milk banks to very preterm babies where their maternal supply is insufficient or unavailable. Donor milk is currently processed by Holder pasteurization, producing a microbiologically safe product but significantly reducing immunoprotective components. Ultraviolet-C (UV-C) irradiation at 254 nm is being investigated as an alternative treatment method and has been shown to preserve components such as lactoferrin, lysozyme and secretory IgA considerably better than Holder pasteurization. We describe the inactivation of cytomegalovirus, a virus commonly excreted into breast milk, using UV-C irradiation. Full replication was ablated by various treatment doses. However, evidence of viral immediate early proteins within the cells was never completely eliminated indicating that some viral gene transcription was still occurring. In conclusion, UV-C may be a safe alternative to pasteurisation for the treatment of human donor milk that preserves the bioactivity. However, our data suggests that CMV inactivation will have to be carefully evaluated for each device designed to treat breast milk using UV-C irradiation. PMID:27537346

  1. Inactivation of Cytomegalovirus in Breast Milk Using Ultraviolet-C Irradiation: Opportunities for a New Treatment Option in Breast Milk Banking

    Science.gov (United States)

    Hod, Nurul; Jayaraman, Jothsna; Marchant, Elizabeth A.; Christen, Lukas; Chiang, Peter; Hartmann, Peter; Simmer, Karen

    2016-01-01

    Pasteurized donor human milk is provided by milk banks to very preterm babies where their maternal supply is insufficient or unavailable. Donor milk is currently processed by Holder pasteurization, producing a microbiologically safe product but significantly reducing immunoprotective components. Ultraviolet-C (UV-C) irradiation at 254 nm is being investigated as an alternative treatment method and has been shown to preserve components such as lactoferrin, lysozyme and secretory IgA considerably better than Holder pasteurization. We describe the inactivation of cytomegalovirus, a virus commonly excreted into breast milk, using UV-C irradiation. Full replication was ablated by various treatment doses. However, evidence of viral immediate early proteins within the cells was never completely eliminated indicating that some viral gene transcription was still occurring. In conclusion, UV-C may be a safe alternative to pasteurisation for the treatment of human donor milk that preserves the bioactivity. However, our data suggests that CMV inactivation will have to be carefully evaluated for each device designed to treat breast milk using UV-C irradiation. PMID:27537346

  2. Dosimetric comparison of the simultaneous integrated boost in whole-breast irradiation after breast-conserving surgery: IMRT, IMRT plus an electron boost and VMAT.

    Directory of Open Access Journals (Sweden)

    Sangang Wu

    Full Text Available To compare the target volume coverage and doses to organs at risks (OARs using three techniques that simultaneous integrated boost (SIB in whole-breast irradiation (WBI after breast-conserving surgery, including intensity-modulated radiation therapy (IMRT, IMRT plus an electron boost (IMRT-EB, and volumetric-modulated arc therapy (VMAT.A total of 10 patients with early-stage left-sided breast cancer after breast-conserving surgery were included in this study. IMRT, IMRT-EB and VMAT plans were generated for each patient.The conformity index (CI of the planning target volumes evaluation (PTV-Eval of VMAT was significantly superior to those of IMRT and IMRT-EB (P 0.05.Considered the target volume coverage and radiation dose delivered to the OARs (especially the heart and lung, IMRT may be more suitable for the SIB in WBI than IMRT-EB and VMAT. Additional clinical studies with a larger sample size will be needed to assess the long-term feasibility and efficacy of SIB using different radiotherapy techniques.

  3. Five-Year Analysis of Treatment Efficacy and Cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in Patients Treated With Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose: To present 5-year data on treatment efficacy, cosmetic results, and toxicities for patients enrolled on the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Methods and Materials: A total of 1440 patients (1449 cases) with early-stage breast cancer receiving breast-conserving therapy were treated with the MammoSite device to deliver accelerated partial-breast irradiation (APBI) (34 Gy in 3.4-Gy fractions). Of 1449 cases, 1255 (87%) had invasive breast cancer (IBC) (median size, 10 mm) and 194 (13%) had ductal carcinoma in situ (DCIS) (median size, 8 mm). Median follow-up was 54 months. Results: Thirty-seven cases (2.6%) developed an ipsilateral breast tumor recurrence (IBTR), for a 5-year actuarial rate of 3.80% (3.86% for IBC and 3.39% for DCIS). Negative estrogen receptor status (p = 0.0011) was the only clinical, pathologic, or treatment-related variable associated with IBTR for patients with IBC and young age (<50 years; p = 0.0096) and positive margin status (p = 0.0126) in those with DCIS. The percentage of breasts with good/excellent cosmetic results at 60 months (n = 371) was 90.6%. Symptomatic breast seromas were reported in 13.0% of cases, and 2.3% developed fat necrosis. A subset analysis of the first 400 consecutive cases enrolled was performed (352 with IBC, 48 DCIS). With a median follow-up of 60.5 months, the 5-year actuarial rate of IBTR was 3.04%. Conclusion: Treatment efficacy, cosmesis, and toxicity 5 years after treatment with APBI using the MammoSite device are good and similar to those reported with other forms of APBI with similar follow-up.

  4. Release of monocyte migration signals by breast cancer cell lines after ablative and fractionated γ-irradiation

    International Nuclear Information System (INIS)

    Radiotherapy, administered in fractionated as well as ablative settings, is an essential treatment component for breast cancer. Besides the direct tumor cell death inducing effects, there is growing evidence that immune mechanisms contribute - at least in part - to its therapeutic success. The present study was designed to characterize the type and the extent of cell death induced by fractionated and ablative radiotherapy as well as its impact on the release of monocyte migration stimulating factors by dying breast cancer cells. Cell death and senescence assays were employed to characterize the response of a panel of breast cancer cell lines with different receptor and p53 status towards γ-irradiation applied in a fractionated (daily doses of 2 Gy) or ablative setting (single dose of 20 Gy). Cell-free culture supernatants were examined for their monocyte migration stimulating potential in transwell migration and 2D chemotaxis/chemokinesis assays. Irradiation-induced transcriptional responses were analyzed by qRT-PCR, and CD39 surface expression was measured by flow cytometry. Fast proliferating, hormone receptor negative breast cancer cell lines with defective p53 predominantly underwent primary necrosis in response to γ-irradiation when applied at a single, ablative dose of 20 Gy, whereas hormone receptor positive, p53 wildtype cells revealed a combination of apoptosis, primary, and secondary (post-apoptotic) necrosis. During necrosis the dying tumor cells released apyrase-sensitive nucleotides, which effectively stimulated monocyte migration and chemokinesis. In hormone receptor positive cells with functional p53 this was hampered by irradiation-induced surface expression of the ectonucleotidase CD39. Our study shows that ablative radiotherapy potently induces necrosis in fast proliferating, hormone receptor negative breast cancer cell lines with mutant p53, which in turn release monocyte migration and chemokinesis stimulating nucleotides. Future studies have

  5. Implant breast reconstruction followed by radiotherapy: Can helical tomotherapy become a standard irradiation treatment?

    Energy Technology Data Exchange (ETDEWEB)

    Massabeau, Carole, E-mail: cmassabeau@hotmail.com [Department of Radiation Oncology, Institut Curie, Paris (France); Fournier-Bidoz, Nathalie; Wakil, Georges; Castro Pena, Pablo; Viard, Romain; Zefkili, Sofia; Reyal, Fabien; Campana, Francois; Fourquet, Alain; Kirova, Youlia M. [Department of Radiation Oncology, Institut Curie, Paris (France)

    2012-01-01

    To evaluate the benefits and limitations of helical tomotherapy (HT) for loco-regional irradiation of patients after a mastectomy and immediate implant-based reconstruction. Ten breast cancer patients with retropectoral implants were randomly selected for this comparative study. Planning target volumes (PTVs) 1 (the volume between the skin and the implant, plus margin) and 2 (supraclavicular, infraclavicular, and internal mammary nodes, plus margin) were 50 Gy in 25 fractions using a standard technique and HT. The extracted dosimetric data were compared using a 2-tailed Wilcoxon matched-pair signed-rank test. Doses for PTV1 and PTV2 were significantly higher with HT (V95 of 98.91 and 97.91%, respectively) compared with the standard technique (77.46 and 72.91%, respectively). Similarly, the indexes of homogeneity were significantly greater with HT (p = 0.002). HT reduced ipsilateral lung volume that received {>=}20 Gy (16.7 vs. 35%), and bilateral lungs (p = 0.01) and neighboring organs received doses that remained well below tolerance levels. The heart volume, which received 25 Gy, was negligible with both techniques. HT can achieve full target coverage while decreasing high doses to the heart and ipsilateral lung. However, the low doses to normal tissue volumes need to be reduced in future studies.

  6. Accelerated partial breast irradiation using intensity-modulated radiotherapy technique compared to whole breast irradiation for patients aged 70 years or older: subgroup analysis from a randomized phase 3 trial.

    Science.gov (United States)

    Meattini, Icro; Saieva, Calogero; Marrazzo, Livia; Di Brina, Lucia; Pallotta, Stefania; Mangoni, Monica; Meacci, Fiammetta; Bendinelli, Benedetta; Francolini, Giulio; Desideri, Isacco; De Luca Cardillo, Carla; Scotti, Vieri; Furfaro, Ilaria Francesca; Rossi, Francesca; Greto, Daniela; Bonomo, Pierluigi; Casella, Donato; Bernini, Marco; Sanchez, Luis; Orzalesi, Lorenzo; Simoncini, Roberta; Nori, Jacopo; Bianchi, Simonetta; Livi, Lorenzo

    2015-10-01

    The purpose of this study was to report the efficacy and the safety profile on the subset of selected early breast cancer (BC) patients aged 70 years or older from a single-center phase 3 trial comparing whole breast irradiation (WBI) to accelerated partial breast irradiation (APBI) using intensity-modulated radiation therapy technique. Between 2005 and 2013, 520 patients aged more than 40 years old were enrolled and randomly assigned to receive either WBI or APBI in a 1:1 ratio. Eligible patients were women with early BC (maximum diameter 2.5 cm) suitable for breast conserving surgery. This study is registered with ClinicalTrials.gov, NCT02104895. A total of 117 patients aged 70 years or more were analyzed (58 in the WBI arm, 59 in the APBI arm). At a median follow-up of 5-years (range 3.4-7.0), the ipsilateral breast tumor recurrence (IBTR) rate was 1.9 % in both groups. No significant difference between the two groups was identified (log-rank test p = 0.96). The 5-year disease-free survival (DFS) rates in the WBI group and APBI group were 6.1 and 1.9 %, respectively (p = 0.33). The APBI group presented significantly better results in terms of acute skin toxicity, considering both any grade (p = 0.0001) and grade 2 or higher (p = 0.0001). Our subgroup analyses showed a very low rate and no significant difference in terms of IBTR, using both WBI and APBI. A significant impact on patients compliance in terms of acute and early late toxicity was shown, which could translate in a consistent improvement of overall quality of life. PMID:26350524

  7. Accelerated partial breast irradiation: Bi-fractionated 40 Gy in one week. A French pilot phase II study; Etude pilote francaise de phase 2 d'irradiation partielle acceleree du sein conformationnelle tridimensionnelle bi-fractionnee hebdomadaire de 40 Gy

    Energy Technology Data Exchange (ETDEWEB)

    Bourgier, C.; Heymann, S.; Bourhis, J.; Marsiglia, H. [Departement d' oncologie-radiotherapie, institut Gustave-Roussy, 94 - Villejuif (France); Pichenot, C.; Verstraet, R.; Biron, B. [Departement de physique, institut Gustave-Roussy, 94 - Villejuif (France); Balleyguier, C. [Departement de radiologie, institut Gustave-Roussy, 94 - Villejuif (France); Delalogen, S. [Departement d' oncologie medicale, institut Gustave-Roussy, 94 - Villejuif (France); Mathieu, M.C. [Departement d' anatomie-pathologie, institut Gustave-Roussy, 94 - Villejuif (France); Uzan, C.; Garbay, J.R.; Marsiglia, H. [Departement de chirurgie-senologie, institut Gustave-Roussy, 94 - Villejuif (France); Taghian, A. [Departement d' oncologie-radiotherapie, Massachusetts General Hospital, Harvard Medical School, Massachusetts (United States); Bourgier, C.; Pichenot, C.; Verstraet, R.; Heymann, S.; Biron, B.; Balleyguier, C.; Delalogen, S.; Mathieu, M.C.; Uzan, C.; Garbay, J.R.; Bourhis, J.; Taghian, A.; Marsiglia, H. [Universite de Florence, Firenze (Italy)

    2010-12-15

    Purpose: Since 2009, accelerated partial breast irradiation (APBI) in North America has been allowed to be used for selected group of patients outside a clinical trial according to the ASTRO consensus statement. In France, accelerated partial breast irradiation is still considered investigational, several clinical trials have been conducted using either intraoperative (Montpellier) or Mammosite{sup R} (Lille) or brachytherapy modality (PAC GERICO/FNCLCC). Here, we report the original dosimetric results of this technique. Patients and methods: Since October 2007, Institut Gustave-Roussy has initiated a phase II trial using 3D-conformal accelerated partial breast irradiation (40 Gy in 10 fractions BID in 1 week). Twenty-five patients with pT1N0 breast cancer were enrolled and were treated by two mini-tangent photons beams (6 MV) and an 'en face' electron beam (6-22 MeV). Results: The mean clinical target volume and planning target volume were respectively 15.1 cm{sup 3} (range: 5.2-28.7 cm{sup 3}) and 117 cm{sup 3} (range: 52-185 cm{sup 3}). The planning target volume coverage was adequate with at least a mean of 99% of the volume encompassed by the isodose 40 Gy. The mean dose to the planning target volume was 41.8 Gy (range: 41-42.4 Gy). Dose inhomogeneity did not exceed 5%. Mean doses to the ipsilateral lung and heart were 1.6 Gy (range: 1.0-2.3 Gy) and 1.2 Gy (range: 1.0-1.6 Gy), respectively. Conclusion: The 3D conformal accelerated partial breast irradiation using two mini-tangent and 'en face' electron beams using a total dose of 40 Gy in 10 fractions BID over 5 days achieves appropriate planning target volume coverage and offers significant normal-tissue sparing (heart, lung). Longer follow-up is needed to evaluate the tissue tolerance to this radiation dose. (authors)

  8. Three-Year Outcomes of a Canadian Multicenter Study of Accelerated Partial Breast Irradiation Using Conformal Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Berrang, Tanya S., E-mail: tberrang@bccancer.bc.ca [British Columbia Cancer Agency-Vancouver Island, BC (Canada); University of British Columbia, BC (Canada); Olivotto, Ivo [British Columbia Cancer Agency-Vancouver Island, BC (Canada); University of British Columbia, BC (Canada); Kim, Do-Hoon [Juravinski Cancer Centre, Ontario (Canada); McMaster University, Ontario (Canada); Nichol, Alan [British Columbia Cancer Agency-Vancouver Centre, BC (Canada); University of British Columbia, BC (Canada); Cho, B.C. John [Princess Margaret Hospital, Ontario (Canada); University of Toronto, Ontario (Canada); Mohamed, Islam G. [British Columbia Cancer Agency-Southern Interior, BC (Canada); University of British Columbia, BC (Canada); Parhar, Tarnjit [British Columbia Cancer Agency-Vancouver Centre, BC (Canada); University of British Columbia, BC (Canada); Wright, J.R. [Juravinski Cancer Centre, Ontario (Canada); McMaster University, Ontario (Canada); Truong, Pauline [British Columbia Cancer Agency-Vancouver Island, BC (Canada); University of British Columbia, BC (Canada); Tyldesley, Scott [British Columbia Cancer Agency-Vancouver Centre, BC (Canada); University of British Columbia, BC (Canada); Sussman, Jonathan [Juravinski Cancer Centre, Ontario (Canada); McMaster University, Ontario (Canada); Wai, Elaine [British Columbia Cancer Agency-Vancouver Island, BC (Canada); University of British Columbia, BC (Canada); Whelan, Tim [Juravinski Cancer Centre, Ontario (Canada); McMaster University, Ontario (Canada)

    2011-12-01

    Purpose: To report 3-year toxicity, cosmesis, and efficacy of a multicenter study of external beam, accelerated partial breast irradiation (APBI) for early-stage breast cancer. Methods and Materials: Between March 2005 and August 2006, 127 women aged {>=}40 years with ductal carcinoma in situ or node-negative invasive breast cancer {<=}3 cm in diameter, treated with breast-conserving surgery achieving negative margins, were accrued to a prospective study involving five Canadian cancer centers. Women meeting predefined dose constraints were treated with APBI using 3 to 5 photon beams, delivering 35 to 38.5 Gy in 10 fractions, twice a day, over 1 week. Patients were assessed for treatment-related toxicities, cosmesis, and efficacy before APBI and at specified time points for as long as 3 years after APBI. Results: 104 women had planning computed tomography scans showing visible seromas, met dosimetric constraints, and were treated with APBI to doses of 35 Gy (n = 9), 36 Gy (n = 33), or 38.5 Gy (n = 62). Eighty-seven patients were evaluated with minimum 3-year follow-up after APBI. Radiation dermatitis, breast edema, breast induration, and fatigue decreased from baseline levels or stabilized by the 3-year follow-up. Hypopigmentation, hyperpigmentation, breast pain, and telangiectasia slightly increased from baseline levels. Most toxicities at 3 years were Grade 1. Only 1 patient had a Grade 3 toxicity with telangiectasia in a skin fold inside the 95% isodose. Cosmesis was good to excellent in 86% (89/104) of women at baseline and 82% (70/85) at 3 years. The 3-year disease-free survival was 97%, with only one local recurrence that occurred in a different quadrant away from the treated site and two distant recurrences. Conclusions: At 3 years, toxicity and cosmesis were acceptable, and local control and disease-free survival were excellent, supporting continued accrual to randomized APBI trials.

  9. Sci—Thur PM: Planning and Delivery — 04: Respiratory margin derivation and verification in partial breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Quirk, S [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta (Canada); Conroy, L [Department of Physics and Astronomy, University of Calgary, Calgary, Alberta (Canada); Smith, WL [Department of Oncology, University of Calgary, Calgary, Alberta (Canada)

    2014-08-15

    Partial breast irradiation (PBI) following breast-conserving surgery is emerging as an effective means to achieve local control and reduce irradiated breast volume. Patients are planned on a static CT image; however, treatment is delivered while the patient is free-breathing. Respiratory motion can degrade plan quality by reducing target coverage and/or dose homogeneity. A variety of methods can be used to determine the required margin for respiratory motion in PBI. We derive geometric and dosimetric respiratory 1D margin. We also verify the adequacy of the typical 5 mm respiratory margin in 3D by evaluating plan quality for increasing respiratory amplitudes (2–20 mm). Ten PBI plans were used for dosimetric evaluation. A database of volunteer respiratory data, with similar characteristics to breast cancer patients, was used for this study. We derived a geometric 95%-margin of 3 mm from the population respiratory data. We derived a dosimetric 95%-margin of 2 mm by convolving 1D dose profiles with respiratory probability density functions. The 5 mm respiratory margin is possibly too large when 1D coverage is assessed and could lead to unnecessary normal tissue irradiation. Assessing margins only for coverage may be insufficient; 3D dosimetric assessment revealed degradation in dose homogeneity is the limiting factor, not target coverage. Hotspots increased even for the smallest respiratory amplitudes, while target coverage only degraded at amplitudes greater than 10 mm. The 5 mm respiratory margin is adequate for coverage, but due to plan quality degradation, respiratory management is recommended for patients with respiratory amplitudes greater than 10 mm.

  10. Feasibility and acute toxicity of 3-dimensional conformal external-beam accelerated partial-breast irradiation for early-stage breast cancer after breast-conserving surgery in Chinese female patients

    Institute of Scientific and Technical Information of China (English)

    LI Feng-yan; HE Zhen-yu; XUE Ming; CHEN Li-xin; WU San-gang; GUAN Xun-xing

    2011-01-01

    Background A growing number of studies worldwide have advocated the replacement of whole-breast irradiation with accelerated partial breast irradiation using three-dimensional conformal external-beam radiation (APBI-3DCRr) for early-stage breast cancer. But APBI can be only used in selected population of patients with early-staged breast cancer. It is not replacing the whole breast radiotherapy. This study aimed to examine the feasibility and acute normal tissue toxicity of the APBI-3DCRT technique in Chinese female patients who generally have smaller breasts compared to their Western counterparts.Methods From May 2006 to December 2009, a total of 48 Chinese female patients (with early-stage breast cancer who met the inclusion criteria) received APBI-3DCRT after breast-conserving surgery at Sun Yat-sen University Cancer Center. The total dosage from APBI-3DCRT was 34 Gy, delivered in 3.4 Gy per fractions, twice per day at intervals of at least six hours. The radiation dose, volume of the target area and volume of irradiated normal tissues were calculated.Acute toxicity was evaluated according to the Common Toxicity Criteria (CTC) 3.0.Results Among the 48 patients, the planning target volume for evaluation (PTVE) was (90.42±9.26) cm3, the ipsilateral breast volume (IBV) was (421.74±28.53) cm3, and the ratio between the two was (20.74±5.86)%. Evaluation of the dosimetric characteristics of the PTVE revealed excellent dosimetric results in 14 patients and acceptable results in 34 patients. The dose delivered to the PTVE ranged from 93% to 110% of the prescribed dose. The average ratio of the volume of PTVE receiving 95% of the prescription dose (V95) was (99.26±0.37)%. The habituation index (HI) and the conformity index (CI) were 1.08±0.01 and 0.72±0.02, respectively, suggesting good homogeneity and conformity of the dose delivered to the target field. The radiation dose to normal tissues and organs was within the dose limitation.Subjects experienced mild acute

  11. Fate of gamma-irradiated Listeria monocytogenes during refrigerated storage on raw or cooked turkey breast meat

    International Nuclear Information System (INIS)

    The radiation resistance and ability of Listeria monocytogenes ATCC 7644, 15313, 43256, and 49594 to multiply on irradiated, air-packed, refrigerated raw or cooked turkey breast meat nuggets (ca. 25 g) and ground turkey breast meat was investigated. Gamma-radiation D values for L. monocytogenes were significantly different on raw and cooked nuggets, 0.56 +/- 0.03 kGy and 0.69 +/- 0.03 kGy, respectively; but they were not significantly different (P less than or equal to 0.05) on raw and cooked ground turkey meat. High populations (approximately 10(9) CFU/g) of L. monocytogenes declined during 14 days of storage at 4 degrees C in both irradiated and nonirradiated samples of raw but not of cooked ground turkey breast meat. A moderate inoculum (approximately 10(3) CFU/g) did not survive a radiation dose of 3 kGy. The population increased in cooked but not in raw samples of irradiated ground turkey meat stored at either 2 or 7 degrees C for 21 days. The D value changed significantly from 0.70 +/- 0.04 to 0.60 +/- 0.02 kGy when the product was cooked to an internal temperature of 80 degrees C before irradiation. Growth on either raw or cooked turkey meat did not alter the radiation resistance of L. monocytogenes. Analyses were performed for pH, a(w), moisture, and reducing potential of raw and cooked turkey meat and for pH, amino acid profile, thiamine, and riboflavin contents of aqueous extracts of raw and cooked turkey meats without identifying the factor or factors involved in differences in the survival and multiplication of L. monocytogenes on raw and cooked meat

  12. Role of lymph node irradiation in patients free of nodal involvement after neoadjuvant chemotherapy for breast cancer; Role de l'irradiation ganglionnaire chez les patientes indemnes d'envahissement ganglionnaire apres chimiotherapie neoadjuvante pour un cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Daveau, C.; Stevens, D.; Brain, E.; Berges, O.; Gardner, M.; Villette, S.; Moisson, P.; De la Lande, B.; Labib, A.; Le Scodan, R. [Centre Rene-Huguenin, 92 - Saint-Cloud (France)

    2009-10-15

    The results suggest that an only breast irradiation is not associated to a higher risk of local recurrence or death in patients with a classified pN0 breast cancer after neoadjuvant chemotherapy. (N.C.)

  13. Changes in pulmonary function after incidental lung irradiation for breast cancer: A prospective study

    International Nuclear Information System (INIS)

    Purpose: The aim of this study was to analyze changes in pulmonary function after radiation therapy (RT) for breast cancer. Methods and Materials: A total of 39 consecutive eligible women, who underwent postoperative irradiation for breast cancer, were entered in the study. Spirometry consisting of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), carbon monoxide diffusing capacity (DLCO), and gammagraphic (ventilation and perfusion) pulmonary function tests (PFT) were performed before RT and 6, 12, and 36 months afterwards. Dose-volume and perfusion-weighted parameters were obtained from 3D dose planning: Percentage of lung volume receiving more than a threshold dose (Vi) and between 2 dose levels (V(i-j)). The impact of clinical and dosimetric parameters on PFT changes (ΔPFT) after RT was evaluated by Pearson correlation coefficients and stepwise lineal regression analysis. Results: No significant differences on mean PFT basal values (before RT) with respect to age, smoking, or previous chemotherapy (CT) were found. All the PFT decreased at 6 to 12 months. Furthermore FVC, FEV1, and ventilation recovered almost to their previous values, whereas DLCO and perfusion continued to decrease until 36 months (-3.3% and -6.6%, respectively). Perfusion-weighted and interval-scaled dose-volume parameters (pV(i-j)) showed better correlation with ΔPFT (only Δperfusion reached statistically significance at 36 months). Multivariate analysis showed a significant relation between pV(10-20) and Δperfusion at 3 years, with a multiple correlation coefficient of 0.48. There were no significant differences related to age, previous chemotherapy, concurrent tamoxifen and smoking, although a tendency toward more perfusion reduction in older and nonsmoker patients was seen. Conclusions: Changes in FVC, FEV1 and ventilation were reversible, but not the perfusion and DLCO. We have not found a conclusive mathematical predictive model, provided that the best model

  14. Consensus conferences

    DEFF Research Database (Denmark)

    Nielsen, Annika Porsborg; Lassen, Jesper

    Our results point to significant national variation both in terms of the perceived aim of consensus conferences, expectations to conference outcomes, conceptions of the roles of lay people and experts, and in terms of the way in which the role of public deliberation is interpreted. Interestingly......, the differing perceptions are each in their own way rooted in an argument for democratic legitimacy. We therefore argue that national interpretations of consensus conferences, and of their ability to functions as a tool for public participation, depend to a great extent on the dominant ideals of democratic...

  15. Partial breast irradiation for early breast cancer: 3-year results of the German-Austrian phase II-trial; Teilbrustbestrahlung beim Mammakarzinom mit guenstigen prognostischen Faktoren: 3-Jahres-Ergebnisse der deutschoesterreichischen Phase II-Studie

    Energy Technology Data Exchange (ETDEWEB)

    Ott, O.J.; Lotter, M.; Sauer, R.; Strnad, V. [Strahlenklinik, Universitaetsklinikum Erlangen (Germany); Poetter, R. [Universitaetsklinik fuer Strahlentherapie und Strahlenbiologie, AKH Wien (Austria); Hildebrandt, G. [Strahlenklinik, Universitaetsklinikum Leipzig (Germany); Hammer, J. [Abt. fuer Strahlentherapie, KH Barmherzige Schwestern Linz (Austria); Beckmann, M.W. [Frauenklinik, Universitaetsklinikum Erlangen (Germany)

    2005-07-01

    Purpose: to evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. Materials and methods: from 11/2000 to 11/2004, 240 women with early stage breast cancer participated in a protocol of tumor bed irradiation alone using pulsed dose rate (PDR) or high dose rate (HDR) interstitial multi-catheter implants (partial breast irradiation). Perioperative morbidity, acute and late toxicity as well as cosmetic outcome were assessed. Of the first 51 patients treated in this multicenter trial, we present interim findings after a median follow-up of 36 months. Results: perioperative Morbidity: Bacterial infection of the implant: 2% (1/51). Acute toxicity: radiodermatitis grade 1: 4% (2/51). Late toxicity: breast pain grade 1: 8% (4/51), grade 2: 2% (1/51); dyspigmentation grade 1: 8% (4/51); fibrosis grade 1: 4% (2/51), grade 2: 8% (4/51); telangiectasia grade 1: 10% (5/51), grade 2: 4% (2/51). Cosmetic results: Excellent and good in 94% (48/51) of the patients. Conclusion: this analysis indicates that accelerated partial breast irradiation with 192-iridium interstitial multicatheter PDR-/HDR-implants (partial breast irradiation) is feasible with low perioperative morbidity, low acute and mild late toxicity at a median follow-up of 36 months. The cosmetic result is not significantly affected. (orig.)

  16. Results With Accelerated Partial Breast Irradiation in Terms of Estrogen Receptor, Progesterone Receptor, and Human Growth Factor Receptor 2 Status

    International Nuclear Information System (INIS)

    Purpose: To report our results with accelerated partial breast irradiation (APBI) in terms of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2/neu) status. Methods and Materials: Between February 2003 and June 2009, 209 women with early-stage breast carcinomas were treated with APBI using multicatheter, MammoSite, or Contura brachytherapy to 34 Gy in 10 fractions twice daily over 5-7 days. Three patient groups were defined by receptor status: Group 1: ER or PR (+) and HER-2/neu (-) (n = 180), Group 2: ER and PR (-) and HER-2/neu (+) (n = 10), and Group 3: ER, PR, and HER-2/neu (-) (triple negative breast cancer, n = 19). Median follow-up was 22 months. Results: Group 3 patients had significantly higher Scarff-Bloom-Richardson scores (p < 0.001). The 3-year ipsilateral breast tumor control rates for Groups 1, 2, and 3 were 99%, 100%, and 100%, respectively (p = 0.15). Group 3 patients tended to experience relapse in distant sites earlier than did non-Group 3 patients. The 3-year relapse-free survival rates for Groups 1, 2, and 3 were 100%, 100%, and 81%, respectively (p = 0.046). The 3-year cause-specific and overall survival rates for Groups 1, 2, and 3 were 100%, 100%, and 89%, respectively (p = 0.002). Conclusions: Triple negative breast cancer patients typically have high-grade tumors with significantly worse relapse-free, cause-specific, and overall survival. Longer follow-up will help to determine whether these patients also have a higher risk of ipsilateral breast tumor relapse.

  17. Hypo-fractionated whole breast irradiation: Pro and cons; Irradiation hypofractionnee dans le cancer du sein: pour ou contre?

    Energy Technology Data Exchange (ETDEWEB)

    Cutuli, B. [Institut du cancer Courlancy, 38, rue de Courlancy, 51100 Reims (France); Fourquet, A. [Institut Curie, 26, rue d' Ulm, 75005 Paris (France)

    2011-10-15

    The continuous increase of breast cancer (BC) incidence, the logistic constraints of the protracted standard 5-week radiations regimen have led to test short hypo-fractionated whole breast radiation therapy schemes. Three prospective randomized trials and a pilot trial have been published. Large numbers of patients were included, with follow-up duration ranging from 5 to 12 years. The conclusions of these trials were similar, showing local control and toxicity equivalent to those of the standard regimen, and supporting the use of three schemes: 42.5 Gy/16 fractions/3 weeks, 40 Gy/15 fractions/3 weeks or 41.6 Gy/13 fractions/5 weeks. However, the patients in these trials had favourable prognostic factors, were treated to the breast only and the boost dose, when indicated, was delivered with a standard fractionation. Hypo-fractionated treatment can only be recommended in patients treated to the breast only, without nodal involvement, with grade < 3 tumours and who are not candidate to chemotherapy. If a boost is to be given, a standard fractionation should be used. Particular care should be taken to avoid heterogeneities leading to high fractional doses to organs at risk (lung and heart). (authors)

  18. Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation

    International Nuclear Information System (INIS)

    Purpose: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated.Materials and methods: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours.Results: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (n=93), either with (n=30) or without (n=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (P<0.05) and nodal status (P<0.0510%) and low risk (<10%) group for LRR could be identified.Conclusions: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  19. MO-A-BRD-06: In Vivo Cherenkov Video Imaging to Verify Whole Breast Irradiation Treatment

    International Nuclear Information System (INIS)

    Purpose: To show in vivo video imaging of Cherenkov emission (Cherenkoscopy) can be acquired in the clinical treatment room without affecting the normal process of external beam radiation therapy (EBRT). Applications of Cherenkoscopy, such as patient positioning, movement tracking, treatment monitoring and superficial dose estimation, were examined. Methods: In a phase 1 clinical trial, including 12 patients undergoing post-lumpectomy whole breast irradiation, Cherenkov emission was imaged with a time-gated ICCD camera synchronized to the radiation pulses, during 10 fractions of the treatment. Images from different treatment days were compared by calculating the 2-D correlations corresponding to the averaged image. An edge detection algorithm was utilized to highlight biological features, such as the blood vessels. Superficial dose deposited at the sampling depth were derived from the Eclipse treatment planning system (TPS) and compared with the Cherenkov images. Skin reactions were graded weekly according to the Common Toxicity Criteria and digital photographs were obtained for comparison. Results: Real time (fps = 4.8) imaging of Cherenkov emission was feasible and feasibility tests indicated that it could be improved to video rate (fps = 30) with system improvements. Dynamic field changes due to fast MLC motion were imaged in real time. The average 2-D correlation was about 0.99, suggesting the stability of this imaging technique and repeatability of patient positioning was outstanding. Edge enhanced images of blood vessels were observed, and could serve as unique biological markers for patient positioning and movement tracking (breathing). Small discrepancies exists between the Cherenkov images and the superficial dose predicted from the TPS but the former agreed better with actual skin reactions than did the latter. Conclusion: Real time Cherenkoscopy imaging during EBRT is a novel imaging tool that could be utilized for patient positioning, movement tracking

  20. MO-A-BRD-06: In Vivo Cherenkov Video Imaging to Verify Whole Breast Irradiation Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, R; Glaser, A [Dartmouth College, Hanover, NH - New Hampshire (United States); Jarvis, L [Dartmouth-Hitchcock Medical Center, City Of Lebanon, New Hampshire (United States); Gladstone, D [Dartmouth-Hitchcock Medical Center, Hanover, City of Lebanon (Lebanon); Andreozzi, J; Hitchcock, W; Pogue, B [Dartmouth College, Hanover, NH (United States)

    2014-06-15

    Purpose: To show in vivo video imaging of Cherenkov emission (Cherenkoscopy) can be acquired in the clinical treatment room without affecting the normal process of external beam radiation therapy (EBRT). Applications of Cherenkoscopy, such as patient positioning, movement tracking, treatment monitoring and superficial dose estimation, were examined. Methods: In a phase 1 clinical trial, including 12 patients undergoing post-lumpectomy whole breast irradiation, Cherenkov emission was imaged with a time-gated ICCD camera synchronized to the radiation pulses, during 10 fractions of the treatment. Images from different treatment days were compared by calculating the 2-D correlations corresponding to the averaged image. An edge detection algorithm was utilized to highlight biological features, such as the blood vessels. Superficial dose deposited at the sampling depth were derived from the Eclipse treatment planning system (TPS) and compared with the Cherenkov images. Skin reactions were graded weekly according to the Common Toxicity Criteria and digital photographs were obtained for comparison. Results: Real time (fps = 4.8) imaging of Cherenkov emission was feasible and feasibility tests indicated that it could be improved to video rate (fps = 30) with system improvements. Dynamic field changes due to fast MLC motion were imaged in real time. The average 2-D correlation was about 0.99, suggesting the stability of this imaging technique and repeatability of patient positioning was outstanding. Edge enhanced images of blood vessels were observed, and could serve as unique biological markers for patient positioning and movement tracking (breathing). Small discrepancies exists between the Cherenkov images and the superficial dose predicted from the TPS but the former agreed better with actual skin reactions than did the latter. Conclusion: Real time Cherenkoscopy imaging during EBRT is a novel imaging tool that could be utilized for patient positioning, movement tracking

  1. Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy in Women Undergoing Breast Conservation for Early Disease Yields High Rates of Excellent to Good Cosmetic Outcomes in Patients With Large and/or Pendulous Breasts

    International Nuclear Information System (INIS)

    Purpose: To report our institution's experience using prone positioning for three-dimensional conformal radiotherapy (3D-CRT) to deliver post-lumpectomy whole breast irradiation (WBI) in a cohort of women with large and/or pendulous breasts, to determine the rate of acute and late toxicities and, more specifically, cosmetic outcomes. We hypothesized that using 3D-CRT for WBI in the prone position would reduce or eliminate patient and breast size as negative prognostic indicators for toxicities associated with WBI. Methods and Materials: From 1998 to 2006, 110 cases were treated with prone WBI using 3D-CRT. The lumpectomy, breast target volumes, heart, and lung were contoured on all computed tomography scans. A dose of 45–50 Gy was prescribed to the breast volume using standard fractionation schemes. The planning goals were ≥95% of prescription to 95% of the breast volume, and 100% of boost dose to 95% of lumpectomy planning target volume. Toxicities and cosmesis were prospectively scored using the Common Terminology Criteria for Adverse Effects Version 3.0 and the Harvard Scale. The median follow-up was 40 months. Results: The median body mass index (BMI) was 33.6 kg/m2, and median breast volume was 1396 cm3. The worst toxicity encountered during radiation was Grade 3 dermatitis in 5% of our patient population. Moist desquamation occurred in 16% of patients, with only 2% of patients with moist desquamation outside the inframammary/axillary folds. Eleven percent of patients had Grade ≥2 late toxicities, including Grade 3 induration/fibrosis in 2%. Excellent to good cosmesis was achieved in 89%. Higher BMI was associated with moist desquamation and breast pain, but BMI and breast volume did not impact fibrosis or excellent to good cosmesis. Conclusion: In patients with higher BMI and/or large–pendulous breasts, delivering prone WBI using 3D-CRT results in favorable toxicity profiles and high excellent to good cosmesis rates. Higher BMI was associated with

  2. Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy in Women Undergoing Breast Conservation for Early Disease Yields High Rates of Excellent to Good Cosmetic Outcomes in Patients With Large and/or Pendulous Breasts

    Energy Technology Data Exchange (ETDEWEB)

    Bergom, Carmen; Kelly, Tracy; Morrow, Natalya; Wilson, J. Frank [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Walker, Alonzo [Department of Surgery, Medical College of Wisconsin, Milwaukee, WI (United States); Xiang Qun; Ahn, Kwang Woo [Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI (United States); White, Julia, E-mail: jwhite@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

    2012-07-01

    Purpose: To report our institution's experience using prone positioning for three-dimensional conformal radiotherapy (3D-CRT) to deliver post-lumpectomy whole breast irradiation (WBI) in a cohort of women with large and/or pendulous breasts, to determine the rate of acute and late toxicities and, more specifically, cosmetic outcomes. We hypothesized that using 3D-CRT for WBI in the prone position would reduce or eliminate patient and breast size as negative prognostic indicators for toxicities associated with WBI. Methods and Materials: From 1998 to 2006, 110 cases were treated with prone WBI using 3D-CRT. The lumpectomy, breast target volumes, heart, and lung were contoured on all computed tomography scans. A dose of 45-50 Gy was prescribed to the breast volume using standard fractionation schemes. The planning goals were {>=}95% of prescription to 95% of the breast volume, and 100% of boost dose to 95% of lumpectomy planning target volume. Toxicities and cosmesis were prospectively scored using the Common Terminology Criteria for Adverse Effects Version 3.0 and the Harvard Scale. The median follow-up was 40 months. Results: The median body mass index (BMI) was 33.6 kg/m{sup 2}, and median breast volume was 1396 cm{sup 3}. The worst toxicity encountered during radiation was Grade 3 dermatitis in 5% of our patient population. Moist desquamation occurred in 16% of patients, with only 2% of patients with moist desquamation outside the inframammary/axillary folds. Eleven percent of patients had Grade {>=}2 late toxicities, including Grade 3 induration/fibrosis in 2%. Excellent to good cosmesis was achieved in 89%. Higher BMI was associated with moist desquamation and breast pain, but BMI and breast volume did not impact fibrosis or excellent to good cosmesis. Conclusion: In patients with higher BMI and/or large-pendulous breasts, delivering prone WBI using 3D-CRT results in favorable toxicity profiles and high excellent to good cosmesis rates. Higher BMI was

  3. An audit of indications and techniques for supraclavicular fossa irradiation in early breast cancer in the United Kingdom.

    Science.gov (United States)

    Landau, D B; Laing, R W

    2000-01-01

    This article describes an audit of the indications and techniques used by clinical oncologists in the United Kingdom (UK) in the delivery of adjuvant radiotherapy to the supraclavicular fossa (SCF) in patients with early breast cancer. A postal questionnaire was sent to one consultant clinical oncologist in each UK radiotherapy centre in November 1999. These were the same individuals listed in the Maher Committee Report as providing breast cancer services. Forty-one out of 51 completed forms were returned. The results show significant variation in the indications for SCF irradiation and for the definition of the radiotherapy target volume. We discuss the possible basis for the variations found in the audit. There was broad agreement on technique, in particular on the need for matching the tangential and SCF fields and maintaining patient position between fields, factors that are likely to minimize serious morbidity, including brachial plexus injury. PMID:10942334

  4. Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema. The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation. Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema. Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings

  5. Dose volume histogram analysis of normal structures associated with accelerated partial breast irradiation delivered by high dose rate brachytherapy and comparison with whole breast external beam radiotherapy fields

    Directory of Open Access Journals (Sweden)

    Mutyala Subhakar

    2008-11-01

    Full Text Available Abstract Purpose To assess the radiation dose delivered to the heart and ipsilateral lung during accelerated partial breast brachytherapy using a MammoSite™ applicator and compare to those produced by whole breast external beam radiotherapy (WBRT. Materials and methods Dosimetric analysis was conducted on patients receiving MammoSite breast brachytherapy following conservative surgery for invasive ductal carcinoma. Cardiac dose was evaluated for patients with left breast tumors with a CT scan encompassing the entire heart. Lung dose was evaluated for patients in whom the entire lung was scanned. The prescription dose of 3400 cGy was 1 cm from the balloon surface. MammoSite dosimetry was compared to simulated WBRT fields with and without radiobiological correction for the effects of dose and fractionation. Dose parameters such as the volume of the structure receiving 10 Gy or more (V10 and the dose received by 20 cc of the structure (D20, were calculated as well as the maximum and mean doses received. Results Fifteen patients were studied, five had complete lung data and six had left-sided tumors with complete cardiac data. Ipsilateral lung volumes ranged from 925–1380 cc. Cardiac volumes ranged from 337–551 cc. MammoSite resulted in a significantly lower percentage lung V30 and lung and cardiac V20 than the WBRT fields, with and without radiobiological correction. Conclusion This study gives low values for incidental radiation received by the heart and ipsilateral lung using the MammoSite applicator. The volume of heart and lung irradiated to clinically significant levels was significantly lower with the MammoSite applicator than using simulated WBRT fields of the same CT data sets. Trial registration Dana Farber Trial Registry number 03-179

  6. Influence of family history, irradiation and anti-cancer drug (mitomycin C) on the occurrence of multiple primary neoplasms in breast carcinoma patients

    International Nuclear Information System (INIS)

    The influence of family history, irradiation and anti-cancer drug (Mitomycin C) on the occurrence of multiple primary neoplasms was analysed using the person-year method in 1359 Japanese breast carcinoma patients. There were 111 multiple primary neoplasms, including bilaterl breast cancer, in 109 patients; the incidence rate was 0.0072 per person-year. The incidence rate in patients with a family history of cancer was 1.29 times higher than in those without. In the bilateral breast cancer group there was about a 3 times higher frequency of family history of breast cancer. Irradiation therapy raised the occurrence of multiple primary neoplasms 1.28 fold, and Mitomycin C (40 mg) had no effect on the occurrence of neoplasms during a 10-year observation period. (author)

  7. Accelerated Partial Breast Irradiation Is Safe and Effective Using Intensity-Modulated Radiation Therapy in Selected Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lewin, Alan A., E-mail: alanl@baptisthealth.net [Department of Radiation Oncology, Baptist Hospital of Miami, Miami, FL (United States); Derhagopian, Robert [Department of Surgery, Baptist Hospital of Miami, Miami, FL (United States); Saigal, Kunal; Panoff, Joseph E. [Department of Radiation Oncology, University of Miami, Miami, FL (United States); Abitbol, Andre; Wieczorek, D. Jay; Mishra, Vivek [Department of Radiation Oncology, Baptist Hospital of Miami, Miami, FL (United States); Reis, Isildinha; Ferrell, Annapoorna [Division of Biostatistics, University of Miami, Miami, FL (United States); Moreno, Lourdes [Department of Radiation Oncology, Baptist Hospital of Miami, Miami, FL (United States); Takita, Cristiane [Department of Radiation Oncology, University of Miami, Miami, FL (United States)

    2012-04-01

    Purpose: To report the feasibility, toxicity, cosmesis, and efficacy of using intensity-modulated radiation therapy (IMRT) with respiratory gating to deliver accelerated partial breast irradiation (APBI) in selected Stage I/II breast cancer after breast-conserving surgery. Methods and Materials: Eligible patients with node-negative Stage I/II breast cancer were prospectively enrolled in an institutional review board approved protocol to receive APBI using IMRT after breast-conserving surgery. The target volume was treated at 3.8 Gy/fraction twice daily for 5 days, to a total dose of 38 Gy. Results: Thirty-six patients were enrolled for a median follow-up time of 44.8 months. The median tumor size was 0.98 cm (range, 0.08-3 cm). The median clinical target volume (CTV) treated was 71.4 cc (range, 19-231 cc), with the mean dose to the CTV being 38.96 Gy. Acute toxicities included Grade 1 erythema in 44% of patients and Grade 2 in 6%, Grade 1 hyperpigmentation in 31% of patients and Grade 2 in 3%, and Grade 1 breast/chest wall tenderness in 14% of patients. No Grade 3/4 acute toxicities were observed. Grade 1 and 2 late toxicities as edema, fibrosis, and residual hyperpigmentation occurred in 14% and 11% of patients, respectively; Grade 3 telangiectasis was observed in 3% of patients. The overall cosmetic outcome was considered 'excellent' or 'good' by 94% of patients and 97% when rated by the physician, respectively. The local control rate was 97%; 1 patient died of a non-cancer-related cause. Conclusions: APBI can be safely and effectively administered using IMRT. In retrospective analysis, IMRT enabled the achievement of normal tissue dose constraints as outlined by Radiation Therapy Oncology Group 04-13/NSABP B-13 while providing excellent conformality for the CTV. Local control and cosmesis have remained excellent at current follow-up, with acceptable rates of acute/late toxicities. Our data suggest that cosmesis is dependent on target volume

  8. Post–breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach — a review of the literature and discussion

    Science.gov (United States)

    Waltho, Daniel; Rockwell, Gloria

    2016-01-01

    Background Post-mastectomy pain syndrome (PMPS) is a frequent complication of breast surgery. There is currently no standard definition for this chronic pain syndrome. The purpose of this review was to establish a consensus for defining PMPS by identifying the various elements included in the definitions and how they vary across the literature, determining how these definitions affect the methodological components therein, and proposing a definition that appropriately encompasses all of the appropriate elements. Methods We searched PubMed to retrieve all studies and case reports on PMPS, and we analyzed definitions of PMPS, inclusion/exclusion criteria, and methods of measuring PMPS. Results Twenty-three studies were included in this review. We identified 7 independent domains for defining PMPS: surgical breast procedure, neuropathic nature, pain of at least moderate intensity, protracted duration, frequent symptoms, appropriate location of the symptoms and exacerbation with movement. These domains were used with varying frequency. Inclusion/exclusion criteria and methods for assessing PMPS also varied markedly. Conclusion To prevent future discrepancies in both the clinical and research settings, we propose a new and complete definition based on the results of our review: PMPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50% of the time; and may be exacerbated by movements of the shoulder girdle. PMID:27668333

  9. Implementation of the technique of partial irradiation accelerated the breast with high doses (HDR) brachytherapy; Puesta en marcha de la tecnica de irradiacion parcial acelerada de la mama con braquterapia de alta tasa de dosis (HDR)

    Energy Technology Data Exchange (ETDEWEB)

    Molina Lopez, M. Y.; Pardo Perez, E.; Castro Novais, J.; Martinez Ortega, J.; Ruiz Maqueda, S.; Cerro Penalver, E. del

    2013-07-01

    The objective of this work is presents procedure carried out in our Centre for the implementation of the accelerated partial breast irradiation (APBI, accelerated partial-breast irradiation) with high-rate brachytherapy (HDR), using plastic tubes as applicators. Carried out measures, the evaluation of the dosimetric parameters analyzing and presenting the results. (Author)

  10. Why Consensus?

    Directory of Open Access Journals (Sweden)

    Francesca Polletta

    2016-05-01

    Full Text Available Activists have long justified their egalitarian organizational forms in prefigurative terms. Making decisions by consensus, decentralizing organization, and rotating leadership serves to model the radically democratic society that activists hope to bring into being. Our comparison of consensus-based decision-making in three historical periods, however, shows that activists have understood the purposes of prefiguration in very different ways. Whereas radical pacifists in the 1940s saw their cooperative organizations as sustaining movement stalwarts in a period of political repression, new left activists in the 1960s imagined that their radically democratic practices would be adopted by ever-widening circles. Along with the political conditions in which they have operated, activists’ distinctive understandings of equality have also shaped the way they have made decisions. Our interviews with 30 leftist activists today reveal a view of decision-making as a place to work through inequalities that are informal, unacknowledged, and pervasive.

