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Sample records for breast radiation therapy

  1. Preoperative breast radiation therapy: Indications and perspectives

    DEFF Research Database (Denmark)

    Lightowlers, S V; Boersma, L J; Fourquet, A

    2017-01-01

    Preoperative breast radiation therapy (RT) is not a new concept, but older studies failed to change practice. More recently, there has been interest in revisiting preoperative RT using modern techniques. This current perspective discusses the indications, summarises the published literature and t...

  2. Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

    Energy Technology Data Exchange (ETDEWEB)

    Hannan, Raquibul, E-mail: Raquibul.Hannan@gmail.com [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Thompson, Reid F.; Chen Yu; Bernstein, Karen; Kabarriti, Rafi; Skinner, William [Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (United States); Chen, Chin C. [Department of Radiation Oncology, Columbia University Medical Center, New York, New York (United States); Landau, Evan; Miller, Ekeni; Spierer, Marnee; Hong, Linda; Kalnicki, Shalom [Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (United States)

    2012-11-15

    Purpose: To evaluate the effects of breast size on dose-volume histogram parameters and clinical toxicity in whole-breast hypofractionated radiation therapy using intensity modulated radiation therapy (IMRT). Materials and Methods: In this retrospective study, all patients undergoing breast-conserving therapy between 2005 and 2009 were screened, and qualifying consecutive patients were included in 1 of 2 cohorts: large-breasted patients (chest wall separation >25 cm or planning target volume [PTV] >1500 cm{sub 3}) (n=97) and small-breasted patients (chest wall separation <25 cm and PTV <1500 cm{sub 3}) (n=32). All patients were treated prone or supine with hypofractionated IMRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost dose (9.6 Gy in 4 fractions). Dosimetric and clinical toxicity data were collected and analyzed using the R statistical package (version 2.12). Results: The mean PTV V95 (percentage of volume receiving >= 95% of prescribed dose) was 90.18% and the mean V105 percentage of volume receiving >= 105% of prescribed dose was 3.55% with no dose greater than 107%. PTV dose was independent of breast size, whereas heart dose and maximum point dose to skin correlated with increasing breast size. Lung dose was markedly decreased in prone compared with supine treatments. Radiation Therapy Oncology Group grade 0, 1, and 2 skin toxicities were noted acutely in 6%, 69%, and 25% of patients, respectively, and at later follow-up (>3 months) in 43%, 57%, and 0% of patients, respectively. Large breast size contributed to increased acute grade 2 toxicity (28% vs 12%, P=.008). Conclusions: Adequate PTV coverage with acceptable hot spots and excellent sparing of organs at risk was achieved by use of IMRT regardless of treatment position and breast size. Although increasing breast size leads to increased heart dose and maximum skin dose, heart dose remained within our institutional constraints and the incidence of overall skin toxicity was comparable

  3. Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

    International Nuclear Information System (INIS)

    Hannan, Raquibul; Thompson, Reid F.; Chen Yu; Bernstein, Karen; Kabarriti, Rafi; Skinner, William; Chen, Chin C.; Landau, Evan; Miller, Ekeni; Spierer, Marnee; Hong, Linda; Kalnicki, Shalom

    2012-01-01

    Purpose: To evaluate the effects of breast size on dose-volume histogram parameters and clinical toxicity in whole-breast hypofractionated radiation therapy using intensity modulated radiation therapy (IMRT). Materials and Methods: In this retrospective study, all patients undergoing breast-conserving therapy between 2005 and 2009 were screened, and qualifying consecutive patients were included in 1 of 2 cohorts: large-breasted patients (chest wall separation >25 cm or planning target volume [PTV] >1500 cm 3 ) (n=97) and small-breasted patients (chest wall separation 3 ) (n=32). All patients were treated prone or supine with hypofractionated IMRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost dose (9.6 Gy in 4 fractions). Dosimetric and clinical toxicity data were collected and analyzed using the R statistical package (version 2.12). Results: The mean PTV V95 (percentage of volume receiving >= 95% of prescribed dose) was 90.18% and the mean V105 percentage of volume receiving >= 105% of prescribed dose was 3.55% with no dose greater than 107%. PTV dose was independent of breast size, whereas heart dose and maximum point dose to skin correlated with increasing breast size. Lung dose was markedly decreased in prone compared with supine treatments. Radiation Therapy Oncology Group grade 0, 1, and 2 skin toxicities were noted acutely in 6%, 69%, and 25% of patients, respectively, and at later follow-up (>3 months) in 43%, 57%, and 0% of patients, respectively. Large breast size contributed to increased acute grade 2 toxicity (28% vs 12%, P=.008). Conclusions: Adequate PTV coverage with acceptable hot spots and excellent sparing of organs at risk was achieved by use of IMRT regardless of treatment position and breast size. Although increasing breast size leads to increased heart dose and maximum skin dose, heart dose remained within our institutional constraints and the incidence of overall skin toxicity was comparable to that reported in the