  11. Dosimetric comparison of three dimensional conformal radiation therapy versus intensity modulated radiation therapy in accelerated partial breast irradiation

    Directory of Open Access Journals (Sweden)

    S Moorthy

    2016-01-01

    Full Text Available Aim of Study: Breast conserving surgery (BCS is the standard treatment for stage I and II breast cancer. Multiple studies have shown that recurrences after lumpectomy occur mainly in or near the tumor bed. Use of accelerated partial breast irradiation (APBI allows for significant reduction in the overall treatment time that results in increasing patient compliance and decreasing healthcare costs. We conducted a treatment planning study to evaluate the role of intensity modulated radiation therapy (IMRT with regards to three-dimensional conformal radiation therapy (3DCRT in APBI. Materials and Methods: Computed tomography planning data sets of 33 patients (20 right sided and 13 left sided with tumor size less than 3 cm and negative axillary lymph nodes were used for our study. Tumor location was upper outer, upper inner, central, lower inner, and lower outer quadrants in 10, 10, 5, 4 and 4 patients, respectively. Multiple 3DCRT and IMRT plans were created for each patient. Total dose of 38.5 Gy in 10 fractions were planned. Dosimetric analysis was done for the best 3DCRT and IMRT plans. Results: The target coverage has been achieved by both the methods but IMRT provided better coverage (P = 0.04 with improved conformity index (P = 0.01. Maximum doses were well controlled in IMRT to below 108% (P < 0.01. Heart V2 Gy (P < 0.01, lung V5 Gy (P = 0.01, lung V10 Gy (P = 0.02, contralateral breast V1 Gy (P < 0.01, contralateral lung V2 Gy (P < 0.01, and ipsilateral uninvolved breast (P < 0.01 doses were higher with 3DCRT compared to IMRT. Conclusion: Dosimetrically, IMRT–APBI provided best target coverage with less dose to normal tissues compared with 3DCRT-APBI.

  12. Possibility of conservative local treatment after combined chemotherapy and preoperative irradiation for locally advanced noninflammatory breast cancer

    International Nuclear Information System (INIS)

    Purpose: The aims of this prospective study were to evaluate the outcome and the possibility of breast conservation therapy for patients with locally advanced noninflammatory breast cancer after primary chemotherapy followed by external preoperative irradiation. Methods and Materials: Between April 1982 and June 1990, 97 patients with locally advanced nonmetastatic and noninflammatory breast cancer were treated. The median follow-up was 93 months from the beginning of treatment. The induction treatment consisted of four courses of chemotherapy (doxorubicin, vincristine, cyclophosphamide, 5-fluorouracil) followed by preoperative irradiation (45 Gy to the breast and nodal areas). A fifth course of chemotherapy was given after radiation therapy. Three different loco-regional approaches were proposed, depending on the tumoral response. In 37 patients (38%) with residual tumor larger than 3 cm in diameter or located behind the nipple or with bifocal tumors, mastectomy and axillary dissection were performed. Sixty other patients (62%) benefited from conservative treatment: 33 patients (34%) achieved complete remission and no surgery was done but additional radiation boost was given to the initial tumor bed; 27 patients (28%) who had a residual mass less than or equal to 3 cm in diameter were treated by wide excision and axillary dissection followed by a boost to the excision site. After completion of local therapy, all patients received a sixth course of chemotherapy. A maintenance adjuvant chemotherapy regimen without anthracycline was prescribed (12 monthly cycles). Results: The 5-year actuarial loco-regional relapse rate was 16% after radiotherapy alone, 16% following wide excision and radiotherapy, and 5.4% following mastectomy. The 5-year loco-regional relapse rate was significantly higher after conservative local treatment (wide excision and radiotherapy, and radiotherapy alone) than after mastectomy (p = 0.04). After conservative local treatment, the 5-year breast

  13. Adoption of Hypofractionated Whole-Breast Irradiation for Early-Stage Breast Cancer: A National Cancer Data Base Analysis

    International Nuclear Information System (INIS)

    Purpose: To evaluate the relationship of patient, hospital, and cancer characteristics with the adoption of hypofractionation in a national sample of patients diagnosed with early-stage breast cancer. Methods and Materials: We performed a retrospective study of breast cancer patients in the National Cancer Data Base from 2004-2011 who were treated with radiation therapy and met eligibility criteria for hypofractionation. We used logistic regression to identify factors associated with receipt of hypofractionation (vs conventional fractionation). Results: We identified 13,271 women (11.7%) and 99,996 women (88.3%) with early-stage breast cancer who were treated with hypofractionation and conventional fractionation, respectively. The use of hypofractionation increased significantly, with 5.4% of patients receiving it in 2004 compared with 22.8% in 2011 (P<.001 for trend). Patients living ≥50 miles from the cancer reporting facility had increased odds of receiving hypofractionation (odds ratio 1.57 [95% confidence interval 1.44-1.72], P<.001). Adoption of hypofractionation was associated with treatment at an academic center (P<.001) and living in an area with high median income (P<.001). Hypofractionation was less likely to be used in patients with high-risk disease, such as increased tumor size (P<.001) or poorly differentiated histologic grade (P<.001). Conclusions: The use of hypofractionation is rising and is associated with increased travel distance and treatment at an academic center. Further adoption of hypofractionation may be tempered by both clinical and nonclinical concerns

  14. Adoption of Hypofractionated Whole-Breast Irradiation for Early-Stage Breast Cancer: A National Cancer Data Base Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Elyn H. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Mougalian, Sarah S. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Department of Medical Oncology, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Soulos, Pamela R. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Rutter, Charles E.; Evans, Suzanne B. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States); Haffty, Bruce G. [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Gross, Cary P. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Yu, James B., E-mail: james.b.yu@yale.edu [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States)

    2014-12-01

    Purpose: To evaluate the relationship of patient, hospital, and cancer characteristics with the adoption of hypofractionation in a national sample of patients diagnosed with early-stage breast cancer. Methods and Materials: We performed a retrospective study of breast cancer patients in the National Cancer Data Base from 2004-2011 who were treated with radiation therapy and met eligibility criteria for hypofractionation. We used logistic regression to identify factors associated with receipt of hypofractionation (vs conventional fractionation). Results: We identified 13,271 women (11.7%) and 99,996 women (88.3%) with early-stage breast cancer who were treated with hypofractionation and conventional fractionation, respectively. The use of hypofractionation increased significantly, with 5.4% of patients receiving it in 2004 compared with 22.8% in 2011 (P<.001 for trend). Patients living ≥50 miles from the cancer reporting facility had increased odds of receiving hypofractionation (odds ratio 1.57 [95% confidence interval 1.44-1.72], P<.001). Adoption of hypofractionation was associated with treatment at an academic center (P<.001) and living in an area with high median income (P<.001). Hypofractionation was less likely to be used in patients with high-risk disease, such as increased tumor size (P<.001) or poorly differentiated histologic grade (P<.001). Conclusions: The use of hypofractionation is rising and is associated with increased travel distance and treatment at an academic center. Further adoption of hypofractionation may be tempered by both clinical and nonclinical concerns.

  15. Comparative dosimetric findings using accelerated partial breast irradiation across five catheter subtypes

    International Nuclear Information System (INIS)

    Accelerated partial breast irradiation (APBI) with balloon and strut adjusted volume implants (SAVI) show promising results with excellent tumor control and minimal toxicity. Knowing the factors that contribute to a high skin dose, rib dose, and D95 coverage may reduce toxicity, improve tumor control, and help properly predict patient outcomes following APBI. A retrospective analysis of 594 patients treated with brachytherapy based APBI at a single institution from May 2008 to September 2014 was grouped by applicator subtype. Patients were treated to a total of 34 Gy (3.4 Gy x 10 fractions over 5 days delivered BID) targeting a planning target volume (PTV) 1.0 cm beyond the lumpectomy cavity using a high dose rate source. SAVI devices had the lowest statistically significant values of DmaxSkin (81.00 ± 29.83), highest values of D90 (101.50 ± 3.66), and D95 (96.09 ± 4.55). SAVI-mini devices had the lowest statistically significant values of DmaxRib (77.66 ± 32.92) and smallest V150 (18.01 ± 3.39). Multi-lumen balloons were able to obtain the smallest V200 (5.89 ± 2.21). Strut-based applicators were more likely to achieve a DmaxSkin and a DmaxRib less than or equal to 100 %. The effect of PTV on V150 showed a strong positive relationship (p < .001). PTV and DmaxSkin showed a weak negative relationship in multi-lumen applicators (p = .016) and SAVI-mini devices (p < .001). PTV and DmaxRib showed a weak negative relationship in multi-lumen applicators (p = .009), SAVI devices (p < .001), and SAVI-mini devices (p < .001). PTV volume is strongly correlated with V150 in all devices and V200 in strut based devices. Larger PTV volumes result in greater V150 and V200, which could help predict potential risks for hotspots and resulting toxicities in these devices. PTV volume is also weakly negatively correlated with max skin dose and max rib dose, meaning that as the PTV volumes increase one can expect slightly smaller max skin and rib doses. Strut based applicators are

  16. Interim Cosmetic Results and Toxicity Using 3D Conformal External Beam Radiotherapy to Deliver Accelerated Partial Breast Irradiation in Patients With Early-Stage Breast Cancer Treated With Breast-Conserving Therapy

    International Nuclear Information System (INIS)

    Purpose: We present our ongoing clinical experience utilizing three-dimensional (3D)-conformal radiation therapy (3D-CRT) to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer treated with breast-conserving therapy. Methods and Materials: Ninety-one consecutive patients were treated with APBI using our previously reported 3D-CRT technique. The clinical target volume consisted of the lumpectomy cavity plus a 10- to 15 -mm margin. The prescribed dose was 34 or 38.5 Gy in 10 fractions given over 5 consecutive days. The median follow-up was 24 months. Twelve patients have been followed for ≥4 years, 20 for ≥3.5 years, 29 for >3.0 years, 33 for ≥2.5 years, and 46 for ≥2.0 years. Results: No local recurrences developed. Cosmetic results were rated as good/excellent in 100% of evaluable patients at ≥ 6 months (n = 47), 93% at 1 year (n = 43), 91% at 2 years (n = 21), and in 90% at ≥3 years (n = 10). Erythema, hyperpigmentation, breast edema, breast pain, telangiectasias, fibrosis, and fat necrosis were evaluated at 6, 24, and 36 months after treatment. All factors stabilized by 3 years posttreatment with grade I or II rates of 0%, 0%, 0%, 0%, 9%, 18%, and 9%, respectively. Only 2 patients (3%) developed grade III toxicity (breast pain), which resolved with time. Conclusions: Delivery of APBI with 3D-CRT resulted in minimal chronic (≥6 months) toxicity to date with good/excellent cosmetic results. Additional follow-up is needed to assess the long-term efficacy of this form of APBI

  17. External beam irradiation plus 192Ir implant after breast-preserving surgery in women with early breast cancer

    International Nuclear Information System (INIS)

    Purpose: To provide more information for the clinician and to analyze the impact of the boost with brachytherapy on the local disease-free survival (LDFS), disease-free survival (DFS), specific overall survival (OS), and cosmesis, a retrospective study of external radiation therapy and 192Ir implantation in early breast cancer at Institut Catala d'Oncologia has been undertaken. Patients and Methods: From 1986 to 1996, 530 patients were selected for this study with a median follow-up period of 39.5 months (range, 10-115 months). External radiation therapy (combined with brachytherapy) was administered postoperatively to the breast in all patients. Mean given dose was 48.7 Gy (range, 42-52 Gy) with external radiation therapy to the breast, and 16.8 Gy (range, 10-27 Gy) was the mean dose with brachytherapy. Variables have been tested for cosmesis. Univariate and multivariate analysis have also been carried out. Results: Mean age of the patients was 54 years (range, 28-81 years). Stages were distributed as follows: 350 patients (66%) in Stage I, 173 in Stage II (32.8%), and 7 in Stage III (1.1%). Pathologic distribution was 445 patients with infiltrating ductal carcinoma (84%), 20 patients with infiltrating lobular carcinoma (4%), and 65 patients (12%) of a miscellaneous group. OS for the entire group was 89.4% and 85.9% at 5 and 7 years respectively. Probability of DFS was 81.7% and 70.1% at 5 and 7 years. The LDFS was 94.9% and 91.7% at 5 and 7 years. The MFS probability was 85.5% and 76.9% at 5 and 7 years, respectively. Univariate analysis demonstrated that age (older than 52 years), premenopausal status, moderate and high histologic grades (Grades II-III), and presence of intraductal comedocarcinoma were prognostic factors for local relapse. Multivariate analysis for local disease-free survival demonstrated that only perineural or muscular infiltration remain as prognostic factors. Tumor dose bed of 70 Gy or higher had a negative impact in breast subcutaneous

  18. Low dose reirradiation in combination with hyperthermia: a palliative treatment for patients with breast cancer recurring in previously irradiated areas.

    Science.gov (United States)

    van der Zee, J; Treurniet-Donker, A D; The, S K; Helle, P A; Seldenrath, J J; Meerwaldt, J H; Wijnmaalen, A J; van den Berg, A P; van Rhoon, G C; Broekmeyer-Reurink, M P

    1988-12-01

    Ninety-seven patients with breast cancer recurring in a previously irradiated area (mean dose 44 Gy) were reirradiated in combination with hyperthermia and had evaluable tumor responses. In the reirradiation series, radiotherapy was given twice weekly in most patients, with a fraction size varying from 200 to 400 cGy, the total dose varying from 8 to 32 Gy. Hyperthermia was given following the radiotherapy fractions. The combined treatment resulted in 35% complete and 55% partial responses. Duration of response was median 4 months for partial response and 26 months for complete response, respectively. The median survival time for all patients was 12 months. Acute skin reaction was mild, with more than moderate erythema in only 14/97 patients. Thermal burns occurred in 44/97 patients, generally at sites where pain sensation was decreased, and therefore they did not cause much inconvenience. In the 19 patients who survived more than 2 years, no late radiation damage was observed. When patients who received a "high dose" (greater than 29 Gy and hyperthermia) were compared with those who received a "low dose" (less than 29 Gy and hyperthermia), a higher complete response rate was observed in the high dose group (58% vs. 24%), whereas no difference in acute toxicity was found. We conclude that reirradiation with 8 x 4 Gy in combination with hyperthermia twice weekly is a safe, effective and well tolerated method for palliative treatment of patients with breast cancer recurring in previously irradiated areas.

  19. Accelerated partial breast irradiation: Using the CyberKnife as the radiation delivery platform in the treatment of early breast cancer

    Directory of Open Access Journals (Sweden)

    Sandra eVermeulen

    2011-11-01

    Full Text Available We evaluate the CyberKnife (Accuray, Incorporated, Sunnyvale, CA for non-invasive delivery of accelerated partial breast irradiation (APBI in early breast cancer patients. Between 6/2009 and 5/2011, 9 patients were treated with CyberKnife APBI. Normal tissue constraints were imposed as outlined in the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 (NSABP/RTOG Protocol (Vicini and White, 2007. Patients received a total dose of 30 Gy in 5 fractions (group 1, n=2 or 34 Gy in 10 fractions (group 2, n=7 delivered to the planning treatment volume (PTV defined as the clinical target volume (CTV + 2 mm. The CTV was defined as either the lumpectomy cavity plus 10 mm (n=2 or 15 mm (n=7. The cavity was defined by a T2-weighted non-contrast breast MRI fused to a planning non-contrast thoracic CT. The CyberKnife Synchrony system tracked gold fiducials sutured into the cavity wall during lumpectomy. Treatments started 4-5 weeks after lumpectomy. The mean PTV was 100 cm3 (range, 92-108 cm3 and 105 cm3 (range, 49-241 cm3 and the mean PTV isodose prescription line was 70% for groups 1 and 2, respectively. The mean percent of whole breast reference volume receiving 100% and 50% of the dose (V100 and V50 for group 1 was 11% (range, 8-13% and 23% (range, 16-30% and for group 2 was 11% (range, 7-14% and 26% (range, 21- 35.0% , respectively. At a median 7 months follow-up (range, 4-26 months, no acute toxicities were seen. Acute cosmetic outcomes were excellent or good in all patients; for those patients with more than 12 months follow-up the late cosmesis outcomes were excellent or good. In conclusion, the lack of observable acute side effects and current excellent/good cosmetic outcomes is promising. We believe this suggests the CyberKnife is a suitable non-invasive radiation platform for delivering APBI with achievable normal tissue constraints.

  20. Identifying Patients Who Are Unsuitable for Accelerated Partial Breast Irradiation Using Three-dimensional External Beam Conformal Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Shikama, Naoto, E-mail: nshikama0525@gmail.com [Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama (Japan); Nakamura, Naoki; Kunishima, Naoaki; Hatanaka, Shogo; Sekiguchi, Kenji [Department of Radiation Oncology, St. Luke' s International Hospital, Tokyo (Japan)

    2012-07-01

    Purpose: Several recent studies reported that severe late toxicities including soft-tissue fibrosis and fat necrosis are present in patients treated with accelerated partial breast irradiation (APBI) and that these toxicities are associated with the large volume of tissue targeted by high-dose irradiation. The present study was performed to clarify which patients are unsuitable for APBI to avoid late severe toxicities. Methods and Materials: Study subjects comprised 50 consecutive patients with Stage 0-II unilateral breast cancer who underwent breast-conserving surgery, and in whom five or six surgical clips were placed during surgery. All patients were subsequently replanned using three-dimensional conformal radiotherapy (3D-CRT) APBI techniques according to the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39 and Radiation Therapy Oncology Group (RTOG) 0413 protocol. The beam arrangements included mainly noncoplanar four- or five-field beams using 6-MV photons alone. Results: Dose-volume histogram (DVH) constraints for normal tissues according to the NSABP/RTOG protocol were satisfied in 39 patients (78%). Multivariate analysis revealed that only long craniocaudal clip distance (CCD) was correlated with nonoptimal DVH constraints (p = 0.02), but that pathological T stage, anteroposterior clip distance (APD), site of ipsilateral breast (IB) (right/left), location of the tumor (medial/lateral), and IB reference volume were not. DVH constraints were satisfied in 20% of patients with a long CCD ({>=}5.5 cm) and 92% of those with a short CCD (p < 0.0001). Median IB reference volume receiving {>=}50% of the prescribed dose (IB-V{sub 50}) of all patients was 49.0% (range, 31.4-68.6). Multivariate analysis revealed that only a long CCD was correlated with large IB-V{sub 50} (p < 0.0001), but other factors were not. Conclusion: Patients with long CCDs ({>=}5.5 cm) might be unsuitable for 3D-CRT APBI because of nonoptimal DVH constraints and large IB

  1. Treatment of partial breast irradiation using modulated electron radiotherapy (MERT) in combination with IMRT; Tratamiento de irradiacion parcial de mama usando radioterapia de electrones modulados (MERT) en combinacion con IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Palma, B. A.; Urba, A.; Leal, A.

    2011-07-01

    Techniques accelerated partial breast irradiation (APBI) is currently being investigated as an alternative to total breast irradiation (WBI). APBI technique involves irradiation of the tumor bed, in a short period of time, based on evidence of local recurrences occur near the primary tumor. The aim of this paper is to investigate the feasibility of APBI treatment plan using the techniques MERT or MERT+IMRT with a scheduler based on Monte Carlo methods (CARMEN).

  2. Calcium distribution in ribs of wistar rats after photon irradiation treatment for breast cancer using micro-XRF

    Energy Technology Data Exchange (ETDEWEB)

    Nogueira, L.P.; Almeida, A.P.; Braz, D. [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil); Barroso, R.C.; Almeida, C.E. de; Salata, C.; Andrade, C.B.V.; Silva, C.M. [Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ (Brazil)

    2012-07-01

    Full text: Therapeutic doses of radiation have been shown to have deleterious consequences on bone health. Among the treatment strategies used for breast cancer treatment, the most used are radiotherapy and chemotherapy. Radiotherapy may be given to destroy the cancer cells using high-dose x-rays. Protocols vary considerably, but generally whole body irradiation totals from 10 to 15 Gy, whereas local therapy totals from 40 to 70 Gy. In clinical practice, the quantitative evaluation of bone tissue relies on measurements of bone mineral density values, which are closely associated with the risk of osteoporotic fracture. Improved survivorship rates of cancer patients receiving radiotherapy increase the importance of understanding the mechanisms and long-term effects of radiation-induced bone loss. In this work, we investigated the variation on calcium distribution in ribs of female Wistar rats (Rattus norvegicus) submitted to photon irradiation with a single dose of 20 Gy. The determination of the calcium distribution was performed using synchrotron radiation micro fluorescence (SR-{mu}XRF) at the X-ray Fluorescence beamline at Brazilian Synchrotron Light Laboratory (LNLS). Animals were irradiated using the linear accelerator Varian (CLINAC 2100) at the University Centre for Cancer Control of the State University of Rio de Janeiro (CUCC/UERJ). The total dose delivered was 20 Gy. The animals were about three months old and weighting about 200g. They were distributed into two groups (seven per group): control (did not receive any treatment) and irradiated (submitted to irradiation procedure) groups. Results showed that calcium content decreased within the dorsal ribs of rats submitted to radiotherapy in comparison to the control group. (author)

  3. The deep inspiration breath hold technique using Abches reduces cardiac dose in patients undergoing left-sided breast irradiation

    International Nuclear Information System (INIS)

    We explored whether the deep inspiration breath hold (DIBH) technique using Abches during left-sided breast irradiation was effective for minimizing the amount of radiation to the heart and lung compared to free breathing (FB). Between February and July 2012, a total of 25 patients with left-sided breast cancer underwent two computed tomography scans each with the DIBH using Abches and using FB after breast-conserving surgery. The scans were retrospectively replanned using standardized criteria for the purpose of this study. The DIBH plans for each patient were compared with FB plans using dosimetric parameters. All patients were successfully treated with the DIBH technique using Abches. Significant differences were found between the DIBH and FB plans for mean heart dose (2.52 vs. 4.53 Gy), heart V30 (16.48 vs. 45.13 cm3), V20 (21.35 vs. 54.55 cm3), mean left anterior descending coronary artery (LAD) dose (16.01 vs. 26.26 Gy, all p 3 of the LAD (41.65 vs. 47.27 Gy, p = 0.017). The mean left lung dose (7.53 vs. 8.03 Gy, p = 0.073) and lung V20 (14.63% vs. 15.72%, p 0.060) of DIBH using Abches were not different significantly compared with FB. We report that the use of a DIBH technique using Abches in breathing adapted radiotherapy for left-sided breast cancer is easily feasible in daily practice and significantly reduces the radiation doses to the heart and LAD, therefore potentially reducing cardiac risk.

  4. Nomogram for Predicting the Risk of Locoregional Recurrence in Patients Treated With Accelerated Partial-Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose: To develop a nomogram taking into account clinicopathologic features to predict locoregional recurrence (LRR) in patients treated with accelerated partial-breast irradiation (APBI) for early-stage breast cancer. Methods and Materials: A total of 2000 breasts (1990 women) were treated with APBI at William Beaumont Hospital (n=551) or on the American Society of Breast Surgeons MammoSite Registry Trial (n=1449). Techniques included multiplanar interstitial catheters (n=98), balloon-based brachytherapy (n=1689), and 3-dimensional conformal radiation therapy (n=213). Clinicopathologic variables were gathered prospectively. A nomogram was formulated utilizing the Cox proportional hazards regression model to predict for LRR. This was validated by generating a bias-corrected index and cross-validated with a concordance index. Results: Median follow-up was 5.5 years (range, 0.9-18.3 years). Of the 2000 cases, 435 were excluded because of missing data. Univariate analysis found that age <50 years, pre-/perimenopausal status, close/positive margins, estrogen receptor negativity, and high grade were associated with a higher frequency of LRR. These 5 independent covariates were used to create adjusted estimates, weighting each on a scale of 0-100. The total score is identified on a points scale to obtain the probability of an LRR over the study period. The model demonstrated good concordance for predicting LRR, with a concordance index of 0.641. Conclusions: The formulation of a practical, easy-to-use nomogram for calculating the risk of LRR in patients undergoing APBI will help guide the appropriate selection of patients for off-protocol utilization of APBI

  5. Nomogram for Predicting the Risk of Locoregional Recurrence in Patients Treated With Accelerated Partial-Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Wobb, Jessica L. [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan (United States); Chen, Peter Y., E-mail: PChen@beaumont.edu [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan (United States); Shah, Chirag [Department of Radiation Oncology, Summa Health System, Akron, Ohio (United States); Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Norwich, Connecticut (United States); Shaitelman, Simona F. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Vicini, Frank A. [Department of Radiation Oncology, Michigan Healthcare Professionals/21st Century Oncology, Farmington, Michigan (United States); Mbah, Alfred K.; Lyden, Maureen [Biostat International Inc, Tampa, Florida (United States); Beitsch, Peter [Department of Surgery, Dallas Breast Center, Dallas, Texas (United States)

    2015-02-01

    Purpose: To develop a nomogram taking into account clinicopathologic features to predict locoregional recurrence (LRR) in patients treated with accelerated partial-breast irradiation (APBI) for early-stage breast cancer. Methods and Materials: A total of 2000 breasts (1990 women) were treated with APBI at William Beaumont Hospital (n=551) or on the American Society of Breast Surgeons MammoSite Registry Trial (n=1449). Techniques included multiplanar interstitial catheters (n=98), balloon-based brachytherapy (n=1689), and 3-dimensional conformal radiation therapy (n=213). Clinicopathologic variables were gathered prospectively. A nomogram was formulated utilizing the Cox proportional hazards regression model to predict for LRR. This was validated by generating a bias-corrected index and cross-validated with a concordance index. Results: Median follow-up was 5.5 years (range, 0.9-18.3 years). Of the 2000 cases, 435 were excluded because of missing data. Univariate analysis found that age <50 years, pre-/perimenopausal status, close/positive margins, estrogen receptor negativity, and high grade were associated with a higher frequency of LRR. These 5 independent covariates were used to create adjusted estimates, weighting each on a scale of 0-100. The total score is identified on a points scale to obtain the probability of an LRR over the study period. The model demonstrated good concordance for predicting LRR, with a concordance index of 0.641. Conclusions: The formulation of a practical, easy-to-use nomogram for calculating the risk of LRR in patients undergoing APBI will help guide the appropriate selection of patients for off-protocol utilization of APBI.

  6. Combined modulated electron and photon beams planned by a Monte-Carlo-based optimization procedure for accelerated partial breast irradiation

    Science.gov (United States)

    Atriana Palma, Bianey; Ureba Sánchez, Ana; Salguero, Francisco Javier; Arráns, Rafael; Míguez Sánchez, Carlos; Walls Zurita, Amadeo; Romero Hermida, María Isabel; Leal, Antonio

    2012-03-01

    The purpose of this study was to present a Monte-Carlo (MC)-based optimization procedure to improve conventional treatment plans for accelerated partial breast irradiation (APBI) using modulated electron beams alone or combined with modulated photon beams, to be delivered by a single collimation device, i.e. a photon multi-leaf collimator (xMLC) already installed in a standard hospital. Five left-sided breast cases were retrospectively planned using modulated photon and/or electron beams with an in-house treatment planning system (TPS), called CARMEN, and based on MC simulations. For comparison, the same cases were also planned by a PINNACLE TPS using conventional inverse intensity modulated radiation therapy (IMRT). Normal tissue complication probability for pericarditis, pneumonitis and breast fibrosis was calculated. CARMEN plans showed similar acceptable planning target volume (PTV) coverage as conventional IMRT plans with 90% of PTV volume covered by the prescribed dose (Dp). Heart and ipsilateral lung receiving 5% Dp and 15% Dp, respectively, was 3.2-3.6 times lower for CARMEN plans. Ipsilateral breast receiving 50% Dp and 100% Dp was an average of 1.4-1.7 times lower for CARMEN plans. Skin and whole body low-dose volume was also reduced. Modulated photon and/or electron beams planned by the CARMEN TPS improve APBI treatments by increasing normal tissue sparing maintaining the same PTV coverage achieved by other techniques. The use of the xMLC, already installed in the linac, to collimate photon and electron beams favors the clinical implementation of APBI with the highest efficiency.

  7. A planning comparison of 7 irradiation options allowed in RTOG 1005 for early-stage breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Guang-Pei, E-mail: gpchen@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Liu, Feng [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); White, Julia [Department of Radiation Oncology, The Ohio State University, Columbus, OH (United States); Vicini, Frank A. [Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI (United States); Freedman, Gary M. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Arthur, Douglas W. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

    2015-04-01

    This study compared the 7 treatment plan options in achieving the dose-volume criteria required by the Radiation Therapy Oncology Group (RTOG) 1005 protocol. Dosimetry plans were generated for 15 representative patients with early-stage breast cancer (ESBC) based on the protocol-required dose-volume criteria for each of the following 7 treatment options: 3D conformal radiotherapy (3DCRT), whole-breast irradiation (WBI) plus 3DCRT lumpectomy boost, 3DCRT WBI plus electron boost, 3DCRT WBI plus intensity-modulated radiation therapy (IMRT) boost, IMRT WBI plus 3DCRT boost, IMRT WBI plus electron boost, IMRT WBI plus IMRT boost, and simultaneous integrated boost (SIB) with IMRT. A variety of dose-volume parameters, including target dose conformity and uniformity and normal tissue sparing, were compared for these plans. For the patients studied, all plans met the required acceptable dose-volume criteria, with most of them meeting the ideal criteria. When averaged over patients, most dose-volume goals for all plan options can be achieved with a positive gap of at least a few tenths of standard deviations. The plans for all 7 options are generally comparable. The dose-volume goals required by the protocol can in general be easily achieved. IMRT WBI provides better whole-breast dose uniformity than 3DCRT WBI does, but it causes no significant difference for the dose conformity. All plan options are comparable for lumpectomy dose uniformity and conformity. Patient anatomy is always an important factor when whole-breast dose uniformity and conformity and lumpectomy dose conformity are considered.

  8. A new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from breast cancer

    International Nuclear Information System (INIS)

    Elderly patients become more important in oncology. In this group, personalized treatment approaches taking into account survival prognoses and comorbidities play a major role. Predictive instruments are necessary to estimate the survival of elderly cancer patients. The importance of separate instruments for different tumor entities has been recognized. In this study, an instrument was generated to estimate the survival of elderly patients developing metastatic spinal cord compression (MSCC) from breast cancer. In 218 elderly patients (age ≥65 years) irradiated for MSCC from breast cancer, nine factors were evaluated for survival: fractionation regimen, age, time from breast cancer diagnosis to RT of MSCC, visceral metastases, other bone metastases, time developing motor deficits, pre-radiotherapy ambulatory status, number of involved vertebrae, and Eastern Cooperative Oncology Group (ECOG) performance score. Factors significantly associated with survival in the Cox regression analysis were included in the prognostic instrument. Scores for each factor were calculated by dividing the 6-months survival rates by 10. The sums of these scores represented the patients’ scores. On multivariate analyses, visceral metastases (p < 0.001), time developing motor deficits (p < 0.001), ambulatory status (p < 0.001), number of involved vertebrae (p = 0.032), and ECOG performance score (p < 0.001) were significant and included in the prognostic instrument. Based on the patients’ scores, three groups were designed: 18–27 points, 28–39 points and 40–42 points. Six-months survival rates were 4, 62 and 100 %, respectively (p < 0.001). This new instrument contributes to personalized treatment in elderly patients with MSCC from breast cancer by predicting an individual patient’s survival prognosis

  9. Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study

    International Nuclear Information System (INIS)

    Background and purpose: To report the 12-year updated results of accelerated partial-breast irradiation (APBI) using multicatheter interstitial high-dose-rate (HDR) brachytherapy (BT). Patients and methods: Forty-five prospectively selected patients with T1N0-N1mi, nonlobular breast cancer without the presence of an extensive intraductal component and with negative surgical margins were treated with APBI after breast-conserving surgery (BCS) using interstitial HDR BT. A total dose of 30.3 Gy (n = 8) and 36.4 Gy (n = 37) in seven fractions within 4 days was delivered to the tumour bed plus a 1-2 cm margin. The median follow-up time was 133 months for surviving patients. Local and regional control, disease-free (DFS), cancer-specific (CSS), and overall survival (OS), as well as late side effects, and cosmetic results were assessed. Results: Four (8.9%) ipsilateral breast tumour recurrences were observed, for a 5-, 10-, and 12-year actuarial rate of 4.4%, 9.3%, and 9.3%, respectively. A total of two regional nodal failures were observed for a 12-year actuarial rate of 4.4%. The 12-year DFS, CSS, and OS was 75.3%, 91.1%, and 88.9%, respectively. Grade 3 fibrosis was observed in one patient (2.2%). No patient developed grade 3 teleangiectasia. Fat necrosis requiring surgical intervention occurred in one woman (2.2%). Cosmetic results were rated excellent or good in 35 patients (77.8%). Conclusions: Twelve-year results with APBI using HDR multicatheter interstitial implants continue to demonstrate excellent long-term local tumour control, survival, and cosmetic results with a low-rate of late side effects.

  10. Accelerated partial breast irradiation in an Asian population: dosimetric findings and preliminary results of a multicatheter interstitial program

    Directory of Open Access Journals (Sweden)

    Koh YV

    2016-09-01

    Full Text Available Yaling Vicky Koh,1 Poh Wee Tan,1 Shaik Ahmad Buhari,2 Philip Iau,2 Ching Wan Chan,2 Liang Shen,3 Sing Huang Tan,4 Johann I-Hsiung Tang1 1Department of Radiation Oncology, National University Cancer Institute Singapore, 2Department of Surgery, National University Hospital, 3Department of Medicine, Biostatistics Unit, National University of Singapore, 4Department of Medical Oncology, National University Cancer Institute Singapore, Singapore Introduction: Accelerated partial breast irradiation (APBI using the multicatheter method has excellent cosmesis and low rates of long-term toxicity. However, there are few studies looking at the feasibility of this procedure and the outcomes in an Asian population. This study aims to look at outcomes at our hospital.Methods: We identified 121 patients treated with APBI at our center between 2008 and 2014. The median follow-up for our patient group was 30 months (range 3.7–66.5. The prescribed dose per fraction was 3.4 Gy in 10 fractions. In this study population, 71% of the patients were Chinese while 15% (n=19 were of other Asian ethnicity.Results: In this study, the median breast volume was 850 cc (range 216–2,108 with 59.5% (n=72 patients with a breast volume of <1,000 cc. The average planning target volume was 134 cc (range 28–324. The number of catheters used ranged from 8 to 25 with an average of 18 catheters used per patient. We achieved an average dose homogeneity index of 0.76 in our patients. The average D90(% was 105% and the average D90(Gy was 3.6 Gy per fraction. The median volume receiving 100% of the prescribed dose (V100 was 161.7 cc (range 33.9–330.1, 150% of the prescribed dose (V150 and 200% of the prescribed dose (V200 was 39.4 cc (range 14.6–69.6 and 14.72 cc (range 6.48–22.25, respectively. Our dosimetric outcomes were excellent even in patients with breast volume under 1,000 cc. There were no cases of grade 3 skin toxicity or acute pneumonitis. Two patients had a

  11. Myocardial perfusion changes in patients irradiated for left-sided breast cancer and correlation with coronary artery distribution

    International Nuclear Information System (INIS)

    Purpose: To evaluate postradiation regional heart perfusion changes with single photon emission tomography (SPECT) myocardial perfusion imaging in 69 patients treated with tangential photon beams radiation therapy (RT) for left-sided breast cancer. To correlate SPECT changes with percent irradiated left ventricle (LV) volume and risk factors for coronary artery disease (CAD). Methods and Materials: Rest SPECT of the LV was acquired pre-RT and at 6-month intervals post-RT. The extent of defects (%) with a severity > 1.5 standard deviations below the mean was quantitatively analyzed for the distributions of the left anterior descending (LAD) artery, left circumflex (LCX) artery, and right coronary artery (RCA) based on computer assisted polar map reconstruction (i.e., bull's-eye-view). Changes in perfusion were correlated with percent irradiated LV receiving > 25 Gy (range 0-32%). Data on patient- and treatment-related factors were collected prospectively (e.g., cardiac premorbidity, risk factors for CAD, chemotherapy, and hormonal treatment). Results: In the LAD distribution, there were increased perfusion defects at 6 months (median 11%; interquartile range 2-23) compared with baseline (median 5%; interquartile range 1-14) (p<0.001). There were no increases in perfusion defects in the LCX or RCA distributions. In multivariate analysis, the SPECT perfusion changes in the LAD distribution at 6 months were independently associated with percent irradiated LV (p<0.001), hormonal therapy (p=0.005), and pre-RT hypercholesterolemia (p=0.006). The SPECT defects in the LAD distribution at 12 and 18 months were not statistically different from those at 6 months. The perfusion defects in the LAD distribution were limited essentially to the regions of irradiated myocardium. Conclusion: Tangential photon beam RT in patients with left-sided breast cancer was associated with short-term SPECT defects in the vascular distribution corresponding to the radiation portals. Factors

  12. Angiosarcoma arising in the non-operated, sclerosing breast after primary irradiation, surviving 6 years post-resection: A case report and review of the Japanese literature

    Directory of Open Access Journals (Sweden)

    Takaaki Ito

    2016-01-01

    Conclusion: Angiosarcoma may occur in the non-operated breast, post irradiation. The potential difficulties of diagnosing angiosarcoma against background fibrosis should be kept in mind. Initial radical surgery currently represents the only effective treatment for improving survival in these patients.

  13. Irradiation of the tumor bed alone after lumpectomy in selected patients with early stage breast cancer treated with breast conserving therapy

    International Nuclear Information System (INIS)

    Purpose: We present the initial findings of our in-house protocol treating the tumor bed alone after lumpectomy with low dose rate (LDR) interstitial brachytherapy in selected patients with early stage breast cancer treated with breast conserving therapy (BCT). Materials and Methods: Since 1/1/93, 50 women with early stage breast cancer were entered into a protocol of tumor bed irradiation alone using an interstitial LDR implant. Patients were eligible if their tumor was an infiltrating ductal carcinoma ≤ 3 cm in maximum diameter, pathologic margins were clear by at least 2 mm, the tumor did not contain an extensive intraductal component, the axilla was surgically staged with ≤ 3 nodes involved with cancer, and a postoperative mammogram was performed. Implants were positioned using a template guide delivering 50 Gy over 96 hours to the lumpectomy bed plus a 1-2 cm margin. Local control, cosmetic outcome, and complications were assessed. Results: Patients ranged in age from 40 to 84 years (median 65). The median tumor size was 10 mm (range, 1-25). Seventeen patients (34%) had well differentiated tumors, 22 (4%) had moderately differentiated tumors, and in 11 (22%) the tumor was poorly differentiated. Forty-five patients (90%) were node negative while 5 (10%) had 1-3 positive nodes. A total of 23 (46%) patients were placed on tamoxifen and 3 (6%) received adjuvant systemic chemotherapy. No patient was lost to follow-up. The median follow-up is 40 months (range 29-50). No patient has experienced a local, regional, or distant failure. One patient died from colorectal carcinoma with no evidence of recurrent breast cancer. Good-to-excellent cosmetic results have been observed in all 50 patients (median cosmetic follow-up 36 months). No patient has experienced significant sequelae related to their implant. Conclusions: Early results with treatment of the tumor bed alone with a LDR interstitial implant appear promising. Long-term follow-up of these patients will be

  14. Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Sharon M., E-mail: sharonlu@ucsd.edu [Department of Radiation Oncology and Center for Advanced Radiotherapy Technologies (CART), University of California, San Diego, La Jolla, CA (United States); Scanderbeg, Daniel J.; Barna, Patrick; Yashar, William; Yashar, Catheryn [Department of Radiation Oncology and Center for Advanced Radiotherapy Technologies (CART), University of California, San Diego, La Jolla, CA (United States)

    2012-04-01

    The SAVI and Contura breast brachytherapy applicators represent 2 recent advancements in brachytherapy technology that have expanded the number of women eligible for accelerated partial breast irradiation in the treatment of early-stage breast cancer. Early clinical experience with these 2 single-entry, multichannel high-dose-rate brachytherapy devices confirms their ease of use and dosimetric versatility. However, current clinical guidelines for SAVI and Contura brachytherapy may result in a smaller or less optimal volume of treated tissue compared with traditional interstitial brachytherapy. This study evaluates the feasibility of using the SAVI and Contura to irradiate larger and irregularly shaped target volumes, approaching what is treatable with the interstitial technique. To investigate whether additional tissue can be treated, 17 patients treated with the SAVI and 3 with the Contura were selected. For each patient, the planning target volume (PTV) was modified to extend 1.1 cm, 1.3 cm, and 1.5 cm beyond the tumor bed cavity. To evaluate dose conformance to an irregularly shaped target volume, 9 patients treated with the SAVI and 3 with the Contura were selected from the original 20 patients. The following asymmetric PTV margin combinations were assessed for each patient: 1.5/0.3, 1.3/0.3, and 1.1/0.3 cm. For all patients, treatment planning was performed, adopting the National Surgical Adjuvant Breast and Bowel Project guidelines, and dosimetric comparisons were made. The 6-1 and 8-1 SAVI devices can theoretically treat a maximal tissue margin of 1.5 cm and an asymmetric PTV with margins ranging from 0.3 to 1.5 cm. The 10-1 SAVI and Contura can treat a maximal margin of 1.3 cm and 1.1 cm, respectively, and asymmetric PTV with margins ranging from 0.3-1.3 cm. Compared with the Contura, the SAVI demonstrated greater dosimetric flexibility. Risk of developing excessive hot spots increased with the size of the SAVI device. Both the SAVI and Contura appear

  15. Persistent seroma after intraoperative placement of MammoSite for accelerated partial breast irradiation: Incidence, pathologic anatomy, and contributing factors

    International Nuclear Information System (INIS)

    Purpose: To investigate the incidence of, and possible factors associated with, seroma formation after intraoperative placement of the MammoSite catheter for accelerated partial breast irradiation. Methods and Materials: This study evaluated 38 patients who had undergone intraoperative MammoSite catheter placement at lumpectomy or reexcision followed by accelerated partial breast irradiation with 34 Gy in 10 fractions. Data were collected regarding dosimetric parameters, including the volume of tissue enclosed by the 100%, 150%, and 200% isodose shells, dose homogeneity index, and maximal dose at the surface of the applicator. Clinical and treatment-related factors were analyzed, including patient age, patient weight, history of diabetes and smoking, use of reexcision, interval between surgery and radiotherapy, total duration of catheter placement, total excised specimen volume, and presence or absence of postprocedural infection. Seroma was verified by clinical examination, mammography, and/or ultrasonography. Persistent seroma was defined as seroma that was clinically detectable >6 months after radiotherapy completion. Results: After a median follow-up of 17 months, the overall rate of any detectable seroma was 76.3%. Persistent seroma (>6 months) occurred in 26 (68.4%) of 38 patients, of whom 46% experienced at least modest discomfort at some point during follow-up. Of these symptomatic patients, 3 required biopsy or complete cavity excision, revealing squamous metaplasia, foreign body giant cell reaction, fibroblasts, and active collagen deposition. Of the analyzed dosimetric, clinical, and treatment-related variables, only body weight correlated positively with the risk of seroma formation (p = 0.04). Postprocedural infection correlated significantly (p = 0.05) with a reduced risk of seroma formation. Seroma was associated with a suboptimal cosmetic outcome, because excellent scores were achieved in 61.5% of women with seroma compared with 83% without seroma

  16. Breast; Sein

    Energy Technology Data Exchange (ETDEWEB)

    Bourgier, C.; Garbay, J.R.; Pichenot, C.; Uzan, C.; Delaloge, S.; Andre, F.; Spielmann, M.; Arriagada, R.; Lefkopoulos, D.; Marsigli, H.; Bondiau, P.Y.; Courdi, A.; Lallemand, M.; Peyrotte, I.; Chapellier, C.; Ferrero, J.M.; Chiovati, P.; Baldissera, A.; Frezza, G.; Vicenzi, L.; Palombarini, M.; Martelli, O.; Degli Esposti, C.; Donini, E.; Romagna CDR, E.; Romagna CDF, E.; Benmensour, M.; Bouchbika, Z.; Benchakroun, N.; Jouhadi, H.; Tawfiq, N.; Sahraoui, S.; Benider, A.; Gilliot, O.; Achard, J.L.; Auvray, H.; Toledano, I.; Bourry, N.; Kwiatkowski, F.; Verrelle, P.; Lapeyre, M.; Tebra Mrad, S.; Braham, I.; Chaouache, K.; Bouaouin, N.; Ghorbel, L.; Siala, W.; Sallemi, T.; Guermazi, M.; Frikha, M.; Daou, J.; El Omrani, A.; Chekrine, T.; Mangoni, M.; Castaing, M.; Folino, E.; Livi, L.; Dunant, A.; Mathieu, M.C.; Bitib, G.P.; Arriagada, R.; Marsigli, H

    2007-11-15

    Nine articles treat the question of breast cancer. Three-dimensional conformal accelerated partial breast irradiation: dosimetric feasibility study; test of dose escalation neo-adjuvant radiotherapy focused by Cyberknife in breast cancer; Three dimensional conformal partial irradiation with the technique by the Irma protocol ( dummy run multi centers of the Emilie Romagne area Italy); Contribution of the neo-adjuvant chemotherapy in the treatment of locally evolved cancers of the uterine cervix; Post operative radiotherapy of breast cancers (N0, pN) after neo-adjuvant chemotherapy. Radiotherapy of one or two mammary glands and ganglions areas,The breast cancer at man; breast conservative treatment; breast cancers without histological ganglions invasion; the breast cancer at 70 years old and more women; borderline mammary phyllod tumors and malignant. (N.C.)

  17. Effects of combined electron-beam irradiation and sous-vide treatments on microbiological and other qualities of chicken breast meat

    International Nuclear Information System (INIS)

    The microbiological safety, refrigeration shelf-life, and nutritional quality of chicken breast meat were investigated following combined electron-beam irradiation and cooking under vacuum (sous-vide). Chicken breast meat inoculated with 106 CFU/g of Listeria monocytogenes was irradiated with an electron beam at doses up to 3.1 kGy under vacuum in barrier bags, cooked in a boiling water bath for 3 min 45 s (previously determined to achieve an internal temperature of 71.1oC), and stored at 8oC for up to 5 weeks. Listeria was undetectable in samples treated with combined sous-vide and irradiation at 3.1 kGy, but the organism survived the sous-vide treatment without irradiation and multiplied during storage. A similar study, conducted with uninoculated chicken breast meat, revealed that the product which received both irradiation (3 kGy) and sous-vide treatment had a shelf-life of at least 8 weeks at 8oC, whereas the unirradiated samples treated sous-vide spoiled in 16 days. Listeria was undetectable in combination treated samples, but some of the unirradiated sous-vide samples tested after long storage showed high levels of Listeria. Some loss of thiamine occurred with the combined treatments. (author)

  18. Effects of combined electron-beam irradiation and sous-vide treatments on microbiological and other qualities of chicken breast meat

    Energy Technology Data Exchange (ETDEWEB)

    Shamsuzzaman, K.; Lucht, L.; Chuaqui-Offermanns, N

    1994-07-01

    The microbiological safety, refrigeration shelf-life, and nutritional quality of chicken breast meat were investigated following combined electron-beam irradiation and cooking under vacuum (sous-vide). Chicken breast meat inoculated with 10{sup 6} CFU/g of Listeria monocytogenes was irradiated with an electron beam at doses up to 3.1 kGy under vacuum in barrier bags, cooked in a boiling water bath for 3 min 45 s (previously determined to achieve an internal temperature of 71.1{sup o}C), and stored at 8{sup o}C for up to 5 weeks. Listeria was undetectable in samples treated with combined sous-vide and irradiation at 3.1 kGy, but the organism survived the sous-vide treatment without irradiation and multiplied during storage. A similar study, conducted with uninoculated chicken breast meat, revealed that the product which received both irradiation (3 kGy) and sous-vide treatment had a shelf-life of at least 8 weeks at 8{sup o}C, whereas the unirradiated samples treated sous-vide spoiled in 16 days. Listeria was undetectable in combination treated samples, but some of the unirradiated sous-vide samples tested after long storage showed high levels of Listeria. Some loss of thiamine occurred with the combined treatments. (author)

  19. Postmastectomy electron-beam-rotation irradiation in locally advanced breast cancer. Prognostic factors of locoregional tumor control

    International Nuclear Information System (INIS)

    Background: Different radiotherapy techniques are used for postmastectomy irradiation. We review the results with the electron-beam-rotation technique in advanced breast cancer patients. Main endpoint was local tumor control. Patients and Methods: From 1990 to 1998 119 patients with adverse pathology features (pT3 17% of patients, pT4 42%, multicentricity 36%, pN≥3 positive nodes and/or pN1biii 81%, close margins 30%) underwent electron-beam-rotation irradiation of the chest wall with daily fractions of 2.0-2.5 Gy per day to 50 Gy total dose after modified radical mastectomy and axillary lymph nodes dissection. A local boost of 10 Gy and/or irradiation of locoregional lymph nodes were applied depending on the completeness of resection and lymph node involvement. Results: After a median follow-up of 73 months for patients at risk the 5-year local tumor control, local tumor control first event, disease-free, and overall survival were 82%, 92%, 57%, and 63% (Kaplan Meier analysis), respectively. Significant predictors of poor local tumor control were maximal tumor diameter ≥5 cm (p=0.01), 'close margins' or residual tumor (p<0.01), four or more involved axillary lymph nodes (p=0.02), two or more involved lymph node levels (p=0.04), negative estrogen receptor status (p=0.03), and high-grade histopathology (GIIb-III, p<0.01). The subgroup analysis showed a high local failure rate of 37% for high-grade (GIIb-III) and estrogen receptor negative tumors, whereas no local recurrence was found in low-grade (GI-IIa) and receptor positive tumors (p=0.01). The multivariate analysis revealed maximal tumor diameter ≥5 cm, four or more involved axillary lymph nodes and high-grade histopathology (GIIb-III) as independent predictors of poor local tumor control. Conclusion: In high-risk breast cancer patients postmastectomy irradiation with the electron-beam-rotation technique is an effective therapy, resulting in a 5-year local failure rate of 8%. Intensified local therapy

  20. Left-Sided Whole Breast Irradiation with Hybrid-IMRT and Helical Tomotherapy Dosimetric Comparison

    OpenAIRE

    An-Cheng Shiau; Chen-Hsi Hsieh; Hui-Ju Tien; Hsin-Pei Yeh; Chi-Ta Lin; Pei-Wei Shueng; Le-Jung Wu

    2014-01-01

    Purpose. Limited-tomotherapy and hybrid-IMRT treatment techniques were compared for reductions in ipsilateral and contralateral lung, heart, and contralateral breast radiation doses. Methods and Materials. Thirty consecutively treated left-sided early-stage breast cancer patients were scheduled for lTomo and hIMRT. For the hIMRT plan conventional tangential-field and four-field IMRT plans were combined with different weightings in the prescribed dose. For the lTomo plan a geometrically limite...

  1. Left-sided breast cancer irradiation using rotational and fixed-field radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Qi, X. Sharon, E-mail: xqi@mednet.ucla.edu [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA (United States); Liu, Tian X. [Department of Radiology, Baylor College of Medicine, Houston, TX (United States); Liu, Arthur K.; Newman, Francis; Rabinovitch, Rachel; Kavanagh, Brian [Department of Radiation Oncology, University of Colorado, Denver, CO (United States); Hu, Y. Angie [Department of Radiation Oncology, Duke University, Durham, NC (United States)

    2014-10-01

    The 3-dimensional conformal radiotherapy (3DCRT) technique is the standard for breast cancer radiotherapy. During treatment planning, not only the coverage of the planning target volume (PTV) but also the minimization of the dose to critical structures, such as the lung, heart, and contralateral breast tissue, need to be considered. Because of the complexity and variations of patient anatomy, more advanced radiotherapy techniques are sometimes desired to better meet the planning goals. In this study, we evaluated external-beam radiation treatment techniques for left breast cancer using various delivery platforms: fixed-field including TomoDirect (TD), static intensity-modulated radiotherapy (sIMRT), and rotational radiotherapy including Elekta volumetric-modulated arc therapy (VMAT) and tomotherapy helical (TH). A total of 10 patients with left-sided breast cancer who did or did not have positive lymph nodes and were previously treated with 3DCRT/sIMRT to the entire breast were selected, their treatment was planned with Monaco VMAT, TD, and TH. Dosimetric parameters including PTV coverage, organ-at-risk (OAR) sparing, dose-volume histograms, and target minimum/maximum/mean doses were evaluated. It is found that for plans providing comparable PTV coverage, the Elekta VMAT plans were generally more inhomogeneous than the TH and TD plans. For the cases with regional node involvement, the average mean doses administered to the heart were 9.2 (± 5.2) and 8.8 (± 3.0) Gy in the VMAT and TH plans compared with 11.9 (± 6.4) and 11.8 (± 9.2) Gy for the 3DCRT and TD plans, respectively, with slightly higher doses given to the contralateral lung or breast or both. On average, the total monitor units for VMAT plans are 11.6% of those TH plans. Our studies have shown that VMAT and TH plans offer certain dosimetric advantages over fixed-field IMRT plans for advanced breast cancer requiring regional nodal treatment. However, for early-stage breast cancer fixed

  2. Modern Hypofractionation Schedules for Tangential Whole Breast Irradiation Decrease the Fraction Size-corrected Dose to the Heart

    DEFF Research Database (Denmark)

    Appelt, Ane L; Vogelius, Ivan R; Bentzen, Søren M

    2013-01-01

    as calculated from the EQD(2) dose distributions, were compared between schedules. Results: For alpha/beta = 3 Gy, V-40(Gy)EQD2 favours hypofractionation for 40 Gy/15 fractions, 39 Gy/13 fractions and 42.5 Gy/16 fractions, but not for 41.6 Gy/13 fractions. All of the hypofractionation schedules result in lower...... D-mean(EQD2) compared with normofractionation. These results hold as long as alpha/beta greater than or similar to 1.5 Gy. If the heart is blocked from the treatment beam, the fraction size-corrected dose is lower for the first three hypofractionation schedules, compared with normofractionation......, even for alpha/beta = similar to 1 Gy. Conclusion: For standard tangential field whole breast irradiation, most of the examined hypofractionation schedules are estimated to spare the heart when compared with normofractionation. The dose to the heart, adjusted for fraction size using the linear...

  3. Three-year outcomes of a once daily fractionation scheme for accelerated partial breast irradiation (APBI) using 3-D conformal radiotherapy (3D-CRT)

    International Nuclear Information System (INIS)

    The aim of this study was to report 3-year outcomes of toxicity, cosmesis, and local control using a once daily fractionation scheme (49.95 Gy in 3.33 Gy once daily fractions) for accelerated partial breast irradiation (APBI) using three-dimensional conformal radiotherapy (3D-CRT). Between July 2008 and August 2010, women aged ≥40 years with ductal carcinoma in situ or node-negative invasive breast cancer ≤3 cm in diameter, treated with breast-conserving surgery achieving negative margins, were accrued to a prospective study. Women were treated with APBI using 3–5 photon beams, delivering 49.95 Gy over 15 once daily fractions over 3 weeks. Patients were assessed for toxicities, cosmesis, and local control rates before APBI and at specified time points. Thirty-four patients (mean age 60 years) with Tis 0 (n = 9) and T1N0 (n = 25) breast cancer were treated and followed up for an average of 39 months. Only 3% (1/34) patients experienced a grade 3 subcutaneous fibrosis and breast edema and 97% of the patients had good/excellent cosmetic outcome at 3 years. The 3-year rate of ipsilateral breast tumor recurrence (IBTR) was 0% while the rate of contralateral breast events was 6%. The 3-year disease-free survival (DFS), overall survival (OS), and breast cancer-specific survival (BCSS) was 94%, 100%, and 100%, respectively. Our novel accelerated partial breast fractionation scheme of 15 once daily fractions of 3.33 Gy (49.95 Gy total) is a remarkably well-tolerated regimen of 3D-CRT-based APBI. A larger cohort of patients is needed to further ascertain the toxicity of this accelerated partial breast regimen

  4. Techniques of tumour bed boost irradiation in breast conserving therapy: Current evidence and suggested guidelines

    International Nuclear Information System (INIS)

    Breast conservation surgery followed by external beam radiotherapy to breast has become the standard of care in management of early carcinoma breast. A boost to the tumour bed after whole breast radiotherapy is employed in view of the pattern of tumour bed recurrences in the index quadrant and was particularly considered in patients with some adverse histopathological characteristics such as positive margins, extensive intraductal carcinoma (EIC), lymphovascular invasion (LVI), etc. There is however, now, a conclusive evidence of improvement in local control rates after a boost radiotherapy dose in patients even without such factors and for all age groups. The maximum absolute reduction of local recurrences by the addition of boost is especially seen in young premenopausal patients. At the same time, the addition of boost is associated with increased risk of worsening of cosmesis and no clear cut survival advantage. Radiological modalities such as fluoroscopy, ultrasound and CT scan have aided in accurate delineation of tumour bed with increasing efficacy. A widespread application of these techniques might ultimately translate into improved local control with minimal cosmetic deficit. The present article discusses the role of radiotherapy boost and the means to delineate and deliver the same, identify the high risk group, optimal technique and the doses and fractionations to be used. It also discusses the extent of adverse cosmetic outcome after boost delivery, means to minimise it and relevance of tumour bed in present day scenario of advanced radiotherapy delivery techniques like (IMRT)

  5. Twelve years' experience with irradiation as the primary treatment for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nobler, M.P. (Mount Sinai School of Medicine, New York, NY); Venet, L.

    1981-01-01

    Ninety patients received comprehensive, high-dose, supervoltage teletherapy as the primary treatment for carcinoma of the breast, following a biopsy or a segmental resection. The tumor doses delivered to the breast ranged between 5600 and 7000 rad in six to nine weeks; the draining lymph nodes received tumor doses of 5000 to 7000 rad in six to eight weeks. In five cases, Iridium-192 implants were employed to boost the radiation dose to the breast, and in seven instances a toilette mastectomy was performed for residual cancer. Satisfactory local control and cosmetic results were achieved in 86 patients. The patients were followed for 2 1/2 to 12 1/2 years. The local control rates were: Stage I, 100%, Stage II, 95%; Stage III, 100%; Stave IV (M-0), 89%; Stave IV (M-1), 100%. The overall disease-free survival figures were: Stage I, 85%; Stage II, 48%; Stage III, 50%; and Stage IV (M-0), 29%. We feel that this approach to the initial management of breast cancer is a practical, useful, and successful substitute for mastectomy when medical or surgical contraindications exist, or when the patient refuses a mastectomy.

  6. Techniques of tumour bed boost irradiation in breast conserving therapy: Current evidence and suggested guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Jalali, Rakesh; Singh, Suruchi; Budrukkar, Ashwini [Tata Memorial Hospital, Mumbai (India)

    2007-10-15

    Breast conservation surgery followed by external beam radiotherapy to breast has become the standard of care in management of early carcinoma breast. A boost to the tumour bed after whole breast radiotherapy is employed in view of the pattern of tumour bed recurrences in the index quadrant and was particularly considered in patients with some adverse histopathological characteristics such as positive margins, extensive intraductal carcinoma (EIC), lymphovascular invasion (LVI), etc. There is however, now, a conclusive evidence of improvement in local control rates after a boost radiotherapy dose in patients even without such factors and for all age groups. The maximum absolute reduction of local recurrences by the addition of boost is especially seen in young premenopausal patients. At the same time, the addition of boost is associated with increased risk of worsening of cosmesis and no clear cut survival advantage. Radiological modalities such as fluoroscopy, ultrasound and CT scan have aided in accurate delineation of tumour bed with increasing efficacy. A widespread application of these techniques might ultimately translate into improved local control with minimal cosmetic deficit. The present article discusses the role of radiotherapy boost and the means to delineate and deliver the same, identify the high risk group, optimal technique and the doses and fractionations to be used. It also discusses the extent of adverse cosmetic outcome after boost delivery, means to minimise it and relevance of tumour bed in present day scenario of advanced radiotherapy delivery techniques like (IMRT)

  7. Investigation of variability in image acquisition and contouring during 3D ultrasound guidance for partial breast irradiation

    International Nuclear Information System (INIS)

    Three-dimensional ultrasound (3DUS) at simulation compared to 3DUS at treatment is an image guidance option for partial breast irradiation (PBI). This study assessed if user dependence in acquiring and contouring 3DUS (operator variability) contributed to variation in seroma shifts calculated for breast IGRT. Eligible patients met breast criteria for current randomized PBI studies. 5 Operators participated in this study. For each patient, 3 operators were involved in scan acquisitions and 5 were involved in contouring. At CT simulation (CT1), a 3DUS (US1) was performed by a single radiation therapist (RT). 7 to 14 days after CT1 a second CT (CT2) and 3 sequential 3DUS scans (US2a,b,c) were acquired by each of 3 RTs. Seroma shifts, between US1 and US2 scans were calculated by comparing geometric centers of the seromas (centroids). Operator contouring variability was determined by comparing 5 RT’s contours for a single image set. Scanning variability was assessed by comparing shifts between multiple scans acquired at the same time point (US1-US2a,b,c). Shifts in seromas contoured on CT (CT1-CT2) were compared to US data. From an initial 28 patients, 15 had CT visible seromas, met PBI dosimetric constraints, had complete US data, and were analyzed. Operator variability contributed more to the overall variability in seroma localization than the variability associated with multiple scan acquisitions (95% confidence mean uncertainty of 6.2 mm vs. 1.1 mm). The mean standard deviation in seroma shift was user dependent and ranged from 1.7 to 2.9 mm. Mean seroma shifts from simulation to treatment were comparable to CT. Variability in shifts due to different users acquiring and contouring 3DUS for PBI guidance were comparable to CT shifts. Substantial inter-observer effect needs to be considered during clinical implementation of 3DUS IGRT

  8. Cosmetic Outcomes for Accelerated Partial Breast Irradiation Before Surgical Excision of Early-Stage Breast Cancer Using Single-Dose Intraoperative Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: Determine cosmetic outcome and toxicity profile of intraoperative radiation delivered before tumor excision for patients with early-stage breast cancer. Methods and Materials: Patients age 48 or older with ultrasound-visible invasive ductal cancers <3 cm and clinically negative lymph nodes were eligible for treatment on this institutional review board-approved Phase II clinical trial. Treatment planning ultrasound was used to select an electron energy and cone size sufficient to cover the tumor plus a 1.5- to 2.0-cm circumferential margin laterally and a 1-cm-deep margin with the 90% isodose line. The dose was prescribed to a nominal 15 Gy and delivered using a Mobetron electron irradiator before tumor excision by segmental mastectomy. Physician- and patient-assessed cosmetic outcome and patient satisfaction were determined by questionnaire. Results: From March 2003 to July 2007, 71 patients were treated with intraoperative radiation therapy. Of those, 56 patients were evaluable, with a median follow-up of 3.1 years (minimum 1 year). Physician and patient assessment of cosmesis was 'good or excellent' (Radiation Therapy Oncology Group cosmesis scale) in 45/56 (80%) and 32/42 (76%) of all patients, respectively. Eleven patients who received additional whole breast radiation had similar rates of good or excellent cosmesis: 40/48 (83%) and 29/36 (81%), respectively). Grade 1 or 2 acute toxicities were seen in 4/71 (6%) patients. No Grade 3 or 4 toxicities or serious adverse events have been seen. Conclusion: Intraoperative radiotherapy delivered to an in situ tumor is feasible with acceptable acute tolerance. Patient and physician assessment of the cosmetic outcome is good to excellent.

  9. The in vitro immunogenic potential of caspase-3 proficient breast cancer cells with basal low immunogenicity is increased by hypofractionated irradiation

    International Nuclear Information System (INIS)

    Radiotherapy is an integral part of breast cancer treatment. Immune activating properties of especially hypofractionated irradiation are in the spotlight of clinicians, besides the well-known effects of radiotherapy on cell cycle and the reduction of the clonogenic potential of tumor cells. Especially combination of radiotherapy with further immune stimulation induces immune-mediated anti-tumor responses. We therefore examined whether hypofractionated irradiation alone or in combination with hyperthermia as immune stimulants is capable of inducing breast cancer cells with immunogenic potential. Clonogenic assay, AnnexinA5-FITC/Propidium iodide assay and ELISA analyses of heat shock protein 70 and high mobility group box 1 protein were applied to characterize colony forming capability, cell death induction, cell death forms and release of danger signals by breast cancer cells in response to hypofractionated radiation (4x4Gy, 6x3Gy) alone and in combination with hyperthermia (41.5 °C for 1 h). Caspase-3 deficient, hormone receptor positive, p53 wild type MCF-7 and caspase-3 intact, hormone receptor negative, p53 mutated MDA-MB231 breast cancer cells, the latter in absence or presence of the pan-caspase inhibitor zVAD-fmk, were used. Supernatants of the treated tumor cells were analyzed for their potential to alter the surface expression of activation markers on human-monocyte-derived dendritic cells. Irradiation reduced the clonogenicity of caspase deficient MCF-7 cells more than of MDA-B231 cells. In contrast, higher amounts of apoptotic and necrotic cells were induced in MDA-B231 cells after single irradiation with 4Gy, 10Gy, or 20Gy or after hypofractionated irradiation with 4x4Gy or 6x3Gy. MDA-B231 cells consecutively released higher amounts of Hsp70 and HMGB1 after hypofractionated irradiation. However, only the release of Hsp70 was further increased by hyperthermia. Both, apoptosis induction and release of the danger signals, was dependent on caspase-3. Only

  10. Radiation Therapy Risk Factors for Development of Lymphedema in Patients Treated With Regional Lymph Node Irradiation for Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: We previously evaluated the risk of breast cancer-related lymphedema (LE) with the addition of regional lymph node irradiation (RLNR) and found an increased risk when RLNR is used. Here we analyze the association of technical radiation therapy (RT) factors in RLNR patients with the risk of LE development. Methods and Materials: From 2005 to 2012, we prospectively screened 1476 women for LE who underwent surgery for breast cancer. Among 1507 breasts treated, 172 received RLNR and had complete technical data for analysis. RLNR was delivered as supraclavicular (SC) irradiation (69% [118 of 172 patients]) or SC plus posterior axillary boost (PAB) (31% [54 of 172]). Bilateral arm volume measurements were performed pre- and postoperatively. Patients' RT plans were analyzed for SC field lateral border (relative to the humeral head), total dose to SC, RT fraction size, beam energy, and type of tangent (normal vs wide). Cox proportional hazards models were used to analyze associated risk factors for LE. Results: Median postoperative follow-up was 29.3 months (range: 4.9-74.1 months). The 2-year cumulative incidence of LE was 22% (95% confidence interval [CI]: 15%-32%) for SC and 20% (95% CI: 11%-37%) for SC plus PAB (SC+PAB). None of the analyzed variables was significantly associated with LE risk (extent of humeral head: P=.74 for <1/3 vs >2/3, P=.41 for 1/3 to 2/3 vs >2/3; P=.40 for fraction size of 1.8 Gy vs 2.0 Gy; P=.57 for beam energy 6 MV vs 10 MV; P=.74 for tangent type wide vs regular; P=.66 for SC vs SC+PAB). Only pretreatment body mass index (hazard ratio [HR]: 1.09; 95% CI: 1.04-1.15, P=.0007) and the use of axillary lymph node dissection (HR: 7.08, 95% CI: 0.98-51.40, P=.05) were associated with risk of subsequent LE development. Conclusions: Of the RT parameters tested, none was associated with an increased risk of LE development. This study underscores the need for future work investigating alternative RLNR risk factors for LE

  11. Radiation Therapy Risk Factors for Development of Lymphedema in Patients Treated With Regional Lymph Node Irradiation for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chandra, Ravi A. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Miller, Cynthia L. [Harvard Medical School, Boston, Massachusetts (United States); Skolny, Melissa N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Horick, Nora [Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts (United States); Jammallo, Lauren S.; Sadek, Betro T.; Shenouda, Mina N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); O' Toole, Jean [Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts (United States); Specht, Michelle C. [Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-03-15

    Purpose: We previously evaluated the risk of breast cancer-related lymphedema (LE) with the addition of regional lymph node irradiation (RLNR) and found an increased risk when RLNR is used. Here we analyze the association of technical radiation therapy (RT) factors in RLNR patients with the risk of LE development. Methods and Materials: From 2005 to 2012, we prospectively screened 1476 women for LE who underwent surgery for breast cancer. Among 1507 breasts treated, 172 received RLNR and had complete technical data for analysis. RLNR was delivered as supraclavicular (SC) irradiation (69% [118 of 172 patients]) or SC plus posterior axillary boost (PAB) (31% [54 of 172]). Bilateral arm volume measurements were performed pre- and postoperatively. Patients' RT plans were analyzed for SC field lateral border (relative to the humeral head), total dose to SC, RT fraction size, beam energy, and type of tangent (normal vs wide). Cox proportional hazards models were used to analyze associated risk factors for LE. Results: Median postoperative follow-up was 29.3 months (range: 4.9-74.1 months). The 2-year cumulative incidence of LE was 22% (95% confidence interval [CI]: 15%-32%) for SC and 20% (95% CI: 11%-37%) for SC plus PAB (SC+PAB). None of the analyzed variables was significantly associated with LE risk (extent of humeral head: P=.74 for <1/3 vs >2/3, P=.41 for 1/3 to 2/3 vs >2/3; P=.40 for fraction size of 1.8 Gy vs 2.0 Gy; P=.57 for beam energy 6 MV vs 10 MV; P=.74 for tangent type wide vs regular; P=.66 for SC vs SC+PAB). Only pretreatment body mass index (hazard ratio [HR]: 1.09; 95% CI: 1.04-1.15, P=.0007) and the use of axillary lymph node dissection (HR: 7.08, 95% CI: 0.98-51.40, P=.05) were associated with risk of subsequent LE development. Conclusions: Of the RT parameters tested, none was associated with an increased risk of LE development. This study underscores the need for future work investigating alternative RLNR risk factors for LE.

  12. Postoperative irradiation in breast cancer patients with one to three positive axillary lymph nodes. Is there an impact of axillary extranodal tumor extension on locoregional and distant control?

    Energy Technology Data Exchange (ETDEWEB)

    Stranzl, H. [Dept. of Radiotherapy-Radiooncology, Univ. Medical School, Graz (Austria); Ofner, P. [Inst. for Medical Informatics, Statistics and Documentation, Univ. Medical School, Graz (Austria); Peintinger, F. [Div. of Gynecology, Leoben (Austria)

    2006-10-15

    Background and purpose: to evaluate the impact of extracapsular extension (ECE) on locoregional and distant control in breast cancer patients with one to three positive axillary lymph nodes treated with postoperative irradiation. As shown in literature, ECE is diagnosed in up to 30% of node-positive breast cancer patients. Consequences of ECE and prognosis of these patients are unclear. Patients and methods: the medical records of 1,142 node-positive females with a carcinoma of the breast, postoperatively irradiated between 1994 and 2003, were retrospectively reviewed. Of the 274 patients presenting with one to three positive axillary lymph nodes, 91 (33.2%) showed ECE, While all patients were irradiated using tangential fields, only eight out of 274 patients received additional nodal irradiation. Results: patients' mean age was 58.2 years (range, 28-96 years), and the mean observation period 42.9 months (range, 6.6-101 months). In 93.4% of patients, locoregional control was achieved. On multivariate analysis of metastases-free survival, the hazard ratios for ECE and histological grade 3 were 2.71 (95% confidence interval [CI], 1.316-5.581; p = 0.007) and 2.435 (95% CI, 1.008-5.885; p = 0.048), respectively. The 3-year and 5-year metastases-free survival rates for patients with ECE were 78% and 66%, compared to 90% and 87% in patients without ECE (p = 0.0048). Conclusion: locoregional recurrence remains low in breast cancer patients (one to three positive axillary lymph nodes {+-} ECE) treated with surgery, adequate axillary dissection, and tangential field irradiation only. However, ECE is significantly linked to a considerable risk for subsequent distant failure. (orig.)

  13. Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI)

    Energy Technology Data Exchange (ETDEWEB)

    Qiu, Jian-Jian [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai (China); Department of Oncology, Shanghai Medical College, Fudan University, Shanghai (China); Chang, Zheng; Horton, Janet K.; Wu, Qing-Rong Jackie; Yoo, Sua [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Yin, Fang-Fang, E-mail: fangfang.yin@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

    2014-07-01

    The purpose is to dosimetrically compare the following 3 delivery techniques: 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated arc therapy (IMRT), and volumetric-modulated arc therapy (V-MAT) in the treatment of accelerated partial-breast irradiation (APBI). Overall, 16 patients with T1/2N0 breast cancer were treated with 3D-CRT (multiple, noncoplanar photon fields) on the RTOG 0413 partial-breast trial. These cases were subsequently replanned using static gantry IMRT and V-MAT technology to understand dosimetric differences among these 3 techniques. Several dosimetric parameters were used in plan quality evaluation, including dose conformity index (CI) and dose-volume histogram analysis of normal tissue coverage. Quality assurance studies including gamma analysis were performed to compare the measured and calculated dose distributions. The IMRT and V-MAT plans gave more conformal target dose distributions than the 3D-CRT plans (p < 0.05 in CI). The volume of ipsilateral breast receiving 5 and 10 Gy was significantly less using the V-MAT technique than with either 3D-CRT or IMRT (p < 0.05). The maximum lung dose and the ipsilateral lung volume receiving 10 (V{sub 10}) or 20 Gy (V{sub 20}) were significantly less with both V-MAT and IMRT (p < 0.05). The IMRT technique was superior to 3D-CRT and V-MAT of low dose distributions in ipsilateral lung (p < 0.05 in V{sub 5} and D{sub 5}). The total mean monitor units (MUs) for V-MAT (621.0 ± 111.9) were 12.2% less than those for 3D-CRT (707.3 ± 130.9) and 46.5% less than those for IMRT (1161.4 ± 315.6) (p < 0.05). The average machine delivery time was 1.5 ± 0.2 minutes for the V-MAT plans, 7.0 ± 1.6 minutes for the 3D-CRT plans, and 11.5 ± 1.9 minutes for the IMRT plans, demonstrating much less delivery time for V-MAT. Based on this preliminary study, V-MAT and IMRT techniques offer improved dose conformity as compared with 3D-CRT techniques without increasing dose to the ipsilateral lung. In

  14. A Prospective Study of the Utility of Magnetic Resonance Imaging in Determining Candidacy for Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Dorn, Paige L.; Al-Hallaq, Hania A.; Haq, Farah; Goldberg, Mira [Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois (United States); Abe, Hiroyuki [Department of Radiology, University of Chicago Medical Center, Chicago, Illinois (United States); Hasan, Yasmin [Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois (United States); Chmura, Steven J., E-mail: schmura@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois (United States)

    2013-03-01

    Purpose: Retrospective data have demonstrated that breast magnetic resonance imaging (MRI) may change a patient's eligibility for partial breast irradiation (PBI) by identifying multicentric, multifocal, or contralateral disease. The objective of the current study was to prospectively determine the frequency with which MRI identifies occult disease and to establish clinical factors associated with a higher likelihood of MRI prompting changes in PBI eligibility. Methods and Materials: At The University of Chicago, women with breast cancer uniformly undergo MRI in addition to mammography and ultrasonography. From June 2009 through May 2011, all patients were screened prospectively in a multidisciplinary conference for PBI eligibility based on standard imaging, and the impact of MRI on PBI eligibility according to National Surgical Adjuvant Breast and Bowel Project protocol B-39/Radiation Therapy Oncology Group protocol 0413 entry criteria was recorded. Univariable analysis was performed using clinical characteristics in both the prospective cohort and in a separate cohort of retrospectively identified patients. Pooled analysis was used to derive a scoring index predictive of the risk that MRI would identify additional disease. Results: A total of 521 patients were screened for PBI eligibility, and 124 (23.8%) patients were deemed eligible for PBI based on standard imaging. MRI findings changed PBI eligibility in 12.9% of patients. In the pooled univariable analysis, tumor size ≥2 cm on mammography or ultrasonography (P=.02), age <50 years (P=.01), invasive lobular histology (P=.01), and HER-2/neu amplification (P=.01) were associated with a higher likelihood of MRI changing PBI eligibility. A predictive score was generated by summing the number of significant risk factors. Patients with a score of 0, 1, 2, and 3 had changes to eligibility based on MRI findings in 2.8%, 13.2%, 38.1%, and 100%, respectively (P<.0001). Conclusions: MRI identified additional

  15. Treatment of early stage breast cancer by limited surgery and radical irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Chu, A.M.; Cope, O.; Russo, R.; Wang, C.C.; Schulz, M.D.; Wang, C.; Rodkey, G.

    1980-01-01

    Eighty-five female patients with early stage breast cancer, i.e., Stage I and II were treated by limited surgery followed by radical radiation therapy at Massachusetts General Hospital between January, 1956 and December, 1974. Patients included those who were medically inoperable or who refused mastectomy. The 5-year survival rate was 83% and 76% for Stage I and II, respectively. The corresponding disease free survival (absolute) was 67% and 42%. Although the number of patients so treated is small, there was no significant difference in survival from the results of the radical mastectomy series at the same institution. No major complications were encountered. Seventeen of eighty-five patients developed minor problems; mostly fibrosis and minimal arm lymphedema stemmming from older orthovoltage equipment and treatment techniques. With the current availability of megavoltage equipment, improvements in techniques and dosimetry, complications should decrease. Combined limited surgery and radical radiation therapy should be considered in those patients where a radical mastectomy is not feasible because of psychological or medical problems. Since this procedure results in a cosmetically acceptable breast, radical radiation in early stage breast cancer seems a reasonable alternative to radical mastectomy.

  16. Changes in Pulmonary Function Up to 10 Years After Locoregional Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose: To evaluate the long-term impact of locoregional breast radiotherapy (RT) on pulmonary function tests (PFTs). Methods and Materials: This study included 75 women who underwent postoperative locoregional breast RT. PFTs were performed before RT and 3, 6, and 12 months and 8 to 10 years after RT. By use of univariate and multivariate analyses, the impact of treatment- and patient-related factors on late changes in PFTs was evaluated. Results: During the first year after RT, all PFTs significantly worsened at 3 to 6 months after RT (p 1) recovered almost to baseline values, whereas total lung capacity (TLC) and diffusion capacity of carbon monoxide (DLCO) recovered only slightly and were still found to be decreased compared with baseline (p 1 of 4% (p = 0.03) and in VC, DLCO, and TLC of 5%, 9%, and 11% (all p 1 (p = 0.027). For FEV1 and DLCO, an early decrease was predictive for a late decrease (p = 0.003 and p = 0.0009, respectively). Conclusions: The time course of PFT changes after locoregional RT for breast cancer follows a biphasic pattern. An early reduction in PFTs at 3 to 6 months with a partial recovery at 12 months after RT is followed by a late, more important PFT reduction up to 8 to 10 years after RT. Tamoxifen use may have an impact on this late decline in PFTs.

  17. Left-Sided Whole Breast Irradiation with Hybrid-IMRT and Helical Tomotherapy Dosimetric Comparison

    Directory of Open Access Journals (Sweden)

    An-Cheng Shiau

    2014-01-01

    Full Text Available Purpose. Limited-tomotherapy and hybrid-IMRT treatment techniques were compared for reductions in ipsilateral and contralateral lung, heart, and contralateral breast radiation doses. Methods and Materials. Thirty consecutively treated left-sided early-stage breast cancer patients were scheduled for lTomo and hIMRT. For the hIMRT plan conventional tangential-field and four-field IMRT plans were combined with different weightings in the prescribed dose. For the lTomo plan a geometrically limited arc was designed for the beamlet entrance. A Dp of 50.4 Gy in 28 fractions was used for the PTV. The dose coverage, homogeneity index, conformity index of the target, and the dose volumes of critical structures were compared. Results. Both modalities presented similar target coverage. The homogeneity and conformity were improved for lTomo with P<0.001 and P=0.006, respectively. In the lTomo plan a concave dose distribution was generated with significant dose reductions in both high and low dose regions for ipsilateral lung and heart (P<0.001. Conclusions. lTomo plan can have similar dose coverage and better homogeneity and conformity to the target. By properly designing the directionally and completely blocked structure, lTomo plan was developed successfully in reducing doses to the healthy tissues for early-stage left-sided breast cancer radiotherapy.

  18. Endostatin and irradiation modifies the activity of ADAM10 and neprilysin in breast cancer cells.

    Science.gov (United States)

    Aydemir, Esra Arslan; Şimşek, Ece; Korcum, Aylin Fidan; Fişkin, Kayahan

    2016-09-01

    Angiogenesis, the formation of new blood vessels, is regarded as a key cancer cell property. Endostatin (ES) is a potential antiangiogenic agent and it may be useful when implemented in combination with other cancer therapeutic strategies. The present study investigated the in vitro effects of ES, radiotherapy (RT) or combination therapy (ES + RT) on two important proteases, a disintegrin and metalloproteinase domain‑containing protein 10 (ADAM10) and neprilysin (NEP) in 4T1 mouse breast cancer cells and the more metastatic phenotype of 4THMpc breast cancer cells. 4T1 and 4THMpc cells were treated with recombinant murine ES (4 µg/ml) alone, RT (45 Gy) alone or with ES + RT. ADAM10 enzyme activity was determined using a tumor necrosis factor‑α converting enzyme (α‑secretase) activity assay kit, and NEP enzyme activity was measured with a fluorometric assay based on the generation of free dansyl‑D‑Ala‑Gly from N-dansyl-Ala-Gly-D-nitro-Phe-Gly, the substrate of NEP. Western blotting analysis was performed to determine whether the altered enzyme activity levels of the two cell lines occurred due to changes in expression level. These data indicate that ES independently potentiates the activity of ADAM10 and NEP enzymes in 4T1 and 4THMpc breast cancer cells. PMID:27430992

  19. Can We Predict Plan Quality for External Beam Partial Breast Irradiation: Results of a Multicenter Feasibility Study (Trans Tasman Radiation Oncology Group Study 06.02)

    Energy Technology Data Exchange (ETDEWEB)

    Kron, Tomas, E-mail: Tomas.Kron@petermac.org [Peter MacCallum Cancer Centre, Departments of Radiation Oncology, Physical Sciences and Radiation Therapy, Melbourne, Victoria (Australia); Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria (Australia); School of Science, Engineering and Technology, Royal Melbourne Institute of Technology University, Melbourne, Victoria (Australia); Willis, David; Link, Emma [Peter MacCallum Cancer Centre, Departments of Radiation Oncology, Physical Sciences and Radiation Therapy, Melbourne, Victoria (Australia); Lehman, Margot [Princess Alexandra Hospital, Department of Radiation Oncology, Brisbane, Queensland (Australia); Campbell, Gillian [Auckland City Hospital, Department of Radiation Oncology, Auckland (New Zealand); O' Brien, Peter [Newcastle Calvary Mater Hospital, Department of Radiation Oncology, Newcastle, NSW (Australia); Chua, Boon [Peter MacCallum Cancer Centre, Departments of Radiation Oncology, Physical Sciences and Radiation Therapy, Melbourne, Victoria (Australia); Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria (Australia)

    2013-11-15

    Purpose: Partial breast irradiation (PBI) after lumpectomy may be an option for selected patients with early breast cancer. A feasibility study of accelerated PBI delivered using external beam 3-dimensional conformal radiation therapy (RT) was undertaken at 8 Australasian centers. The present study evaluated the impact of patient, tumor, and RT technique-related factors on the quality of RT plans as determined by the dose–volume parameters of organs at risk. Methods and Materials: Forty-eight patients were enrolled in the study. All RT plans were centrally reviewed using predefined dosimetric criteria before commencement and after completion of protocol therapy. The RT plans of 47 patients met the dose–volume constraints, and all 47 patients received PBI to a prescribed dose of 38.5 Gy in 10 fractions. The RT plan quality was determined by volumes of the ipsilateral whole breast, lung, and heart that received 50% and 95%; 30%; and 5% of the prescribed dose, respectively. Patient, tumor, and RT technique-related factors were investigated for association with the parameters of RT plan quality. Results: The ratio of the planning target volume to the ipsilateral whole-breast volume was significantly associated with the ipsilateral breast doses on multiple variable analyses. The distance of the postlumpectomy surgical cavity from the heart and lung were predictive for heart and lung doses, respectively. A distance between surgical cavity and heart of >4 cm typically resulted in <1% of the heart volume receiving 5 Gy or less. It was more difficult to meet the heart dose constraint for left-sided and medially located tumors. Conclusions: Partial breast irradiation using 3-dimensional conformal RT was feasible within the study constraints. The ratio of planning target volume to ipsilateral whole-breast volume and the distance of surgical cavity from the heart were significant predictors of the quality of treatment plan for external beam PBI.

  20. Five-Year Outcomes, Cosmesis, and Toxicity With 3-Dimensional Conformal External Beam Radiation Therapy to Deliver Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose: To report the interim results from a study comparing the efficacy, toxicity, and cosmesis of breast-conserving treatment with accelerated partial breast irradiation (APBI) or whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy (3D-CRT). Methods and Materials: 102 patients with early-stage breast cancer who underwent breast-conserving surgery were randomized to receive either WBI (n=51) or APBI (n=51). In the WBI arm, 48 Gy was delivered to the whole breast in daily fractions of 2 Gy, with or without additional 10 Gy to the tumor bed. In the APBI arm, patients received 37.5 Gy in 3.75 Gy per fraction delivered twice daily. Toxicity results were scored according to the Radiation Therapy Oncology Group Common Toxicity Criteria. Skin elasticity was measured using a dedicated device (Multi-Skin-Test-Center MC-750-B2, CKelectronic-GmbH). Cosmetic results were assessed by the physician and the patients as good/excellent, regular, or poor. Results: The median follow-up time was 5 years. No local recurrences were observed. No significant differences in survival rates were found. APBI reduced acute side effects and radiation doses to healthy tissues compared with WBI (P75% of patients in the APBI arm had excellent or good cosmesis, and these outcomes appear to be stable over time. The percentage of patients with excellent/good cosmetic results was similar in both groups. Conclusions: APBI delivered by 3D-CRT to the tumor bed for a selected group of early-stage breast cancer patients produces 5-year results similar to those achieved with conventional WBI

  1. Breast

    International Nuclear Information System (INIS)

    Ultrasound is not an efficacious screening modality to detect early-stage breast malignancy in a clinically unremarkable population of women. Computed body tomography is similarly not practical for screening because of slice thickness and partial volume averaging, a higher radiation dose than modern mammography, and the lack of availability of such units for such a high throughput requirement. Nevertheless, these two imaging modalities can be very useful in management to guide the least invasive and efficacious treatment of the patient. X-ray mammography remains the principal imaging modality in the search for breast malignancy, but ultrasound is the single most important second study in the diagnostic evaluation of the breast. The combined use of these techniques and the ability to perform guided aspiration and localization procedures can result in a reduction in the surgical removal of benign cysts and reduction in the amount of tissue volume required if excision becomes necessary

  2. Supraclavicular Nodal Failure after Surgery in N1 Breast Cancer Patients without Supraclavicular Irradiation

    Directory of Open Access Journals (Sweden)

    Alia M. Attia

    2016-01-01

    Full Text Available Background: We conducted a retrospective analysis to evaluate the impact of omission of supraclavicular radiotherapy on supraclavicular failure rate and treatment outcomes in N1 breast cancer patients with evaluation of prognostic factors that affected supraclavicular recurrence free survival. Methods: This study analyzed the medical records of 109 patients with N1 breast cancer. All patients underwent surgery and received adjuvant chemotherapy without supraclavicular radiotherapy. Supraclavicular recurrence free survival, distant metastasis free survival, disease free survival, and overall survival were estimated using the Kaplan-Meier method and compared using log-rank analysis. Results:After a median follow up period of 58 months, treatment failed in 31 patients (28.4%; patterns of failure consisted of locoregional (n=21, 19.3%, isolated supraclavicular (n=7, 6.4%, and distant metastasis (n=14, 12.8%. Survival rates at 5 years were as follows: supraclavicular recurrence free survival (84.9%, distant metastasis free survival (87.6%, and overall survival (86.4%. Univariate analysis revealed that the type of chemotherapeutic regimen was the only significant prognostic factor affected supraclavicular recurrence free survival; patients who received the cyclophosphamide, methotrexate, 5-fluorouracil chemotherapy regimen experienced lower supraclavicular recurrence free survival than those who received doxorubicin based and taxane based chemotherapy. Development of supraclavicular recurrence significantly lowered the 5-year overall survival (57.1% and distant metastasis free survival (50% rates compared to patients without supraclavicular recurrence who had an overall survival rate of 88.5% (P<0.0001 and distant metastasis free survival rate of 90% (P<0.0001. Conclusion: Patients with N1 breast cancer had an overall supraclavicular recurrence of 6.4% which denoted that additional supraclavicular radiotherapy was unnecessary and could be given in N1

  3. Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed

    International Nuclear Information System (INIS)

    Purpose: A prospectively applied treatment policy for breast-conserving therapy used margin assessment as the exclusive guide to the intensity of therapy directed at the tumor-bearing quadrant. Methods and Materials: From 1982-1994, there were 509 treated Stage I and II breast carcinomas with a median follow-up of 72 months. For operational purposes, tumor excision margins were prospectively defined as: > 5 mm, 2.1-5 mm, > 0 ≤ 2 mm, and positive. If a margin was assessed as ≤2 mm or indeterminate, and it was deemed cosmetically feasible, a reexcision of the tumor bed would be performed. All patients received whole breast irradiation to 50-50.4 Gy. The following scheme for tumor bed boost irradiation as a function of final margin status (FMS) was observed: (a) Minimal risk = no tumor found on reexcision, no boost performed; (b) low risk = FMS > 5 mm, boost of 10 Gy; intermediate risk = FMS 2.1-5 mm, boost to 14 Gy; high risk = FMS ≤ 2 mm or positive, boost to 20 Gy. Cases were analyzed for local failure (LF) with respect to histology (invasive ductal (IDC), IDC with associated DCIS (IDC/DCIS), invasive lobular (ILC)), age, tumor size, total excision volume, reexcision, total dose, tamoxifen therapy, and chemotherapy. Results: There were 19 breast recurrences for a Kaplan-Meier local failure rate for all cases at 5 and 10 years of 2.7% and 7.1%, respectively. Local failure in the first 4 years of follow-up was rare, with a mean annual incidence rate of 0.25% that rose to a mean of 1.1% in subsequent years. Univariate results of Cox proportional hazards regression survival models found positive FMS (p 0.02), IDC/DCIS (p = 0.04) and age (0.0006) as significantly associated with local failure. In a multivariable model of FMS and IDC/DCIS, FMS retained significance (p = 0.01) but IDC/DCIS was borderline (p = 0.06). When FMS and age were included in a multivariable model, there was a significant interaction (p = 0.01) between the two variables. There was a

  4. Treatment Optimization Using Computed Tomography-Delineated Targets Should be Used for Supraclavicular Irradiation for Breast Cancer

    International Nuclear Information System (INIS)

    Background: The purpose of this study was to determine whether the use of optimized CT treatment planning offered better coverage of axillary level III (LIII)/supraclavicular (SC) targets than the empirically derived dose prescription that are commonly used. Materials/Methods: Thirty-two consecutive breast cancer patients who underwent CT treatment planning of a SC field were evaluated. Each patient was categorized according to body mass index (BMI) classes: normal, overweight, or obese. The SC and LIII nodal beds were contoured, and four treatment plans for each patient were generated. Three of the plans used empiric dose prescriptions, and these were compared with a CT-optimized plan. Each plan was evaluated by two criteria: whether 98% of target volume receive >90% of prescribed dose and whether < 5% of the irradiated volume received 105% of prescribed dose. Results: The mean depth of SC and LIII were 3.2 cm (range, 1.4-6.7 cm) and 3.1 (range, 1.7-5.8 cm). The depth of these targets varied according across BMI classes (p = 0.01). Among the four sets of plans, the CT-optimized plans were the most successful at achieving both of the dosimetry objectives for every BMI class (normal BMI, p = .003; overweight BMI, p < .0001; obese BMI, p < .001). Conclusions: Across all BMI classes, routine radiation prescriptions did not optimally cover intended targets for every patient. Optimized CT-based treatment planning generated the most successful plans; therefore, we recommend the use of routine CT simulation and treatment planning of SC fields in breast cancer

  5. Study on antitussive effects of eprazinone dihydrochloride on radiation induced inflammation of upper respiratory tract due to postoperative irradiation of breast cancer

    International Nuclear Information System (INIS)

    Discussion was made of antitussive effects of Eprazinone hydrochloride (Resplen) on radiation induced inflammation of the upper respiratory tract in 15 cases irradiated after an operation of breast cancer. Depth dose at 3 cm was 200 rads/day, and 5000 rad/25 times/5 weeks was irradiated with telecobalt. Mainly abnormal sensation and pain in the throat and cough appeared and patients complained of suffering from a common cold, because a part of irradiation field included the throat, trachea, and esophagus. At the same time as manifestation of symptoms, 120 mg/day of Eprazinone Dihydrochloride was administered. In 8 cases, other drugs were added to, or irradiation schedule was changed because the symptoms were not improved or were exaggerated. The symptoms disappeared up to 5000 rad irradiation in one case, up to 4000 - 5000 rad irradiation in 4 cases, and up to 4000 rad irradiation in 2 cases. It is impossible to decide effective rate of this drug because of shortage of clinical cases, but it is suggested that there is a significance to increase cases treated successively with this drug in future. (Tsunoda, M.)

  6. Radiation injuries to bones of the thorax after irradiation of carcinoma of the breast and lung

    International Nuclear Information System (INIS)

    An analysis of the state of 396 patients undergoing radiotherapy for carcinoma of the breast and carcinoma of the lung gave the following results. During treatment of carcinoma of the breast, radiation injuries, mainly of the ribs and clavicle, were found in 11 of 158 patients treated (7.0 +/- 2.0 percent), more frequently after x-ray therapy (in nine of 70 cases, 12.9 +/- 4.0 percent). In the case of x-ray therapy, the minimal focal dose causing radiation injury to bone was 4,500 rads. The larger the dose and the shorter the course of treatment, the more frequently these changes were found. During treatment of carcinoma of the lung, radiation injuries were discovered in the ribs in ten patients and in the spine in one (of 238 patients treated). The frequency was 4.6 +/- 1.4 percent. They occurred after treatment on a linear accelerator with a frequency of 5.1 +/- 1.6 percent, and after treatment on the γ-ray apparatus in 1 of 27 patients. The minimal focal dose causing injury to bone when a linear accelerator was used was 5,000 rad. If the skin above the region of injury remained intact, clinical manifestations of the lesion were minimal. Repeated observations over a course of several years showed that the changes developed slowly and that consolidation of a radiation fracture can take place. On the whole, the course of the process is directly dependent on the size of the dose given

  7. Role of lymph node irradiation in breast cancer patients with negative pathologic node status after neo-adjuvant chemotherapy: The Rene-Huguenin Cancer Center experience; Role de l'irradiation ganglionnaire chez les patientes indemnes d'envahissement ganglionnaire apres chimiotherapie neoadjuvante pour un cancer du sein: experience du centre Rene-Huguenin

    Energy Technology Data Exchange (ETDEWEB)

    Daveau, C.; Labib, A.; Berges, O.; Moisson, P.; De la Lande, B.; Le Scodan, R. [Departement de radiotherapie, centre Rene-Huguenin, hopital Rene Huguenin, institut Curie, 92 - Saint-Cloud (France); Stevens, D. [Departement de biostatistiques, centre Rene-Huguenin, 92 - Saint-Cloud (France)

    2010-12-15

    Purpose: Neo-adjuvant chemotherapy generally induces significant changes in the pathological extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation in breast cancer patients with pathological N0 status (pN0) after neo-adjuvant chemotherapy and breast-conserving surgery. Patients and materials: Among 1054 breast cancer patients treated with neo-adjuvant chemotherapy in our institution between 1990 and 2004, 248 patients with clinical N0 or N1-N2 lymph node status at diagnosis had pN0 status after neo-adjuvant chemotherapy and breast-conserving surgery. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival, disease-free survival and overall survival. Results: All 248 patients received breast irradiation, and 158 patients (63.7%) also received lymph node irradiation. With a median follow-up of 88 months, the 5-year locoregional recurrence-free survival and overall survival rates were respectively 89.4% and 88.7% with lymph node irradiation and 86.2% and 92% without lymph node irradiation (no significant difference). Survival was poorer among patients who did not have a pathological complete primary tumor response (pCR) (hazards ratio [HR] = 3.05; 95% CI, 1.17 to 7.99) and in patients with N1-N2 clinical status at diagnosis ([HR] = 2.24; 95% CI, 1.15 to 4.36). Lymph node irradiation did not significantly affect survival. Conclusions: Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among breast cancer patients with pN0 status after neo-adjuvant chemotherapy. These results need to be confirmed in a prospective study. (authors)

  8. Locally advanced non inflammatory breast cancer treated by combined chemotherapy and preoperative irradiation: updated results in a series of 120 patients

    International Nuclear Information System (INIS)

    Purpose. - To evaluate our updated data concerning survival and locoregional control in a study of locally advanced non inflammatory breast cancer after primary chemotherapy followed by external preoperative irradiation. Patients and methods. - Between 1982 and 1998, 120 patients (75 stage IIIA, 41 stage IIIB, and 4 stage IIIC according to AJCC staging system 2002) were consecutively treated by four courses of induction chemotherapy with anthracycline-containing combinations followed by preoperative irradiation (45 Gy to the breast and nodal areas) and a fifth course of chemotherapy. Three different locoregional approaches were proposed, depending on tumour characteristics and tumour response. After completion of local therapy, all patients received a sixth course of chemotherapy and a maintenance adjuvant chemotherapy regimen without anthracycline. The median follow-up from the beginning of treatment was 140 months. Results. - Mastectomy and axillary dissection were performed in 49 patients (with residual tumour larger than 3 cm in diameter or located behind the nipple or with bifocal tumour), and conservative treatment in 71 patients (39 achieved clinical complete response or partial response >90% and received additional radiation boost to initial tumour bed; 32 had residual mass ≤3 cm in diameter and were treated by wide excision and axillary dissection followed by a boost to the excision site). Ten-year actuarial local failure rate was 13% after irradiation alone, 23% after wide excision and irradiation, and 4% after mastectomy (p =0.1). After multivariate analysis, possibility of breast-conserving therapy was related to initial tumour size (<6 vs. ≥6 cm in diameter, p =0.002). Ten-year overall metastatic disease-free survival rate was 61%. After multivariate analysis, metastatic disease-free survival rates were significantly influenced by clinical stage (stage IIIA-B vs. IIIC, p =0.0003), N-stage (N0 vs. N1-2a, and 3c, p = 0.017), initial tumour size (<6

  9. Irradiation techniques for the breast cancer treatment; Tecnicas de irradiacion para el tratamiento de cancer de mama

    Energy Technology Data Exchange (ETDEWEB)

    Varon T, C.F.; Rojas C, E.L. [ININ, 52750 La Marquesa, Estado de Mexico (Mexico)]. e-mail: cbaron4@yahoo.es

    2007-07-01

    The radiotherapy is a cancer treatment way based on the radiation employment. It acts on the tumor, destroying the wicked cells and impeding that this it grows and reproduce. With the radiotherapy the probability of cure of some types of cancer; among them the one of breast, it increases. The investigations in oncology have allowed to develop new technologies with which is possible, for example, to locate the tumors accurately and to adapt the irradiation fields to their form. This has allowed to improve the treatments since it can destroy the tumor applying an intense radiation dose without producing irreversible damages to other organs and healthy tissues of the body. In the underdeveloped countries or in development as Mexico, and almost all those of Latin America, it is not still possible to have several of these technologies in the main oncological centers of the country by their high cost. It is expected that their cost go lowering and that its going to develop technologies more cheap so that they can be applied in more general way to the population that suffers of this suffering. (Author)

  10. The effect of artemisinin additive combined with irradiation on micronucleus of human breast cancer cells MDA-MB-435

    International Nuclear Information System (INIS)

    In order to analyze the change of micronucleus in the p53 mutant human breast cancer cells MDA-MB-435 caused by artemisinin additive, MTT method was used to check the effect of different concentration and treatment time of artemisinin to cytotoxicity. Cytokinesis block micronucleus method (CB method) was used to determine the micronucleus frequency (MNF) and the micronucleus cell frequency (MNCF) of cells treated by artemisinin additive and with different doses of 60Co γ-rays. The experiment results show that artemisinin is of little toxicity to MDA-MB-435. When drug concentration is 200 μmol/L and treatment time is 24 h, the dose-response curves of MNF and MNCF of irradiated cells combined with treatment of or not artemisinin additive confirm that MNF and MNCF of cells treated by artemisinin are both significantly higher than that treated by radiation alone. It can be deduced that artemisinin may have some sensitive action on radiation therapy. (authors)

  11. Effect of low dose irradiation on estrogen receptor level in MCF-7 breast cancer cells.

    Science.gov (United States)

    Devriendt, D; Ma, Y; Kinnaert, E; Journe, F; Seo, H S; Van Houtte, P; Leclercq, G

    2001-02-20

    Exposure of MCF-7 cells to single and/or repeated low gamma-ray doses (0.5 to 8 Gy) resulted in a decrease in the capacity of these cells to concentrate tritiated estradiol ([3H]E2) (reduction of the number of binding sites). The decrease in the [3H]E2-binding capacity was higher than the survival rate, indicating that it could not be ascribed to cell death. Moreover, such low irradiation doses failed to similarly affect the specific incorporation of [3H]ORG 2058, even when the progesterone receptor was induced by E2, a finding that rejects the hypothesis of a nonspecific effect on all steroid hormone receptors. This loss of [3H]E2 binding was reflected by the elimination of the estrogen receptor alpha (ER) when the latter was assessed by immunocytochemistry. However, additional immunochemical studies (Western blot data) performed on cell extracts under denaturing conditions failed to show any similar elimination of the ER peptide, suggesting that the loss of E2-binding capacity would be relevant to subtle changes in the ER structure and/or ER-associated proteins. The loss of binding capacity, produced by a 3-Gy irradiation, failed to decrease the sensitivity of the cells to E2, since progesterone receptor induction and growth stimulation were maintained. Insufficient ER diminution may explain this observation. PMID:11241328

  12. Accelerated Partial Breast Irradiation With Low-Dose-Rate Interstitial Implant Brachytherapy After Wide Local Excision: 12-Year Outcomes From a Prospective Trial

    Energy Technology Data Exchange (ETDEWEB)

    Hattangadi, Jona A. [Harvard Radiation Oncology Program, Boston, MA (United States); Powell, Simon N. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); MacDonald, Shannon M.; Mauceri, Thomas; Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Freer, Phoebe [Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Lawenda, Brian [21st Century Oncology, Las Vegas, NV (United States); Alm El-Din, Mohamed A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Department of Clinical Oncology, Tanta University Hospital, Tanta (Egypt); Gadd, Michele A.; Smith, Barbara L. [Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

    2012-07-01

    Purpose: To evaluate the long-term toxicity, cosmesis, and local control of accelerated partial breast irradiation with implant brachytherapy after wide local excision for Stage T1N0 breast cancer (BCa). Materials and Methods: Between 1997 and 2001, 50 patients with Stage T1N0M0 BCa were treated in a Phase I-II protocol using low-dose-rate accelerated partial breast irradiation with implant brachytherapy after wide local excision and lymph node surgery. The total dose was escalated in three groups: 50 Gy (n = 20), 55 Gy (n = 17), and 60 Gy (n = 13). Patient- and physician-assessed breast cosmesis, patient satisfaction, toxicity, mammographic abnormalities, repeat biopsies, and disease status were prospectively evaluated at each visit. Kendall's tau ({tau}{sub {beta}}) and logistic regression analyses were used to correlate outcomes with dose, implant volume, patient age, and systemic therapy. Results: The median follow-up period was 11.2 years (range, 4-14). The patient satisfaction rate was 67%, 67% reported good-excellent cosmesis, and 54% had moderate-severe fibrosis. Higher dose was correlated with worse cosmetic outcome ({tau}{sub {beta}} 0.6, p < .0001), lower patient satisfaction ({tau}{sub {beta}} 0.5, p < .001), and worse fibrosis ({tau}{sub {beta}} 0.4, p = .0024). Of the 50 patients, 35% had fat necrosis and 34% developed telangiectasias {>=}1 cm{sup 2}. Grade 3-4 late skin and subcutaneous toxicities were seen in 4 patients (9%) and 6 patients (13%), respectively, and both correlated with higher dose ({tau}{sub {beta}} 0.3-0.5, p {<=} .01). One patient had Grade 4 skin ulceration and fat necrosis requiring surgery. Mammographic abnormalities were seen in 32% of the patients, and 30% underwent repeat biopsy, of which 73% were benign. Six patients had ipsilateral breast recurrence: five elsewhere in the breast, and one at the implant site. One patient died of metastatic BCa after recurrence. The 12-year actuarial local control, recurrence

  13. Accelerated Partial Breast Irradiation With Low-Dose-Rate Interstitial Implant Brachytherapy After Wide Local Excision: 12-Year Outcomes From a Prospective Trial

    International Nuclear Information System (INIS)

    Purpose: To evaluate the long-term toxicity, cosmesis, and local control of accelerated partial breast irradiation with implant brachytherapy after wide local excision for Stage T1N0 breast cancer (BCa). Materials and Methods: Between 1997 and 2001, 50 patients with Stage T1N0M0 BCa were treated in a Phase I-II protocol using low-dose-rate accelerated partial breast irradiation with implant brachytherapy after wide local excision and lymph node surgery. The total dose was escalated in three groups: 50 Gy (n = 20), 55 Gy (n = 17), and 60 Gy (n = 13). Patient- and physician-assessed breast cosmesis, patient satisfaction, toxicity, mammographic abnormalities, repeat biopsies, and disease status were prospectively evaluated at each visit. Kendall’s tau (τβ) and logistic regression analyses were used to correlate outcomes with dose, implant volume, patient age, and systemic therapy. Results: The median follow-up period was 11.2 years (range, 4–14). The patient satisfaction rate was 67%, 67% reported good-excellent cosmesis, and 54% had moderate-severe fibrosis. Higher dose was correlated with worse cosmetic outcome (τβ 0.6, p β 0.5, p β 0.4, p = .0024). Of the 50 patients, 35% had fat necrosis and 34% developed telangiectasias ≥1 cm2. Grade 3–4 late skin and subcutaneous toxicities were seen in 4 patients (9%) and 6 patients (13%), respectively, and both correlated with higher dose (τβ 0.3–0.5, p ≤ .01). One patient had Grade 4 skin ulceration and fat necrosis requiring surgery. Mammographic abnormalities were seen in 32% of the patients, and 30% underwent repeat biopsy, of which 73% were benign. Six patients had ipsilateral breast recurrence: five elsewhere in the breast, and one at the implant site. One patient died of metastatic BCa after recurrence. The 12-year actuarial local control, recurrence-free survival, and overall survival rate was 85% (95% confidence interval, 70–97%), 72% (95% confidence interval, 54–86%), and 87% (95% confidence

  14. Five-Year Outcomes, Cosmesis, and Toxicity With 3-Dimensional Conformal External Beam Radiation Therapy to Deliver Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Rodríguez, Núria, E-mail: nrodriguez@parcdesalutmar.cat [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Universidad Pompeu Fabra, Barcelona (Spain); Sanz, Xavier [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Universidad Pompeu Fabra, Barcelona (Spain); Dengra, Josefa [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Foro, Palmira [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Universidad Pompeu Fabra, Barcelona (Spain); Membrive, Ismael; Reig, Anna [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Quera, Jaume [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Universidad Pompeu Fabra, Barcelona (Spain); Fernández-Velilla, Enric; Pera, Óscar; Lio, Jackson; Lozano, Joan [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Algara, Manuel [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut MAR, Barcelona (Spain); Universidad Pompeu Fabra, Barcelona (Spain)

    2013-12-01

    Purpose: To report the interim results from a study comparing the efficacy, toxicity, and cosmesis of breast-conserving treatment with accelerated partial breast irradiation (APBI) or whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy (3D-CRT). Methods and Materials: 102 patients with early-stage breast cancer who underwent breast-conserving surgery were randomized to receive either WBI (n=51) or APBI (n=51). In the WBI arm, 48 Gy was delivered to the whole breast in daily fractions of 2 Gy, with or without additional 10 Gy to the tumor bed. In the APBI arm, patients received 37.5 Gy in 3.75 Gy per fraction delivered twice daily. Toxicity results were scored according to the Radiation Therapy Oncology Group Common Toxicity Criteria. Skin elasticity was measured using a dedicated device (Multi-Skin-Test-Center MC-750-B2, CKelectronic-GmbH). Cosmetic results were assessed by the physician and the patients as good/excellent, regular, or poor. Results: The median follow-up time was 5 years. No local recurrences were observed. No significant differences in survival rates were found. APBI reduced acute side effects and radiation doses to healthy tissues compared with WBI (P<.01). Late skin toxicity was no worse than grade 2 in either group, without significant differences between the 2 groups. In the ipsilateral breast, the areas that received the highest doses (ie, the boost or quadrant) showed the greatest loss of elasticity. WBI resulted in a greater loss of elasticity in the high-dose area compared with APBI (P<.05). Physician assessment showed that >75% of patients in the APBI arm had excellent or good cosmesis, and these outcomes appear to be stable over time. The percentage of patients with excellent/good cosmetic results was similar in both groups. Conclusions: APBI delivered by 3D-CRT to the tumor bed for a selected group of early-stage breast cancer patients produces 5-year results similar to those achieved with

  15. Mammography and sonography of the postlumpectomy and irradiated breast: Scar evolution

    International Nuclear Information System (INIS)

    Increasing numbers of women are electing lumpectomy and radiation (L and R) therapy in preference to mastectomy. For better cosmetic effect, current lumpectomy surgical techniques call for removal of the mass and closure without approximation of deeper tissues, creating a potential space to fill with fluid (hematoma and/or seroma). Fifty-three L and R patients were imaged by serial mammography and sonography beginning with a preradiation postsurgical study. To follow up resolution of postsurgical fluid collections weekly or biweekly, sonography was performed. Forty-nine percent of patients had fluid collections at 3 months. By 6 months, diminished size, increasing internal echoes, and increasing acoustic attenuation was seen. At 12 months, mature scars were imaged in 88% of patients as irregular, hypoechoic structures with posterior acoustic shadowing often linear in one projection and round in another. At 12-24 months, the scar either remained unchanged or became smaller. Interval growth after one year of rounding of the contours should raise suspicion of recurrence. No recurrences were found at 24 months. Sonography can effectively supplement sequential mammographic studies in following up the postlumpectomy and radiation course of the breast carcinoma patient

  16. A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: treatment planning and quality assurance

    International Nuclear Information System (INIS)

    In Japan, breast-conserving surgery with closed cavity has generally been performed for breast cancer patients, and accelerated partial breast irradiation (APBI) is considered difficult because Asian females generally have smaller breast sizes than Western females. Therefore, common identification of target and treatment plan method in APBI is required. A prospective multicenter study was conducted in Japan to determine institutional compliance with APBI using high-dose-rate interstitial brachytherapy (ISBT) designed for Japanese female patients. For this study, 46 patients were recruited at eight institutions from January 2009 to December 2011. The reproducibility of the ISBT–APBI plan was evaluated using three criteria: (1) minimum clinical target volume dose with a clip dose ≥ 6 Gy/fraction, (2) irradiated volume constraint of 40-150 cm3, and (3) uniformity of dose distribution, expressed as the dose non-uniformity ratio (DNR, V150/V100) < 0.35. The ISBT–APBI plan for each patient was considered reproducible when all three criteria were met. When the number of non-reproducible patients was ≤ 4 at study completion, APBI at this institution was considered statistically reproducible. Half of the patients (52 %) had a small bra size (A/B cup). The mean values of the dose-constrained parameters were as follows: Vref, 117 cm3 (range, 40-282), DNR, 0.30 (range, 0.22-0.51), and clip dose, 784 cGy (range, 469-3146). A total of 43/46 treatment plans were judged to be compliant and ISBT–APBI was concluded to be reproducible. This study showed that multi-institutional ISBT–APBI treatment plan was reproducible for small breast patient with closed cavity

  17. Adoptive transfer of Mammaglobin-A epitope specific CD8 T cells combined with a single low dose of total body irradiation eradicates breast tumors.

    Science.gov (United States)

    Lerret, Nadine M; Rogozinska, Magdalena; Jaramillo, Andrés; Marzo, Amanda L

    2012-01-01

    Adoptive T cell therapy has proven to be beneficial in a number of tumor systems by targeting the relevant tumor antigen. The tumor antigen targeted in our model is Mammaglobin-A, expressed by approximately 80% of human breast tumors. Here we evaluated the use of adoptively transferred Mammaglobin-A specific CD8 T cells in combination with low dose irradiation to induce breast tumor rejection and prevent relapse. We show Mammaglobin-A specific CD8 T cells generated by DNA vaccination with all epitopes (Mammaglobin-A2.1, A2.2, A2.4 and A2.6) and full-length DNA in vivo resulted in heterogeneous T cell populations consisting of both effector and central memory CD8 T cell subsets. Adoptive transfer of spleen cells from all Mammaglobin-A2 immunized mice into tumor-bearing SCID/beige mice induced tumor regression but this anti-tumor response was not sustained long-term. Additionally, we demonstrate that only the adoptive transfer of Mammaglobin-A2 specific CD8 T cells in combination with a single low dose of irradiation prevents tumors from recurring. More importantly we show that this single dose of irradiation results in the down regulation of the macrophage scavenger receptor 1 on dendritic cells within the tumor and reduces lipid uptake by tumor resident dendritic cells potentially enabling the dendritic cells to present tumor antigen more efficiently and aid in tumor clearance. These data reveal the potential for adoptive transfer combined with a single low dose of total body irradiation as a suitable therapy for the treatment of established breast tumors and the prevention of tumor recurrence.

  18. Objective and Longitudinal Assessment of Dermatitis After Postoperative Accelerated Partial Breast Irradiation Using High-Dose-Rate Interstitial Brachytherapy in Patients With Breast Cancer Treated With Breast Conserving Therapy: Reduction of Moisture Deterioration by APBI

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Eiichi [Department of Radiation Oncology, National Hospital Organization, Osaka National Hospital, Osaka (Japan); Yamazaki, Hideya, E-mail: hideya10@hotmail.com [Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto (Japan); Yoshida, Ken; Takenaka, Tadashi [Department of Radiation Oncology, National Hospital Organization, Osaka National Hospital, Osaka (Japan); Masuda, Norikazu [Department of Surgery and Breast Oncology, National Hospital Organization, Osaka National Hospital, Osaka (Japan); Kotsuma, Tadayuki; Yoshioka, Yasuo; Inoue, Takehiro [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita (Japan)

    2011-11-15

    Purpose: To objectively evaluate the radiation dermatitis caused by accelerated partial breast irradiation (APBI) using high-dose-rate interstitial brachytherapy. Patients and Methods: The skin color and moisture changes were examined using a newly installed spectrophotometer and corneometer in 22 patients who had undergone APBI using open cavity implant high-dose-rate interstitial brachytherapy (36 Gy in six fractions) and compared with the corresponding values for 44 patients in an external beam radiotherapy (EBRT) control group (50-60 Gy in 25-30 fractions within 5-6 weeks) after breast conserving surgery. Results: All values changed significantly as a result of APBI. The extent of elevation in a Asterisk-Operator (reddish) and reduction in L Asterisk-Operator (black) values caused by APBI were similar to those for EBRT, with slightly delayed recovery for 6-12 months after treatment owing to the surgical procedure. In contrast, only APBI caused a change in the b Asterisk-Operator values, and EBRT did not, demonstrating that the reduction in b Asterisk-Operator values (yellowish) depends largely on the surgical procedure. The changes in moisture were less severe after APBI than after EBRT, and the recovery was more rapid. The toxicity assessment using the Common Toxicity Criteria, version 3, showed that all dermatitis caused by APBI was Grade 2 or less. Conclusion: An objective analysis can quantify the effects of APBI procedures on color and moisture cosmesis. The radiation dermatitis caused by APBI using the present schedule showed an equivalent effect on skin color and a less severe effect on moisture than the effects caused by standard EBRT.

  19. Late Toxicity and Patient Self-Assessment of Breast Appearance/Satisfaction on RTOG 0319: A Phase 2 Trial of 3-Dimensional Conformal Radiation Therapy-Accelerated Partial Breast Irradiation Following Lumpectomy for Stages I and II Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: Late toxicities and cosmetic analyses of patients treated with accelerated partial breast irradiation (APBI) on RTOG 0319 are presented. Methods and Materials: Patients with stages I to II breast cancer ≤3 cm, negative margins, and ≤3 positive nodes were eligible. Patients received three-dimensional conformal external beam radiation therapy (3D-CRT; 38.5 Gy in 10 fractions twice daily over 5 days). Toxicity and cosmesis were assessed by the patient (P), the radiation oncologist (RO), and the surgical oncologist (SO) at 3, 6, and 12 months from the completion of treatment and then annually. National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, was used to grade toxicity. Results: Fifty-two patients were evaluable. Median follow-up was 5.3 years (range, 1.7-6.4 years). Eighty-two percent of patients rated their cosmesis as good/excellent at 1 year, with rates of 64% at 3 years. At 3 years, 31 patients were satisfied with the treatment, 5 were not satisfied but would choose 3D-CRT again, and none would choose standard radiation therapy. The worst adverse event (AE) per patient reported as definitely, probably, or possibly related to radiation therapy was 36.5% grade 1, 50% grade 2, and 5.8% grade 3 events. Grade 3 AEs were all skin or musculoskeletal-related. Treatment-related factors were evaluated to potentially establish an association with observed toxicity. Surgical bed volume, target volume, the number of beams used, and the use of bolus were not associated with late cosmesis. Conclusions: Most patients enrolled in RTOG 0319 were satisfied with their treatment, and all would choose to have the 3D-CRT APBI again

  20. Late Toxicity and Patient Self-Assessment of Breast Appearance/Satisfaction on RTOG 0319: A Phase 2 Trial of 3-Dimensional Conformal Radiation Therapy-Accelerated Partial Breast Irradiation Following Lumpectomy for Stages I and II Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chafe, Susan, E-mail: susan.chafe@albertahealthservices.ca [Department of Radiation Oncology, Cross Cancer Institute-University of Alberta, Edmonton, Alberta (Canada); Moughan, Jennifer [Department of Radiation Oncology, RTOG Statistical Center, Philadelphia, Pennsylvania (United States); McCormick, Beryl [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wong, John [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (United States); Pass, Helen [Womens' Breast Center, Stamford Hospital, Stamford, Connecticut (United States); Rabinovitch, Rachel [Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado (United States); Arthur, Douglas W. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia (United States); Petersen, Ivy [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); White, Julia [Department of Radiation Oncology, Ohio State University, Columbus, Ohio (United States); Vicini, Frank A. [Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, Michigan (United States)

    2013-08-01

    Purpose: Late toxicities and cosmetic analyses of patients treated with accelerated partial breast irradiation (APBI) on RTOG 0319 are presented. Methods and Materials: Patients with stages I to II breast cancer ≤3 cm, negative margins, and ≤3 positive nodes were eligible. Patients received three-dimensional conformal external beam radiation therapy (3D-CRT; 38.5 Gy in 10 fractions twice daily over 5 days). Toxicity and cosmesis were assessed by the patient (P), the radiation oncologist (RO), and the surgical oncologist (SO) at 3, 6, and 12 months from the completion of treatment and then annually. National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, was used to grade toxicity. Results: Fifty-two patients were evaluable. Median follow-up was 5.3 years (range, 1.7-6.4 years). Eighty-two percent of patients rated their cosmesis as good/excellent at 1 year, with rates of 64% at 3 years. At 3 years, 31 patients were satisfied with the treatment, 5 were not satisfied but would choose 3D-CRT again, and none would choose standard radiation therapy. The worst adverse event (AE) per patient reported as definitely, probably, or possibly related to radiation therapy was 36.5% grade 1, 50% grade 2, and 5.8% grade 3 events. Grade 3 AEs were all skin or musculoskeletal-related. Treatment-related factors were evaluated to potentially establish an association with observed toxicity. Surgical bed volume, target volume, the number of beams used, and the use of bolus were not associated with late cosmesis. Conclusions: Most patients enrolled in RTOG 0319 were satisfied with their treatment, and all would choose to have the 3D-CRT APBI again.

  1. Conformal breast irradiation with the arm of the affected side parallel to the body

    Energy Technology Data Exchange (ETDEWEB)

    Vaegler, S.; Bratengeier, K.; Beckmann, G.; Flentje, M. [University of Wuerzburg, Department of Radiation Oncology, Wuerzburg (Germany)

    2014-01-15

    To propose a simple, forward-planned three-dimensional conformal radiotherapy (3D-CRT) technique for breast cancer patients with frozen shoulder. A technique is described that avoids lateral beams transmitting through the arm of the affected side. One medial, tangentially applied beam deposits most of the dose. Further beams with little weight are used to attain dose homogeneity. In order to quantify dose distribution and homogeneity in the planning target volume (PTV), as well as the scattered dose in organs at risk (OAR), the parameters D95, D5, D1, mean and median dose were determined for the individual volumes. Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were created in order to compare these with the proposed technique. The described technique achieved homogenous dose deposition within the PTV. A regimen comprising 25 fractions of 2 Gy prescribed to the PTV resulted in the following dose parameters: PTV(D95): 44.3 Gy, PTV(D5): 52.7 Gy, PTV(D1): 54.8 Gy, PTV(mean): 49.3 Gy and PTV(median): 49.9 Gy. Mean lung dose was 7.0 Gy. The ipsilateral lung received a mean dose of 9.9 Gy. This plan was accepted for treatment. The IMRT and VMAT plans achieved a similar dose distribution in the PTV. These techniques also reduced dose deposition in the OAR. The proposed 3D-CRT technique allows treatment of breast cancer patients who are not able to raise their arms above their head. Homogenous dose distribution in the PTV was achieved while avoiding lateral beams that transmit through the arm of the affected side. Mean lung dose was comparable to that of the conventional technique using opposed tangential beams. IMRT and VMAT also provide good target dose homogeneity with good sparing of OAR. However, these techniques are more demanding in terms of planning and quality assurance. (orig.) [German] Vorstellung einer einfachen, vorwaerts-geplanten dreidimensionalen (3-D) konformalen Bestrahlungstechnik fuer Brustkrebs bei Patienten

  2. Accelerated partial-breast irradiation with interstitial implants. The clinical relevance of the calculation of skin doses

    Energy Technology Data Exchange (ETDEWEB)

    Ott, O.J.; Lotter, M.; Sauer, R.; Strnad, V. [University Hospital Erlangen (Germany). Dept. of Radiation Oncology

    2007-08-15

    Purpose: To describe relative skin dose estimations and their impact on cosmetic outcome in interstitial multicatheter accelerated partial-breast irradiation (APBI). Patients and Methods: Between April 2001 and January 2005, 105 consecutive patients with early breast cancer were recruited in Erlangen, Germany, for this substudy of the German-Austrian APBI phase II trial. 51% (54/105) received pulsed-dose-rate (PDR), and 49% (51/105) high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy every hour. Total treatment time was 3-4 days. With a wire cross on the skin surface during the brachytherapy-planning procedure the minimal, mean and maximal relative skin doses (SD{sub min%}, SD{sub max%}, SD{sub mean%}) were recorded. Endpoint of this evaluation was the cosmetic outcome in relation to the relative skin doses. Results: Median follow-up time was 38 months (range, 19-65 months). Cosmetic results for all patients were excellent in 57% (60/105), good in 36% (38/105), and fair in 7% (7/105). The SD{sub min%} (27.0% vs. 31.7%; p = 0.032), SD{sub mean%} (34.2% vs. 38.1%; p = 0.008), and SD{sub max%} (38.2% vs. 46.4%; p = 0.003) were significantly lower for patients with excellent cosmetic outcome compared to patients with a suboptimal outcome. SD{sub mean%} (37.6% vs. 34.2%; p = 0.026) and SD{sub max%} (45.4% vs. 38.2%; p = 0.008) were significantly higher for patients with good cosmetic outcome compared with the patients with excellent results. Conclusion: The appraisal of skin doses has been shown to be relevant to the achievement of excellent cosmetic outcome. Further investigations are necessary, especially on the basis of CT-based brachytherapy planning, to further improve the treatment results of multicatheter APBI. (orig.)

  3. Locoregional Failure in Early-Stage Breast Cancer Patients Treated With Radical Mastectomy and Adjuvant Systemic Therapy: Which Patients Benefit From Postmastectomy Irradiation?

    Energy Technology Data Exchange (ETDEWEB)

    Trovo, Marco, E-mail: marcotrovo33@hotmail.com [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Durofil, Elena [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Polesel, Jerry [Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Roncadin, Mario [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Perin, Tiziana [Department of Pathology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Mileto, Mario; Piccoli, Erica [Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Quitadamo, Daniela [Scientific Direction, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Massarut, Samuele [Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Carbone, Antonino [Department of Pathology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Trovo, Mauro G. [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)

    2012-06-01

    Purpose: To assess the locoregional failure in patients with Stage I-II breast cancer treated with radical mastectomy and to evaluate whether a subset of these patients might be at sufficiently high risk of locoregional recurrence (LRR) to benefit from postmastectomy irradiation (PMRT). Methods and Materials: Stage I-II breast cancer patients (n = 150) treated with radical mastectomy without adjuvant irradiation between 1999 and 2005 were analyzed. The pattern of LRR was reported. Kaplan-Meier analysis was used to calculate rates of LRR, and Cox proportional hazards methods were used to evaluate potential risk factors. Results: Median follow-up was 75 months. Mean patient age was 56 years. One-hundred forty-three (95%) patients received adjuvant systemic therapy: 85 (57%) hormonal therapy alone, 14 (9%) chemotherapy alone, and 44 (29%) both chemotherapy and hormonal therapy. Statistically significant factors associated with increased risk of LRR were premenopausal status (p = 0.004), estrogen receptor negative cancer (p = 0.02), pathologic grade 3 (p = 0.02), and lymphovascular invasion (p = 0.001). T and N stage were not associated with increased risk of regional recurrence. The 5-year LRR rate for patients with zero or one, two, three, and four risk factors was 1%, 10.3%, 24.2%, and 75%, respectively. Conclusions: A subset of patients with early-stage breast cancer is at high risk of LRR, and therefore PMRT might be beneficial.

  4. Outcome of a phase II prospective study on partial breast irradiation with interstitial multi-catheter high-dose-rate brachytherapy

    International Nuclear Information System (INIS)

    Background and purpose: Partial breast irradiation (PBI) is an alternative to whole-breast irradiation after breast-conserving surgery in selected patients. Until the results of randomized phase III studies are available, phase II studies inform about PBI. We report the 5 year results of a phase II prospective study with PBI using interstitial multi-catheter high-dose-rate brachytherapy (ClinicalTrials.gov Identifier: (NCT00499057)). Methods: Hundred patients received PBI (4 Gy, twice a day for 4 days, until 32 Gy). Inclusion criteria were: age ⩾40 years, infiltrating carcinoma without lobular histology, ductal in situ carcinoma, tumor size ⩽2.5 cm, negative surgical margins and axillary lymph nodes. Results: At a median follow-up of 60 months late toxicity occurred in 25 patients; the 5-year probability of freedom from late toxicity was 72.6% (95% CI: 63.7–81.7). Tamoxifen was the only significant risk factor for late toxicity. Cosmetic results, judged by physicians and patients, were good/excellent in 98 patients. Three local relapses (1 true, 2 elsewhere) and 1 regional relapse occurred. The 5-year probability of local or regional relapse-free survival was 97.7% (95% CI: 91.1–99.4) and 99.0% (95% CI: 92.9–99.8), respectively. Conclusion: PBI with interstitial multi-catheter brachytherapy is associated with low relapse and late toxicity rates

  5. Phase 2 Trial of Accelerated, Hypofractionated Whole-Breast Irradiation of 39 Gy in 13 Fractions Followed by a Tumor Bed Boost Sequentially Delivering 9 Gy in 3 Fractions in Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ja Young [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Jung, So-Youn; Lee, Seeyoun; Kang, Han-Sung; Lee, Eun Sook; Park, In Hae; Lee, Keun Seok; Ro, Jungsil [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Lee, Nam Kwon [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Radiation Oncology, Korea University Medical Center, Collage of Medicine, Seoul (Korea, Republic of); Shin, Kyung Hwan, E-mail: radiat@ncc.re.kr [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Radiation Oncology, Korea University Medical Center, Collage of Medicine, Seoul (Korea, Republic of)

    2013-12-01

    Purpose: To report a phase 2 trial of accelerated, hypofractionated whole-breast irradiation (AH-WBI) delivered as a daily dose of 3 Gy to the whole breast followed by a tumor bed boost. Methods and Materials: Two hundred seventy-six patients diagnosed with breast cancer (pT1-2 and pN0-1a) who had undergone breast-conserving surgery in which the operative margins were negative were treated with AH-WBI delivered as 39 Gy in 13 fractions of 3 Gy to the whole breast once daily over 5 consecutive working days, and 9 Gy in 3 sequential fractions of 3 Gy to a lumpectomy cavity, all within 3.2 weeks. Results: After a median follow-up period of 57 months (range: 27-75 months), the rate of 5-year locoregional recurrence was 1.4% (n=4), whereas that of disease-free survival was 97.4%. No grade 3 skin toxicity was reported during the follow-up period. Qualitative physician cosmetic assessments of good or excellent were noted in 82% of the patients at 2 months after the completion of AH-WBI. The global cosmetic outcome did not worsen over time, and a good or excellent cosmetic outcome was reported in 82% of the patients at 3 years. The mean pretreatment percentage breast retraction assessment was 12.00 (95% confidence interval [CI]: 11.14-12.86). The mean value of percentage breast retraction assessment increased to 13.99 (95% CI: 12.17-15.96) after 1 year and decreased to 13.54 (95% CI: 11.84-15.46) after 3 years but was not significant (P>.05). Conclusions: AH-WBI consisting of 39 Gy in 13 fractions followed by a tumor bed boost sequentially delivering 9 Gy in 3 fractions can be delivered with excellent disease control and tolerable skin toxicity in patients with early-stage breast cancer after breast-conserving surgery.

  6. Phase 2 Trial of Accelerated, Hypofractionated Whole-Breast Irradiation of 39 Gy in 13 Fractions Followed by a Tumor Bed Boost Sequentially Delivering 9 Gy in 3 Fractions in Early-Stage Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: To report a phase 2 trial of accelerated, hypofractionated whole-breast irradiation (AH-WBI) delivered as a daily dose of 3 Gy to the whole breast followed by a tumor bed boost. Methods and Materials: Two hundred seventy-six patients diagnosed with breast cancer (pT1-2 and pN0-1a) who had undergone breast-conserving surgery in which the operative margins were negative were treated with AH-WBI delivered as 39 Gy in 13 fractions of 3 Gy to the whole breast once daily over 5 consecutive working days, and 9 Gy in 3 sequential fractions of 3 Gy to a lumpectomy cavity, all within 3.2 weeks. Results: After a median follow-up period of 57 months (range: 27-75 months), the rate of 5-year locoregional recurrence was 1.4% (n=4), whereas that of disease-free survival was 97.4%. No grade 3 skin toxicity was reported during the follow-up period. Qualitative physician cosmetic assessments of good or excellent were noted in 82% of the patients at 2 months after the completion of AH-WBI. The global cosmetic outcome did not worsen over time, and a good or excellent cosmetic outcome was reported in 82% of the patients at 3 years. The mean pretreatment percentage breast retraction assessment was 12.00 (95% confidence interval [CI]: 11.14-12.86). The mean value of percentage breast retraction assessment increased to 13.99 (95% CI: 12.17-15.96) after 1 year and decreased to 13.54 (95% CI: 11.84-15.46) after 3 years but was not significant (P>.05). Conclusions: AH-WBI consisting of 39 Gy in 13 fractions followed by a tumor bed boost sequentially delivering 9 Gy in 3 fractions can be delivered with excellent disease control and tolerable skin toxicity in patients with early-stage breast cancer after breast-conserving surgery

  7. External Beam Accelerated Partial-Breast Irradiation Using 32 Gy in 8 Twice-Daily Fractions: 5-Year Results of a Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Pashtan, Itai M. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (United States); Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Brachtel, Elena [Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (United States); Abi-Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); D' Alessandro, Helen A. [Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (United States); Levy, Antonin; Wo, Jennifer Y. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Hirsch, Ariel E. [Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts (United States); Kachnic, Lisa A. [Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Goldberg, Saveli [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Specht, Michelle; Gadd, Michelle; Smith, Barbara L. [Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Powell, Simon N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2012-11-01

    Purpose: External beam accelerated partial breast irradiation (APBI) is an increasingly popular technique for treatment of patients with early stage breast cancer following breast-conserving surgery. Here we present 5-year results of a prospective trial. Methods and Materials: From October 2003 through November 2005, 98 evaluable patients with stage I breast cancer were enrolled in the first dose step (32 Gy delivered in 8 twice-daily fractions) of a prospective, multi-institutional, dose escalation clinical trial of 3-dimensional conformal external beam APBI (3D-APBI). Median age was 61 years; median tumor size was 0.8 cm; 89% of tumors were estrogen receptor positive; 10% had a triple-negative phenotype; and 1% had a HER-2-positive subtype. Median follow-up was 71 months (range, 2-88 months; interquartile range, 64-75 months). Results: Five patients developed ipsilateral breast tumor recurrence (IBTR), for a 5-year actuarial IBTR rate of 5% (95% confidence interval [CI], 1%-10%). Three of these cases occurred in patients with triple-negative disease and 2 in non-triple-negative patients, for 5-year actuarial IBTR rates of 33% (95% CI, 0%-57%) and 2% (95% CI, 0%-6%; P<.0001), respectively. On multivariable analysis, triple-negative phenotype was the only predictor of IBTR, with borderline statistical significance after adjusting for tumor grade (P=.0537). Conclusions: Overall outcomes were excellent, particularly for patients with estrogen receptor-positive disease. Patients in this study with triple-negative breast cancer had a significantly higher IBTR rate than patients with other receptor phenotypes when treated with 3D-APBI. Larger, prospective 3D-APBI clinical trials should continue to evaluate the effect of hormone receptor phenotype on IBTR rates.

  8. Nearly Complete Response of Brain Metastases from HER2 Overexpressing Breast Cancer with Lapatinib and Capecitabine after Whole Brain Irradiation

    Directory of Open Access Journals (Sweden)

    Esin Oktay

    2013-01-01

    Full Text Available Trastuzumab treatment does not prevent intracranial seeding and is largely ineffective for established central nervous system metastasis in HER2 overexpressing breast cancer patients. Combination therapy of lapatinib and capecitabine may be an effective treatment option for brain metastasis of HER2-positive breast cancer. We report a patient with breast cancer overexpressing HER-2 where brain metastases were successfully treated with radiation and a combination of lapatinib and capecitabine.

  9. Internal mammary chain irradiation in breast cancer: State of the art; Radiotherapie de la chaine mammaire interne dans les cancers du sein: etat des lieux

    Energy Technology Data Exchange (ETDEWEB)

    Auberdiac, P.; Cartier, L.; Hau Desbat, N.H.; De Laroche, G.; Magne, N. [Unite de curietherapie, departement de radiotherapie, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex (France); Chargari, C. [Service d' oncologie radiotherapie, hopital d' instruction des armees du Val-de-Grace, 74, boulevard Port-Royal, 75230 Paris cedex 5 (France); Zioueche, A. [Service de radiotherapie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges (France); Melis, A. [Departement d' oncologie medicale, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, 42271 Saint-Priest-en-Jarez cedex (France); Kirova, Y.M. [Service de radiotherapie oncologique, institut Curie, 26, rue d' Ulm, 75005 Paris (France)

    2011-04-15

    Radiation therapy has a major role in the management of infiltrative breast cancers. However, there is no consensus for the prophylactic treatment of the internal mammary chain (IMC), with strategies that show strong differences according to centers and physicians. Indications for internal mammary chain radiotherapy are debated, since this treatment significantly increases the dose delivered to the heart and leads to potential technical difficulties. Important prospective data recently suggested that internal mammary chain radiotherapy would not be necessary, even in cases of internal or central tumor locations, or in patients with positive axillary lymph nodes. Although these data warrant confirmation by two other prospective trials, there is evidence that the indications for internal mammary chain radiotherapy should be careful and that high quality techniques should be used for decreasing the dose delivered to the heart. This review of literature presents the state of art on the radiotherapy of internal mammary chain, with special focus on the indications, techniques, and potential toxicity. (authors)

  10. 乳腺癌保乳术后加速部分乳腺照射研究进展%Accelerated partial breast irradiation after breast conserving surgery:a review of techniques and progress

    Institute of Scientific and Technical Information of China (English)

    张勇乾; 王雅棣

    2013-01-01

    Breast-conserving surgery with postoperative whole-breast irradiation (WBI) has become one of the standard treat-ments for early breast cancer. However, traditional WBI has a large radiation field and lengthy course of treatment. Accelerated par-tial-breast irradiation (APBI) has been recognized as an alternative treatment to WBI. Three main techniques constitute APBI: intraoper-ative radiation therapy, external radiation therapy, and brachytherapy. Intraoperative radiation therapy involves the application of thera-peutic levels of radiation during surgery. This technique allows for the exact delivery of radiation beams to the tumor bed; strict preci-sion is observed for equipment in this technique. External radiation therapy is performed by radiotherapists and physicists. This tech-nique is easy to implement. Furthermore, the target dose distribution can be achieved because of the implementation of a treatment plan-ning system. Brachytherapy includes multi-catheter interstitial brachytherapy and mammosite therapy. Presently, mammosite therapy is widely used because of its facile procedure. However, clinical follow-up data are limited because of the short duration of APBI therapy. The selection of appropriate patients and optimal dosimetric distribution is needed before APBI application to reduce the risk of breast cancer recurrence.%  保乳手术加术后全乳腺放疗(whole breast irradiation,WBI)已成为早期乳腺癌的标准治疗模式之一,但是传统的WBI照射范围大,疗程长.近年来,缩小照射范围、缩短总疗程的加速部分乳腺照射(accelerated partial breast irradiation,APBI)作为保乳术后WBI的替代治疗方法,得到了广泛的认同.APBI常用的治疗方式有术中放疗、外照射和近距离放疗三种.术中放疗为保乳手术中给予一次性照射,照射范围准确,但是对设备的要求较高.外照射由专业的放疗科医师和物理师执行,相对容易实现,而且可以通过治疗计划系

  11. High resolution computed tomography findings on the lung of early breast-cancer patients treated by postoperative breast irradiation with a hypofractionated radiotherapy schedule

    Directory of Open Access Journals (Sweden)

    Plataniotis G

    2005-01-01

    Full Text Available Context: Hypofractionated breast radiotherapy (RT, although convenient for patients and health care systems, could have a negative impact on normal tissues such as lung. Aims: To evaluate radiation-induced lung toxicity in early breast-cancer patients treated by hypofractionated RT. Settings and Design: We have been using the 42.5 Gy/16 fractions RT schedule since May 2003. As large fraction size is related to increased normal tissue toxicity we intended to investigate the possible radiation-induced lung toxicity to these patients, by performing high-resolution computed tomography (HRCT 6 months after the completion of the treatment. Methods and Material: A group of 30 consecutive early breast cancer patients (T1-2N0M0 have been treated by the above-mentioned RT schedule, using a pair of opposing tangential fields. The impact of chemotherapy and hormonotherapy and various breast size-related parameters on HRCT lung changes were investigated. Acute skin and breast tissue reactions were also recorded. Statistical analysis: used Correlation of numerical variables was investigated by Pearson correlation coefficient. Logistic regression analysis was used to investigate correlation between HRCT findings (present vs absent with other variables. Results: Minimal HRCT findings were evident in 15/30 patients. These included small septal lines, linear and subpleural opacities and to a lesser extend, focal-ground glass opacification. The HRCT findings were positively correlated only to field separation (distance between the entrance points of the tangential beams on the breast (H.R.=1.33, 95% CI: 1.013-1.75. Conclusions: The short 16-fraction RT schedule for early breast-cancer patients appears to have a minor effect on the underlying lung parenchyma.

  12. Irradiation with external beam and interstitial radioactive implant as primary treatment for early carcinoma of the breast

    International Nuclear Information System (INIS)

    The locoregional control of 60 to 61 patients supports the results published by other centers and compares favorably with results of any surgical series. The cosmetic results are excellent with only three of 61 patients having severe fibrosis of the breast develop. No rib fractures, skin ulcerations, symptomatic radiation pneumonitis, edema of the arm or limitation of arm movement have been observed as complications. Ten of the 28 patients who have had axillary dissection had transient edema of the breast develop. Results of numerous studies suggest that primary radiotherapy without mastectomy is appropriate treatment for early carcinoma of the breast. The accessibility of the breast makes it relatively easy to deliver curative doses of radiation with minimal damage to surrounding normal tissues. The cumulative radiotherapy experience has demonstrated the gratifying results of not only maintaining a rather normal breast but also avoiding the negative physical and psychologic repercussions of the mastectomy. Radiation therapy is an alternative to Halsted's radical mastectomy

  13. Increased incidence of breast carcinoma in patients with irradiation for post-partum mastitis: a screening situation

    International Nuclear Information System (INIS)

    In Rochester, New York, 606 women were treated with ionizing radiation for post-partum mastitis, mostly between 1940 and 1955. Two-thirds of all breasts were treated, the average dose per breast being 377 rads (at 2.5 cm breast depth). Mammographic examinations were performed on 265 of these women still residing in this vicinity. Two nonpalpable carcinomas (with no axillary node metastases) were found in the twelve breast lesions that have been biopsied. Some of the biopsies revealed premalignant changes. It is recommended that women in this high-risk category have close medical supervision, as well as periodic mammographic evaluation, and that the importance of periodic breast self-examinations should be emphasized

  14. Consensus Sequence Zen

    OpenAIRE

    Schneider, Thomas D.

    2002-01-01

    Consensus sequences are widely used in molecular biology but they have many flaws. As a result, binding sites of proteins and other molecules are missed during studies of genetic sequences and important biological effects cannot be seen. Information theory provides a mathematically robust way to avoid consensus sequences. Instead of using consensus sequences, sequence conservation can be quantitatively presented in bits of information by using sequence logo graphics to repre...

  15. Inflammatory Breast Cancer

    Science.gov (United States)

    ... breast cancer: consensus statement for standardized diagnosis and treatment. Annals of Oncology 2011; 22(3):515-523. [PubMed Abstract] Fouad TM, Kogawa T, Reuben JM, Ueno NT. The role of inflammation in inflammatory breast cancer. Advances in Experimental Medicine and Biology 2014; 816:53-73. [PubMed ...

  16. Extended (5-year) Outcomes of Accelerated Partial Breast Irradiation Using MammoSite Balloon Brachytherapy: Patterns of Failure, Patient Selection, and Dosimetric Correlates for Late Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Vargo, John A.; Verma, Vivek; Kim, Hayeon; Kalash, Ronny; Heron, Dwight E.; Johnson, Ronald; Beriwal, Sushil, E-mail: beriwals@upmc.edu

    2014-02-01

    Purpose: Accelerated partial breast irradiation (APBI) with balloon and catheter-based brachytherapy has gained increasing popularity in recent years and is the subject of ongoing phase III trials. Initial data suggest promising local control and cosmetic results in appropriately selected patients. Long-term data continue to evolve but are limited outside of the context of the American Society of Breast Surgeons Registry Trial. Methods and Materials: A retrospective review of 157 patients completing APBI after breast-conserving surgery and axillary staging via high-dose-rate {sup 192}Ir brachytherapy from June 2002 to December 2007 was made. APBI was delivered with a single-lumen MammoSite balloon-based applicator to a median dose of 34 Gy in 10 fractions over a 5-day period. Tumor coverage and critical organ dosimetry were retrospectively collected on the basis of computed tomography completed for conformance and symmetry. Results: At a median follow-up time of 5.5 years (range, 0-10.0 years), the 5-year and 7-year actuarial incidences of ipsilateral breast control were 98%/98%, of nodal control 99%/98%, and of distant control 99%/99%, respectively. The crude rate of ipsilateral breast recurrence was 2.5% (n=4); of nodal failure, 1.9% (n=3); and of distant failure, 0.6% (n=1). The 5-year and 7-year actuarial overall survival rates were 89%/86%, with breast cancer–specific survival of 100%/99%, respectively. Good to excellent cosmetic outcomes were achieved in 93.4% of patients. Telangiectasia developed in 27% of patients, with 1-year, 3-year, and 5-year actuarial incidence of 7%/24%/33%; skin dose >100% significantly predicted for the development of telangiectasia (50% vs 14%, P<.0001). Conclusions: Long-term single-institution outcomes suggest excellent tumor control, breast cosmesis, and minimal late toxicity. Skin toxicity is a function of skin dose, which may be ameliorated with dosimetric optimization afforded by newer multicatheter brachytherapy

  17. Impact of residual and intrafractional errors on strategy of correction for image-guided accelerated partial breast irradiation

    International Nuclear Information System (INIS)

    The cone beam CT (CBCT) guided radiation can reduce the systematic and random setup errors as compared to the skin-mark setup. However, the residual and intrafractional (RAIF) errors are still unknown. The purpose of this paper is to investigate the magnitude of RAIF errors and correction action levels needed in cone beam computed tomography (CBCT) guided accelerated partial breast irradiation (APBI). Ten patients were enrolled in the prospective study of CBCT guided APBI. The postoperative tumor bed was irradiated with 38.5 Gy in 10 fractions over 5 days. Two cone-beam CT data sets were obtained with one before and one after the treatment delivery. The CBCT images were registered online to the planning CT images using the automatic algorithm followed by a fine manual adjustment. An action level of 3 mm, meaning that corrections were performed for translations exceeding 3 mm, was implemented in clinical treatments. Based on the acquired data, different correction action levels were simulated, and random RAIF errors, systematic RAIF errors and related margins before and after the treatments were determined for varying correction action levels. A total of 75 pairs of CBCT data sets were analyzed. The systematic and random setup errors based on skin-mark setup prior to treatment delivery were 2.1 mm and 1.8 mm in the lateral (LR), 3.1 mm and 2.3 mm in the superior-inferior (SI), and 2.3 mm and 2.0 mm in the anterior-posterior (AP) directions. With the 3 mm correction action level, the systematic and random RAIF errors were 2.5 mm and 2.3 mm in the LR direction, 2.3 mm and 2.3 mm in the SI direction, and 2.3 mm and 2.2 mm in the AP direction after treatments delivery. Accordingly, the margins for correction action levels of 3 mm, 4 mm, 5 mm, 6 mm and no correction were 7.9 mm, 8.0 mm, 8.0 mm, 7.9 mm and 8.0 mm in the LR direction; 6.4 mm, 7.1 mm, 7.9 mm, 9.2 mm and 10.5 mm in the SI direction; 7.6 mm, 7.9 mm, 9.4 mm, 10.1 mm and 12.7 mm in the AP direction

  18. Primary chemotherapy and preoperative-dose irradiation for patients with stage II larger than 3 CM or locally advanced non inflammatory breast cancer

    International Nuclear Information System (INIS)

    Purpose: The aims of this prospective study were to evaluate the outcome and the possibility of breast conserving treatment for patients with stage II larger than 3 cm or locally advanced non inflammatory breast cancer, after primary chemotherapy followed by external preoperative-dose irradiation. Materials and methods: Between April 1982 and June 1990, 147 consecutive patients with large breast cancer (stage II > 3 cm [n=50], stage IIIA [n=58], stage IIIB [n=35] and stage IV with isolated clinical supraclavicular or sub-clavicular node involvement [n=4] were treated. The median age was 49 years. Mean tumor size was 6 cm (range 1 - 16 cm). Sixty percent (n=88) of the patients were postmenopausal. Histological classification was : 120 infiltrating ductal carcinomas, 21 infiltrating lobular carcinomas, 4 medullary carcinomas and 2 mucosecreting carcinomas. Grade distribution according to Scarff, Bloom and Richardson was : 14 grade 1, 72 grade 2, 30 grade 3 and 31 non classified. Median follow-up was 94 months from the beginning of the treatment. The induction treatment consisted of 4 courses of chemotherapy (doxorubicin, vincristine, cyclophosphamide, 5-fluorouracil) every 4 weeks followed by preoperative irradiation (45 Gy to the breast and nodal areas) using 60Co in 141 patients and 6 MV photons in 6 patients. A fifth course of chemotherapy was given after radiation therapy and three different locoregional approaches were proposed depending on the tumoral response. In 52 patients (35%) with residual tumor larger than 3 cm in diameter or located behind the nipple or with bifocal tumors, mastectomy and axillary dissection were performed. Ninety-five other patients (65%) benefited from conservative treatment : 48 patients (33%) achieved complete remission and received a booster dose of 25 to 30 Gy to the initial tumor bed by external photon beam or by iridium 192 implant ; 47 patients (32%) who had a residual mass less than or equal to 3 cm in diameter were treated by

  19. TH-C-12A-09: Planning and Delivery of the Fully Dynamic Trajectory Modulated Arc Therapy: Application to Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Liang, J; Atwood, T; Fahimian, B; Chin, E; Hristov, D [Department of Radiation Oncology, Stanford University, CA (United States); Otto, K [Department of Physics, University of British Columbia, BC (Canada)

    2014-06-15

    Purpose: A novel trajectory modulated arc therapy (TMAT) system was developed that uses source motion trajectory involving synchronized gantry rotation with translational and rotational couch movement. MLC motion and dose rate were fully optimized for dynamic beam delivery. This work presents a platform for planning deliverable TMAT on a collision free coronal trajectory and evaluates its benefit for accelerated partial breast irradiation (APBI) in a prone position. Methods: The TMAT algorithm was built on VMAT with modifications (physical properties on couch movement were defined) and enhancements (pencil beam dose calculation engine to support extended SSDs) to make it feasible for TMAT delivery. A Matlab software environment for TMAT optimization and dose calculation was created to allow any user specified motion axis. TMAT delivery was implemented on Varian TrueBeamTM STx via XML scripts. 10 prone breast irradiation cases were evaluated in VMAT and compared with a 6- field non-coplanar IMRT plan. Patient selection/exclusion criteria and structure contouring followed the guidelines of NSABP B-39/RTOG 0413 protocol. Results: TMAT delivery time was ∼4.5 minutes. 251.5°±7.88° of non-isocentric couch arc was achieved by the optimized trajectory with 180– 210 control points at 1°–2° couch increments. The improved dose distribution by TMAT was most clearly observed by the marked reduction in the volume of irradiated normal breast tissue in the high dose region. The ratios of the normal breast tissue volume receiving more than 50%, 80% and 100% of the prescription dose for TMAT versus IMRT were: V50%(TMAT/IMRT) = 78.38%±13.03%, V80%(TMAT/IMRT) = 44.19%±9.04% and V100% (TMAT/IMRT) = 9.96%±7.55%, all p≤0.01. Conclusion: The study is the first demonstration of planning and delivery implementation of a fully dynamic APBI TMAT system with continuous couch motion. TMAT achieved significantly improved dosimetry over noncoplanar IMRT on dose volume parameters

  20. SU-E-J-37: Feasibility of Utilizing Carbon Fiducials to Increase Localization Accuracy of Lumpectomy Cavity for Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Y; Hieken, T; Mutter, R; Park, S; Yan, E; Brinkmann, D; Pafundi, D [Mayo Clinic, Rochester, MN (United States)

    2015-06-15

    Purpose To investigate the feasibility of utilizing carbon fiducials to increase localization accuracy of lumpectomy cavity for partial breast irradiation (PBI). Methods Carbon fiducials were placed intraoperatively in the lumpectomy cavity following resection of breast cancer in 11 patients. The patients were scheduled to receive whole breast irradiation (WBI) with a boost or 3D-conformal PBI. WBI patients were initially setup to skin tattoos using lasers, followed by orthogonal kV on-board-imaging (OBI) matching to bone per clinical practice. Cone beam CT (CBCT) was acquired weekly for offline review. For the boost component of WBI and PBI, patients were setup with lasers, followed by OBI matching to fiducials, with final alignment by CBCT matching to fiducials. Using carbon fiducials as a surrogate for the lumpectomy cavity and CBCT matching to fiducials as the gold standard, setup uncertainties to lasers, OBI bone, OBI fiducials, and CBCT breast were compared. Results Minimal imaging artifacts were introduced by fiducials on the planning CT and CBCT. The fiducials were sufficiently visible on OBI for online localization. The mean magnitude and standard deviation of setup errors were 8.4mm ± 5.3 mm (n=84), 7.3mm ± 3.7mm (n=87), 2.2mm ± 1.6mm (n=40) and 4.8mm ± 2.6mm (n=87), for lasers, OBI bone, OBI fiducials and CBCT breast tissue, respectively. Significant migration occurred in one of 39 implanted fiducials in a patient with a large postoperative seroma. Conclusion OBI carbon fiducial-based setup can improve localization accuracy with minimal imaging artifacts. With increased localization accuracy, setup uncertainties can be reduced from 8mm using OBI bone matching to 3mm using OBI fiducial matching for PBI treatment. This work demonstrates the feasibility of utilizing carbon fiducials to increase localization accuracy to the lumpectomy cavity for PBI. This may be particularly attractive for localization in the setting of proton therapy and other scenarios

  1. SU-E-J-37: Feasibility of Utilizing Carbon Fiducials to Increase Localization Accuracy of Lumpectomy Cavity for Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose To investigate the feasibility of utilizing carbon fiducials to increase localization accuracy of lumpectomy cavity for partial breast irradiation (PBI). Methods Carbon fiducials were placed intraoperatively in the lumpectomy cavity following resection of breast cancer in 11 patients. The patients were scheduled to receive whole breast irradiation (WBI) with a boost or 3D-conformal PBI. WBI patients were initially setup to skin tattoos using lasers, followed by orthogonal kV on-board-imaging (OBI) matching to bone per clinical practice. Cone beam CT (CBCT) was acquired weekly for offline review. For the boost component of WBI and PBI, patients were setup with lasers, followed by OBI matching to fiducials, with final alignment by CBCT matching to fiducials. Using carbon fiducials as a surrogate for the lumpectomy cavity and CBCT matching to fiducials as the gold standard, setup uncertainties to lasers, OBI bone, OBI fiducials, and CBCT breast were compared. Results Minimal imaging artifacts were introduced by fiducials on the planning CT and CBCT. The fiducials were sufficiently visible on OBI for online localization. The mean magnitude and standard deviation of setup errors were 8.4mm ± 5.3 mm (n=84), 7.3mm ± 3.7mm (n=87), 2.2mm ± 1.6mm (n=40) and 4.8mm ± 2.6mm (n=87), for lasers, OBI bone, OBI fiducials and CBCT breast tissue, respectively. Significant migration occurred in one of 39 implanted fiducials in a patient with a large postoperative seroma. Conclusion OBI carbon fiducial-based setup can improve localization accuracy with minimal imaging artifacts. With increased localization accuracy, setup uncertainties can be reduced from 8mm using OBI bone matching to 3mm using OBI fiducial matching for PBI treatment. This work demonstrates the feasibility of utilizing carbon fiducials to increase localization accuracy to the lumpectomy cavity for PBI. This may be particularly attractive for localization in the setting of proton therapy and other scenarios

  2. The Limits of Consensus.

    Science.gov (United States)

    Poster, John B.

    Dynamics in the education policy arena suggest that, despite two generations of researchers extolling democratic leadership styles and consensus building over autocratic techniques, wide participation in policymaking and the broadest possible consensus are not always productive: American society has not yet agreed on what schools should…

  3. Model-based consensus

    NARCIS (Netherlands)

    M. Boumans

    2014-01-01

    The aim of the rational-consensus method is to produce "rational consensus", that is, "mathematical aggregation", by weighing the performance of each expert on the basis of his or her knowledge and ability to judge relevant uncertainties. The measurement of the performance of the experts is based on

  4. SNPs in DNA repair or oxidative stress genes and late subcutaneous fibrosis in patients following single shot partial breast irradiation

    OpenAIRE

    Falvo Elisabetta; Strigari Lidia; Citro Gennaro; Giordano Carolina; Boboc Genoveva; Fabretti Fabiana; Bruzzaniti Vicente; Bellesi Luca; Muti Paola; Blandino Giovanni; Pinnarò Paola

    2012-01-01

    Abstract Background The aim of this study was to evaluate the potential association between single nucleotide polymorphisms related response to radiotherapy injury, such as genes related to DNA repair or enzymes involved in anti-oxidative activities. The paper aims to identify marker genes able to predict an increased risk of late toxicity studying our group of patients who underwent a Single Shot 3D-CRT PBI (SSPBI) after BCS (breast conserving surgery). Methods A total of 57 breast cancer pa...

  5. Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage

    International Nuclear Information System (INIS)

    Background and purpose. Cardiac disease and pulmonary complications are documented risk factors in tangential breast irradiation. Respiratory gating radiotherapy provides a possibility to substantially reduce cardiopulmonary doses. This CT planning study quantifies the reduction of radiation doses to the heart and lung, using deep inspiration breath-hold (DIBH). Patients and methods. Seventeen patients with early breast cancer, referred for adjuvant radiotherapy, were included. For each patient two CT scans were acquired; the first during free breathing (FB) and the second during DIBH. The scans were monitored by the Varian RPM respiratory gating system. Audio coaching and visual feedback (audio-visual guidance) were used. The treatment planning of the two CT studies was performed with conformal tangential fields, focusing on good coverage (V95>98%) of the planning target volume (PTV). Dose-volume histograms were calculated and compared. Doses to the heart, left anterior descending (LAD) coronary artery, ipsilateral lung and the contralateral breast were assessed. Results. Compared to FB, the DIBH-plans obtained lower cardiac and pulmonary doses, with equal coverage of PTV. The average mean heart dose was reduced from 3.7 to 1.7 Gy and the number of patients with >5% heart volume receiving 25 Gy or more was reduced from four to one of the 17 patients. With DIBH the heart was completely out of the beam portals for ten patients, with FB this could not be achieved for any of the 17 patients. The average mean dose to the LAD coronary artery was reduced from 18.1 to 6.4 Gy. The average ipsilateral lung volume receiving more than 20 Gy was reduced from 12.2 to 10.0%. Conclusion. Respiratory gating with DIBH, utilizing audio-visual guidance, reduces cardiac and pulmonary doses for tangentially treated left sided breast cancer patients without compromising the target coverage

  6. Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage

    Energy Technology Data Exchange (ETDEWEB)

    Vikstroem, Johan; Hjelstuen, Mari H.B.; Mjaaland, Ingvil; Dybvik, Kjell Ivar (Dept. of Radiotherapy, Stavanger Univ. Hospital, Stavanger (Norway)), e-mail: vijo@sus.no

    2011-01-15

    Background and purpose. Cardiac disease and pulmonary complications are documented risk factors in tangential breast irradiation. Respiratory gating radiotherapy provides a possibility to substantially reduce cardiopulmonary doses. This CT planning study quantifies the reduction of radiation doses to the heart and lung, using deep inspiration breath-hold (DIBH). Patients and methods. Seventeen patients with early breast cancer, referred for adjuvant radiotherapy, were included. For each patient two CT scans were acquired; the first during free breathing (FB) and the second during DIBH. The scans were monitored by the Varian RPM respiratory gating system. Audio coaching and visual feedback (audio-visual guidance) were used. The treatment planning of the two CT studies was performed with conformal tangential fields, focusing on good coverage (V95>98%) of the planning target volume (PTV). Dose-volume histograms were calculated and compared. Doses to the heart, left anterior descending (LAD) coronary artery, ipsilateral lung and the contralateral breast were assessed. Results. Compared to FB, the DIBH-plans obtained lower cardiac and pulmonary doses, with equal coverage of PTV. The average mean heart dose was reduced from 3.7 to 1.7 Gy and the number of patients with >5% heart volume receiving 25 Gy or more was reduced from four to one of the 17 patients. With DIBH the heart was completely out of the beam portals for ten patients, with FB this could not be achieved for any of the 17 patients. The average mean dose to the LAD coronary artery was reduced from 18.1 to 6.4 Gy. The average ipsilateral lung volume receiving more than 20 Gy was reduced from 12.2 to 10.0%. Conclusion. Respiratory gating with DIBH, utilizing audio-visual guidance, reduces cardiac and pulmonary doses for tangentially treated left sided breast cancer patients without compromising the target coverage

  7. Factors Associated With Optimal Long-Term Cosmetic Results in Patients Treated With Accelerated Partial Breast Irradiation Using Balloon-Based Brachytherapy

    International Nuclear Information System (INIS)

    Purpose: To evaluate factors associated with optimal cosmetic results at 72 months for early-stage breast cancer patients treated with Mammosite balloon-based accelerated partial breast irradiation (APBI). Methods and Materials: A total of 1,440 patients (1,449 cases) with early-stage breast cancer undergoing breast-conserving therapy were treated with balloon-based brachytherapy to deliver APBI (34 Gy in 3.4-Gy fractions). Cosmetic outcome was evaluated at each follow-up visit and dichotomized as excellent/good (E/G) or fair/poor (F/P). Follow-up was evaluated at 36 and 72 months to establish long-term cosmesis, stability of cosmesis, and factors associated with optimal results. Results: The percentage of evaluable patients with excellent/good (E/G) cosmetic results at 36 months and more than 72 months were 93.3% (n = 708/759) and 90.4% (n = 235/260). Factors associated with optimal cosmetic results at 72 months included: larger skin spacing (p = 0.04) and T1 tumors (p = 0.02). Using multiple regression analysis, the only factors predictive of worse cosmetic outcome at 72 months were smaller skin spacing (odds ratio [OR], 0.89; confidence interval [CI], 0.80–0.99) and tumors greater than 2 cm (OR, 4.96, CI, 1.53–16.07). In all, 227 patients had both a 36-month and a 72-month cosmetic evaluation. The number of patients with E/G cosmetic results decreased only slightly from 93.4% at 3 years to 90.8% (p = 0.13) at 6 years, respectively. Conclusions: APBI delivered with balloon-based brachytherapy produced E/G cosmetic results in 90.4% of cases at 6 years. Larger tumors (T2) and smaller skin spacing were found to be the two most important independent predictors of cosmesis.

  8. Monte Carlo-derived TLD cross-calibration factors for treatment verification and measurement of skin dose in accelerated partial breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Garnica-Garza, H M [Centro de Investigacion y de Estudios Avanzados del Instituto Politecnico Nacional Unidad Monterrey, VIa del Conocimiento 201 Parque de Investigacion e Innovacion Tecnologica, Apodaca NL C.P. 66600 (Mexico)], E-mail: hgarnica@cinvestav.mx

    2009-03-21

    Monte Carlo simulation was employed to calculate the response of TLD-100 chips under irradiation conditions such as those found during accelerated partial breast irradiation with the MammoSite radiation therapy system. The absorbed dose versus radius in the last 0.5 cm of the treated volume was also calculated, employing a resolution of 20 {mu}m, and a function that fits the observed data was determined. Several clinically relevant irradiation conditions were simulated for different combinations of balloon size, balloon-to-surface distance and contents of the contrast solution used to fill the balloon. The thermoluminescent dosemeter (TLD) cross-calibration factors were derived assuming that the calibration of the dosemeters was carried out using a Cobalt 60 beam, and in such a way that they provide a set of parameters that reproduce the function that describes the behavior of the absorbed dose versus radius curve. Such factors may also prove to be useful for those standardized laboratories that provide postal dosimetry services.

  9. Do the intervals between operation and irradiation and further therapeutic measures influence damage in the brachial plexus in cases of operated breast cancer

    International Nuclear Information System (INIS)

    In a retrospective investigation, the case histories of 1030 female patients were evaluated - 516 being post-examined - who had been operated on because of a carcinoma of the breast and post-irradiated. 39 patients suffered from a radiation-induced damage of the plexus. As for the development of the damage, in addition to the dose dependence, also an influence by hyperaemisation and hyperhydration as it can come into existence in the postoperative phase and by hormonal influences must be assumed. For radically operated-on patients, following conclusions were derived. 1) The starting date of the irradiation should not be too long before the 20th postoperative day. 2) Patients under the age of 45 and/or with arm oedema must be controlled especially carefully, as far as dose calculation and starting date of irradiation are concerned. 3) For patients treated with hormones and/or chemotherapeutically no maximal doses should be aimed at, max, 42-45 Gy. (orig.) 891 MG/orig. 892 RDG

  10. Clinical application of a OneDose(TM) MOSFET for skin dose measurements during internal mammary chain irradiation with high dose rate brachytherapy in carcinoma of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Kinhikar, Rajesh A [Department of Medical Physics, Tata Memorial Hospital, Parel, Mumbai 400 012 (India); Sharma, Pramod K [Department of Medical Physics, Tata Memorial Hospital, Parel, Mumbai 400 012 (India); Tambe, Chandrashekhar M [Department of Medical Physics, Tata Memorial Hospital, Parel, Mumbai 400 012 (India); Mahantshetty, Umesh M [Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400 012 (India); Sarin, Rajiv [Advanced Centre for Training Research and Education in Cancer, Kharghar, Navi Mumbai (India); Deshpande, Deepak D [Department of Medical Physics, Tata Memorial Hospital, Parel, Mumbai 400 012 (India); Shrivastava, Shyam K [Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400 012 (India)

    2006-07-21

    In our earlier study, we experimentally evaluated the characteristics of a newly designed metal oxide semiconductor field effect transistor (MOSFET) OneDose(TM) in-vivo dosimetry system for Ir-192 (380 keV) energy and the results were compared with thermoluminescent dosimeters (TLDs). We have now extended the same study to the clinical application of this MOSFET as an in-vivo dosimetry system. The MOSFET was used during high dose rate brachytherapy (HDRBT) of internal mammary chain (IMC) irradiation for a carcinoma of the breast. The aim of this study was to measure the skin dose during IMC irradiation with a MOSFET and a TLD and compare it with the calculated dose with a treatment planning system (TPS). The skin dose was measured for ten patients. All the patients' treatment was planned on a PLATO treatment planning system. TLD measurements were performed to compare the accuracy of the measured results from the MOSFET. The mean doses measured with the MOSFET and the TLD were identical (0.5392 Gy, 15.85% of the prescribed dose). The mean dose was overestimated by the TPS and was 0.5923 Gy (17.42% of the prescribed dose). The TPS overestimated the skin dose by 9% as verified by the MOSFET and TLD. The MOSFET provides adequate in-vivo dosimetry for HDRBT. Immediate readout after irradiation, small size, permanent storage of dose and ease of use make the MOSFET a viable alternative for TLDs. (note)

  11. Dosimetric validation of planning system Eclipse 10 in partial breast irradiation treatments with IMRT; Validacion dosimetrica del sistema de planeacion Eclipse 10 en tratamientos de irradiacion parcial de mama con IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Velazquez T, J. J.; Gutierrez M, J. G.; Ortiz A, C. S.; Chagoya G, A.; Gutierrez C, J. G., E-mail: jvelaesfm@gmail.com [Centro Medico Nacional Siglo XXI, Hospital de Oncologia, Departamentos de Fisica Medica y Radioterapia, Av. Cuauhtemoc 330, 03020 Mexico D. F. (Mexico)

    2015-10-15

    Partial breast irradiation is a new type of external radiation therapy to treat breast cancer in early clinical stages. Consist of administering to the channel surgical high doses of radiation in few treatment sessions. In this paper the dose calculations of the planning system Eclipse version 10 for a treatment of partial breast irradiation with X-rays beams (6 MV) intensity modulated were compared against the measurements made with OSL dosimeters and radio-chromic dye film. An anthropomorphic mannequin was used in which OSL dosimeters were collocated near the surface, an inside the radio-chromic dye film one plate; with this latest one dimensional dose distribution was measured. Previously dosimeters were calibrated irradiating them with a beam of X-rays 6 MV under the conditions specified in the IAEA-398 protocol. The OSL dosimeters were read in the Micro star Landauer equipment, the radio-chromic dye films were read with a scanner Epson 10000-Xl and analyzed with FilmCal and PTW Verisoft programs. The differences between measured and calculated dose were as follows: 3.6±1% for the OSL dosimeter and 96.3±1% of the analyzed points approved the gamma index criterion (3%, 3m m) when comparing the matrices of calculated dose and measured with the radio-chromic dye film. These results confirm the good dosimetric performance of planning system used under specific conditions used in the partial breast irradiation technique. (Author)

  12. Small-arc volumetric-modulated arc therapy: A new approach that is superior to fixed-field IMRT in optimizing dosimetric and treatment-relevant parameters for patients undergoing whole-breast irradiation following breast-conserving surgery.

    Science.gov (United States)

    Yu, Jing; Hu, Tao; Chen, Yeshan

    2016-08-01

    Volumetric-modulated arc therapy (VMAT) is considered to deliver a better dose distribution and to shorten treatment time. There is a lack of research regarding breast irradiation after breast-conserving surgery (BCS) using VMAT with prone positioning. We developed a new small-arc VMAT methodology and compared it to conventional (fixed-field) intensity-modulated radiation therapy (IMRT) in the dosimetric and treatment relevant parameters for breast cancer patients in the prone position.Ten early-stage breast cancer patients were included in this exploratory study. All patients underwent computed tomography (CT) simulation scan in the prone position and for each patient, IMRT and VMAT plans were generated using the Monaco planning system. Two symmetrical partial arcs were applied in the VMAT plans. The angle ranges of the 2 arcs were set to approximately 60° to 100° and 220° to 260°, with small adjustments to maximize target coverage, while minimizing lung and heart exposure. The IMRT plans used 4 fixed fields. Prescribed doses were 50 Gy in 25 fractions. The target coverage, homogeneity, conformity, dose to organs at risk (OAR), treatment time, and monitor units (MU) were evaluated.Higher median conformal index (CI) and lower homogeneity index (HI) of the planning target volume (PTV) were respectively observed in VMAT and plans group (CI, 95% vs 91%; HI, 0.09 vs 0.12; P volumes of ipsilateral lung receiving 30, 20, 10, and 5 Gy were lower for VMAT (P volumes of the heart receiving 30 and 40 Gy were similar for the 2 methods. In addition, the median treatment time (161 vs 412 seconds; P < 0.001) and the mean MU (713 vs 878; P < 0.001) were lower for VMAT.Small-arc VMAT plan improved CI and HI for the target, spared the dose of lung, and reduced treatment time and MU, compared to IMRT. It is a more promising irradiation technique for post-BCS radiotherapy. PMID:27559956

  13. Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial

    International Nuclear Information System (INIS)

    Purpose: to evaluate perioperative morbidity, toxicity, and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole irradiation modality after breast-conserving surgery. Patients and methods: from November 1, 2000 to January 31, 2004, 176 women with early-stage breast cancer became partakers in a protocol of tumor bed irradiation alone using pulsed-dose-rate (PDR) or high-dose-rate (HDR) interstitial multicatheter implants. Patients became eligible, if their tumor was an infiltrating carcinoma ≤ 3 cm in diameter, the surgical margins were clear by at least 2 mm, the axilla was surgically staged node-negative, the tumor was estrogen and/or progesterone receptor-positive, well or moderately differentiated (G1/2), the tumor did not contain an extensive intraductal component (EIC) and the patient's age was > 35 years. Implants were positioned using a template guide, delivering either 49.8 Gy in 83 consecutive hours (PDR) or 32.0 Gy in two daily fractions over 4 days (HDR). Perioperative morbidity, toxicity, and cosmetic outcome were assessed. Interim findings of the first 69 patients, who were treated in this multicenter trial, after a median follow-up of 24 months (range, 15-39 months) are presented. Results: one of the 69 patients (1.4%) developed a bacterial infection of the implant. No other perioperative complications, for example bleeding or hematoma, were observed. Acute toxicity was low: 2.9% of the patients (2/69) experienced mild radiodermatitis. Late toxicity: hypersensation/mild pain 7.2% (5/69), intermittent but tolerable pain 1.4% (1/69), mild dyspigmentation 10.1% (7/69), mild fibrosis 11.6% (8/69), moderate fibrosis 1.4% (1/69), mild telangiectasia (2) 11.6% (8/69), and moderate teleangiectasia (1-4 cm2) 1.4% (1/69). Good to excellent cosmetic results were observed in 92.4% of the patients evaluated. All patients (n = 176) remained disease-free to the date of evaluation. Conclusion: this analysis indicates

  14. Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial

    Energy Technology Data Exchange (ETDEWEB)

    Ott, O.J.; Lotter, M.; Sauer, R.; Strnad, V. [Dept. of Radiation Oncology, Univ. Hospital Erlangen, Erlangen (Germany); Poetter, R.; Resch, A. [Dept. of Radiotherapy and Radiobiology, Univ. Hospital AKH Wien, Vienna (Austria); Hammer, J. [Dept. of Radiation Oncology, Barmherzige Schwestern Hospital Linz, Linz (Austria); Hildebrandt, G. [Dept. of Radiation Oncology, Univ. Hospital Leipzig, Leipzig (Germany); Poehls, U.; Beckmann, M.W. [Dept. of Gynecology, Univ. Hospital Erlangen, Erlangen (Germany)

    2004-10-01

    Purpose: to evaluate perioperative morbidity, toxicity, and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole irradiation modality after breast-conserving surgery. Patients and methods: from November 1, 2000 to January 31, 2004, 176 women with early-stage breast cancer became partakers in a protocol of tumor bed irradiation alone using pulsed-dose-rate (PDR) or high-dose-rate (HDR) interstitial multicatheter implants. Patients became eligible, if their tumor was an infiltrating carcinoma {<=} 3 cm in diameter, the surgical margins were clear by at least 2 mm, the axilla was surgically staged node-negative, the tumor was estrogen and/or progesterone receptor-positive, well or moderately differentiated (G1/2), the tumor did not contain an extensive intraductal component (EIC) and the patient's age was > 35 years. Implants were positioned using a template guide, delivering either 49.8 Gy in 83 consecutive hours (PDR) or 32.0 Gy in two daily fractions over 4 days (HDR). Perioperative morbidity, toxicity, and cosmetic outcome were assessed. Interim findings of the first 69 patients, who were treated in this multicenter trial, after a median follow-up of 24 months (range, 15-39 months) are presented. Results: one of the 69 patients (1.4%) developed a bacterial infection of the implant. No other perioperative complications, for example bleeding or hematoma, were observed. Acute toxicity was low: 2.9% of the patients (2/69) experienced mild radiodermatitis. Late toxicity: hypersensation/mild pain 7.2% (5/69), intermittent but tolerable pain 1.4% (1/69), mild dyspigmentation 10.1% (7/69), mild fibrosis 11.6% (8/69), moderate fibrosis 1.4% (1/69), mild telangiectasia (< 1 cm{sup 2}) 11.6% (8/69), and moderate teleangiectasia (1-4 cm{sup 2}) 1.4% (1/69). Good to excellent cosmetic results were observed in 92.4% of the patients evaluated. All patients (n = 176) remained disease-free to the date of evaluation. Conclusion

  15. Surface hyperthermia guided by infrared image and re-irradiation of local relapses of breast cancer; Hyperthermie superficielle guidee par image infrarouge et la re-irradiation des recidives locales du cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Notter, M.; Yanes, B.; Germond, J.F. [Hopital Neuchatelois, La Chaux de Fonds (Switzerland)

    2010-10-15

    As the taking into care of local relapses of cancer breast after a conventional treatment remains a challenge, the authors report the exploration of the use of a re-irradiation combined with hyperthermia. As disappointing results obtained with surface hyperthermia are attributed to some technical problems, they use a high resolution infrared image to get a better temperature distribution and to be able to adapt heat application to the dynamic changes of the tumour and of normal tissues, and to improve the hyperthermia quality. Preliminary results obtained on five patients are discussed and seem promising. It provides a better therapeutic efficiency, and gives access to information related to the tumour response, to inflammatory processes, to the vascularisation of healthy tissues, and to radio-induced reactions. Short communication

  16. Influence of adjuvant irradiation on the development of late arm lymphedema and impaired shoulder mobility after mastectomy for carcinoma of the breast

    DEFF Research Database (Denmark)

    Ryttov, N; Holm, N V; Qvist, N;

    1988-01-01

    The influence of postoperative radiation therapy on development of late arm lymphedema and shoulder joint disability following mastectomy was evaluated from a series of 57 women with operable carcinoma of the breast. The patients were divided into three groups. Common for all three groups was...... mastectomy and partial axillary dissection. In addition one group received postoperative irradiation plus systemic therapy and another group systemic therapy alone. The incidence of late arm lymphedema/impaired shoulder mobility was 11%/4% in the group of patients undergoing surgery alone, 46%/38% in the...... mastectomy. Adjuvant systemic therapy can be administered to high risk patients without increasing the risk of late arm lymphedema and shoulder disability....

  17. Impact of respiratory motion on breast tangential radiotherapy using the field-in-field technique compared to irradiation using physical wedges

    International Nuclear Information System (INIS)

    This study aimed to evaluate whether the field-in-field (FIF) technique was more vulnerable to the impact of respiratory motion than irradiation using physical wedges (PWs). Ten patients with early stage breast cancer were enrolled. Computed tomography (CT) was performed during free breathing (FB). After the FB-CT data set acquisition, 2 additional CT scans were obtained during a held breath after light inhalation (IN) and light exhalation (EX). Based on the FB-CT images, 2 different treatment plans were created for the entire breast for each patient and copied to the IN-CT and EX-CT images. The amount of change in the volume of the target receiving 107%, 95%, and 90% of the prescription dose (V107%, V95%, and V90%, respectively), on the IN-plan and EX-plan compared with the FB-plan were evaluated. The V107%, V95%, and V90% were significantly larger for the IN-plan than for the FB-plan in both the FIF technique and PW technique. While the amount of change in the V107% was significantly smaller in the FIF than in the PW plan, the amount of change in the V95% and V90% was significantly larger in the FIF plan. Thus, the increase in the V107% was smaller while the increases in the V95% and V90% were larger in the FIF than in the PW plan. During respiratory motion, the dose parameters stay within acceptable range irrespective of irradiation technique used although the amount of change in dose parameters was smaller with FIF technique

  18. SU-E-J-172: Bio-Physical Effects of Patients Set-Up Errors According to Whole Breast Irradiation Techniques

    International Nuclear Information System (INIS)

    Purpose: The dose-related effects of patient setup errors on biophysical indices were evaluated for conventional wedge (CW) and field-in-field (FIF) whole breast irradiation techniques. Methods: The treatment plans for 10 patients receiving whole left breast irradiation were retrospectively selected. Radiobiological and physical effects caused by dose variations were evaluated by shifting the isocenters and gantry angles of the treatment plans. Dose-volume histograms of the planning target volume (PTV), heart, and lungs were generated, and conformity index (CI), homogeneity index (HI), tumor control probability (TCP), and normal tissue complication probability (NTCP) were determined. Results: For “isocenter shift plan” with posterior direction, the D95 of the PTV decreased by approximately 15% and the TCP of the PTV decreased by approximately 50% for the FIF technique and by 40% for the CW; however, the NTCPs of the lungs and heart increased by about 13% and 1%, respectively, for both techniques. Increasing the gantry angle decreased the TCPs of the PTV by 24.4% (CW) and by 34% (FIF). The NTCPs for the two techniques differed by only 3%. In case of CW, the CIs and HIs were much higher than that of the FIF in all cases. It had a significant difference between two techniques (p<0.01). According to our results, however, the FIF had more sensitive response by set up errors rather than CW in bio-physical aspects. Conclusions: The radiobiological-based analysis can detect significant dosimetric errors then, can provide a practical patient quality assurance method to guide the radiobiological and physical effects

  19. SU-E-J-172: Bio-Physical Effects of Patients Set-Up Errors According to Whole Breast Irradiation Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Lee, S; Suh, T; Park, S; Kim, M; Lee, M [Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul (Korea, Republic of); Park, J [Stanford University School of Medicine, Stanford, CA (United States)

    2015-06-15

    Purpose: The dose-related effects of patient setup errors on biophysical indices were evaluated for conventional wedge (CW) and field-in-field (FIF) whole breast irradiation techniques. Methods: The treatment plans for 10 patients receiving whole left breast irradiation were retrospectively selected. Radiobiological and physical effects caused by dose variations were evaluated by shifting the isocenters and gantry angles of the treatment plans. Dose-volume histograms of the planning target volume (PTV), heart, and lungs were generated, and conformity index (CI), homogeneity index (HI), tumor control probability (TCP), and normal tissue complication probability (NTCP) were determined. Results: For “isocenter shift plan” with posterior direction, the D95 of the PTV decreased by approximately 15% and the TCP of the PTV decreased by approximately 50% for the FIF technique and by 40% for the CW; however, the NTCPs of the lungs and heart increased by about 13% and 1%, respectively, for both techniques. Increasing the gantry angle decreased the TCPs of the PTV by 24.4% (CW) and by 34% (FIF). The NTCPs for the two techniques differed by only 3%. In case of CW, the CIs and HIs were much higher than that of the FIF in all cases. It had a significant difference between two techniques (p<0.01). According to our results, however, the FIF had more sensitive response by set up errors rather than CW in bio-physical aspects. Conclusions: The radiobiological-based analysis can detect significant dosimetric errors then, can provide a practical patient quality assurance method to guide the radiobiological and physical effects.

  20. Dosimetric Evaluation of Three Partial Breast Irradiation Devices and the Dosimetric Effect of Tissue Thickness Surrounding a Multi-Lumen Partial Breast Applicator

    Science.gov (United States)

    Detwiler, Jordyn Ashle

    Many High Dose Rate treatment planning systems that are in use fail to correct for heterogeneities. If the treatment planning system does not correct for heterogeneities, it would assume that the patient is receiving full scatter when in reality, the patient will possibly be underdosed. A 1cm diameter planning target volume for a lumpectomy cavity could extend beyond the skin or chest wall for the patient and could be a great problem when it comes to treatment with the MammoSiteRTM single lumen breast applicator. A previous Monte Carlo study tested 3 MammoSiteRTM balloon sizes at various depths beyond the planning target volume to see how much tissue would be needed to achieve full scatter. The results showed that on average, if there was no tissue beyond the prescription line of 1cm there would be a 10% dose reduction for the breast -- skin interface. The purpose of this study is to use the Strut Adjusted Volume Implant (SAVI) multi-lumen breast applicator to re-create the measurements done with the MammoSiteRTM balloon and expand these measurements to include tissue thicknesses less than the PTV. Previous simulations with the MammoSiteRTM were done using Monte Carlo, with tissue thicknesses beyond the planning target volume of 0 -- 10cm. This study will re-create these measurements using Metal Oxide Semiconductor Field Effect Transistors (MOSFETs) and also take measurements below the prescription line of 1cm due to the ability of the SAVI applicator to adjust dose to the skin.

  1. Partial breast irradiation as sole therapy for low risk breast carcinoma: Early toxicity, cosmesis and quality of life results of a MammoSite brachytherapy phase II study

    International Nuclear Information System (INIS)

    Purpose: The MammoSite is a device that was developed with the goal of making breast-conserving surgery (BCT) more widely available. Our objective was to evaluate the MammoSite device performances after an open cavity placement procedure and quality of life in highly selected patients with early-stage breast cancer. Methods and materials: From March 2003 to March 2005, 43 patients with T1 breast cancer were enrolled in a phase II study. The median age was 72 years. Twenty-five (58%) patients were treated with high-dose rate brachytherapy using the MammoSite applicator to deliver 34 Gy in 10 fractions. The main disqualifying factor was pathologic sentinel node involvement (10/43; 23%). There were no device malfunctions, migration or rupture of the balloon. Results: After a median follow-up of 13 months, there were no local recurrences and one contralateral lobular carcinoma. Seventeen (68%), 13 (52%), 8 (32%), 5 (20%) and 2 (8%) patients had erythema, seroma, inflammation, hematoma and sever infection, respectively. Only 2 patients developed telangiectasia. At 1 year the rate of 'good to excellent' cosmetic results was 84%. Significant changes in QoL were observed for emotional and social well-being between 3 and 12 months. At 24 months, only emotional well-being subscore changes were statistically significant (p = 0.015). Conclusions: Our data in patients older than 60 years support the previously published data. Histologic features were the main disqualifying criteria. With higher skin spacing levels we observed very low incidence of telangiectasia. QoL evaluation indicates that baseline scores were satisfactory. Changes concerned emotional and social well-being

  2. A survey of patients with inflammatory skin recurrence corresponding to the area of previous irradiation after postoperative radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    One of the unusual patterns of local recurrence in breast cancer patient is an inflammatory skin recurrence (ISR) sharply demarcating the area of previous radiation fields. To clarify the characteristics of this recurrence, we conducted a nationwide survey. We sent a survey to radiation oncologists at 200 institutions in Japan and received answers from 92. Of these, 24 institutions had some experience with patients who developed ISR affecting the previously irradiated area. The case details of 16 patients from 11 institutions were available and analyzed in this study. Eight patients experienced ISR after breast conservative therapy (groupA) and 8 patients experienced ISR after post-mastectomy radiotherapy (groupB). The postoperative pathological examination of groups A and B showed positive axillary lymph-nodes in 7/8 and 8/8 patients, positive lymphatic invasion in 4/7 and 7/8 patients, and estrogen receptor (ER) status negative in 7/8 and 6/7 patients respectively. Median survival period was 266 days in groupA and 1105 days in groupB (p=0.0001). Patients who developed the ISR tended to have several characteristics, including positive lymph-node metastases, intensive lymphatic invasion, and ER status negative. Physicians should contemplate the diagnosis of ISR next to radiation recall or radiation dermatitis, especially when the aforementioned risk factors are present. (author)

  3. Elevated breast cancer risk in irradiated BALB/c mice associates with unique functional polymorphism of the Prkdc (DNA-dependent protein kinase catalytic subunit) gene

    Science.gov (United States)

    Yu, Y.; Okayasu, R.; Weil, M. M.; Silver, A.; McCarthy, M.; Zabriskie, R.; Long, S.; Cox, R.; Ullrich, R. L.

    2001-01-01

    Female BALB/c mice are unusually radiosensitive and more susceptible than C57BL/6 and other tested inbred mice to ionizing radiation (IR)-induced mammary tumors. This breast cancer susceptibility is correlated with elevated susceptibility for mammary cell transformation and genomic instability following irradiation. In this study, we report the identification of two BALB/c strain-specific polymorphisms in the coding region of Prkdc, the gene encoding the DNA-dependent protein kinase catalytic subunit, which is known to be involved in DNA double-stranded break repair and post-IR signal transduction. First, we identified an A --> G transition at base 11530 resulting in a Met --> Val conversion at codon 3844 (M3844V) in the phosphatidylinositol 3-kinase domain upstream of the scid mutation (Y4046X). Second, we identified a C --> T transition at base 6418 resulting in an Arg --> Cys conversion at codon 2140 (R2140C) downstream of the putative leucine zipper domain. This unique PrkdcBALB variant gene is shown to be associated with decreased DNA-dependent protein kinase catalytic subunit activity and with increased susceptibility to IR-induced genomic instability in primary mammary epithelial cells. The data provide the first evidence that naturally arising allelic variation in a mouse DNA damage response gene may associate with IR response and breast cancer risk.

  4. Volumetric modulated arc therapy and breath-hold in image-guided locoregional left-sided breast irradiation

    NARCIS (Netherlands)

    Osman, S.O.; Hol, S.; Poortmans, P.M.P.; Essers, M.

    2014-01-01

    PURPOSE: To investigate the effects of using volumetric modulated arc therapy (VMAT) and/or voluntary moderate deep inspiration breath-hold (vmDIBH) in the radiation therapy (RT) of left-sided breast cancer including the regional lymph nodes. MATERIALS AND METHODS: For 13 patients, four treatment co

  5. Long-term Cosmetic Outcomes and Toxicities of Proton Beam Therapy Compared With Photon-Based 3-Dimensional Conformal Accelerated Partial-Breast Irradiation: A Phase 1 Trial

    International Nuclear Information System (INIS)

    Purpose: To present long-term outcomes of a prospective feasibility trial using either protons or 3-dimensional conformal photon-based (accelerated partial-breast irradiation [APBI]) techniques. Methods and Materials: From October 2003 to April 2006, 98 evaluable patients with stage I breast cancer were treated with APBI (32 Gy in 8 fractions given twice daily) on a prospective clinical trial: 19 with proton beam therapy (PBT) and 79 with photons or mixed photons/electrons. Median follow-up was 82.5 months (range, 2-104 months). Toxicity and patient satisfaction evaluations were performed at each visit. Results: At 7 years, the physician rating of overall cosmesis was good or excellent for 62% of PBT patients, compared with 94% for photon patients (P=.03). Skin toxicities were more common for the PBT group: telangiectasia, 69% and 16% (P=.0013); pigmentation changes, 54% and 22% (P=.02); and other late skin toxicities, 62% and 18% (P=.029) for PBT and photons, respectively. There were no significant differences between the groups in the incidences of breast pain, edema, fibrosis, fat necrosis, skin desquamation, and rib pain or fracture. Patient-reported cosmetic outcomes at 7 years were good or excellent for 92% and 96% of PBT and photon patients, respectively (P=.95). Overall patient satisfaction was 93% for the entire cohort. The 7-year local failure rate for all patients was 6%, with 3 local recurrences in the PBT group (7-year rate, 11%) and 2 in photon-treated patients (4%) (P=.22). Conclusions: Local failure rates of 3-dimensional APBI and PBT were similar in this study. However, PBT, as delivered in this study, led to higher rates of long-term telangiectasia, skin color changes, and skin toxicities. We recommend the use of multiple fields and treatment of all fields per treatment session or the use of scanning techniques to minimize skin toxicity

  6. Accelerated partial breast irradiation with external beam three-dimensional conformal radiotherapy. Five-year results of a prospective phase II clinical study

    International Nuclear Information System (INIS)

    The aim of this study was to report the 5-year results of accelerated partial breast irradiation (APBI) using external beam three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2011, 44 patients with low-risk, stage I-II breast cancer underwent breast-conserving surgery. Postoperative APBI was given by means of 3D-CRT using three to five non-coplanar fields. The total dose of APBI was 36.9 Gy (nine fractions of 4.1 Gy b.i.d.). The mean follow-up time was 58.2 months for surviving patients. Survival results, side effects, and cosmetic results were assessed. One (2.3 %) local recurrence was observed, for a 5-year actuarial rate of 3.7 %. Neither regional nor distant failure was observed. Two patients died of internal disease. The 5-year disease-free, cancer-specific, and overall survival rates were 96.3, 100, and 95.1 %, respectively. Acute side effects included grade 1 (G1) erythema in 75 %, G1 parenchymal induration in 46 %, and G1 pain in 46 % of patients. No G2 or higher acute side effect occurred. Late side effects included G1, G2, and G3 fibrosis in 44, 7, and 2 % of patients, respectively, G1 skin pigmentation in 12 %, and G1 pain in 2 %. Asymptomatic fat necrosis occurred in 14 %. Cosmetic results were rated excellent or good in 86 % of cases by the patients themselves and 84 % by the physicians. The 5-year local tumor control, toxicity profile, and cosmetic results of APBI delivered with external beam 3D-CRT are encouraging and comparable to other APBI series. (orig.)

  7. Long-term Cosmetic Outcomes and Toxicities of Proton Beam Therapy Compared With Photon-Based 3-Dimensional Conformal Accelerated Partial-Breast Irradiation: A Phase 1 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Galland-Girodet, Sigolène; Pashtan, Itai; MacDonald, Shannon M.; Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Hirsch, Ariel E.; Kachnic, Lisa A. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts (United States); Specht, Michelle; Gadd, Michele; Smith, Barbara L. [Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Powell, Simon N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-11-01

    Purpose: To present long-term outcomes of a prospective feasibility trial using either protons or 3-dimensional conformal photon-based (accelerated partial-breast irradiation [APBI]) techniques. Methods and Materials: From October 2003 to April 2006, 98 evaluable patients with stage I breast cancer were treated with APBI (32 Gy in 8 fractions given twice daily) on a prospective clinical trial: 19 with proton beam therapy (PBT) and 79 with photons or mixed photons/electrons. Median follow-up was 82.5 months (range, 2-104 months). Toxicity and patient satisfaction evaluations were performed at each visit. Results: At 7 years, the physician rating of overall cosmesis was good or excellent for 62% of PBT patients, compared with 94% for photon patients (P=.03). Skin toxicities were more common for the PBT group: telangiectasia, 69% and 16% (P=.0013); pigmentation changes, 54% and 22% (P=.02); and other late skin toxicities, 62% and 18% (P=.029) for PBT and photons, respectively. There were no significant differences between the groups in the incidences of breast pain, edema, fibrosis, fat necrosis, skin desquamation, and rib pain or fracture. Patient-reported cosmetic outcomes at 7 years were good or excellent for 92% and 96% of PBT and photon patients, respectively (P=.95). Overall patient satisfaction was 93% for the entire cohort. The 7-year local failure rate for all patients was 6%, with 3 local recurrences in the PBT group (7-year rate, 11%) and 2 in photon-treated patients (4%) (P=.22). Conclusions: Local failure rates of 3-dimensional APBI and PBT were similar in this study. However, PBT, as delivered in this study, led to higher rates of long-term telangiectasia, skin color changes, and skin toxicities. We recommend the use of multiple fields and treatment of all fields per treatment session or the use of scanning techniques to minimize skin toxicity.

  8. Evaluation of surface dose outside the treatment area for five breast cancer irradiation modalities using thermo-luminescent dosimeters

    Directory of Open Access Journals (Sweden)

    Suraj Prasad Khanal

    2015-03-01

    Full Text Available Purpose: To measure and compare the surface dose outside the treatment area at six different points of interest (POIs for five different breast cancer radiation treatment modalities by using thermo-luminescent dosimeters (TLDs. This experiment will evaluate the magnitude of the dose due to scatter and leakage radiation at different areas outside the target on a patient that could potentially lead, in the long term, to radiation induced secondary malignancies.Methods: TLD-100 were calibrated according to the University of Wisconsin Radiation Calibration Laboratory protocol and then used for dose measurements at selected POIs namely sternum, lower abdomen, contralateral breast, thyroid, shoulder, and eye. Twenty five breast cancer patients and the following modalities were included in this study: Strut-adjusted volume implant (SAVI, mammosite multi-lumen (ML, Accuboost, electron boost and photon boost. The surface doses in all patients were measured in a single fraction. The delivered target doses were normalized to 200 cGy. Finally, breast quadrant analysis was performed.Results: The maximum average dose for each POI was as follows: Sternum 6.51 cGy (SD 2.93, lower abdomen 4.50 cGy (SD 2.63, contralateral breast 8.52 cGy (SD 3.86, thyroid 5.50 cGy (SD 2.75, shoulder 5.58 cGy (SD 2.77, and eye 2.65 cGy (SD 0.68. The highest POI dose of 15.84 cGy was found in contralateral breast.Conclusion: The measured surface dose at each POI varies with the modality of treatment. The surface doses show a strong correlation to the tumor bed location in the breast quadrant. The SAVI, electron boost, and photon boost modalities had delivered smaller surface dose at POIs than the Accuboost and Mammosite ML modalities. While the measured doses fall within the low range, its significance in producing second malignancies would require a large cohort of patients and a longer follow up.

  9. Coverage of Axillary Lymph Nodes with Tangential Breast Irradiation in Korea: A Multi-Institutional Comparison Study

    Directory of Open Access Journals (Sweden)

    Jinhong Jung

    2016-01-01

    Full Text Available Introduction. To evaluate the dose distribution and coverage of axilla using only tangential field for whole breast radiotherapy (RT at three institutions in Korea. Methods. We used computed tomography (CT images of nine consecutive 1-2 sentinel lymph node-positive patients who underwent breast conserving surgery and whole breast RT without axillary lymph node (ALN dissection for clinical T1-2N0 breast cancer. The CT data were transferred to three radiation oncologists in 3 institutions and each radiation oncologist created treatment plans for all nine patients; a total of 27 treatment plans were analyzed. Results. The mean doses delivered to levels I and II were 31.9 Gy (9.9–47.9 Gy and 22.3 Gy (3.4–47.7 Gy. Ninety-five percent of levels I and II received a mean dose of 11.8 Gy (0.4–43.0 Gy and 3.0 Gy (0.3–40.0 Gy. The percent volumes of levels I and II covered by 95% of the prescribed dose were only 29.0% (0.2–74.1% and 11.5% (0.0–70.1%. The dose distribution and coverage of axilla were significantly different between three institutions (p=0.001. Conclusion. There were discrepancies in ALN coverage between three institutions. A standardization of whole breast RT technique through further research with a nationwide scale is needed.

  10. Coverage of Axillary Lymph Nodes with Tangential Breast Irradiation in Korea: A Multi-Institutional Comparison Study.

    Science.gov (United States)

    Jung, Jinhong; Kong, Moonkyoo; Kim, Su Ssan; Yoon, Won Sup

    2016-01-01

    Introduction. To evaluate the dose distribution and coverage of axilla using only tangential field for whole breast radiotherapy (RT) at three institutions in Korea. Methods. We used computed tomography (CT) images of nine consecutive 1-2 sentinel lymph node-positive patients who underwent breast conserving surgery and whole breast RT without axillary lymph node (ALN) dissection for clinical T1-2N0 breast cancer. The CT data were transferred to three radiation oncologists in 3 institutions and each radiation oncologist created treatment plans for all nine patients; a total of 27 treatment plans were analyzed. Results. The mean doses delivered to levels I and II were 31.9 Gy (9.9-47.9 Gy) and 22.3 Gy (3.4-47.7 Gy). Ninety-five percent of levels I and II received a mean dose of 11.8 Gy (0.4-43.0 Gy) and 3.0 Gy (0.3-40.0 Gy). The percent volumes of levels I and II covered by 95% of the prescribed dose were only 29.0% (0.2-74.1%) and 11.5% (0.0-70.1%). The dose distribution and coverage of axilla were significantly different between three institutions (p = 0.001). Conclusion. There were discrepancies in ALN coverage between three institutions. A standardization of whole breast RT technique through further research with a nationwide scale is needed. PMID:27525123

  11. A comparison of dosimetric variance for external-beam partial breast irradiation using three-dimensional and four-dimensional computed tomography

    Directory of Open Access Journals (Sweden)

    Guo B

    2016-03-01

    Full Text Available Bing Guo,1,2 Jian-Bin Li,2 Wei Wang,2 Min Xu,2 Yan-Kang Li,2,3 Tong-Hai Liu21School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, People’s Republic of China; 2Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Jinan, Shandong Province, People’s Republic of China; 3School of Medicine, Shandong University, Jinan, Shandong Province, People’s Republic of ChinaPurpose: To investigate the potential dosimetric benefits from four-dimensional computed tomography (4DCT compared with three-dimensional computed tomography (3DCT in radiotherapy treatment planning for external-beam partial breast irradiation (EB-PBI.Patients and methods: 3DCT and 4DCT scan sets were acquired for 20 patients who underwent EB-PBI. The volume of the tumor bed (TB was determined based on seroma or surgical clips on 3DCT images (defined as TB3D and the end inhalation (EI and end exhalation (EE phases of 4DCT images (defined as TBEI and TBEE, respectively. The clinical target volume (CTV consisted of the TB plus a 1.0 cm margin. The planning target volume (PTV was the CTV plus 0.5 cm (defined as PTV3D, PTVEI, and PTVEE. For each patient, a conventional 3D conformal plan (3D-CRT was generated (defined as EB-PBI3D, EB-PBIEI, and EB-PBIEE.Results: The PTV3D, PTVEI, and PTVEE were similar (P=0.549, but the PTV coverage of EB-PBI3D was significantly less than that of EB-PBIEI or EB-PBIEE (P=0.001 and P=0.025, respectively. There were no significant differences in the homogeneity or conformity indexes between the three treatment plans (P=0.125 and P=0.536, respectively. The EB-PBI3D plan resulted in the largest organs at risk dose.Conclusion: There was a significant benefit for patients when using 3D-CRT based on 4DCT for EB-PBI with regard to reducing nontarget organ exposure. Respiratory motion did not affect the dosimetric distribution during free breathing, but might result in poor dose

  12. Comparison of two treatment strategies for irradiation of regional lymph nodes in patients with breast cancer: Lymph flow guided portals versus standard radiation fields

    Science.gov (United States)

    Novikov, Sergey Nikolaevich; Kanaev, Sergey Vasilevich; Semiglazov, Vladimir Fedorovich; Jukova, Ludmila Alekseevna; Krzhivitckiy, Pavel Ivanovich

    2014-01-01

    Aim and Background Radiotherapy being an essential part of breast cancer treatment, we evaluate various radiotherapy strategies in patients with breast cancer. Materials and methods Lymph node (LN) scintigraphy was performed in 172 primary patients with BC. LN visualization started 30–360 min after intratumoral injection of 75–150 MBq of 99mTc-nanocolloids. Our standard recommendation for postoperative radiotherapy in patients with LN invasion by BC were as follows: for patients with external localization of tumour – breast + axillary (Ax) + sub-supraclavicular (SSCL) regions; with internal localization – all above + internal mammary nodes (IM). Proposed strategy of lymph flow guided radiotherapy is based on the assumption that only regions that contain ‘hot’ LNs must be included in a treatment volume. Results Among 110 patients with external localization of BC, Ax LNs were visualized in all cases and in 62 patients it was the only region with ‘hot’ LN. Twenty-three patients (20.9%) had drainage to Ax + SSCL, 12 (10.9%) – Ax + IM, 13 (11.8%) – Ax + SSCL + IM regions. After the visualization of lymph flow patterns, standard treatment volume was changed in 87/110 cases (79.1%): in 56.4%, reduced, in 22.7%, enlarged or changed. In 62 patients with tumours in internal quadrants, we revealed the following patterns of lymph-flow: only to the Ax region in 23 (37.1%); Ax + IM, 13 (21%); Ax + SSCL, 15 (24.2%); Ax + IM + ISSCL, 11 (17.7%) cases. After lymph-flow visualization, the standard irradiation volume was reduced in 53/62 (85.5%) cases. Conclusion Visualization of an individual lymph flow pattern from BC can be used for the optimization of standard fields used for irradiation of regional LNs. PMID:25535581

  13. Tracking the dynamic seroma cavity using fiducial markers in patients treated with accelerated partial breast irradiation using 3D conformal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Yue, Ning J.; Haffty, Bruce G.; Goyal, Sharad [Department of Radiation Oncology, Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903 (United States); Kearney, Thomas; Kirstein, Laurie [Division of Surgical Oncology, Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903 (United States); Chen Sining [Department of Biostatistics, Cancer Institute of New Jersey, UMDNJ/School of Public Health, New Brunswick, NJ 08901 (United States)

    2013-02-15

    Purpose: The purpose of the present study was to perform an analysis of the changes in the dynamic seroma cavity based on fiducial markers in early stage breast cancer patients treated with accelerated partial breast irradiation (APBI) using three-dimensional conformal external beam radiotherapy (3D-CRT). Methods: A prospective, single arm trial was designed to investigate the utility of gold fiducial markers in image guided APBI using 3D-CRT. At the time of lumpectomy, four to six suture-type gold fiducial markers were sutured to the walls of the cavity. Patients were treated with a fractionation scheme consisting of 15 fractions with a fractional dose of 333 cGy. Treatment design and planning followed NSABP/RTOG B-39 guidelines. During radiation treatment, daily kV imaging was performed and the markers were localized and tracked. The change in distance between fiducial markers was analyzed based on the planning CT and daily kV images. Results: Thirty-four patients were simulated at an average of 28 days after surgery, and started the treatment on an average of 39 days after surgery. The average intermarker distance (AiMD) between fiducial markers was strongly correlated to seroma volume. The average reduction in AiMD was 19.1% (range 0.0%-41.4%) and 10.8% (range 0.0%-35.6%) for all the patients between simulation and completion of radiotherapy, and between simulation and beginning of radiotherapy, respectively. The change of AiMD fits an exponential function with a half-life of seroma shrinkage. The average half-life for seroma shrinkage was 15 days. After accounting for the reduction which started to occur after surgery through CT simulation and treatment, radiation was found to have minimal impact on the distance change over the treatment course. Conclusions: Using the marker distance change as a surrogate for seroma volume, it appears that the seroma cavity experiences an exponential reduction in size. The change in seroma size has implications in the size of

  14. Practical Techniques for Achieving Consensus.

    Science.gov (United States)

    Kline, John A.

    Consensus is important in the making of a policy decision. If a decision is reached without consensus, morale and unit satisfaction may both suffer. With genuine consensus, a unit tends to willingly support and implement the new policy. After analyzing how observed small groups had actually reached consensus, the following ten techniques were…

  15. Regional nodal recurrence in the management of breast cancer patients with one to three positive axillary lymph nodes. Outcome of patients following tangential irradiation without a separate nodal field

    Energy Technology Data Exchange (ETDEWEB)

    Stranzl, H.; Prettenhofer, U.; Mayer, R.; Hackl, A. [Dept. of Radiotherapy, Univ. Medical School, Graz (Austria); Peintinger, F. [Div. of Gynecology, Leoben (Austria); Ofner, P. [Dept. of Medical Informatics, Statistics and Documentation, Univ. Medical School, Graz (Austria)

    2004-10-01

    Purpose: to examine the prognosis of breast cancer patients (T1-3, one to three positive axillary lymph nodes) and locoregional failure rate after breast-conserving therapy/modified radical mastectomy and adequate axillary dissection following tangential radiotherapy without irradiation of the regional lymph nodes. Patients and methods: from 1994 to 2002, the medical records of 183 breast cancer patients (T1-3, one to three involved axillary lymph nodes) were examined in order to identify those experiencing regional nodal recurrence, with or without local recurrence. The median age of the patient population was 58 years (range, 28-86 years). All patients underwent surgical treatment, either breast-conserving therapy (n = 146) or modified radical mastectomy (n = 37). The median number of lymph nodes removed was twelve (range, seven to 26 nodes). Irradiation was given to the breast through tangential fields. Chemotherapy was administered to 101 patients (55%), hormonal therapy to 124 (60%), and combined systemic treatment to 47 (26%). Results: the median observation time was 44.4 months (range, 11-102 months). Of the 14 patients (7.7%) with a relapse, six (3.3%) had a local recurrence, five (2.8%) a regional relapse, and three (1.6%) a simultaneous recurrence. Nine out of 14 patients with locoregional relapse developed distant failure subsequently and seven of them (78%) died of the disease. Conclusion: regional recurrence is uncommon among patients with one to three positive axillary lymph nodes treated with surgery, adequate axillary dissection, and tangential field irradiation only. The authors conclude that regional nodal irradiation should not routinely be given following adequate axillary dissection when only one to three lymph nodes are positive. (orig.)

  16. Large-fraction preoperative irradiation in combination with organ-sparing surgery for first- or second-stage breast cancer

    International Nuclear Information System (INIS)

    A method of combined organ-sparing treatment for first-or second-stage breast cancer has been developed. It includes large-fraction preoperative radiation (28.5 Gy in 5 daily fractions) and segmental mastectomy with axillary lymphadenectomy. The method has been used in 25 patients. Mean follow-up time is 23 months. No local or regional relapses have been recorded. Total relapse-free survival is 92%. The cosmetic and functional effect is satisfactory

  17. Cosmetic results in early breast cancer treated with lumpectomy, peri-operative interstitial irradiation, and external beam radiation

    International Nuclear Information System (INIS)

    Patients with operable breast cancer were treated at the University of Kansas Medical Center with lumpectomy, peri-operative interstitial Iridium, and external beam radiotherapy, and concomitant adjuvant chemotherapy in a majority of node positive cases. Examination of the cosmetic results in 85 breasts followed for at least 2 years, at a median of 41 months revealed 20% to be excellent, 44% to be very good, 24% good, 9% fair, and 4% to have poor results. In this paper cosmesis is analyzed with reference to the size of the primary, its location, age of the patient, whether the patient received adjuvant chemotherapy, and whether the regional nodes were treated. In this group of patients, the size and the site of the primary, patient's age, and whether adjuvant chemotherapy was administered or not, did not adversely affect the aesthetic outcome. Treatment of the regional nodes gave a worse mean cosmetic score compared to the group in whom only the breast was treated (37.51 vs. 58.98 respectively, p less than 0.001). Among the 11 patients with fair/poor cosmesis, all had regional nodal treatment, 7/11 had inner quadrant lesions, and 7/11 had lesions greater than T1. Further follow-up and accrual would be needed to confirm our results and affirm if other factors would change

  18. Some hot issues in the treatment of bone metastasis of breast cancer: interpretation of Expert Consensus on the Diagnosis and Treatment of Bone Metastasis and Skeletal Related Diseases in Breast Cancer (2014 version)%乳腺癌骨转移治疗的若干热点问题思考和讨论:乳腺癌骨转移和骨相关疾病临床诊疗专家共识(2014版)解读

    Institute of Scientific and Technical Information of China (English)

    王如良; 江泽飞

    2015-01-01

    乳腺癌是女性最常见的恶性肿瘤,骨转移引起的骨痛、病理性骨折等骨相关事件可严重影响患者的生命质量.2014年中国抗癌协会乳腺癌专业委员会组织相关专家再次讨论制定了"乳腺癌骨转移和骨相关疾病临床诊疗专家共识(2014版)",文章对其中若干热点问题进行一些思考及探讨.%Breast cancer is the most common malignant tumor in women, bone related events (SREs), such as bone pain, pathological fracture and so on, can affect seriously the quality of life.Experts in Chinese Anti-Cancer Association, Committee of Breast Cancer Society (CACA-CBCS) discussed the Consensus on the Diagnosis and Treatment of Bone Metastasis and Skeletal Related Diseases in Breast Cancer (2014 version), here reflections on several hot issues were explored.

  19. Continuity and consensus

    DEFF Research Database (Denmark)

    Abrahamson, Peter

    2010-01-01

    maternal leave. These changes can be explained as adjustments to post-industrial conditions within a political culture relying on class compromises and a broad consensus informed by expert advice coming from civil servants and ad hoc policy commissions. The paper concludes that changes in Danish family...... policy reflect changing conditions for employment and the minding of children and that there has been a high degree of continuity and consensus about the change, as indicated by the strong increase in female labour market involvement....

  20. Minimising contralateral breast dose in post-mastectomy intensity-modulated radiotherapy by incorporating conformal electron irradiation

    NARCIS (Netherlands)

    van der Laan, Hans Paul; Korevaar, Erik W; Dolsma, Willemtje; Maduro, John H; Langendijk, Johannes A

    2010-01-01

    PURPOSE: To assess the potential benefit of incorporating conformal electron irradiation in intensity-modulated radiotherapy (IMRT) for loco-regional post-mastectomy RT. PATIENTS AND METHODS: Ten consecutive patients that underwent left-sided mastectomy were selected for this comparative planning st

  1. Model-based consensus

    NARCIS (Netherlands)

    Boumans, Marcel

    2014-01-01

    The aim of the rational-consensus method is to produce “rational consensus”, that is, “mathematical aggregation”, by weighing the performance of each expert on the basis of his or her knowledge and ability to judge relevant uncertainties. The measurement of the performance of the experts is based on

  2. Critique, Contextualism and Consensus

    Science.gov (United States)

    Green, Jane

    2004-01-01

    In an epistemology of contextualism, how robust does consensus need to be for critique to be practically effective? In 'Relativism and the Critical Potential of Philosophy of Education,' Frieda Heyting proposes a form of contextualism, but her argument raises a number of problems. The kinds of criteria that her version of contextualism will…

  3. Making Consensus Tractable

    CERN Document Server

    Mossel, Elchanan

    2010-01-01

    The process of consensus voting has many distinct advantages: it fosters discussion and participation, empowers minorities and independent thinkers, and is more likely, after a decision has been made, to secure the participants' support for the chosen course of action. The disadvantage of consensus decision making is, of course, the difficulty of reaching consensus. While this challenge is largely overcome in many theoretical settings such as Aumann's ``agree to disagree'' result, a hitherto unsolved difficulty is the lack of a framework offering rational (i.e., Bayesian) consensus decision making that can be performed using simple and efficient calculations. We propose a model featuring two possible states of the world and a finite number of individuals. The group has to come to a binary decision, where the merit of each of the two possible courses of action depends on the state of the world. Each member of the group has a private and independent signal at his or her disposal, giving some indication as to wh...

  4. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy*

    Science.gov (United States)

    Leite, Elton Trigo Teixeira; Ugino, Rafael Tsuneki; Santana, Marco Antônio; Ferreira, Denis Vasconcelos; Lopes, Maurício Russo; Pelosi, Edilson Lopes; da Silva, João Luis Fernandes; Carvalho, Heloisa de Andrade

    2016-01-01

    Objective To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique.

  5. Long-term Changes in Pulmonary Function After Incidental Lung Irradiation for Breast Cancer: A Prospective Study With 7-Year Follow-up

    International Nuclear Information System (INIS)

    Purpose: To evaluate late pulmonary function changes after incidental pulmonary irradiation for breast cancer. Methods and Materials: Forty-three consecutive female patients diagnosed with breast carcinoma and treated with postoperative radiation therapy (RT) at the same dose (50 Gy) and fractionation (2 Gy/fraction, 5 days/week) were enrolled. Pulmonary function tests (PFT) and ventilation/perfusion scans were performed before RT and 6, 12, 24, and 84 months afterward. Results: Forty-one patients, mean age 55 years, were eligible for the analysis. No differences were found in the baseline PFT values for age, smoking status and previous chemotherapy; women undergoing mastectomy showed baseline spirometric PFT values lower than did women treated with conservative surgery. The mean pulmonary dose was 10.9 Gy, being higher in women who also received lymph node RT (15.8 vs 8.6, P<.01). Only 1 patient experienced symptomatic pneumonitis. All PFT values showed a reduction at 6 months. From then on, the forced vital capacity and forced expiratory volume in 1 second began their recovery until reaching, and even exceeding, their baseline values at 7 years. Diffusing capacity of the lungs for carbon monoxide and ventilation/perfusion scans continued to reduce for 24 months and then partially recovered their baseline values (−3.5%, −3.8%, and −5.5%, respectively). Only the percentage difference at 7 years in the ventilation scan correlated with the dosimetric parameters studied. Other variables, such as age, smoking status, previous chemotherapy, and concomitant tamoxifen showed no significant relation with changes in PFT (ΔPFT) values at 7 years. Conclusions: The study of reproducible subclinical parameters, such as PFT values, shows how their figures decrease in the first 2 years but practically recover their baseline values in the long term. The extent of the reduction in PFT values was small, and there was no clear association with several dosimetric and clinical

  6. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy*

    Science.gov (United States)

    Leite, Elton Trigo Teixeira; Ugino, Rafael Tsuneki; Santana, Marco Antônio; Ferreira, Denis Vasconcelos; Lopes, Maurício Russo; Pelosi, Edilson Lopes; da Silva, João Luis Fernandes; Carvalho, Heloisa de Andrade

    2016-01-01

    Objective To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique. PMID:27403017

  7. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Leite, Elton Trigo Teixeira; Ugino, Rafael Tsuneki; Lopes, Mauricio Russo; Pelosi, Edilson Lopes; Silva, Joao Luis Fernandes da, E-mail: eltontt@gmail.com [Hospital Sirio-Libanes, Sao paulo, SP (Brazil). Departamento de Radiologia e Oncologia; Santana, Marco Antonio; Ferreira, Denis Vasconcelos; Carvalho, Heloisa de Andrade [Universidade de Sao Paulo (FM/USP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Departamento de Radiologia e Oncologia

    2016-05-15

    Objective: to evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods: This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results: Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion: Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique. (author)

  8. Multi-catheter interstitial brachytherapy for partial breast irradiation: an audit of implant quality based on dosimetric evaluation comparing intra-operative versus post-operative placement

    Science.gov (United States)

    Gurram, Lavanya; Joshi, Kishor; Phurailatpam, Reena; Paul, Siji; Sarin, Rajiv

    2016-01-01

    Purpose The use of multicatheter interstitial brachytherapy (MIB) for accelerated partial breast irradiation (APBI) in early breast cancer (EBC) patients outside the trial setting has increased. Hence, there is a need to critically evaluate implant quality. Moreover, there is a scarcity of reports using an open cavity technique. We report the dosimetric indices of open and closed cavity MIB techniques. Material and methods The dosimetric parameters of 60 EBC patients treated with MIB (open and closed cavity) who underwent three dimensional, computerized tomography (CT) based planning for APBI from November 2011 to July 2015 were evaluated. Coverage Index (CI), Dose Homogeneity Index (DHI), Conformity Index (COIN), Plan Quality Index (PQI), and Dose Non-uniformity Index (DNR) were assessed. Results Forty-one patients underwent open cavity and 19 patients underwent closed cavity placement of brachytherapy catheters. The median number of planes was 4 and median number of needles was 20. Median dose was 34 Gy with dose per fraction of 3.4 Gy, given twice a day, 6 hours apart. The D90 of the cavity and clinical target volume (CTV) were 105% and 89%, respectively. The median doses to the surgical clips were greater than 100%. The median CI of the cavity and CTV was 0.96 and 0.82, respectively. The DHI and COIN index of the CTV was 0.73 and 0.67. There were no significant differences in the dosimetric parameters based on whether the technique was done open or closed. Conclusions Critical evaluation of the dosimetric parameters of MIB-APBI is important for optimal results. While the open and closed techniques have similar dosimetry, our institutional preference is for an open technique which eases the procedure due to direct visualization of the tumor cavity. PMID:27257415

  9. Long-term Changes in Pulmonary Function After Incidental Lung Irradiation for Breast Cancer: A Prospective Study With 7-Year Follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Jaen, Javier, E-mail: javier.jaen.sspa@juntadeandalucia.es [Unidad de Atencion Integral al Cancer, Hospital Universitario Puerta del Mar, Cadiz (Spain); Vazquez, Gonzalo [Servicio de Oncologia Radioterapica, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid (Spain); Alonso, Enrique; De Las Penas, Maria D.; Diaz, Laura [Unidad de Atencion Integral al Cancer, Hospital Universitario Puerta del Mar, Cadiz (Spain); De Las Heras, Manuel [Servicio de Oncologia Radioterapica, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid (Spain); Perez-Regadera, Jose F. [Servicio de Oncologia Radioterapica, Hospital Universitario Doce de Octubre, Madrid (Spain)

    2012-12-01

    Purpose: To evaluate late pulmonary function changes after incidental pulmonary irradiation for breast cancer. Methods and Materials: Forty-three consecutive female patients diagnosed with breast carcinoma and treated with postoperative radiation therapy (RT) at the same dose (50 Gy) and fractionation (2 Gy/fraction, 5 days/week) were enrolled. Pulmonary function tests (PFT) and ventilation/perfusion scans were performed before RT and 6, 12, 24, and 84 months afterward. Results: Forty-one patients, mean age 55 years, were eligible for the analysis. No differences were found in the baseline PFT values for age, smoking status and previous chemotherapy; women undergoing mastectomy showed baseline spirometric PFT values lower than did women treated with conservative surgery. The mean pulmonary dose was 10.9 Gy, being higher in women who also received lymph node RT (15.8 vs 8.6, P<.01). Only 1 patient experienced symptomatic pneumonitis. All PFT values showed a reduction at 6 months. From then on, the forced vital capacity and forced expiratory volume in 1 second began their recovery until reaching, and even exceeding, their baseline values at 7 years. Diffusing capacity of the lungs for carbon monoxide and ventilation/perfusion scans continued to reduce for 24 months and then partially recovered their baseline values (-3.5%, -3.8%, and -5.5%, respectively). Only the percentage difference at 7 years in the ventilation scan correlated with the dosimetric parameters studied. Other variables, such as age, smoking status, previous chemotherapy, and concomitant tamoxifen showed no significant relation with changes in PFT ({Delta}PFT) values at 7 years. Conclusions: The study of reproducible subclinical parameters, such as PFT values, shows how their figures decrease in the first 2 years but practically recover their baseline values in the long term. The extent of the reduction in PFT values was small, and there was no clear association with several dosimetric and clinical

  10. Preliminary simulation of implants breast through the accelerated partial irradiation technique: coverage rates and homogeneity; Simulacion previa de implates de mama mediante la tecnica de irradiacion parcial acelerada: indices de cubrimiento y homegeneidad

    Energy Technology Data Exchange (ETDEWEB)

    Moral Sanchez, S. C.; Paula Carranza, B. de; Erzibengoa, M.; Bragado Alvarez, L.; Guisasola Berasetegui, A.

    2013-07-01

    In this work we present and evaluate the process of pre-simulation we have drawn up when it comes to treatments of accelerated partial irradiation of breast. Previous simulation that we will allow you to have greater control over the location of catheters with respect to the area to radiate. The goodness of this procedure is evaluated through representative quality indexes of the implant. (Author)

  11. Occurrence of Breast Cancer After Chest Wall Irradiation for Pediatric Cancer, as Detected by a Multimodal Screening Program

    Energy Technology Data Exchange (ETDEWEB)

    Terenziani, Monica [Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Casalini, Patrizia [Molecular Biology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Scaperrotta, Gianfranco; Gandola, Lorenza; Trecate, Giovanna [Radiology and Radiotherapy Departments, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Catania, Serena; Cefalo, Graziella [Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Conti, Alberto [Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Massimino, Maura; Meazza, Cristina; Podda, Marta; Spreafico, Filippo [Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Suman, Laura [Radiology and Radiotherapy Departments, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Gennaro, Massimiliano, E-mail: gennaromassimiliano@istitutotumori.mi.it [Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy)

    2013-01-01

    Purpose: To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program. Patients and Methods: We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment. Results: Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%. Conclusions: Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population.

  12. Occurrence of Breast Cancer After Chest Wall Irradiation for Pediatric Cancer, as Detected by a Multimodal Screening Program

    International Nuclear Information System (INIS)

    Purpose: To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program. Patients and Methods: We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment. Results: Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%. Conclusions: Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population.

  13. SNPs in DNA repair or oxidative stress genes and late subcutaneous fibrosis in patients following single shot partial breast irradiation

    Directory of Open Access Journals (Sweden)

    Falvo Elisabetta

    2012-01-01

    Full Text Available Abstract Background The aim of this study was to evaluate the potential association between single nucleotide polymorphisms related response to radiotherapy injury, such as genes related to DNA repair or enzymes involved in anti-oxidative activities. The paper aims to identify marker genes able to predict an increased risk of late toxicity studying our group of patients who underwent a Single Shot 3D-CRT PBI (SSPBI after BCS (breast conserving surgery. Methods A total of 57 breast cancer patients who underwent SSPBI were genotyped for SNPs (single nucleotide polymorphisms in XRCC1, XRCC3, GST and RAD51 by Pyrosequencing technology. Univariate analysis (ORs and 95% CI was performed to correlate SNPs with the risk of developing ≥ G2 fibrosis or fat necrosis. Results A higher significant risk of developing ≥ G2 fibrosis or fat necrosis in patients with: polymorphic variant GSTP1 (Ile105Val (OR = 2.9; 95%CI, 0.88-10.14, p = 0.047. Conclusions The presence of some SNPs involved in DNA repair or response to oxidative stress seem to be able to predict late toxicity. Trial Registration ClinicalTrials.gov: NCT01316328

  14. [Methods of exclusive irradiation of cancers of the breast. Société de Radiologie, 18 March 1974].

    Science.gov (United States)

    1975-05-01

    It was the object of this round table to discuss the different techniques for treatment of breast cancer by radiation only, in order to seek out their common points. Six French Centres participated: the Foundation Curie (Paris), the Centre Anti-Cancéreux de l'Hôpital Sainte-Marguerite (Marseille), the Service de Radiologie de l'Hôpital Civil (Strasbourg), the Centre René-Huguenin (Saint-Cloud)k, the Service de Carcinologie Radiothérapique de l'Hôpital Henri-Mondor (Créteil) and the Institut Gustave-Roussy (Villejuif). Our readers can see the details of the treatments practiced by each of the six schools in their own particular techniques, in the following pages. We will confine ourselves here to a brief summary only. It should be recalled that these techniques for treatment of breast cancer by radiotherapy alone vere developed almost simultaneously in several different Centres around 1960, as a result of the revolution in radiotherapy which began in 1975 with the installation of tele-Cobalt...

  15. Locoregional recurrence in patients suffering from a triple-negative breast cancer: interest of a systematic adjuvant ganglionary irradiation; Recidives locoregionales chez les patientes atteintes d'un cancer du sein triple-negatif: interet d'une irradiation ganglionnaire adjuvante systematique?

    Energy Technology Data Exchange (ETDEWEB)

    Clerc, J.; Sunyach, M.P.; Duruisseaux, M.; Mignotte, H.; Bajard, A.; Tredan, O.; Carrie, C.; Arnaud, A. [Centre Leon-Berard, Lyon (France)

    2011-10-15

    The authors report the assessment of locoregional recurrence percentage within women suffering from a triple-negative breast cancer without ganglionary attack, in order to examine the interest of a systematic adjuvant ganglionary irradiation. Nearly 250 women have been treated for a breast cancer between 1999 and 2009 in the Leon-Berard Centre in Lyons. All had surgery followed or not by a chemotherapy and/or a radiotherapy. The locoregional recurrence rate is not very high, but the authors cannot yet be sure to systematically propose this treatment. Short communication

  16. The Effect of Dose-Volume Parameters and Interfraction Interval on Cosmetic Outcome and Toxicity After 3-Dimensional Conformal Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Leonard, Kara Lynne, E-mail: karalynne.kerr@gmail.com [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts (United States); Hepel, Jaroslaw T. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts (United States); Department of Radiation Oncology, Rhode Island Hospital, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island (United States); Hiatt, Jessica R. [Department of Radiation Oncology, Rhode Island Hospital, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island (United States); Dipetrillo, Thomas A. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts (United States); Department of Radiation Oncology, Rhode Island Hospital, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island (United States); Price, Lori Lyn [Department of Biostatistics Research Center, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts (United States); Wazer, David E. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts (United States); Department of Radiation Oncology, Rhode Island Hospital, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island (United States)

    2013-03-01

    Purpose: To evaluate dose-volume parameters and the interfraction interval (IFI) as they relate to cosmetic outcome and normal tissue effects of 3-dimensional conformal radiation therapy (3D-CRT) for accelerated partial breast irradiation (APBI). Methods and Materials: Eighty patients were treated by the use of 3D-CRT to deliver APBI at our institutions from 2003-2010 in strict accordance with the specified dose-volume constraints outlined in the National Surgical Adjuvant Breast and Bowel Project B39/Radiation Therapy Oncology Group 0413 (NSABP-B39/RTOG 0413) protocol. The prescribed dose was 38.5 Gy in 10 fractions delivered twice daily. Patients underwent follow-up with assessment for recurrence, late toxicity, and overall cosmetic outcome. Tests for association between toxicity endpoints and dosimetric parameters were performed with the chi-square test. Univariate logistic regression was used to evaluate the association of interfraction interval (IFI) with these outcomes. Results: At a median follow-up time of 32 months, grade 2-4 and grade 3-4 subcutaneous fibrosis occurred in 31% and 7.5% of patients, respectively. Subcutaneous fibrosis improved in 5 patients (6%) with extended follow-up. Fat necrosis developed in 11% of women, and cosmetic outcome was fair/poor in 19%. The relative volume of breast tissue receiving 5%, 20%, 50%, 80%, and 100% (V5-V100) of the prescribed dose was associated with risk of subcutaneous fibrosis, and the volume receiving 50%, 80%, and 100% (V50-V100) was associated with fair/poor cosmesis. The mean IFI was 6.9 hours, and the minimum IFI was 6.2 hours. The mean and minimum IFI values were not significantly associated with late toxicity. Conclusions: The incidence of moderate to severe late toxicity, particularly subcutaneous fibrosis and fat necrosis and resulting fair/poor cosmesis, remains high with continued follow-up. These toxicity endpoints are associated with several dose-volume parameters. Minimum and mean IFI values were

  17. Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Liss, Adam L. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Ben-David, Merav A. [Department of Radiation Oncology, The Sheba Medical Center, Ramat Gan (Israel); Jagsi, Reshma; Hayman, James A. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [Biostatistics Unit, University of Michigan, Ann Arbor, Michigan (United States); Moran, Jean M.; Marsh, Robin B. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Pierce, Lori J., E-mail: ljpierce@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2014-05-01

    Purpose: To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) with active-breathing control (ABC). Methods and Materials: Women older than 40 with breast cancer stages 0-I who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep inspiration breath-hold. Patients received 38.5 Gy in 3.85-Gy fractions given twice daily over 5 consecutive days. The planning target volume was defined as the lumpectomy cavity with a 1.5-cm margin. Cosmesis was scored on a 4-category scale by the treating physician. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). We report the cosmetic and toxicity results at a median follow-up of 5 years. Results: A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women at a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at the time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to CTCAE at last assessment was 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions: In this prospective trial with 5-year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique.

  18. The Effect of Dose-Volume Parameters and Interfraction Interval on Cosmetic Outcome and Toxicity After 3-Dimensional Conformal Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Purpose: To evaluate dose-volume parameters and the interfraction interval (IFI) as they relate to cosmetic outcome and normal tissue effects of 3-dimensional conformal radiation therapy (3D-CRT) for accelerated partial breast irradiation (APBI). Methods and Materials: Eighty patients were treated by the use of 3D-CRT to deliver APBI at our institutions from 2003-2010 in strict accordance with the specified dose-volume constraints outlined in the National Surgical Adjuvant Breast and Bowel Project B39/Radiation Therapy Oncology Group 0413 (NSABP-B39/RTOG 0413) protocol. The prescribed dose was 38.5 Gy in 10 fractions delivered twice daily. Patients underwent follow-up with assessment for recurrence, late toxicity, and overall cosmetic outcome. Tests for association between toxicity endpoints and dosimetric parameters were performed with the chi-square test. Univariate logistic regression was used to evaluate the association of interfraction interval (IFI) with these outcomes. Results: At a median follow-up time of 32 months, grade 2-4 and grade 3-4 subcutaneous fibrosis occurred in 31% and 7.5% of patients, respectively. Subcutaneous fibrosis improved in 5 patients (6%) with extended follow-up. Fat necrosis developed in 11% of women, and cosmetic outcome was fair/poor in 19%. The relative volume of breast tissue receiving 5%, 20%, 50%, 80%, and 100% (V5-V100) of the prescribed dose was associated with risk of subcutaneous fibrosis, and the volume receiving 50%, 80%, and 100% (V50-V100) was associated with fair/poor cosmesis. The mean IFI was 6.9 hours, and the minimum IFI was 6.2 hours. The mean and minimum IFI values were not significantly associated with late toxicity. Conclusions: The incidence of moderate to severe late toxicity, particularly subcutaneous fibrosis and fat necrosis and resulting fair/poor cosmesis, remains high with continued follow-up. These toxicity endpoints are associated with several dose-volume parameters. Minimum and mean IFI values were

  19. Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

    International Nuclear Information System (INIS)

    Purpose: To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) with active-breathing control (ABC). Methods and Materials: Women older than 40 with breast cancer stages 0-I who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep inspiration breath-hold. Patients received 38.5 Gy in 3.85-Gy fractions given twice daily over 5 consecutive days. The planning target volume was defined as the lumpectomy cavity with a 1.5-cm margin. Cosmesis was scored on a 4-category scale by the treating physician. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). We report the cosmetic and toxicity results at a median follow-up of 5 years. Results: A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women at a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at the time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to CTCAE at last assessment was 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions: In this prospective trial with 5-year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique

  20. Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity

    International Nuclear Information System (INIS)

    The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity. From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34–83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59 %), luminal-B 24 pts (24 %), basal-like 10 pts (10 %), Her-2 like 7 pts (7 %). 82 pts (82 %) received hormonal therapy, 9 pts (9 %) neo-adjuvant chemotherapy, 81pts (81 %) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation. Within a median follow-up of 50 months (range 19–82), 6 (6 %) pts died, 1 pt (1 %) had local progression disease, 2 pts (2 %) developed distant metastasis and 1 subject (1 %) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27 %) presented lymphedema, but only 10 cases (10 %) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis. Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related

  1. Market trials of irradiated chicken

    International Nuclear Information System (INIS)

    The potential market for irradiated chicken breasts was investigated using a mail survey and a retail trial. Results from the mail survey suggested a significantly higher level of acceptability of irradiated chicken than did the retail trial. A subsequent market experiment involving actual purchases showed levels of acceptability similar to that of the mail survey when similar information about food irradiation was provided

  2. Achieving diagnosis by consensus

    LENUS (Irish Health Repository)

    Kane, Bridget

    2009-08-01

    This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.

  3. Overlapping Consensus in Malaysia

    OpenAIRE

    Monsen, Mats

    2007-01-01

    An empirical study of how Malaysian pluralism is understood through Islam Hadhari, Article 11 and the Inter-faith Commission against the backdrop of current Malaysian political and social history, coupled with a theoretical analysis through John Rawls' Political Liberalism, with particular emphasis on the idea of Overlapping Consensus. The thesis is an attempt at applying Rawls' theory on the practical case of Malaysia, as a plural society, while at the same time using the practical case of M...

  4. Note on level r consensus

    OpenAIRE

    Poliakov, Nikolay L.

    2016-01-01

    We show that the hierarchy of level $r$ consensus partially collapses. In particular, any profile $\\pi\\in \\mathcal{P}$ that exhibits consensus of level $(K-1)!$ around $\\succ_0$ in fact exhibits consensus of level $1$ around $\\succ_0$.

  5. Spanish Consensus Statement

    Science.gov (United States)

    Rey, Guillermo Álvarez; Cuesta, Jordi Ardevol; Loureda, Rafael Arriaza; España, Fernando Ávila; Matas, Ramón Balius; Pazos, Fernando Baró; de Dios Beas Jiménez, Juan; Rosell, Jorge Candel; Fernandez, César Cobián; Ros, Francisco Esparza; Colmenero, Josefina Espejo; de Prado, Jorge Fernández; Cota, Juan José García; González, Jose Ignacio Garrido; Santander, Manuela González; Munilla, Miguel Ángel Herrador; Ruiz, Francisco Ivorra; Díaz, Fernando Jiménez; Marqueta, Pedro Manonelles; Fernandez, Antonio Maestro; Benito, Juan José Muñoz; Vilás, Ramón Olivé; Teres, Xavier Peirau; Amaro, José Peña; Roque, Juan Pérez San; Parenteu, Christophe Ramírez; Serna, Juan Ribas; Álvarez, Mikel Sánchez; Marchori, Carlos Sanchez; Soto, Miguel del Valle; Alonso, José María Villalón; García, Pedro Guillen; de la Iglesia, Nicolas Hugo; Alcorocho, Juan Manuel Lopez

    2016-01-01

    On the 21st of March, 2015, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of The Spanish Society for Sports Traumatology (SETRADE), The Spanish Federation of Sports Medicine (FEMEDE), The Spanish Association of Medical Services for Football Clubs (AEMEF), and The Spanish Association of Medical Services for Basketball Clubs (AEMB) with the aim of establishing a round table that would allow specialists to consider the most appropriate current general actions to be taken when treating muscle tears in sport, based on proven scientific data described in the medical literature. Each expert received a questionnaire prior to the aforementioned meeting comprising a set of questions concerning therapeutic indications generally applied in the different stages present during muscle repair. The present Consensus Document is the result of the answers to the questionnaire and resulting discussion and consensus over which are the best current indications in the treatment of muscle tears in sport. Avoiding immobilization, not taking nonsteroidal anti-inflammatory drugs (NSAIDs) randomly, fostering early mobilization, increasing vascularization of injured, site and regulating inflammatory mechanisms—without inhibiting these from the early stages of the recovery period—all stood out as main points of the Consensus Document. Additionally, there is controversy concerning cell stimulation techniques and the use of growth factors or cell inhibitors. The decision concerning discharge was unanimous, as was the criteria considered when it came to performing sport techniques without pain. PMID:27213161

  6. Weekly bi-fractionated 40 Gy three-dimensional conformational accelerated partial irradiation of breast: results of a phase II French pilot study; Irradiation partielle acceleree du sein tridimensionnelle conformationnelle de 40Gy bifractionnee hebdomadaire: resultats d'une etude pilote francaise de phase II

    Energy Technology Data Exchange (ETDEWEB)

    Bourgier, C.; Pichenot, C.; Verstraet, R.; Heymann, S.; Biron, B.; Delaloge, S.; Garbay, J.R.; Marsiglia, H.; Bourhis, J. [Intitut Gustave-Roussy, 94 - Villejuif (France); Taghian, A. [Massachusetts General Hospital-Harvard, Boston (United States); Marsiglia, H. [Universite Florence (Italy)

    2010-10-15

    The authors report the first French experience of three-dimensional conformational and accelerated partial irradiation of breast. Twenty five patients have been concerned by this phase II trial. The prescribed total dose was 40 Gy, was delivered over 5 days in two daily fractions. Irradiation was performed with two 6 MV tangential mini-beams and a 6-22 MeV front electron beams. The planning target volume coverage was very good. Toxicity has been assessed. Healthy tissues (heart, lungs) are considerably protected. The acute and late toxicity is correct. Short communication

  7. Randomized phase III study comparing best supportive care to biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation therapy oncology group (RTOG) 97-13

    International Nuclear Information System (INIS)

    Purpose: To determine if Biafine compared to Best Supportive Care (BSC) is effective in minimizing or preventing radiation-induced dermatitis in women undergoing breast irradiation. Methods and Materials: Patients were randomized between Biafine (n = 83) vs. BSC (n = 89). The institutions identified preference for BSC at the time of randomization. A no-treatment arm was allowed (16% received no treatment). Patients were instructed to apply randomized product three times a day, but not within 4 h of their daily RT session. Application began following their first radiation treatment and continued 2 weeks postradiation. Skin dermatitis was scored weekly utilizing the RTOG and ONS (Oncology Nursing Society) skin toxicity scales, a weekly patient satisfaction and quality-of-life questionnaire. Results: Using the RTOG toxicity scale there was no overall difference for maximum dermatitis during RT between Biafine and BSC (p = 0.77). There was no difference in maximum toxicity by arm or breast size. There was an interaction between breast size and toxicity, with large-breasted women exhibiting more toxicity. Large-breasted women receiving Biafine were more likely to have no toxicity 6 weeks post RT. Conclusion: There was no overall difference between BSC and Biafine in the prevention, time to, or duration of radiation-induced dermatitis.

  8. Achieving consensus in environmental programs

    International Nuclear Information System (INIS)

    In this paper, the authors describe a research effort on consensus tied to the Environmental Restoration Program (ERP) within the U.S. Department of Energy's Office of Defense Waste and Transportation Management (DWTM). They define consensus and explain why consensus decisions are not merely desirable but necessary in furthering ERP activities. As examples of their planned applied research, the authors first discuss nominal group technique as a representative consensus-generating tool, and conclude by describing the consensus-related mission of the Waste Management Review Group, established to conduct independent, third-party review of DWTM/ERP plans and activities

  9. Achieving consensus in environmental programs

    Energy Technology Data Exchange (ETDEWEB)

    Kurstedt, Jr., H. A.; Jones, R. M.; Walker, J. A.; Middleman, L. I.

    1989-01-01

    In this paper, we describe a new research effort on consensus tied to the Environmental Restoration Program (ERP) within the US Department of Energy's Office of Defense Waste and Transportation Management (DWTM). We define consensus and explain why consensus decisions are not merely desirable but necessary in furthering ERP activities. As examples of our planned applied research, we first discuss Nominal Group Technique as a representative consensus-generating tool, and we conclude by describing the consensus-related mission of the Waste Management Review Group, established at Virginia Tech to conduct independent, third-party review of DWTM/ERP plans and activities. 10 refs.

  10. Preliminary report. Concomitant irradiation and paclitaxel as radiosensitizer to increase the operability of unresectable locally advanced breast cancer

    International Nuclear Information System (INIS)

    The objective of this non-randomized, single-arm pilot study was to investigate whether paclitaxel (50 mg/m2 body surface area) concomitantly administered with radiation (2 Gy/fr, total 50 Gy) could increase the operability of unresectable locally advanced breast cancer (LABC). Operability was assessed based on the Haagensen criteria, toxicity based on EORTC criteria, and response to therapy based on WHO criteria. Thus far 13 inoperable LABC patients have participated in the study as subjects in the treatment group, and 12 of the cases have been analyzable. As a result of radiopaclitaxel therapy, 10 of the 12 tumors became operable (>83%), and in 3 of the 10 patients there was no evidence of residual tumor. To date there have been no cases of local relapse in the treatment group. Given these results, the preliminary conclusions of the study are as follows: The results of radiochemotherapy, specifically with radiopaclitaxel, are quite promising as a method of treating inoperable LABC by reducing tumor size until it becomes operable. The efficacy and safety of the 50 mg/m2 body surface area dose of paclitaxel were adequate, allowing use of higher doses with the expectation of better results. The schedule of administration in this study yielded effective results. (K.H.)

  11. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer-a review

    Energy Technology Data Exchange (ETDEWEB)

    Galecki, Jacek; Hicer-Grzenkowicz, Joanna; Grudzien-Kowalska, Malgorzata; Zalucki, Wojciech [Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland). Dept. of Radiotherapy; Michalska, Teresa [Academy of Medicine, Warsaw (Poland). Neurological Clinic, Second Dept.

    2006-04-15

    In order to increase the availability of adjuvant radiotherapy of breast cancer patients and make it more convenient and cheaper, in numerous cancer centres, the dose per fraction has been increased from 2 Gy to 2.25-2.75 Gy and the total dose has been decreased from 50 Gy to 40-45 Gy. The risk of developing any late complications after conventionally fractionated megavoltage radiotherapy is estimated to be below 1%. The aim of this review is to determine whether hypofractionated regimens increase the risk of damage to the brachial plexus. A review of the published literature shows that the use of doses per fraction in the range from 2.2 Gy to 4.58 Gy with the total doses between 43.5 Gy and 60 Gy causes a significant risk of brachial plexus injury which ranged from 1.7% up to 73%. The risk of radiation induced brachial plexopathy was smaller than 1% using regimens with doses per fraction between 2.2 and 2.5 Gy with the total doses between 34 and 40 Gy. Surgical manipulations in the axilla and chemotherapy have to be taken into account as additional factors which may increase the risk of brachial plexopathy.

  12. In vivo dosimetry for tangential breast irradiation; Role of the equipment in the accuracy of dose delivery

    Energy Technology Data Exchange (ETDEWEB)

    Leunens, G.; Verstraete, J.; Van Dam, J.; Dutreix, A.; Van der Schueren, E. (University Hospital St. Rafael, Leuven (Belgium). Department of Radiotherapy)

    1991-12-01

    Entrance dose measurements (920) have been performed on both tangential treatment fields for 105 breast cancer patients. About half of the (52) were treated on a modern unit (Mevatron, Siemens), supplied with an automatic verification system, the other half (53) were treated on an old therapy unit (cobalt-60). A team of three radiographers worked on the modern unit, while only one radiographer was responsible for treatment set-up on the old unit. A small systematic error (+14%) has been detected on the old unit; a small discrepancy existed in the region of the maximum dose between the measured and the published percentage depth-dose values, the latter being used for dose calculation. A striking difference has been observed for the rate of large deviations (of 5% and more from the mean dose): 2.3% (10/430) for the modern unit vs. 15 (75/490) for the old one. This shows clearly that the precision in dose delivery is strongly dependent on the characteristics and staffing of the therapy unit, the modern unit being supplied with a check-and-confirm system and with beam accessory devices in fixed position in the beam and a team of radiographers responsible for the set-up. (author). 12 refs.; 1 tab.

  13. Trajectory Modulated Arc Therapy: A Fully Dynamic Delivery With Synchronized Couch and Gantry Motion Significantly Improves Dosimetric Indices Correlated With Poor Cosmesis in Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Jieming; Atwood, Todd; Eyben, Rie von; Fahimian, Benjamin; Chin, Erika; Horst, Kathleen [Department of Radiation Oncology, Stanford University, California (United States); Otto, Karl [Department of Physics, University of British Columbia, British Columbia (Canada); Hristov, Dimitre, E-mail: dimitre.hristov@stanford.edu [Department of Radiation Oncology, Stanford University, California (United States)

    2015-08-01

    Purpose: To develop planning and delivery capabilities for linear accelerator–based nonisocentric trajectory modulated arc therapy (TMAT) and to evaluate the benefit of TMAT for accelerated partial breast irradiation (APBI) with the patient in prone position. Methods and Materials: An optimization algorithm for volumetrically modulated arc therapy (VMAT) was generalized to allow for user-defined nonisocentric TMAT trajectories combining couch rotations and translations. After optimization, XML scripts were automatically generated to program and subsequently deliver the TMAT plans. For 10 breast patients in the prone position, TMAT and 6-field noncoplanar intensity modulated radiation therapy (IMRT) plans were generated under equivalent objectives and constraints. These plans were compared with regard to whole breast tissue volume receiving more than 100%, 80%, 50%, and 20% of the prescription dose. Results: For TMAT APBI, nonisocentric collision-free horizontal arcs with large angular span (251.5 ± 7.9°) were optimized and delivered with delivery time of ∼4.5 minutes. Percentage changes of whole breast tissue volume receiving more than 100%, 80%, 50%, and 20% of the prescription dose for TMAT relative to IMRT were −10.81% ± 6.91%, −27.81% ± 7.39%, −14.82% ± 9.67%, and 39.40% ± 10.53% (P≤.01). Conclusions: This is a first demonstration of end-to-end planning and delivery implementation of a fully dynamic APBI TMAT. Compared with IMRT, TMAT resulted in marked reduction of the breast tissue volume irradiated at high doses.

  14. Microscopic enteritis: Bucharest consensus.

    Science.gov (United States)

    Rostami, Kamran; Aldulaimi, David; Holmes, Geoffrey; Johnson, Matt W; Robert, Marie; Srivastava, Amitabh; Fléjou, Jean-François; Sanders, David S; Volta, Umberto; Derakhshan, Mohammad H; Going, James J; Becheanu, Gabriel; Catassi, Carlo; Danciu, Mihai; Materacki, Luke; Ghafarzadegan, Kamran; Ishaq, Sauid; Rostami-Nejad, Mohammad; Peña, A Salvador; Bassotti, Gabrio; Marsh, Michael N; Villanacci, Vincenzo

    2015-03-01

    Microscopic enteritis (ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. This work recognises a need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. The consensus working party reviewed statements about the aetiology, diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment. Following the 5(th) International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME. A five-step agreement scale (from strong agreement to strong disagreement) was used to score 21 statements, independently. There was strong agreement on all statements about ME histology (95%-100%). Statements concerning diagnosis achieved 85% to 100% agreement. A statement on the management of ME elicited agreement from the lowest rate (60%) up to 100%. The remaining two categories showed general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of ME. There was strong agreement on the histological definition of ME. Weaker agreement on management indicates a need for further investigations, better definitions and clinical trials to produce quality guidelines for management. This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.

  15. Applications of tissue heterogeneity corrections and biologically effective dose volume histograms in assessing the doses for accelerated partial breast irradiation using an electronic brachytherapy source

    Energy Technology Data Exchange (ETDEWEB)

    Shi Chengyu; Guo Bingqi; Eng, Tony; Papanikolaou, Nikos [Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, TX 78229 (United States); Cheng, Chih-Yao, E-mail: shic@uthscsa.ed [Radiation Oncology Department, Oklahoma University Health Science Center, Oklahoma, OK 73104 (United States)

    2010-09-21

    A low-energy electronic brachytherapy source (EBS), the model S700 Axxent(TM) x-ray device developed by Xoft Inc., has been used in high dose rate (HDR) intracavitary accelerated partial breast irradiation (APBI) as an alternative to an Ir-192 source. The prescription dose and delivery schema of the electronic brachytherapy APBI plan are the same as the Ir-192 plan. However, due to its lower mean energy than the Ir-192 source, an EBS plan has dosimetric and biological features different from an Ir-192 source plan. Current brachytherapy treatment planning methods may have large errors in treatment outcome prediction for an EBS plan. Two main factors contribute to the errors: the dosimetric influence of tissue heterogeneities and the enhancement of relative biological effectiveness (RBE) of electronic brachytherapy. This study quantified the effects of these two factors and revisited the plan quality of electronic brachytherapy APBI. The influence of tissue heterogeneities is studied by a Monte Carlo method and heterogeneous 'virtual patient' phantoms created from CT images and structure contours; the effect of RBE enhancement in the treatment outcome was estimated by biologically effective dose (BED) distribution. Ten electronic brachytherapy APBI cases were studied. The results showed that, for electronic brachytherapy cases, tissue heterogeneities and patient boundary effect decreased dose to the target and skin but increased dose to the bones. On average, the target dose coverage PTV V{sub 100} reduced from 95.0% in water phantoms (planned) to only 66.7% in virtual patient phantoms (actual). The actual maximum dose to the ribs is 3.3 times higher than the planned dose; the actual mean dose to the ipsilateral breast and maximum dose to the skin were reduced by 22% and 17%, respectively. Combining the effect of tissue heterogeneities and RBE enhancement, BED coverage of the target was 89.9% in virtual patient phantoms with RBE enhancement (actual BED) as

  16. 早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究%Results of a clinical phase Ⅱ trial of whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed after breast-conserving surgery for early breast cancer

    Institute of Scientific and Technical Information of China (English)

    杨昭志; 俞晓立; 梅欣; 马金利; 潘自强; 陈星星; 张丽; 吴炅; 邵志敏

    2016-01-01

    目的 早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究.方法 2010-2013年本中心前瞻性收治200例早期乳腺癌保乳术患者,采用IMRT全乳45Gy分25次同期瘤床加量0.6Gy/次总量60Gy5周完成方案.Logistic回归分析用于检验发生2级放射性皮肤反应的预测因素.结果 所有患者均完成放疗.患侧乳腺和瘤床平均PTV为529.2cm3和92.9cm3.同侧肺V20为17.2%.左侧乳腺癌患者心脏Dmean为531cGy.根据CTCAE3.0标准急性放射性皮炎发生率0、1、2级分别为8.0%、63.0%、29.0%,其中发生湿性脱皮者占10.5%.因素分析显示影响2级皮肤反应因素为瘤床PTV、全乳PTV (P=0.031、0.000).185例患者完成了美容效果自评,其中优、良、一般患者分别为50例(27.1%)、111例(60.0%)、24例(12.9%).患者中位随访38(2~56)个月,3年LC率为98.7%.结论 全乳放疗同期大分割瘤床加量技术可以取得较低的急性皮肤反应和较好的美容效果,3年临床结果显示LC率良好.%Objective To report the clinical results of whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed after breast-conserving surgery for early breast cancer.Methods From October 2010 to April 2013,200 patients with early breast cancer who were admitted to our center and treated with breast-conserving surgery were prospectively enrolled as subjects.All patients received inversely intensity-modulated whole breast irradiation with a dose of 45 Gy in 25 fractions and a simultaneous integrated boost to the tumor bed with a dose of 0.6 Gy/Fx (a total dose of 60 Gy in 25 fractions) five times a week.Logistic regression analysis was used to examine the predictive factors for the occurrence of grade 2 radiation skin reactions.Results All patients completed the radiotherapy treatment.The mean planning target volumes (PTVs) of diseased breast and tumor bed were 529.2 cc and 92.9 cc,respectively.The mean V20

  17. Standard, controversy and consensus of axillary lymph nodes dissection in breast cancer%乳腺癌行腋窝淋巴结清扫规范、争议与共识

    Institute of Scientific and Technical Information of China (English)

    马榕; 张凯

    2015-01-01

    There are many effective methods for breast cancer treatment, surgery is the basis of management of breast cancer. Local control is the symbol of a successful operation. Lymph node status is not only the most important factor in predicting survival in breast cancer, but also the guider of further treatment. Axillary lymph node dissection and pathological examination remains standard management of the axilla and assessment of breast cancer patients. For clinical axillary lymph node metastasis patients, axillary lymph node dissection is critical. Sentinel lymph node biopsy has become standard care for management of the axilla in clinical axillary node-negative early breast cancer patients. It is clear that axillary lymph node dissection should be strongly considered in the management of the sentinel lymph node positive axilla. Omission of axillary lymph node dissection for breast cancer patients with 1-2 positive sentinel lymph nodes is still controversial .%乳腺癌的有效治疗方法很多,但外科手术是公认的乳腺癌治疗的基础。手术成功与否的最根本标志是肿瘤手术区域的局部控制。腋窝淋巴结受累的程度是预测乳腺癌术后复发和生存,指导进一步个体化治疗的最为重要指标。规范的腋窝淋巴结清扫和病理检查对乳腺癌的治疗至关重要。术前判断存在腋窝淋巴结转移的乳腺癌病人,腋窝淋巴结清扫是乳腺癌手术的规范和要求。术前临床诊断无腋窝淋巴结转移(cN0)的早期乳腺癌病人,如果前哨淋巴结活检阴性可不做进一步的腋窝淋巴结清扫也已成为共识。对于前哨淋巴结1或2枚阳性的乳腺癌病人可以不行腋窝淋巴结的清扫的观点仍然存在争论。

  18. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b and c randomized trials

    International Nuclear Information System (INIS)

    Background and aim: Numerous consensus reports recommend that postmastectomy radiotherapy (RT) in addition to systemic therapy is indicated in high-risk patients with 4+ positive nodes, but not in patients with 1-3 positive nodes. A subgroup analysis of the DBCG 82 b and c trials was performed to evaluate the loco-regional recurrence rate and survival in relation to number of positive nodes. Materials and methods: In the DBCG 82 b and c trials 3083 pre- and postmenopausal high-risk women were randomized to postoperative RT in addition to adjuvant systemic therapy. Since many patients had relatively few lymph nodes removed (median 7), the present analysis was limited to 1152 node positive patients with 8 or more nodes removed. Results: The overall 15-year survival rate in the subgroup was 39% and 29% (p = 0.015) after RT and no RT, respectively. RT reduced the 15-year loco-regional failure rate from 51% to 10% (p < 0.001) in 4+ positive node patients and from 27% to 4% (p < 0.001) in patients with 1-3 positive nodes. Similarly, the 15-year survival benefit after RT was significantly improved in both patients with 1-3 positive nodes (57% vs 48%, p = 0.03) and in patients with 4+ positive nodes (21% vs 12%, p = 0.03). Conclusion: The survival benefit after postmastectomy RT was substantial and similar in patients with 1-3 and 4+ positive lymph nodes. Furthermore, it was not strictly associated with the risk of loco-regional recurrence, which was most pronounced in patients with 4+ positive nodes. The indication for RT seems therefore to be at least equally beneficial in patients with 1-3 positive nodes, and future consensus should be modified accordingly

  19. Subclinical Cardiac Dysfunction Detected by Strain Imaging During Breast Irradiation With Persistent Changes 6 Weeks After Treatment

    International Nuclear Information System (INIS)

    Purpose: To evaluate 2-dimensional strain imaging (SI) for the detection of subclinical myocardial dysfunction during and after radiation therapy (RT). Methods and Materials: Forty women with left-sided breast cancer, undergoing only adjuvant RT to the left chest, were prospectively recruited. Standard echocardiography and SI were performed at baseline, during RT, and 6 weeks after RT. Strain (S) and strain rate (Sr) parameters were measured in the longitudinal, circumferential, and radial planes. Correlation of change in global longitudinal strain (GLS % and Δ change) and the volume of heart receiving 30 Gy (V30) and mean heart dose (MHD) were examined. Results: Left ventricular ejection fraction was unchanged; however, longitudinal systolic S and Sr and radial S were significantly reduced during RT and remained reduced at 6 weeks after treatment [longitudinal S (%) −20.44 ± 2.66 baseline vs −18.60 ± 2.70* during RT vs −18.34 ± 2.86* at 6 weeks after RT; longitudinal Sr (s−1) −1.19 ± 0.21 vs −1.06 ± 0.18* vs −1.06 ± 0.16*; radial S (%) 56.66 ± 18.57 vs 46.93 ± 14.56* vs 49.22 ± 15.81*; *P<.05 vs baseline]. Diastolic Sr were only reduced 6 weeks after RT [longitudinal E Sr (s−1) 1.47 ± 0.32 vs 1.29 ± 0.27*; longitudinal A Sr (s−1) 1.19 ± 0.31 vs 1.03 ± 0.24*; *P<.05 vs baseline], whereas circumferential strain was preserved throughout. A modest correlation between S and Sr and V30 and MHD was observed (GLS Δ change and V30 ρ = 0.314, P=.05; GLS % change and V30 ρ = 0.288, P=.076; GLS Δ change and MHD ρ = 0.348, P=.03; GLS % change and MHD ρ = 0.346, P=.031). Conclusions: Subclinical myocardial dysfunction was detected by 2-dimensional SI during RT, with changes persisting 6 weeks after treatment, though long-term effects remain unknown. Additionally, a modest correlation between strain reduction and radiation dose was observed

  20. Subclinical Cardiac Dysfunction Detected by Strain Imaging During Breast Irradiation With Persistent Changes 6 Weeks After Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Queenie [University of New South Wales, Sydney, NSW (Australia); Liverpool Hospital, Sydney, NSW (Australia); Hee, Leia; Batumalai, Vikneswary [University of New South Wales, Sydney, NSW (Australia); Liverpool Hospital, Sydney, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Allman, Christine [Liverpool Hospital, Sydney, NSW (Australia); MacDonald, Peter [University of New South Wales, Sydney, NSW (Australia); St. Vincent' s Hospital, Sydney, NSW (Australia); Delaney, Geoff P. [University of New South Wales, Sydney, NSW (Australia); Liverpool Hospital, Sydney, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Lonergan, Denise [Liverpool Hospital, Sydney, NSW (Australia); Ingham Institute of Applied Medical Research, Liverpool, NSW (Australia); Thomas, Liza, E-mail: l.thomas@unsw.edu.au [University of New South Wales, Sydney, NSW (Australia); Liverpool Hospital, Sydney, NSW (Australia)

    2015-06-01

    Purpose: To evaluate 2-dimensional strain imaging (SI) for the detection of subclinical myocardial dysfunction during and after radiation therapy (RT). Methods and Materials: Forty women with left-sided breast cancer, undergoing only adjuvant RT to the left chest, were prospectively recruited. Standard echocardiography and SI were performed at baseline, during RT, and 6 weeks after RT. Strain (S) and strain rate (Sr) parameters were measured in the longitudinal, circumferential, and radial planes. Correlation of change in global longitudinal strain (GLS % and Δ change) and the volume of heart receiving 30 Gy (V30) and mean heart dose (MHD) were examined. Results: Left ventricular ejection fraction was unchanged; however, longitudinal systolic S and Sr and radial S were significantly reduced during RT and remained reduced at 6 weeks after treatment [longitudinal S (%) −20.44 ± 2.66 baseline vs −18.60 ± 2.70* during RT vs −18.34 ± 2.86* at 6 weeks after RT; longitudinal Sr (s{sup −1}) −1.19 ± 0.21 vs −1.06 ± 0.18* vs −1.06 ± 0.16*; radial S (%) 56.66 ± 18.57 vs 46.93 ± 14.56* vs 49.22 ± 15.81*; *P<.05 vs baseline]. Diastolic Sr were only reduced 6 weeks after RT [longitudinal E Sr (s{sup −1}) 1.47 ± 0.32 vs 1.29 ± 0.27*; longitudinal A Sr (s{sup −1}) 1.19 ± 0.31 vs 1.03 ± 0.24*; *P<.05 vs baseline], whereas circumferential strain was preserved throughout. A modest correlation between S and Sr and V30 and MHD was observed (GLS Δ change and V30 ρ = 0.314, P=.05; GLS % change and V30 ρ = 0.288, P=.076; GLS Δ change and MHD ρ = 0.348, P=.03; GLS % change and MHD ρ = 0.346, P=.031). Conclusions: Subclinical myocardial dysfunction was detected by 2-dimensional SI during RT, with changes persisting 6 weeks after treatment, though long-term effects remain unknown. Additionally, a modest correlation between strain reduction and radiation dose was observed.

  1. Accelerated partial breast irradiation: An analysis of variables associated with late toxicity and long-term cosmetic outcome after high-dose-rate interstitial brachytherapy

    International Nuclear Information System (INIS)

    Purpose: To perform a detailed analysis of variables associated with late tissue effects of high-dose-rate (HDR) interstitial brachytherapy accelerated partial breast irradiation (APBI) in a large cohort of patients with prolonged follow-up. Methods and Materials: Beginning in 1995, 75 women with Stage I/II breast cancer were enrolled in identical institutional trials evaluating APBI as monotherapy after lumpectomy. Patients eligible included those with T1-2, N0-1 (≤3 nodes positive), M0 tumors of nonlobular histology with negative surgical margins, no extracapsular nodal extension, and negative results on postexcision mammogram. All patients underwent surgical excision and postoperative irradiation with HDR interstitial brachytherapy. The planning target volume was defined as the excision cavity plus a 2-cm margin. Treatment was delivered with a high-activity Ir-192 source at 3.4 Gy per fraction twice daily for 5 days to a total dose of 34 Gy. Dosimetric analyses were performed with three-dimensional postimplant dose and volume reconstructions. All patients were evaluated at 3-6-month intervals and assessed with a standardized cosmetic rating scale and according to Radiation Therapy Oncology Group late normal tissue toxicity scoring criteria. Clinical and therapy-related features were analyzed for their relationship to cosmetic outcome and toxicity rating. Clinical features analyzed included age, volume of resection, history of diabetes or hypertension, extent of axillary surgery, and systemic therapies. Therapy-related features analyzed included volume of tissue encompassed by the 100%, 150%, and 200% isodose lines (V100, V150, and V200, respectively), the dose homogeneity index (DHI), number of source dwell positions, and planar separation. Results: The median follow-up of all patients was 73 months (range, 43-118 months). The cosmetic outcome at last follow-up was rated as excellent, good, and fair/poor in 67%, 24%, and 9% of patients, respectively

  2. Accelerated partial breast irradiation with external beam three-dimensional conformal radiotherapy. Five-year results of a prospective phase II clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Mozsa, Emoeke [National Institute of Oncology, Centre of Radiotherapy, Budapest (Hungary); Landesklinikum Wiener Neustadt, Department of Radiooncology and Radiotherapy, Wiener Neustadt (Austria); Meszaros, Norbert; Major, Tibor; Froehlich, Georgina; Stelczer, Gabor; Fodor, Janos; Polgar, Csaba [National Institute of Oncology, Centre of Radiotherapy, Budapest (Hungary); Sulyok, Zoltan [National Institute of Oncology, Centre of Surgery, Budapest (Hungary)

    2014-05-15

    The aim of this study was to report the 5-year results of accelerated partial breast irradiation (APBI) using external beam three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2011, 44 patients with low-risk, stage I-II breast cancer underwent breast-conserving surgery. Postoperative APBI was given by means of 3D-CRT using three to five non-coplanar fields. The total dose of APBI was 36.9 Gy (nine fractions of 4.1 Gy b.i.d.). The mean follow-up time was 58.2 months for surviving patients. Survival results, side effects, and cosmetic results were assessed. One (2.3 %) local recurrence was observed, for a 5-year actuarial rate of 3.7 %. Neither regional nor distant failure was observed. Two patients died of internal disease. The 5-year disease-free, cancer-specific, and overall survival rates were 96.3, 100, and 95.1 %, respectively. Acute side effects included grade 1 (G1) erythema in 75 %, G1 parenchymal induration in 46 %, and G1 pain in 46 % of patients. No G2 or higher acute side effect occurred. Late side effects included G1, G2, and G3 fibrosis in 44, 7, and 2 % of patients, respectively, G1 skin pigmentation in 12 %, and G1 pain in 2 %. Asymptomatic fat necrosis occurred in 14 %. Cosmetic results were rated excellent or good in 86 % of cases by the patients themselves and 84 % by the physicians. The 5-year local tumor control, toxicity profile, and cosmetic results of APBI delivered with external beam 3D-CRT are encouraging and comparable to other APBI series. (orig.) [German] Evaluation der 5-Jahres-Ergebnisse bezueglich Ueberleben, Tumorkontrolle, Nebenwirkungen und Kosmetik nach Teilbrustbestrahlung (APBI) mittels 3-D-konformaler, akzelerierter Radiotherapie (3D-CRT). Zwischen 2006 und 2011 wurden 44 Patienten mit Brustkrebs im Stadium I-II und niedrigem Risikoprofil brusterhaltend operiert. Die adjuvante, 3-D-konformale APBI wurde mittels 3-5 nonkoplanarer Feldern durchgefuehrt. Die Gesamtdosis betrug 36,9 Gy bei 9 -mal 4,1 Gy b.i.d.. Nach

  3. Radiation Pneumonitis in Association with Internal Mammary Node Irradiation in Breast Cancer Patients: An Ancillary Result from the KROG 08-06 Study

    Science.gov (United States)

    Choi, Jinhyun; Kim, Yong Bae; Shin, Kyung Hwan; Ahn, Sung-Ja; Lee, Hyung-Sik; Park, Won; Kim, Su Ssan; Kim, Jin Hee; Lee, Kyu Chan; Kim, Dong Won; Suh, Hyun Suk; Park, Kyung Ran; Shin, Hyun Soo

    2016-01-01

    Purpose The aim of this study is to present the incidence of radiation pneumonitis (RP) reported within 6 months after treatment for breast cancer with or without internal mammary node irradiation (IMNI). Methods In the Korean Radiation Oncology Group (KROG) 08-06 phase III randomized trial, patients who were node-positive after surgery were randomly assigned to receive radiotherapy either with or without IMNI. A total of 747 patients were enrolled, and three-dimensional treatment planning with computed tomography simulation was performed for all patients. Of the 747 patients, 722 underwent chest X-rays before and within 6 months after radiotherapy. These 722 patients underwent evaluation, and RP was diagnosed on the basis of chest radiography findings and clinical symptoms. The relationship between the incidence of RP and clinical/dosimetric parameters was analyzed. Results RP developed in 35 patients (4.8%), including grade 1 RP in 26 patients (3.6%), grade 2 RP in nine patients (1.2%); there was no incidence of grade 3 or higher RP. Grade 2 RP cases were observed in only the IMNI group. The risk of developing RP was influenced by IMNI treatment; pneumonitis occurred in 6.5% of patients (n=23/356) who underwent IMNI and in 3.3% of patients (n=12/366) who did not (p=0.047). The differences in lung dosimetric parameters (mean lung dose, V10–40) were statistically significant between the two groups. Conclusion IMNI treatment resulted in increased radiation exposure to the lung and a higher rate of RP, but the incidence and severity of RP was minimal and acceptable. This minor impact on morbidity should be balanced with the impact on survival outcome in future analyses. PMID:27721877

  4. Improvement of registration accuracy in accelerated partial breast irradiation using the point-based rigid-body registration algorithm for patients with implanted fiducial markers

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Minoru; Yoshimura, Michio, E-mail: myossy@kuhp.kyoto-u.ac.jp; Sato, Sayaka; Nakamura, Mitsuhiro; Yamada, Masahiro; Hirata, Kimiko; Ogura, Masakazu; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Sasaki, Makoto; Fujimoto, Takahiro [Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507 (Japan)

    2015-04-15

    Purpose: To investigate image-registration errors when using fiducial markers with a manual method and the point-based rigid-body registration (PRBR) algorithm in accelerated partial breast irradiation (APBI) patients, with accompanying fiducial deviations. Methods: Twenty-two consecutive patients were enrolled in a prospective trial examining 10-fraction APBI. Titanium clips were implanted intraoperatively around the seroma in all patients. For image-registration, the positions of the clips in daily kV x-ray images were matched to those in the planning digitally reconstructed radiographs. Fiducial and gravity registration errors (FREs and GREs, respectively), representing resulting misalignments of the edge and center of the target, respectively, were compared between the manual and algorithm-based methods. Results: In total, 218 fractions were evaluated. Although the mean FRE/GRE values for the manual and algorithm-based methods were within 3 mm (2.3/1.7 and 1.3/0.4 mm, respectively), the percentages of fractions where FRE/GRE exceeded 3 mm using the manual and algorithm-based methods were 18.8%/7.3% and 0%/0%, respectively. Manual registration resulted in 18.6% of patients with fractions of FRE/GRE exceeding 5 mm. The patients with larger clip deviation had significantly more fractions showing large FRE/GRE using manual registration. Conclusions: For image-registration using fiducial markers in APBI, the manual registration results in more fractions with considerable registration error due to loss of fiducial objectivity resulting from their deviation. The authors recommend the PRBR algorithm as a safe and effective strategy for accurate, image-guided registration and PTV margin reduction.

  5. BRAINSTORMING: Consensus Learning in Practice

    OpenAIRE

    Plewczynski, Dariusz

    2009-01-01

    We present here an introduction to Brainstorming approach, that was recently proposed as a consensus meta-learning technique, and used in several practical applications in bioinformatics and chemoinformatics. The consensus learning denotes heterogeneous theoretical classification method, where one trains an ensemble of machine learning algorithms using different types of input training data representations. In the second step all solutions are gathered and the consensus is build between them....

  6. Political Consensus and Fiscal Outcomes

    DEFF Research Database (Denmark)

    Houlberg, Kurt; Holm Pedersen, Lene

    2015-01-01

    to analyse the association between political consensus and public expenditure growth. The results show that political consensus is positively associated with both budgeted and actual expenditure growth, but also negatively associated with budget overruns. This indicates that political consensus comes...... at a cost, while at the same time politicians may be better at sticking to budgets if political consensus exists. The analysis is based on a pooled regression analysis of the local governments in Denmark in the years 2008 and 2009 using a data set combining survey data with administrative data on the local...

  7. Surface Hopping by Consensus.

    Science.gov (United States)

    Martens, Craig C

    2016-07-01

    We present a new stochastic surface hopping method for modeling molecular dynamics with electronic transitions. The approach, consensus surface hopping (CSH), is a numerical framework for solving the semiclassical limit Liouville equation describing nuclear dynamics on coupled electronic surfaces using ensembles of trajectories. In contrast to existing techniques based on propagating independent classical trajectories that undergo stochastic hops between the electronic states, the present method determines the probabilities of transition of each trajectory collectively with input from the entire ensemble. The full coherent dynamics of the coupled system arise naturally at the ensemble level and ad hoc corrections, such as momentum rescaling to impose strict trajectory energy conservation and artificial decoherence to avoid the overcoherence of the quantum states associated with independent trajectories, are avoided. PMID:27345103

  8. Dummy Run of Quality Assurance Program in a Phase 3 Randomized Trial Investigating the Role of Internal Mammary Lymph Node Irradiation in Breast Cancer Patients: Korean Radiation Oncology Group 08-06 Study

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Yoonsun [Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Jun Won [Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Shin, Kyung Hwan [Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Su Ssan [Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Ahn, Sung-Ja [Department of Radiation Oncology, Chonnam National University Medical School, Gwangju (Korea, Republic of); Park, Won [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Hyung-Sik [Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan (Korea, Republic of); Kim, Dong Won [Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Lee, Kyu Chan [Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon (Korea, Republic of); Suh, Hyun Suk [Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Seoul (Korea, Republic of); Kim, Jin Hee [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Shin, Hyun Soo [Department of Radiation Oncology, Bundang CHA Hospital, School of Medicine, CHA University, Seongnam (Korea, Republic of); Kim, Yong Bae, E-mail: ybkim3@yuhs.ac [Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of); Suh, Chang-Ok [Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-02-01

    Purpose: The Korean Radiation Oncology Group (KROG) 08-06 study protocol allowed radiation therapy (RT) technique to include or exclude breast cancer patients from receiving radiation therapy to the internal mammary lymph node (IMN). The purpose of this study was to assess dosimetric differences between the 2 groups and potential influence on clinical outcome by a dummy run procedure. Methods and Materials: All participating institutions were asked to produce RT plans without irradiation (Arm 1) and with irradiation to the IMN (Arm 2) for 1 breast-conservation treatment case (breast-conserving surgery [BCS]) and 1 mastectomy case (modified radical mastectomy [MRM]) whose computed tomography images were provided. We assessed interinstitutional variations in IMN delineation and evaluated the dose-volume histograms of the IMN and normal organs. A reference IMN was delineated by an expert panel group based on the study guidelines. Also, we analyzed the potential influence of actual dose variation observed in this study on patient survival. Results: Although physicians intended to exclude the IMN within the RT field, the data showed almost 59.0% of the prescribed dose was delivered to the IMN in Arm 1. However, the mean doses covering the IMN in Arm 1 and Arm 2 were significantly different for both cases (P<.001). Due to the probability of overdose in Arm 1, the estimated gain in 7-year disease-free survival rate would be reduced from 10% to 7.9% for BCS cases and 7.1% for MRM cases. The radiation doses to the ipsilateral lung, heart, and coronary artery were lower in Arm 1 than in Arm 2. Conclusions: Although this dummy run study indicated that a substantial dose was delivered to the IMN, even in the nonirradiation group, the dose differences between the 2 groups were statistically significant. However, this dosimetric profile should be studied further with actual patient samples and be taken into consideration when analyzing clinical outcomes according to IMN

  9. Seroma volume change on cone-beam CT during whole breast irradiation for early-stage breast cancer after breast conservative surgery%锥形束 CT 观察早期乳癌保乳术后全乳放疗过程中血清肿的体积变化

    Institute of Scientific and Technical Information of China (English)

    李良; 吴广银; 雒建超; 王权

    2015-01-01

    目的:评价锥形束CT观察早期乳癌保乳术后全乳放疗过程中血清肿体积变化的临床价值。方法:选取32例早期乳癌保乳术后出现血清肿的全乳放疗患者,采用锥形束CT和普通CT分别在每例患者全乳放疗初次和末次进行扫描成像,然后由2名医师分别在两类CT图像上勾画出血清肿大小,并比较两类CT图像上血清肿的体积变化值、血清肿可见度评分(SCS)和适形指数(CI)。结果:锥形束CT和普通CT图像上的血清肿体积变化值分别为(17.5±7.8)和(17.7±7.7)cm3,差异无统计学意义(t配对=1.939,P=0.062)。锥形束CT的SCS和普通CT的SCS一致性较差(Kappa=0.293,P=0.005),但两者呈正相关(rS=0.848,P<0.001)。锥形束CT的血清肿CI值和普通CT的血清肿CI值呈正相关(rP=0.882,P<0.001)。锥形束CT图像上血清肿的CI值和SCS呈正相关(rS=0.843,P<0.001),当SCS≥3分时,其CI值>0.60。结论:锥形束CT可以用来观察早期乳癌保乳术后全乳放疗过程中血清肿的体积变化,尤其是当SCS≥3分时,应用效果最佳。%Aim:To evaluate the clinical value of cone-beam CT in assessing the seroma volume change during whole breast irradiation for early-stage breast cancer after breast conservative surgery .Methods:A total of 32 early-stage breast cancer patients who received breast conservative surgery generating seroma and underwent cone -beam CT scans and conven-tional CT scans at both the initial and the last time of whole breast irradiation were collected .Two senior radiation oncolo-gists contoured seroma on all scans.Seroma volume change, seroma clarity score(SCS), and conformity index(CI) were further examined.Results:The difference in seroma volume change between cone-beam CT [(17.5 ±7.8) cm3 ] and conventional CT [(17.7 ±7.7) cm3] were not statistically significant(tpaired =1.939, P=0

  10. Main: ANAERO5CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO5CONSENSUS S000481 05-November-2005 (last modified) kehi One of 16 motifs found in silico...ty et al., 2005); Arbitrary named ANAERO5CONSENSUS by the PLACEdb curator; See also S000477, S000478, S00047...); Hordeum vulgare (barley); Oryza sativa (rice); Petunia hybrida (petunia); Lycopersicon esculentum (tomato); TTCCCTGTT ...

  11. Main: ANAERO2CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO2CONSENSUS S000478 05-November-2005 (last modified) kehi One of 16 motifs found in silico...ty et al., 2005); Arbitrary named ANAERO2CONSENSUS by the PLACEdb curator; See also S000477, S000479, S00048...); Hordeum vulgare (barley); Oryza sativa (rice); Petunia hybrida (petunia); Lycopersicon esculentum (tomato); AGCAGC ...

  12. Main: ANAERO1CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO1CONSENSUS S000477 05-November-2005 (last modified) kehi One of 16 motifs found in silico...ty et al., 2005); Arbitrary named ANAERO1CONSENSUS by the PLACEdb curator; See also S000478, S000479, S00048...); Hordeum vulgare (barley); Oryza sativa (rice); Petunia hybrida (petunia); Lycopersicon esculentum (tomato); AAACAAA ...

  13. Main: ANAERO3CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO3CONSENSUS S000479 05-November-2005 (last modified) kehi One of 16 motifs found in silico...ty et al., 2005); Arbitrary named ANAERO3CONSENSUS by the PLACEdb curator; See also S000477, S000478, S00048...); Hordeum vulgare (barley); Oryza sativa (rice); Petunia hybrida (petunia); Lycopersicon esculentum (tomato); TCATCAC ...

  14. Issues in food irradiation

    International Nuclear Information System (INIS)

    This discussion paper has two goals: first, to raise public awareness of food irradiation, an emerging technology in which Canada has the potential to build a new industry, mainly oriented to promising overseas markets; and second, to help build consensus among government and private sector decision makers about what has to be done to realize the domestic and export potential. The following pages discuss the potential of food irradiation; indicate how food is irradiated; outline the uses of food irradiation; examine questions of the safety of the equipment and both the safety and nutritional value of irradiated food; look at international commercial developments; assess the current and emerging domestic scene; and finally, draw some conclusions and offer suggestions for action

  15. Between consensus and contestation.

    Science.gov (United States)

    Weale, Albert

    2016-08-15

    Purpose - Noting that discussions of public participation and priority setting typically presuppose certain political theories of democracy, the purpose of this paper is to discuss two theories: the consensual and the agonistic. The distinction is illuminating when considering the difference between institutionalized public participation and contestatory participation. Design/methodology/approach - The approach is a theoretical reconstruction of two ways of thinking about public participation in relation to priority setting in health care, drawing on the work of Habermas, a deliberative theorist, and Mouffe, a theorist of agonism. Findings - The different theoretical approaches can be associated with different ways of understanding priority setting. In particular, agonistic democratic theory would understand priority setting as system of inclusions and exclusions rather than the determination of a consensus of social values, which is the typical deliberative way of thinking about the issues. Originality/value - The paper shows the value of drawing out explicitly the tacit assumptions of practices of political participation in order to reveal their scope and limitations. It suggests that making such theoretical presuppositions explicit has value for health services management in recognizing these implicit choices. PMID:27468774

  16. Consensus on consensus: a synthesis of consensus estimates on human-caused global warming

    Science.gov (United States)

    Cook, John; Oreskes, Naomi; Doran, Peter T.; Anderegg, William R. L.; Verheggen, Bart; Maibach, Ed W.; Carlton, J. Stuart; Lewandowsky, Stephan; Skuce, Andrew G.; Green, Sarah A.; Nuccitelli, Dana; Jacobs, Peter; Richardson, Mark; Winkler, Bärbel; Painting, Rob; Rice, Ken

    2016-04-01

    The consensus that humans are causing recent global warming is shared by 90%-100% of publishing climate scientists according to six independent studies by co-authors of this paper. Those results are consistent with the 97% consensus reported by Cook et al (Environ. Res. Lett. 8 024024) based on 11 944 abstracts of research papers, of which 4014 took a position on the cause of recent global warming. A survey of authors of those papers (N = 2412 papers) also supported a 97% consensus. Tol (2016 Environ. Res. Lett. 11 048001) comes to a different conclusion using results from surveys of non-experts such as economic geologists and a self-selected group of those who reject the consensus. We demonstrate that this outcome is not unexpected because the level of consensus correlates with expertise in climate science. At one point, Tol also reduces the apparent consensus by assuming that abstracts that do not explicitly state the cause of global warming (‘no position’) represent non-endorsement, an approach that if applied elsewhere would reject consensus on well-established theories such as plate tectonics. We examine the available studies and conclude that the finding of 97% consensus in published climate research is robust and consistent with other surveys of climate scientists and peer-reviewed studies.

  17. Dissection or irradiation of the axilla in postmenopausal patients with breast cancer? Long-term results and late effects in 655 patients; Axilladissektion oder Axillabestrahlung bei postmenopausalen Patientinnen mit Mammakarzinom?

    Energy Technology Data Exchange (ETDEWEB)

    Albrecht, M.R.; Zink, K.; Ruehl, U. [Abt. fuer Strahlentherapie, Klinikum im Friedrichshain, Standort Moabit, Berlin (Germany); Busch, W. [Abt. fuer Gynaekologie, Krankenhaus Moabit Berlin (Germany)

    2002-09-01

    Patients and methods: From 1986 to 1993 we irradiated 655 patients with breast cancer after breast conserving surgery (BET). In all 144 cN1- and all 209 premenopausal cNO-patients axillary dissection was recommended. Of 302 postmenopausal cNO-patients 129 had breast surgery in our institution. In a total of 129 patients axillary dissection was replaced by irradiation (AxRT-group). They were compared with all 173 patients referred from other hospitals for irradiation after both breast conserving surgery and axillary dissection (AxOP-group). Dissected patients with gross tumor involvement of the axilla or less than eight nodes removed had additional axillary irradiation. Patients age, tumor size, vessel-, muscle- or skin invasion and grading were similar in both groups. However, in the AxRT-group there were more patients with negative hormon receptors, multifocal and medial sited tumors. Late complications after dissection and/or irradiation of the axilla were evaluated in 502 patients free of locoregional relapse and with a minimal follow up of 3 years (media 9,5 years). Results: After 5, 10 and 15 years tumor free survival rated were 90%, 82% and 79% in the AxOP-group vs 91%, 82% and 80% in the AxRT-group, respectively (p = 0.95). Overall survival (p = 0.98) local (p = 0.47) and axillary control (p = 0.12) were equal in both groups. However, serious problems like lymphedema of the arm, pain, mobility impairment occured in 26% patients following axillary dissection but only in 1% after axillary irradiation. No difference in late sequelae after axillary dissection with or without irradiation could be detected (26 vs 27%). (orig.) [German] Patientinnen und Methoden: Von 1986 bis 1993 wurden 655 Patientinnen mit Mammakarzinom nach brusterhaltender Operation (BET) bestrahlt. Davon waren praeoperativ 144 cN1- und 511 cNO-Patientinnen. Bei allen 144 cN1- und allen 209 praemenopausalen cNO-Patientinnen war eine Axilladissektion vorgesehen. Von 302 postmenopausalen c

  18. WE-G-BRE-09: Targeted Radiotherapy Enhancement During Accelerated Partial Breast Irradiation (ABPI) Using Controlled Release of Gold Nanoparticles (GNPs)

    Energy Technology Data Exchange (ETDEWEB)

    Cifter, G; Ngwa, W [University of Massachusetts (United States); Harvard Medical School, Dana Farber Cancer Institute (United States); Chin, J; Cifter, F; Sajo, E [University of Massachusetts (United States); Sinha, N [Wentworth Institute of Technology, Boston, MA (United States); Bellon, J [Harvard Medical School, Dana Farber Cancer Institute (United States)

    2014-06-15

    Purpose: Several studies have demonstrated low rates of local recurrence with brachytherapy-based accelerated partial breast irradiation (APBI). However, long-term outcomes on toxicity (e.g. telangiectasia), and cosmesis remain a major concern. The purpose of this study is to investigate the dosimetric feasibility of using targeted non-toxic radiosensitizing gold nanoparticles (GNPs) for localized dose enhancement to the planning target volume (PTV) during APBI while reducing dose to normal tissue. Methods: Two approaches for administering the GNPs were considered. In one approach, GNPs are assumed to be incorporated in a micrometer-thick polymer film on the surface of routinely used mammosite balloon applicators, for sustained controlled in-situ release, and subsequent treatment using 50-kVp Xoft devices. In case two, GNPs are administered directly into the lumpectomy cavity e.g. via injection or using fiducials coated with the GNP-loaded polymer film. Recent studies have validated the use of fiducials for reducing the PTV margin during APBI with 6 MV beams. An experimentally determined diffusion coefficient was used to determine space-time customizable distribution of GNPs for feasible in-vivo concentrations of 43 mg/g. An analytic calculational approach from previously published work was employed to estimate the dose enhancement due to GNPs (2 and 10 nm) as a function of distance up to 1 cm from lumpectomy cavity. Results: Dose enhancement due to GNP was found to be about 130% for 50-kVp x-rays, and 110% for 6-MV external beam radiotherapy, 1 cm away from the lumpectomy cavity wall. Higher customizable dose enhancement could be achieved at other distances as a function of nanoparticle size. Conclusion: Our preliminary results suggest that significant dose enhancement can be achieved to residual tumor cells targeted with GNPs during APBI with electronic brachytherapy or external beam therapy. The findings provide a useful basis for developing nanoparticle

  19. Radiotherapy of breast cancers: dosimetry comparison of irradiation complement of the surgical field by photons and electrons; Radiotherapie des cancers du sein: comparaison dosimetrique des complements d'irradiation du lit operatoire par photons et electrons

    Energy Technology Data Exchange (ETDEWEB)

    Hajji, Z.; Lorchel, F.; Barbet, N.; Pouchard, I.; Khodri, M. [Centre de Radiotherapie, 71 - Macon (France)

    2009-10-15

    Purpose: to quantify the dosimetry differences between two plans of irradiation complement of the surgical bed by photons and electrons. Conclusion: We observe a significant difference in favour of photons in term of homogeneity, recovery around the P.T.V. and pulmonary irradiation, at the detriment of a deterioration of the external volume index, attesting of a larger irradiation of the mammary gland. (N.C.)

  20. Breast cancer screening

    OpenAIRE

    Skrabanek, P

    1988-01-01

    Consensus is still lacking on guidelines for breast-cancer screening with mammography: who should be screened, how frequently at what age, to what benefits and at what risks. American, Dutch, Swedish and Italian studies spanning the 1960s to the 1980s reveal a benefit from screening (reduced mortality from breast cancer) that occurs unambiguously only in women 50 years of age and over. Physicians who choose to screen mammographically their over-49-year-old female patients must do so with the ...

  1. Radiotherapy in the management of early breast cancer

    OpenAIRE

    Wang, Wei

    2013-01-01

    Radiotherapy is an indispensible part of the management of all stages of breast cancer. In this article, the common indications for radiotherapy in the management of early breast cancer (stages 0, I, and II) are reviewed, including whole-breast radiotherapy as part of breast-conserving treatment for early invasive breast cancer and pre-invasive disease of ductal carcinoma in situ, post-mastectomy radiotherapy, locoregional radiotherapy, and partial breast irradiation. Key clinical studies tha...

  2. Is There a Consensus on Consensus Methodology? Descriptions and Recommendations for Future Consensus Research.

    Science.gov (United States)

    Waggoner, Jane; Carline, Jan D; Durning, Steven J

    2016-05-01

    The authors of this article reviewed the methodology of three common consensus methods: nominal group process, consensus development panels, and the Delphi technique. The authors set out to determine how a majority of researchers are conducting these studies, how they are analyzing results, and subsequently the manner in which they are reporting their findings. The authors conclude with a set of guidelines and suggestions designed to aid researchers who choose to use the consensus methodology in their work.Overall, researchers need to describe their inclusion criteria. In addition to this, on the basis of the current literature the authors found that a panel size of 5 to 11 members was most beneficial across all consensus methods described. Lastly, the authors agreed that the statistical analyses done in consensus method studies should be as rigorous as possible and that the predetermined definition of consensus must be included in the ultimate manuscript. More specific recommendations are given for each of the three consensus methods described in the article.

  3. Comparison of different treatment plannings for whole breast irradiation with tumor bed boost after breast-conservative surgery%乳腺癌保乳术后全乳加瘤床补量照射不同治疗计划的比较

    Institute of Scientific and Technical Information of China (English)

    李建彬; 卢洁; 范廷勇; 刘娟; 白瞳; 孙涛; 邢军; 王永胜; 邵倩

    2008-01-01

    目的 探讨乳腺癌保乳术后全乳加瘤床照射不同治疗计划靶区剂量适形度、靶区剂量分布均匀性及肺脏、心脏和对侧乳腺受照剂量体积的差异.方法 选择术腔各边界放置银夹且无腋窝淋巴结转移的12例左侧乳腺癌保乳术后患者,每例患者分别制定常规放疗(CRT)、无挡肺子野调强放疗(IMRT-F)、挡肺子野调强(IMRT-F-L)和瘤床同步整合补量调强放疗(SIB-IMRT)计划.比较不同治疗计划全乳靶区和瘤床靶区的剂量适形度和剂量分布均匀性,对比不同治疗计划肺脏、心脏和对侧乳腺受照剂量体积.结果 各计划中V处方剂量-PTV1/VPTV1、VPTV1-处方剂量/VPTV2、V处方剂量-PTV2/VPTV2/VPTV2、VPTV2-处方剂量/VPTV2组间差异均有统计学意义;CRT计划中患侧肺V20显著高于不同方式的IMRT计划,但不同方式的IMRT计划之间V20差异无统计学意义;CRT计划中心脏受照剂量显著高于IMRT和SIBIMRT计划.CRT计划中对侧乳腺最大照射剂量Dmax和平均剂量Dmean明显高于不同实现方式的IMRT计划,但不同实现方式的IMRT计划中Dmax和Dmean差异无统计学意义.结论 IMRT-F、IMRT-F-L、SIBIMRT计划均显著优于CRT计划,而不同方式IMRT计划间除个别参数外差异无统计学意义.%Objective To explore the difference of conformity and homogeneity of dose distribution in the whole breast and tumor bed targets and dose-volume parameters of the irradiated heart,lung and contralateral breast between the different treatment plannings for whole breast irradiation with tumor bed boost after breast-conservative surgery.Methods Twelve left-side breast cancer patients received breast-conservative surgery with negative axillary lymph node and with silver slips set in the cavity were selected.The different plannings including conventional radiotherapy(CRT),forward intensity-modulated radiotherapy with no lung block segments(IMRT-F),forward intensity-modulated radiotherapy with

  4. [Radiotherapy of breast cancer].

    Science.gov (United States)

    Hennequin, C; Barillot, I; Azria, D; Belkacémi, Y; Bollet, M; Chauvet, B; Cowen, D; Cutuli, B; Fourquet, A; Hannoun-Lévi, J M; Leblanc, M; Mahé, M A

    2016-09-01

    In breast cancer, radiotherapy is an essential component of the treatment. After conservative surgery for an infiltrating carcinoma, radiotherapy must be systematically performed, regardless of the characteristics of the disease, because it decreases the rate of local recurrence and by this way, specific mortality. Partial breast irradiation could not be proposed routinely but only in very selected and informed patients. For ductal carcinoma in situ, adjuvant radiotherapy must be also systematically performed after lumpectomy. After mastectomy, chest wall irradiation is required for pT3-T4 tumours and if there is an axillary nodal involvement, whatever the number of involved lymph nodes. After neo-adjuvant chemotherapy and mastectomy, in case of pN0 disease, chest wall irradiation is recommended if there is a clinically or radiologically T3-T4 or node positive disease before chemotherapy. Axillary irradiation is recommended only if there is no axillary surgical dissection and a positive sentinel lymph node. Supra and infra-clavicular irradiation is advised in case of positive axillary nodes. Internal mammary irradiation must be discussed case by case, according to the benefit/risk ratio (cardiac toxicity). Dose to the chest wall or the breast must be between 45-50Gy with a conventional fractionation. A boost dose over the tumour bed is required if the patient is younger than 60 years old. Hypofractionation (42.5 Gy in 16 fractions, or 41.6 Gy en 13 or 40 Gy en 15) is possible after tumorectomy and if a nodal irradiation is not mandatory. Delineation of the breast, the chest wall and the nodal areas are based on clinical and radiological evaluations. 3D-conformal irradiation is the recommended technique, intensity-modulated radiotherapy must be proposed only in case of specific clinical situations. Respiratory gating could be useful to decrease the cardiac dose. Concomitant administration of chemotherapy in unadvised, but hormonal treatment could be start with

  5. Lactation following conservation surgery and radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    A 38-year-old woman with early stage invasive breast cancer was treated with wide excision of the tumor, axillary lymph node dissection, and breast irradiation. Three years later, she gave birth to a normal baby. She attempted breast feeding and had full lactation from the untreated breast. The irradiated breast underwent only minor changes during pregnancy and postpartum but produced small amounts of colostrum and milk for 2 weeks postpartum. There are only a few reports of lactation after breast irradiation. These cases are reviewed, and possible factors affecting breast function after radiotherapy are discussed. Because of scant information available regarding its safety for the infant, nursing from the irradiated breast is not recommended

  6. Ocular allergy latin american consensus

    Directory of Open Access Journals (Sweden)

    Myrna Serapião dos Santos

    2011-12-01

    Full Text Available PURPOSE: To establish current definition, classification and staging, and to develop diagnosis and treatment recommendations for ocular allergy, by using Delphi approach. METHODS: Ten Latin American experts on ocular allergy participated in a 4-round Delphi panel approach. Four surveys were constructed and answered by panelists. A two-thirds majority was defined as consensus. Definition, classification, staging and diagnosis and treatment recommendations were the main outcomes. RESULTS: "Ocular allergy" was proposed as the general term to describe ocular allergic diseases. Consensus regarding classification was not reached. Signs and symptoms were considered extremely important for the diagnosis. It was consensus that a staging system should be proposed based on the disease severity. Environmental control, avoidance of allergens and the use of artificial tears were recommended as first line treatment. The secondary treatment should include topical anti-histamines, mast cell stabilizers and multi actions drugs. Topical non-steroidal anti-inflammatory and vasoconstrictors were not recommended. Topical corticosteroids were recommended as third line of treatment for the most severe keratoconjunctivitis. Consensus was not reached regarding the use of systemic corticosteroids or immunosuppressant. Surgical approach and unconventional treatments were not recommended as routine. CONCLUSION: The task of creating guidelines for ocular allergies showed to be very complex. Many controversial topics remain unsolved. A larger consensus including experts from different groups around the world may be needed to further improve the current recommendations for several aspects of ocular allergy.

  7. Breast pain

    Science.gov (United States)

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  8. Consensus clustering in complex networks

    CERN Document Server

    Lancichinetti, Andrea; 10.1038/srep00336

    2012-01-01

    The community structure of complex networks reveals both their organization and hidden relationships among their constituents. Most community detection methods currently available are not deterministic, and their results typically depend on the specific random seeds, initial conditions and tie-break rules adopted for their execution. Consensus clustering is used in data analysis to generate stable results out of a set of partitions delivered by stochastic methods. Here we show that consensus clustering can be combined with any existing method in a self-consistent way, enhancing considerably both the stability and the accuracy of the resulting partitions. This framework is also particularly suitable to monitor the evolution of community structure in temporal networks. An application of consensus clustering to a large citation network of physics papers demonstrates its capability to keep track of the birth, death and diversification of topics.

  9. MRI screening for breast cancer in women with familial or genetic predisposition : design of the Dutch National Study (MRISC)

    NARCIS (Netherlands)

    Kriege, M; Brekelmans, C T; Boetes, C; Rutgers, E J; Oosterwijk, J C; Tollenaar, R A; Manoliu, R A; Holland, R; de Koning, H J; Klijn, J G

    2001-01-01

    Mammography screening of women aged 50-70 years for breast cancer has proven to be effective in reducing breast cancer mortality. There is no consensus about the value of breast cancer screening in women aged 40-49 years. Five to ten per cent of all breast cancers are hereditary. One of the options

  10. Breast appearance and function after breast conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    Between 1978 and 1985, 247 breast cancer patients were treated with breast conserving surgery and radiotherapy. One hundred and twenty of these patients form the basis of this report, having replied to an 11-point structured questionnaire evaluating breast appearance and breast, shoulder and arm function. Good to perfect cosmetic, functional and overall scores are shown to be in the range 61-89%. The extent of primary surgery and axillary irradiation are the major factors affecting the cosmetic appearance. Other problems with cosmetic and functional assessment from subjective and objective view points are also discussed. (orig.)

  11. C3 glomerulopathy: consensus report

    Science.gov (United States)

    Pickering, Matthew C; D'Agati, Vivette D; Nester, Carla M; Smith, Richard J; Haas, Mark; Appel, Gerald B; Alpers, Charles E; Bajema, Ingeborg M; Bedrosian, Camille; Braun, Michael; Doyle, Mittie; Fakhouri, Fadi; Fervenza, Fernando C; Fogo, Agnes B; Frémeaux-Bacchi, Véronique; Gale, Daniel P; Goicoechea de Jorge, Elena; Griffin, Gene; Harris, Claire L; Holers, V Michael; Johnson, Sally; Lavin, Peter J; Medjeral-Thomas, Nicholas; Paul Morgan, B; Nast, Cynthia C; Noel, Laure-Hélène; Peters, D Keith; Rodríguez de Córdoba, Santiago; Servais, Aude; Sethi, Sanjeev; Song, Wen-Chao; Tamburini, Paul; Thurman, Joshua M; Zavros, Michael; Cook, H Terence

    2013-01-01

    C3 glomerulopathy is a recently introduced pathological entity whose original definition was glomerular pathology characterized by C3 accumulation with absent or scanty immunoglobulin deposition. In August 2012, an invited group of experts (comprising the authors of this document) in renal pathology, nephrology, complement biology, and complement therapeutics met to discuss C3 glomerulopathy in the first C3 Glomerulopathy Meeting. The objectives were to reach a consensus on: the definition of C3 glomerulopathy, appropriate complement investigations that should be performed in these patients, and how complement therapeutics should be explored in the condition. This meeting report represents the current consensus view of the group. PMID:24172683

  12. Accelerated partial breast irradiation with multi-catheter brachytherapy: Local control, side effects and cosmetic outcome for 274 patients. Results of the German-Austrian multi-centre trial

    International Nuclear Information System (INIS)

    Background and purpose: To evaluate the safety and effectiveness of accelerated partial breast irradiation (APBI) with multi-catheter brachytherapy. Patients and methods: Between 11/2000 and 04/2005, 274 patients participated. Patients were eligible for APBI if they had histologically confirmed breast cancer, a tumour diameter ≤3 cm, complete resection with clear margins ≥2 mm, negative axillary lymph nodes or singular nodal micro-metastasis, no distant metastases, hormone receptor-positive tumours, and were ≥35 years. Patients were excluded if mammographically they showed a multicentric invasive growth pattern, poorly differentiated tumours, residual diffuse micro-calcifications, extensive intraductal component, or vessel invasion. Median follow-up was 32 months (range; 8-68). Results: The local control rate was 99.3% (272/274), the 3 year-local-recurrence-free survival probability, 99.6%. Peri-operative complications occurred in 5.5% (15/274): 9 (3.3%) experienced implant infection and 6 (2.2%) hematoma. Acute toxicity (Grade 1/2 radio-dermatitis) was seen in 6.6% (18/274). Late side effects ≥ Grade 3 (fibrosis, telangiectasia) occurred in 1.8% (4/274). Cosmetic results were excellent/good in 94% (253/274). Conclusions: This analysis underlined the safety and effectiveness of APBI in a carefully selected subgroup with favourable disease characteristics. Of course, longer follow-up and randomised trials are necessary to conclusively assess the potential of APBI

  13. The impact of the number of excised axillary nodes and of the percentage of involved nodes on regional nodal failure in patients treated by breast-conserving surgery with or without regional irradiation

    International Nuclear Information System (INIS)

    Purpose: After breast-conserving surgery, recommendations for regional nodal radiotherapy are usually based on the number of positive nodes. This number is dependent on the number of nodes removed during the axillary dissection. This study examines whether the percentage of positive nodes may help to select patients for regional radiotherapy. Methods and Materials: A retrospective study was conducted on 1,372 T1-T2 node-positive breast cancer patients treated at L'Hotel-Dieu de Quebec Hospital between 1972 and 1997. Results: Among the patients who did not receive regional radiotherapy, the percentage of involved nodes was significantly associated with axillary failure. Ten-year axillary control rates were 97% and 91% when the percentage of involved nodes was 3 nodes). Conclusions: The percentage of involved nodes should be taken into consideration in selecting patients for regional radiotherapy. Irradiation of the axilla should be reserved for patients with a specific ratio: >40% involved nodes if N1-3 and ≥50% involved nodes if N>3 nodes

  14. Higher toxicity with 42 Gy in 10 fractions as a total dose for 3D-conformal accelerated partial breast irradiation: results from a dose escalation phase II trial

    International Nuclear Information System (INIS)

    Recent recommendations regarding indications of accelerated partial breast irradiation (APBI) have been put forward for selected breast cancer (BC) patients. However, some treatment planning parameters, such as total dose, are not yet well defined. The Institut Gustave Roussy has initiated a dose escalation trial at the 40 Gy/10 fractions/5 days and at a further step of total dose (TD) of 42 Gy/10 fractions/ 5 days. Here, we report early results of the latest step compared with the 40 Gy dose level. From October 2007 to March 2010, a total of 48 pT1N0 BC patients were enrolled within this clinical trial: 17 patients at a TD of 42 Gy/10f/5d and 31 at a TD of 40 Gy/10f/5d. Median follow-up was 19 months (min-max, 12–26). All the patients were treated by APBI using a technique with 2 minitangents and an “enface” electrons delivering 20% of the total dose. Toxicities were systematically assessed at 1; 2; 6 months and then every 6 months. Patients’ recruitment of 42 Gy step was ended owing to persistent grade 3 toxicity 6 months after APBI completion (n = 1). Early toxicities were statistically higher after a total dose of 42 Gy regarding grade ≥2 dry (p = 0.01) and moist (p = 0.05) skin desquamation. Breast pain was also statistically higher in the 42 Gy step compared to 40 Gy step (p = 0.02). Other late toxicities (grade ≥2 fibrosis and telangectasia) were not statistically different between 42 Gy and 40 Gy. Early toxicities were more severe and higher rates of late toxicities were observed after 42 Gy/10 fractions/5 days when compared to 40 Gy/10 fractions/5 days. This data suggest that 40 Gy/10 fractions/ 5 days could potentially be the maximum tolerance for PBI although longer follow-up is warranted to better assess late toxicities

  15. The Copenhagen Consensus Conference 2016

    DEFF Research Database (Denmark)

    Bangsbo, Jens; Krustrup, Peter; Duda, Joan;

    2016-01-01

    From 4 to 7 April 2016, 24 researchers from 8 countries and from a variety of academic disciplines gathered in Snekkersten, Denmark, to reach evidence-based consensus about physical activity in children and youth, that is, individuals between 6 and 18 years. Physical activity is an overarching term...

  16. Reference: ANAERO2CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO2CONSENSUS Mohanty B, Krishnan SP, Swarup S, Bajic VB. Detection and prelimin...ary analysis of motifs in promoters of anaerobically induced genes of different plant species. Ann Bot (Lond).96: 669-681 (2005) in silico PubMed: 16027132 ...

  17. Reference: ANAERO3CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO3CONSENSUS Mohanty B, Krishnan SP, Swarup S, Bajic VB. Detection and prelimin...ary analysis of motifs in promoters of anaerobically induced genes of different plant species. Ann Bot (Lond).96: 669-681 (2005) in silico PubMed: 16027132 ...

  18. Reference: ANAERO4CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO4CONSENSUS Mohanty B, Krishnan SP, Swarup S, Bajic VB. Detection and prelimin...ary analysis of motifs in promoters of anaerobically induced genes of different plant species. Ann Bot (Lond).96: 669-681 (2005) in silico PubMed: 16027132 ...

  19. Reference: ANAERO5CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO5CONSENSUS Mohanty B, Krishnan SP, Swarup S, Bajic VB. Detection and prelimin...ary analysis of motifs in promoters of anaerobically induced genes of different plant species. Ann Bot (Lond).96: 669-681 (2005) in silico PubMed: 16027132 ...

  20. Reference: ANAERO1CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available ANAERO1CONSENSUS Mohanty B, Krishnan SP, Swarup S, Bajic VB. Detection and prelimin...ary analysis of motifs in promoters of anaerobically induced genes of different plant species. Ann Bot (Lond).96: 669-681 (2005) in silico PubMed: 16027132 ...

  1. Reference: GT1CONSENSUS [PLACE

    Lifescience Database Archive (English)

    Full Text Available GT1CONSENSUS Le Gourrierec J, Li YF, Zhou DX Transcriptional activation by Arabidop...sis GT-1 may be through interaction with TFIIA-TBP-TATA complex Plant J 18:663-668 (1999) PubMed: 10417717 ...

  2. Quantized average consensus with delay

    NARCIS (Netherlands)

    Jafarian, Matin; De Persis, Claudio

    2012-01-01

    Average consensus problem is a special case of cooperative control in which the agents of the network asymptotically converge to the average state (i.e., position) of the network by transferring information via a communication topology. One of the issues of the large scale networks is the cost of co

  3. Trastuzumab in the treatment of advanced breast cancer: Our single-center experience and spotlights of the latest national consensus meeting Trastuzumab en el tratamiento del cáncer de mama avanzado. Nuestra experiencia y aspectos de la última Reunión Nacional de Consenso

    Directory of Open Access Journals (Sweden)

    Adriana Tomadoni

    2004-02-01

    Full Text Available Human epidermal growth factor receptor (HER 2 is amplified in 25 to 30% of breast cancer patients and those whose tumors demonstrate HER 2 gene amplification and protein overexpression have an inferior prognosis manifested by shorter disease-free and overall survival. Trastuzumab, the humanized murine anti-HER 2 monoclonal antibody, inhibits tumor growth when used alone and has synergistic and additive effects when used with chemotherapeutic agents (paclitacel-doxorrubicine. At the present time, the accurate diagnostic assessment of HER 2 is essential for appropriate application of the humanized anti HER 2 monoclonal antibody, trastuzumab, for the treatment of patients with metastatic breast cancer.FDA has approved its use for patients with metastatic breast cancer with HER 2 over-expression since 1998, as a first line treatment in association with paclitaxel or as a second or third line monotherapy. In Argentina, two Consensus Meetings of HER 2 Diagnosis have taken place: the first one on May 15th, 2002 and the second on April 11th, 2003, supported by Roche Laboratories (Herceptin®. In this paper, some topics of these meetings are reviewed. Our single-public center experience is discussed.El receptor para el factor humano de crecimiento epidérmico (HER 2 se encuentra amplificado en el 25 a 30% de los cánceres de mama y aquellas pacientes con tumores que amplifiquen el gen HER 2 y sobreexpresen su proteína tienen un peor pronóstico que se traduce en menor sobreviva global y tiempo libre de enfermedad. Usado como monodroga, Trastuzumab, el anticuerpo monoclonal murino humanizado anti-HER 2, inhibe el crecimiento tumoral y posee efectos sinérgicos y aditivos cuando se agrega a otros agentes quimioterápicos (paclitaxel-doxorrubicina. La determinación diagnóstica precisa del HER 2 es esencial para establecer el uso racional de trastuzumab en el tratamiento de pacientes con cáncer de mama metastático. La FDA aprobó su uso para pacientes

  4. Consumer acceptance of irradiated poultry

    International Nuclear Information System (INIS)

    A simulated supermarket setting (SSS) test was conducted to determine whether consumers (n = 126) would purchase irradiated poultry products, and the effects of marketing strategies on consumer purchase of irradiated poultry products. Consumer preference for irradiated poultry was likewise determined using a home-use test. A slide program was the most effective educational strategy in changing consumers' purchase behavior. The number of participants who purchased irradiated boneless, skinless breasts and irradiated thighs after the educational program increased significantly from 59.5 and 61.9% to 83.3 and 85.7% for the breasts and thighs, respectively. Using a label or poster did not increase the number of participants who bought irradiated poultry products. About 84% of the participants consider it either 'somewhat necessary' or 'very necessary' to irradiate raw chicken and would like all chicken that was served in restaurants or fast food places to be irradiated. Fifty-eight percent of the participants would always buy irradiated chicken if available, and an additional 27% would buy it sometimes. About 44% of the participants were willing to pay the same price for irradiated chicken as for nonirradiated. About 42% of participants were willing to pay 5% or more than what they were currently paying for nonirradiated chicken. Seventy-three percent or more of consumers who participated in the home-use test (n = 74) gave the color, appearance, and aroma of the raw poultry products a minimum rating of 7 (= like moderately). After consumers participated in a home-use test, 84 and 88% selected irradiated thighs and breasts, respectively, over nonirradiated in a second SSS test

  5. What Is Breast Cancer?

    Science.gov (United States)

    ... Next Topic Types of breast cancers What is breast cancer? Breast cancer starts when cells in the breast ... breast cancer? ” and Non-cancerous Breast Conditions . How Breast Cancer Spreads Breast cancer can spread through the lymph ...

  6. Improving intra-fractional target position accuracy using a 3D surface surrogate for left breast irradiation using the respiratory-gated deep-inspiration breath-hold technique.

    Directory of Open Access Journals (Sweden)

    Yi Rong

    Full Text Available PURPOSE: To evaluate the use of 3D optical surface imaging as a surrogate for respiratory gated deep-inspiration breath-hold (DIBH for left breast irradiation. MATERIAL AND METHODS: Patients with left-sided breast cancer treated with lumpectomy or mastectomy were selected as candidates for DIBH treatment for their external beam radiation therapy. Treatment plans were created on both free breathing (FB and DIBH computed tomography (CT simulation scans to determine dosimetric benefits from DIBH. The Real-time Position Management (RPM system was used to acquire patient's breathing trace during DIBH CT acquisition and treatment delivery. The reference 3D surface models from FB and DIBH CT scans were generated and transferred to the "AlignRT" system for patient positioning and real-time treatment monitoring. MV Cine images were acquired during treatment for each beam as quality assurance for intra-fractional position verification. The chest wall excursions measured on these images were used to define the actual target position during treatment, and to investigate the accuracy and reproducibility of RPM and AlignRT. RESULTS: Reduction in heart dose can be achieved using DIBH for left breast/chest wall radiation. RPM was shown to have inferior correlation with the actual target position, as determined by the MV Cine imaging. Therefore, RPM alone may not be an adequate surrogate in defining the breath-hold level. Alternatively, the AlignRT surface imaging demonstrated a superior correlation with the actual target positioning during DIBH. Both the vertical and magnitude real-time deltas (RTDs reported by AlignRT can be used as the gating parameter, with a recommended threshold of ±3 mm and 5 mm, respectively. CONCLUSION: The RPM system alone may not be sufficient for the required level of accuracy in left-sided breast/CW DIBH treatments. The 3D surface imaging can be used to ensure patient setup and monitor inter- and intra- fractional motions

  7. The influence of family history of cancer, irradiation and anticancer medication (mitomycin C), on the occurrence of multiple primary neoplasms with breast cancer

    International Nuclear Information System (INIS)

    The influence of family history of cancer, radiation therapy and anticancer drug therapy (mitomycin C) on the occurrence of multiple primary neoplasms, following treatment of a first primary cancer of the breast, was analyzed by the person-year method in 1,359 patients, in Japan. During 14,371.8 person-years of observation, 111 multiple primary neoplasms including bilateral breast cancers were found in 109 patients. The incidence rate of multiple primary neoplasms were 0.00772 per person-year. The incidence in patients with a family history of cancer was 1.29 times greater than that in patients without such a family history, and the incidence in patients with a family history of breast cancer was about three times greater than that in those without it (p < 0.01). Radiation therapy raised the occurrence of subsequent primary neoplasms 1.28-fold (or 1.62 fold after 5 years), and mitomycin C (a total dose of 0.8 mg/kg) therapy caused no increase in the occurrence of subsequent primary cancers, after an observation of 10 years or so. (author)

  8. Population-based outcomes after whole brain radiotherapy and re-irradiation in patients with metastatic breast cancer in the trastuzumab era

    International Nuclear Information System (INIS)

    This study examined the population-based use and outcomes of brain radiotherapy (BRT) for brain metastases (BM) from breast cancer with a focus on repeat BRT in the trastuzumab era. All women with breast cancer diagnosed from 2000-2007 and treated with BRT were retrospectively identified from a provincial database. A total of 441 women with BM from breast cancer were identified. The median age was 55 years and 40% (176/441) had human epidermal growth factor receptor 2 (HER2) positive disease. The median survival (MS) from the initial BRT for all 441 women was 4.5 months. The MS by Radiation Therapy Oncology Group Recursive Partitioning Analysis (RPA) class was: 1 (14.5 months), 2 (6.4 months) and 3 (1.8 months). For the 37 cases receiving repeat BRT, 27% (10/37) had stereotactic radiosurgery (SRS) and 70% (26/37) had HER2 positive disease, of which, 81% (21/26) received trastuzumab in the metastatic setting. For repeat BRT, the median survival by RPA class was: 1 (9.8 months), 2 (7.4 months) and 3 (2.0 months). For RPA class 1 and 2, the one-year overall survival (OS) was 45%. The proportion of cases with HER2 positive disease was increased at repeat BRT compared to initial BRT. RPA class 1 and 2 patients should be considered for repeat BRT

  9. Estimation of the risk of secondary malignancy arising from whole-breast irradiation: comparison of five radiotherapy modalities, including TomoHDA

    Science.gov (United States)

    Han, Eun Young; Paudel, Nava; Sung, Jiwon; Yoon, Myonggeun; Chung, Weon Kuu; Kim, Dong Wook

    2016-01-01

    The risk of secondary cancer from radiation treatment remains a concern for long-term breast cancer survivors, especially those treated with radiation at the age younger than 45 years. Treatment modalities optimally maximize the dose delivery to the tumor while minimizing radiation doses to neighboring organs, which can lead to secondary cancers. A new TomoTherapy treatment machine, TomoHDATM, can treat an entire breast with two static but intensity-modulated beams in a slice-by-slice fashion. This feature could reduce scattered and leakage radiation doses. We compared the plan quality and lifetime attributable risk (LAR) of a second malignancy among five treatment modalities: three-dimensional conformal radiation therapy, field-in-field forward-planned intensity-modulated radiation therapy, inverse-planned intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy, and TomoDirect mode on the TomoHDA system. Ten breast cancer patients were selected for retrospective analysis. Organ equivalent doses, plan characteristics, and LARs were compared. Out-of-field organ doses were measured with radio-photoluminescence glass dosimeters. Although the IMRT plan provided overall better plan quality, including the lowest probability of pneumonitis, it caused the second highest LAR. The TomoTherapy plan provided plan quality comparable to the IMRT plan and posed the lowest total LAR to neighboring organs. Therefore, it can be a better treatment modality for younger patients who have a longer life expectancy. PMID:27027239

  10. Four cases of radiation pneumonia after breast conservative therapy for breast cancer

    International Nuclear Information System (INIS)

    Between 1983 and 1996, a series of 240 patients with early stage breast cancer were treated with breast conservative treatment, and 201 patients of them all received irradiation at a dose of 46-60 Gy to the affected breast. Among the 201 patients who received breast irradiation, four (2.0%) patients experienced radiation pneumonia. These four patients with radiation pneumonia presented with coughing from 7 to 20 weeks after irradiation. Chest X-ray film revealed interstitial pneumonia in a lung field where coincided with the irradiated field in them. Three out of four patients demanded steroids, but all patients got well within 4 months. Radiation pneumonia following conservative surgery and radiotherapy for breast cancer is an infrequent complication, but attention should be paid to radiation pneumonia if the patient suffers from persistent coughing after radiotherapy. (author)

  11. Energy strategy: Roadmap to consensus

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-01

    The United States lacks a comprehensive approach to policy-making in the energy realm. Today, as in the past, individual constituency groups tend to focus on their particular aspect of the energy challenge. Many employ a decide-announce-defend'' approach to policy-making, setting out to secure a unilateral advantage for themselves. By so doing, they inevitably pit interest against interest. The result is a polarization of constituencies, and shortsighted policies designed to address the issue of the moment. The American Energy Assurance Council (AEAC) is a non-profit organization founded in 1987 for the sole purpose of facilitating progress toward a fair efficient wise, stable, and consensus-based national energy strategy. AEAC does not have a substantive policy agencies. Rather, we are committed to supporting a process whereby the many stakeholders and policy makers concerned with energy-related issues can come together in productive discourse, thereby overcoming ignorance of each other's positions. The Council seeks to act as a facilitative body, providing a safe'' context for inventive and creative thinking. We attempt to build a store of common knowledge, and to build on that store according to mutually agreed-upon groundrules, and employing sophisticated approaches to facilitation and mediation. This report, the National Energy Consensus Experiment (NECE), was an ambitious experiment in consensus-building. We learned a great deal from it, both in terms of substance and process, and we are convinced that it holds important lessons for others who may seek to build consensus in the public policy realm.

  12. Energy strategy: Roadmap to consensus

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-01

    The United States lacks a comprehensive approach to policy-making in the energy realm. Today, as in the past, individual constituency groups tend to focus on their particular aspect of the energy challenge. Many employ a ``decide-announce-defend`` approach to policy-making, setting out to secure a unilateral advantage for themselves. By so doing, they inevitably pit interest against interest. The result is a polarization of constituencies, and shortsighted policies designed to address the issue of the moment. The American Energy Assurance Council (AEAC) is a non-profit organization founded in 1987 for the sole purpose of facilitating progress toward a fair efficient wise, stable, and consensus-based national energy strategy. AEAC does not have a substantive policy agencies. Rather, we are committed to supporting a process whereby the many stakeholders and policy makers concerned with energy-related issues can come together in productive discourse, thereby overcoming ignorance of each other`s positions. The Council seeks to act as a facilitative body, providing a ``safe`` context for inventive and creative thinking. We attempt to build a store of common knowledge, and to build on that store according to mutually agreed-upon groundrules, and employing sophisticated approaches to facilitation and mediation. This report, the National Energy Consensus Experiment (NECE), was an ambitious experiment in consensus-building. We learned a great deal from it, both in terms of substance and process, and we are convinced that it holds important lessons for others who may seek to build consensus in the public policy realm.

  13. Canadian asthma consensus report, 1999

    OpenAIRE

    Boulet, L. P.; A. Becker; Bérubé, D; Beveridge, R.; Ernst, P

    1999-01-01

    OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings. OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. OUTCOMES: Provision of the best control o...

  14. C3 glomerulopathy: consensus report.

    OpenAIRE

    Lavin, Peter

    2013-01-01

    PUBLISHED C3 glomerulopathy is a recently introduced pathological entity whose original definition was glomerular pathology characterized by C3 accumulation with absent or scanty immunoglobulin deposition. In August 2012, an invited group of experts (comprising the authors of this document) in renal pathology, nephrology, complement biology, and complement therapeutics met to discuss C3 glomerulopathy in the first C3 Glomerulopathy Meeting. The objectives were to reach a consensus on: the ...

  15. International consensus on safety principles

    International Nuclear Information System (INIS)

    The International Atomic Energy Agency (IAEA) has been regularly requested by its Member States to provide evidence that radioactive waste can be managed safely and to help demonstrate a harmonization of approach at the international level by providing safety documents. In response, IAEA established a special series of safety documents devoted to radioactive waste management. These documents will be elaborated within the Radioactive Waste Safety Standards (RADWASS) programme [1,2] which covers all aspects of radioactive waste management. The RADWASS programme develops a series of international consensus documents on all parts of the safe management of radioactive waste, including disposal. The purpose of the RADWASS programme is to (i) document existing international consensus in the approaches and methodologies for safe radioactive waste management, (ii) create a mechanism to establish consensus where it does not exist and (iii) provide Member States with a comprehensive series of internationally agreed upon documents to complement national standards and criteria. This paper describes the RADWASS programme, and covers the structure, implementation plans and status of documents under preparation

  16. Factors determining esthetic outcome after breast cancer conservative treatment

    DEFF Research Database (Denmark)

    Cardoso, Maria J; Cardoso, Jaime; Santos, Ana C;

    2007-01-01

    The aim of this study was to evaluate the factors that determine esthetic outcome after breast cancer conservative treatment, based on a consensual classification obtained with an international consensus panel. Photographs were taken from 120 women submitted to conservative unilateral breast canc...

  17. Significant reductions in heart and lung doses using deep inspiration breath hold with active breathing control and intensity-modulated radiation therapy for patients treated with locoregional breast irradiation

    International Nuclear Information System (INIS)

    Purpose: To evaluate the heart and lung sparing effects of moderate deep inspiration breath hold (mDIBH) achieved using an active breathing control (ABC) device, compared with free breathing (FB) during treatment with deep tangents fields (DT) for locoregional (LR) irradiation of breast cancer patients, including the internal mammary (IM) nodes (IMNs). To compare the DT-mDIBH technique to other standard techniques and to evaluate the dosimetric effect of intensity-modulated radiation therapy (IMRT). Methods and Materials: Fifteen patients (9 left-sided and 6 right-sided lesions) with Stages 0-III breast cancer underwent standard FB and ABC computed tomographic (CT) scans in the treatment position. A dosimetric planning study was performed. In FB, the 9 left-sided patients were planned with a 5-field technique where electron fields covering the IM region were matched to shallow tangents using wedges (South West Oncology Group [SWOG] protocol S9927 technique A). This method was compared with a 3-field DT technique covering the breast and the IMNs (SWOG S9927 technique B). Compensation with IMRT was then compared with wedges for each technique. For the 15 total patients, dosimetric planning using DT with IMRT was then reoptimized on the mDIBH CT data set for comparison. Dose-volume histograms for the clinical target volume (CTV) (including the IMNs), planning target volume (PTV), ipsilateral and contralateral breast, and organs at risk (OAR) were analyzed. In addition, normal tissue complication probabilities (NTCP) for lung and heart, mean lung doses, and the number of monitor units (MUs) for a 1.8 Gy fraction were compared. Results: For the 9 left-sided patients, the mean percentage of heart receiving more than 30 Gy (heart V30) was lower with the 5-field wedged technique than with the DT wedged technique (6.8% and 19.1%, respectively, p<0.004). For the DT technique, the replacement of wedges with IMRT slightly diminished the mean heart V30 to 16.3% (p<0.51). The

  18. Breast lump

    Science.gov (United States)

    Breast mass ... males and females of all ages have normal breast tissue. This tissue responds to hormone changes. Because of this, lumps can come and go. Breast lumps may appear at any age: Both male ...

  19. Breast Diseases

    Science.gov (United States)

    Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges (fluids that are not breast milk). If you have a breast lump, pain, ...

  20. Does the Intent to Irradiate the Internal Mammary Nodes Impact Survival in Women With Breast Cancer? A Population-Based Analysis in British Columbia

    International Nuclear Information System (INIS)

    Purpose: To determine the value of the intent to include internal mammary nodes (IMNs) in the radiation therapy (RT) volume for patients receiving adjuvant locoregional (breast or chest wall plus axillary and supraclavicular fossa) RT for breast cancer. Methods and Materials: 2413 women with node-positive or T3/4N0 invasive breast cancer, treated with locoregional RT from 2001 to 2006, were identified in a prospectively maintained, population-based database. Intent to include IMNs in RT volume was determined through review of patient charts and RT plans. Distant relapse free survival (D-RFS), breast cancer–specific survival (BCSS), and overall survival (OS) were compared between the two groups. Prespecified pN1 subgroup analyses were performed. Results: The median follow-up time was 6.2 years. Forty-one percent of study participants received IMN RT. The 5-year D-RFS for IMN inclusion and exclusion groups were 82% vs. 82% (p = 0.82), BCSS was 87% vs. 87% (p = 0.81), and OS was 85% vs. 83% (p = 0.06). In the pN1 subgroup, D-RFS was 90% vs. 88% (p = 0.31), BCSS was 94% vs. 92% (p = 0.18), and OS was 91% vs. 88% (p = 0.01). After potential confounding variables were controlled for, women who received IMN RT did not have significantly different D-RFS (hazard ratio [HR] = 1.02 (95% confidence interval [CI], 0.84–1.24; p = 0.85), BCSS (HR = 0.98 (95% CI, 0.79–1.22; p = 0.88), or OS (HR = 0.95; 95% CI, 0.78–1.15; p = 0.57). In the pN1 subgroup, IMN RT was associated with trends for improved survival that were not statistically significant: D-RFS (HR = 0.87; 95% CI, 0.63–1.22; p = 0.42), BCSS (HR = 0.85; 95% CI, 0.57–1.25; p = 0.39), and OS (HR = 0.78; 95% CI, 0.56–1.09; p = 0.14). Conclusions: After a median follow-up time of 6.2 years, although intentional IMN RT was not associated with a significant improvement in survival, this population-based study suggests that IMN RT may contribute to improved outcomes in selected patients with N1 disease.

  1. Does the Intent to Irradiate the Internal Mammary Nodes Impact Survival in Women With Breast Cancer? A Population-Based Analysis in British Columbia

    Energy Technology Data Exchange (ETDEWEB)

    Olson, Robert A., E-mail: rolson2@bccancer.bc.ca [BC Cancer Agency, Radiation Therapy Program, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Woods, Ryan; Speers, Caroline [BC Cancer Agency, Breast Cancer Outcomes Unit, Vancouver, BC (Canada); Lau, Jeffrey [University of British Columbia, Vancouver, BC (Canada); Lo, Andrea; Truong, Pauline T. [BC Cancer Agency, Radiation Therapy Program, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Tyldesley, Scott; Olivotto, Ivo A. [BC Cancer Agency, Radiation Therapy Program, BC (Canada); University of British Columbia, Vancouver, BC (Canada); BC Cancer Agency, Breast Cancer Outcomes Unit, Vancouver, BC (Canada); Weir, Lorna [BC Cancer Agency, Radiation Therapy Program, BC (Canada); University of British Columbia, Vancouver, BC (Canada)

    2012-05-01

    Purpose: To determine the value of the intent to include internal mammary nodes (IMNs) in the radiation therapy (RT) volume for patients receiving adjuvant locoregional (breast or chest wall plus axillary and supraclavicular fossa) RT for breast cancer. Methods and Materials: 2413 women with node-positive or T3/4N0 invasive breast cancer, treated with locoregional RT from 2001 to 2006, were identified in a prospectively maintained, population-based database. Intent to include IMNs in RT volume was determined through review of patient charts and RT plans. Distant relapse free survival (D-RFS), breast cancer-specific survival (BCSS), and overall survival (OS) were compared between the two groups. Prespecified pN1 subgroup analyses were performed. Results: The median follow-up time was 6.2 years. Forty-one percent of study participants received IMN RT. The 5-year D-RFS for IMN inclusion and exclusion groups were 82% vs. 82% (p = 0.82), BCSS was 87% vs. 87% (p = 0.81), and OS was 85% vs. 83% (p = 0.06). In the pN1 subgroup, D-RFS was 90% vs. 88% (p = 0.31), BCSS was 94% vs. 92% (p = 0.18), and OS was 91% vs. 88% (p = 0.01). After potential confounding variables were controlled for, women who received IMN RT did not have significantly different D-RFS (hazard ratio [HR] = 1.02 (95% confidence interval [CI], 0.84-1.24; p = 0.85), BCSS (HR = 0.98 (95% CI, 0.79-1.22; p = 0.88), or OS (HR = 0.95; 95% CI, 0.78-1.15; p = 0.57). In the pN1 subgroup, IMN RT was associated with trends for improved survival that were not statistically significant: D-RFS (HR = 0.87; 95% CI, 0.63-1.22; p = 0.42), BCSS (HR = 0.85; 95% CI, 0.57-1.25; p = 0.39), and OS (HR = 0.78; 95% CI, 0.56-1.09; p = 0.14). Conclusions: After a median follow-up time of 6.2 years, although intentional IMN RT was not associated with a significant improvement in survival, this population-based study suggests that IMN RT may contribute to improved outcomes in selected patients with N1 disease.

  2. Greatly improving consensus performance via predictive mechanism

    CERN Document Server

    Zhang, Hai-Tao; Chen, Michael ZhiQiang; Zhou, Tao

    2007-01-01

    An important natural phenomenon surfaces that ultrafast consensus can be achieved by introducing the predictive mechanism. By predicting the dynamics of the network several steps ahead and using this information in the design of the consensus protocol of each agent, it is shown that drastic improvement can be achieved in terms of the speed of convergence towards consensus without changing the topology of the network. Moreover, with the predictive mechanism, the range of sampling rates leading to consensus convergence is broadly expanded compared to the routine consensus protocol. In natural science, this study provides support for the idea that some predictive mechanisms exist in widely-spread biological swarms, flocks, and schools. From the industrial engineering point of view, inclusion of an efficient predictive mechanism allows for not only a significant increase in the speed of convergence toward consensus but also a reduction of the communication energy required to achieve a predefined consensus perform...

  3. Transforming Growth Factor β-1 (TGF-β1) Is a Serum Biomarker of Radiation Induced Fibrosis in Patients Treated With Intracavitary Accelerated Partial Breast Irradiation: Preliminary Results of a Prospective Study

    International Nuclear Information System (INIS)

    Purpose: To examine a relationship between serum transforming growth factor β -1 (TGF-β1) values and radiation-induced fibrosis (RIF). Methods and Materials: We conducted a prospective analysis of the development of RIF in 39 women with American Joint Committee on Cancer stage 0-I breast cancer treated with lumpectomy and accelerated partial breast irradiation via intracavitary brachytherapy (IBAPBI). An enzyme-linked immunoassay (Quantikine, R and D, Minneapolis, MN) was used to measure serum TGF-β1 before surgery, before IBAPBI, and during IBAPBI. Blood samples for TGF-β1 were also collected from 15 healthy, nontreated women (controls). The previously validated tissue compliance meter (TCM) was used to objectively assess RIF. Results: The median time to follow-up for 39 patients was 44 months (range, 5-59 months). RIF was graded by the TCM scale as 0, 1, 2, and 3 in 5 of 20 patients (25%), 6 of 20 patients (30%), 5 of 20 patients (25%), and 4 of 20 patients (20%), respectively. The mean serum TGF-β1 values were significantly higher in patients before surgery than in disease-free controls, as follows: all cancer patients (30,201 ± 5889 pg/mL, P=.02); patients with any type of RIF (32,273 ± 5016 pg/mL, PROC of 0.867 (95% confidence interval 0.700-1.000). The TGF-β1 threshold cutoff was determined to be 31,000 pg/mL, with associated sensitivity and specificity of 77.8% and 90.0%, respectively. Conclusions: TGF-β1 levels correlate with the development of moderate to severe RIF. The pre-IBAPBI mean TGF-β1 levels can serve as an early biomarker for the development of moderate to severe RIF after IBAPBI

  4. Breast carcinogenesis: risk of radiation

    International Nuclear Information System (INIS)

    The risk of radiation carcinogenesis in the opposite breast is a major concern for physicians and breast cancer patients who choose to preserve the involved breast through conservation treatment, i.e., conservation survey and radiation therapy. In analyzing the carcinogenic effect of irradiation on the breast, the radiobiologic risks assumed from the studies must be evaluated first in order to determine the accuracy of the epidemiologic data and radiation dosage. It is generally assumed from the carcinogenic studies that radiation is carcinogenic at any dose rate. However, it is well-known that low dose rates are less effective at producing cancer in animal species than high dose rates. However, in most epidemiologic studies no apparent account is taken of dose rate. Also, there are technical differences between the irradiation received by individuals involved in most epidemiologic studies and the therapeutic irradiation received by breast cancer patients. All of these factors make it difficult, if not impossible, to directly correlate the irradiation risk ascertained from the studies and modern radiotherapy. This paper examines what risk exists and how great it is

  5. Does TomoDirect 3DCRT represent a suitable option for post-operative whole breast irradiation? A hypothesis-generating pilot study

    Directory of Open Access Journals (Sweden)

    Borca Valeria Casanova

    2012-12-01

    Full Text Available Abstract Background This study investigates the use of TomoDirectTM 3DCRT for whole breast adjuvant radiotherapy (AWBRT that represents a very attractive treatment opportunity, mainly for radiotherapy departments without conventional Linacs and only equipped with helical tomotherapy units. Methods Plans were created for 17 breast cancer patients using TomoDirect in 3DCRT and IMRT modality and field-in-field 3DCRT planning (FIF and compared in terms of PTV coverage, overdosage, homogeneity, conformality and dose to OARs. The possibility to define patient-class solutions for TD-3DCRT employment was investigated, correlating OARs dose constraints to patient specific anatomic parameters. Results TD-3DCRT showed PTV coverage and homogeneity significantly higher than TD-IMRT and FIF. PTV conformality was significantly better for FIF, while no differences were found between TD-3DCRT and TD-IMRT. TD-3DCRT showed mean values of the OARs dosimetric endpoints significantly higher than TD-IMRT; with respect to FIF, TD-3DCRT showed values significantly higher for lung V20Gy, mean heart dose and V25Gy, while contralateral lung maximum dose and contralateral breast mean dose resulted significantly lower. The Central Lung Distance (CLD and the maximal Heart Distance (HD resulted as useful clinical tools to predict the opportunity to employ TD-3DCRT: positive correlations were found between CLD and both V20Gy and mean lung dose and between HD and both V25Gy and the mean heart dose. TD-3DCRT showed a significantly shorter mean beam-on time than TD-IMRT. Conclusions The present study showed that TD-3DCRT and TD-IMRT are two feasible and dosimetrically acceptable treatment approach for AWBRT, with an optimal PTV coverage and adequate OARs sparing. Some concerns might be raised in terms of dose to organs at risks if TD-3DCRT is applied to a general population. A correct patients clusterization according to simple quantitative anatomic measures, would help to

  6. Simultaneous Integrated Boost Irradiation After Breast-Conserving Surgery: Physician-Rated Toxicity and Cosmetic Outcome at 30 Months’ Follow-Up

    International Nuclear Information System (INIS)

    Purpose: To evaluate toxicity and cosmetic outcome (CO) in breast cancer survivors treated with three-dimensional conformal radiotherapy with a hypofractionated, simultaneous integrated boost (3D-CRT-SIB) and to identify risk factors for toxicity, with special focus on the impact of age. Methods and Materials: Included were 940 consecutive disease-free patients treated for breast cancer (Stage 0–III) with 3D-CRT-SIB, after breast-conserving surgery, from 2005 to 2010. Physician-rated toxicity (Common Terminology Criteria for Adverse Events version 3.0) and CO were prospectively assessed during yearly follow-up, up to 5 years after radiotherapy. Multivariate logistic regression analyses using a bootstrapping method were performed. Results: At 3 years, toxicity scores of 436 patients were available. Grade ≥2 fibrosis in the boost area was observed in 8.5%, non-boost fibrosis in 49.4%, pain to the chest wall in 6.7%, and fair/poor CO in 39.7% of cases. Radiotherapy before chemotherapy was significantly associated with grade ≥2 boost fibrosis at 3 years (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.3–6.0). Non-boost fibrosis was associated with re-resection (OR 2.2, 95% CI 1.2–4.0) and larger tumors (OR 1.1, 95% CI 1.0–1.1). At 1 year, chest wall pain was significantly associated with high boost dosage (OR 2.1, 95% CI 1.2–3.7) and younger age (OR 0.4, 95% CI 0.2–0.7). A fair/poor CO was observed more often after re-resection (OR 4.5, 95% CI 2.4–8.5), after regional radiotherapy (OR 2.9, 95% CI 1.2–7.1), and in larger tumors (OR 1.1, 95% CI 1.0–1.1). Conclusions: Toxicity and CO are not impaired after 3D-CRT-SIB. Fibrosis was not significantly associated with radiotherapy parameters. Independent risk factors for fibrosis were chemotherapy after radiotherapy, re-resection, and larger tumor size. Re-resection was most predictive for worse CO. Age had an impact on chest wall pain occurrence.

  7. Simultaneous Integrated Boost Irradiation After Breast-Conserving Surgery: Physician-Rated Toxicity and Cosmetic Outcome at 30 Months' Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Bantema-Joppe, Enja J.; Schilstra, Cornelis [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Bock, Geertruida H. de [Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Dolsma, Wil V.; Busz, Dianne M.; Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Maduro, John H., E-mail: j.h.maduro@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

    2012-07-15

    Purpose: To evaluate toxicity and cosmetic outcome (CO) in breast cancer survivors treated with three-dimensional conformal radiotherapy with a hypofractionated, simultaneous integrated boost (3D-CRT-SIB) and to identify risk factors for toxicity, with special focus on the impact of age. Methods and Materials: Included were 940 consecutive disease-free patients treated for breast cancer (Stage 0-III) with 3D-CRT-SIB, after breast-conserving surgery, from 2005 to 2010. Physician-rated toxicity (Common Terminology Criteria for Adverse Events version 3.0) and CO were prospectively assessed during yearly follow-up, up to 5 years after radiotherapy. Multivariate logistic regression analyses using a bootstrapping method were performed. Results: At 3 years, toxicity scores of 436 patients were available. Grade {>=}2 fibrosis in the boost area was observed in 8.5%, non-boost fibrosis in 49.4%, pain to the chest wall in 6.7%, and fair/poor CO in 39.7% of cases. Radiotherapy before chemotherapy was significantly associated with grade {>=}2 boost fibrosis at 3 years (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.3-6.0). Non-boost fibrosis was associated with re-resection (OR 2.2, 95% CI 1.2-4.0) and larger tumors (OR 1.1, 95% CI 1.0-1.1). At 1 year, chest wall pain was significantly associated with high boost dosage (OR 2.1, 95% CI 1.2-3.7) and younger age (OR 0.4, 95% CI 0.2-0.7). A fair/poor CO was observed more often after re-resection (OR 4.5, 95% CI 2.4-8.5), after regional radiotherapy (OR 2.9, 95% CI 1.2-7.1), and in larger tumors (OR 1.1, 95% CI 1.0-1.1). Conclusions: Toxicity and CO are not impaired after 3D-CRT-SIB. Fibrosis was not significantly associated with radiotherapy parameters. Independent risk factors for fibrosis were chemotherapy after radiotherapy, re-resection, and larger tumor size. Re-resection was most predictive for worse CO. Age had an impact on chest wall pain occurrence.

  8. The impact of dose calculation algorithms on partial and whole breast radiation treatment plans

    Directory of Open Access Journals (Sweden)

    Berrang Tanya

    2010-12-01

    Full Text Available Abstract Background This paper compares the calculated dose to target and normal tissues when using pencil beam (PBC, superposition/convolution (AAA and Monte Carlo (MC algorithms for whole breast (WBI and accelerated partial breast irradiation (APBI treatment plans. Methods Plans for 10 patients who met all dosimetry constraints on a prospective APBI protocol when using PBC calculations were recomputed with AAA and MC, keeping the monitor units and beam angles fixed. Similar calculations were performed for WBI plans on the same patients. Doses to target and normal tissue volumes were tested for significance using the paired Student's t-test. Results For WBI plans the average dose to target volumes when using PBC calculations was not significantly different than AAA calculations, the average PBC dose to the ipsilateral breast was 10.5% higher than the AAA calculations and the average MC dose to the ipsilateral breast was 11.8% lower than the PBC calculations. For ABPI plans there were no differences in dose to the planning target volume, ipsilateral breast, heart, ipsilateral lung, or contra-lateral lung. Although not significant, the maximum PBC dose to the contra-lateral breast was 1.9% higher than AAA and the PBC dose to the clinical target volume was 2.1% higher than AAA. When WBI technique is switched to APBI, there was significant reduction in dose to the ipsilateral breast when using PBC, a significant reduction in dose to the ipsilateral lung when using AAA, and a significant reduction in dose to the ipsilateral breast and lung and contra-lateral lung when using MC. Conclusions There is very good agreement between PBC, AAA and MC for all target and most normal tissues when treating with APBI and WBI and most of the differences in doses to target and normal tissues are not clinically significant. However, a commonly used dosimetry constraint, as recommended by the ASTRO consensus document for APBI, that no point in the contra

  9. Sites of failure in breast cancer patients with extra-capsular invasion of axillary lymph node metastases. No need for axillary irradiation?.

    Energy Technology Data Exchange (ETDEWEB)

    Gruber, G.; Menzi, S.; Forster, A.; Greiner, R.H. [Bern Univ. (Switzerland). Dept. of Radiation Oncology; Berclaz, G. [Bern Univ. (Switzerland). Dept. of Gynecology; Altermatt, H.J. [Institute of Pathology, Bern (Switzerland)

    2005-09-15

    Extracapsular spread (ECS) is frequent, but the specific sites of relapse are seldom given in the literature. In this study it was evaluated, if ECS might be an indicator for axillary irradiation. After a retrospective review of pathology reports, the information about ECS was available in 254 lymph node-positive patients: ECS was absent in 34% (ECS-negative; n=87) and present in 66% (ECS-positive; n=167). All patients were irradiated locally, 78 patients got periclavicular and 74 axillary irradiation (median total dose: 50.4 Gy). 240/254 patients (94.5%) received systemic treatment/s. Mean follow-up was 46 months. The regional relapse rate was 4.6% without ECS versus 9.6% with ECS. The 5-year axillary relapse-free survival was 100% in ECS-negative and 90% in ECS-positive patients (p=0.01), whereas corresponding values for periclavicular relapse-free survival (with ECS: 91%{+-}4%; without ECS: 94%{+-}3%; p=0.77) and local relapse-free survival (with ECS: 86%{+-}4%; without ECS: 91%{+-}3%; p=0.69) were not significantly different. {chi}{sup 2}-tests revealed a high correlation of ECS with T-stage, number of positive lymph nodes and progesterone receptor status, comparisons with estrogen receptor, grade, or age were not significant. In multivariate analysis number of positive lymph nodes was solely significant for regional failure. Dividing the patients into those with one to three and those with four or more positive lymph nodes, ECS lost its significance for axillary failure. ECS was accompanied by an enhanced axillary failure rate in univariate analysis, which was no longer true after adjusting for the number of positive lymph nodes. (orig.)

  10. Factors associated with regional nodal failure in patients with early stage breast cancer with 0-3 positive axillary nodes following tangential irradiation alone

    International Nuclear Information System (INIS)

    Purpose: Recent randomized trials have suggested that improved local-regional control after radiation therapy significantly increases survival for breast cancer patients with positive axillary nodes treated with adjuvant systemic therapy . It has been our policy to use a third radiation field only in patients with 4 or more positive nodes. The purpose of this study was to assess whether there are any clinical or pathologic factors associated with an increased risk of regional nodal failure (RNF) in patients with 0-3 positive nodes treated with tangential radiotherapy (RT) alone with or without systemic therapy. Methods and Materials: We retrospectively analyzed the incidence of RNF for 691 patients with clinical Stage I or II invasive breast cancer treated with complete gross excision of the primary tumor and tangential RT alone between 1978-87; 12% also received systemic therapy. All had 0-3 positive nodes on axillary dissection that had histologic examination of ≥ 6 nodes, and all had potential 8-year follow-up. The median number of axillary nodes removed was 11 (range 6-36). RNF was defined as any recurrence in ipsilateral axillary, internal mammary, supraclavicular, or infraclavicular nodes in the absence of recurrence in the breast, with or without simultaneous distant metastasis. Crude rates for first sites of failure within the first 8 years after treatment were calculated. A polychotomous logistic regression was used to identify factors prognostic for RNF and other sites of first failure. Results: Within 8 years, RNF was the first site of failure for 27 patients for a crude 8-year rate of 3.9%. Isolated axillary failure occurred in 8 patients (1.2%). Isolated supraclavicular and/or infraclavicular failure occurred in 5 (1.3%) and 3 (0.4%) patients, respectively. Isolated internal mammary node failure occurred in 2 patients (0.3%). A polychotomous logistic regression model of first site of failure (local failure, regional nodal, distant/opposite breast

  11. Practice guideline for the performance of breast ultrasound elastography

    Directory of Open Access Journals (Sweden)

    Su Hyun Lee

    2014-01-01

    Full Text Available

    Ultrasound (US elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.

  12. Locally advanced non inflammatory breast cancer treated by combined chemotherapy and preoperative irradiation: updated results in a series of 120 patients; Cancer du sein localement evolue non inflammatoire traite par association de chimiotherapie et de radiotherapie a dose preoperatoire: reactualisation des resultats d'une serie de 120 patientes

    Energy Technology Data Exchange (ETDEWEB)

    Lerouge, D.; Touboul, E.; Moureau-Zabotto, L. [Hopital Tenon AP-HP, Service d' oncologie-radiotherapie, 75 - Paris (France); Lefran, J.P.; Blondon, J. [Hopital Pitie-Salpetriere AP-HP, Service de chirurgie generale et gynecologique, 75 - Paris (France); Genestie, C. [Hopital Pitie-Salpetriere AP-HP, Service d' anatomopathologie, 75 - Paris (France)

    2004-06-01

    Purpose. - To evaluate our updated data concerning survival and locoregional control in a study of locally advanced non inflammatory breast cancer after primary chemotherapy followed by external preoperative irradiation. Patients and methods. - Between 1982 and 1998, 120 patients (75 stage IIIA, 41 stage IIIB, and 4 stage IIIC according to AJCC staging system 2002) were consecutively treated by four courses of induction chemotherapy with anthracycline-containing combinations followed by preoperative irradiation (45 Gy to the breast and nodal areas) and a fifth course of chemotherapy. Three different locoregional approaches were proposed, depending on tumour characteristics and tumour response. After completion of local therapy, all patients received a sixth course of chemotherapy and a maintenance adjuvant chemotherapy regimen without anthracycline. The median follow-up from the beginning of treatment was 140 months. Results. - Mastectomy and axillary dissection were performed in 49 patients (with residual tumour larger than 3 cm in diameter or located behind the nipple or with bifocal tumour), and conservative treatment in 71 patients (39 achieved clinical complete response or partial response >90% and received additional radiation boost to initial tumour bed; 32 had residual mass {<=}3 cm in diameter and were treated by wide excision and axillary dissection followed by a boost to the excision site). Ten-year actuarial local failure rate was 13% after irradiation alone, 23% after wide excision and irradiation, and 4% after mastectomy (p =0.1). After multivariate analysis, possibility of breast-conserving therapy was related to initial tumour size (<6 vs. {>=}6 cm in diameter, p =0.002). Ten-year overall metastatic disease-free survival rate was 61%. After multivariate analysis, metastatic disease-free survival rates were significantly influenced by clinical stage (stage IIIA-B vs. IIIC, p =0.0003), N-stage (N0 vs. N1-2a, and 3c, p = 0.017), initial tumour size (<6

  13. Breast Cancer

    Science.gov (United States)

    ... I found something when I did my breast self-exam. What should I do now? How often should I have mammograms? I have breast cancer. What are my treatment options? How often should I do breast self-exams? I have breast cancer. Is my daughter ...

  14. Brain metastases from breast cancer during pregnancy

    Directory of Open Access Journals (Sweden)

    Ashish Sharma

    2016-01-01

    Conclusion: There is a lack of guidelines and clinical consensus on medical and surgical treatment for breast cancer metastases in pregnant patients. Treatment usually varies based upon underlying tumor burden, location, gestational age of the fetus, and patient′s preference and symptomatology.

  15. ICON 2013: practical consensus recommendations for hormone receptor-positive Her2-negative advanced or metastatic breastcancer.

    Science.gov (United States)

    Parikh, P M; Gupta, S; Dawood, S; Rugo, H; Bhattacharyya, G S; Agarwal, A; Chacko, R; Sahoo, T P; Babu, G; Agarwal, S; Munshi, A; Goswami, C; Smruti, B K; Bondarde, S; Desai, C; Rajappa, S; Somani, N; Singh, M; Nimmagadda, R; Pavitran, K; Mehta, A; Parmar, V; Desai, S; Nair, R; Doval, D

    2014-01-01

    The management of hormone receptor-positive Her2-negative breast cancer patients with advanced or metastatic disease is a common problem in India and other countries in this region. This expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.

  16. ICON 2013: Practical consensus recommendations for hormone receptor-positive Her2-negative advanced or metastatic breastcancer

    Directory of Open Access Journals (Sweden)

    P M Parikh

    2014-01-01

    Full Text Available The management of hormone receptor-positive Her2-negative breast cancer patients with advanced or metastatic disease is a common problem in India and other countries in this region. This expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.

  17. A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer

    International Nuclear Information System (INIS)

    Since the results from the randomized TARGIT A trial were published, intraoperative radiotherapy (IORT) is used more often. IORT can be provided as accelerated partial breast irradiation (APBI) or as a boost. The definition of suitable patients for IORT as APBI differs between different national societies (e.g. ESTRO and ASTRO) and different inclusion criteria of trials and so does the eligibility of patients. This analysis identifies eligible patients for IORT according to available consensus statements and inclusion criteria of the ongoing TARGIT trials. Between 01/03 – 12/09, 1505 breast cancer cases were treated at the breast cancer center at the University Medical Center Mannheim. Complete data sets for age, stage (T, N, and M), histology and hormone receptor status were available in 1108 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favorable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E “elderly”, risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology, phase II: ≥70 years, IDC, T1, N0, any hormone receptor status, M0; TARGIT C “consolidation”, risk adapted radiotherapy, phase IV: ≥50 years, IDC, T1, N0, positive hormone receptor status, M0; TARGIT BQR “boost quality registry”: every age, every histology, T1-2 (max. 3.5 cm), any hormone receptor status, N0/+, M0/+. Out of the 1108 cases, 379 cases (34.2%) were suitable for IORT as APBI regarding the ESTRO and 175 (15.8%) regarding the ASTRO consensus statements. 82 (7.4%) patients were eligible for the TARGIT E trial, 258 (23.3%) for the TARGIT C trial and 671 (60.6%) for the TARGIT BQR registry. According to the consensus statements of ASTRO (45.1%) and ESTRO (41.4%) about half of the eligible patients were treated with IORT as APBI. From the

  18. IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: results of an ISIORT pooled analysis

    Energy Technology Data Exchange (ETDEWEB)

    Sedlmayer, F.; Fastner, G.; Merz, F.; Deutschmann, H. [Dept. of Radiotherapy and Radio-Oncology, Univ. Clinic Salzburg (Austria); Reitsamer, R.; Menzel, C. [Dept. of Special Gynecology, Univ. Clinic Salzburg (Austria); Ciabattoni, A.; Petrucci, A. [Dept. of Radiotherapy, San Filippo Neri Hospital, Rome (Italy); Hager, E. [Dept. of Radiotherapy, Landeskrankenhaus Klagenfurt (Austria); Willich, N. [Dept. of Radiotherapy, Univ. Clinic Muenster (Germany); Orecchia, R. [Dept. of Radiotherapy, European Inst. of Oncology, Milano (Italy); Valentini, V. [Dept. of Radiotherapy, Catholic Univ. A. Gemelli, Rome (Italy)

    2007-12-15

    There is common consensus that postoperative whole-breast irradiation with doses around 50 Gy remains the gold standard for local treatment after breast co