  4. Generalized Morphea after Breast Cancer Radiation Therapy

    Directory of Open Access Journals (Sweden)

    Jonathan Kushi

    2011-01-01

    Full Text Available We present a case of a 69-year-old woman who received external beam radiation for the treatment of breast cancer. Seven months later, she developed generalized morphea involving the area of irradiated skin of the breast as well as distant sites of the groin and distal lower extremity. Postirradiation morphea is an uncommon yet well-documented phenomenon, usually confined to the radiated site and the immediate surrounding tissue. To our knowledge, this is only the fourth reported case of morphea occurring distant from the radiation field. While most cases of postirradiation morphea have been shown to either resolve spontaneously or respond to topical corticosteroids, our patient required systemic therapy with methotrexate, which resulted in clinical improvement. With this paper, we hope to bring further awareness to this phenomenon and demonstrate a successful treatment response with the use of methotrexate in postirradiation generalized morphea.

  5. Breast conservation therapy for breast cancer. Radiation oncologist's point of view

    International Nuclear Information System (INIS)

    Hiraoka, Masahiro; Mitsumori, Michihide; Kokubo, Masaki; Fujishiro, Satsuki

    1998-01-01

    The roles and problems of radiation therapy in breast conserving therapy for breast cancer were presented. The roles of radiation therapy include decrease in breast recurrence, an alternative to axillary dissection for N0 cases, and neo-adjuvant radiation therapy. On the other hand, problems associated with radiation therapy are question of using radiation therapy for all cases, complications and worsening of cosmetics, and relatively high breast recurrence rates for margin-positive cases. The concept of breast conserving therapy is to improve QOL without decreasing treatment outcomes. It is considered that we should be more concentrated on the aspects of QOL because treatment outcomes of breast conserving therapy in Japan demonstrated sofar appear excellent. (author)

  6. Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

    1999-01-01

    Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

  7. Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] [and others

    1999-03-01

    Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

  8. Radiation therapy for breast cancer: Literature review

    International Nuclear Information System (INIS)

    Balaji, Karunakaran; Subramanian, Balaji; Yadav, Poonam; Anu Radha, Chandrasekaran; Ramasubramanian, Velayudham

    2016-01-01

    Concave shape with variable size target volume makes treatment planning for the breast/chest wall a challenge. Conventional techniques used for the breast/chest wall cancer treatment provided better sparing of organs at risk (OARs), with poor conformity and uniformity to the target volume. Advanced technologies such as intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) improve the target coverage at the cost of higher low dose volumes to OARs. Novel hybrid techniques present promising results in breast/chest wall irradiation in terms of target coverage as well as OARs sparing. Several published data compared these technologies for the benefit of the breast/chest wall with or without nodal volumes. The aim of this article is to review relevant data and identify the scope for further research in developing optimal treatment plan for breast/chest wall cancer treatment.

  9. Radiation therapy for breast cancer: Literature review

    Energy Technology Data Exchange (ETDEWEB)

    Balaji, Karunakaran, E-mail: karthik.balaji85@gmail.com [Department of Radiation Oncology, Global Hospitals, Chennai (India); School of Advanced Sciences, VIT University, Vellore (India); Subramanian, Balaji [Department of Radiation Oncology, Global Hospitals, Chennai (India); Yadav, Poonam [Department of Medical Physics and Human Oncology, University of Wisconsin-Madison, WI and Aspirus UW Cancer Center, Wisconsin Rapids, WI (United States); Anu Radha, Chandrasekaran; Ramasubramanian, Velayudham [School of Advanced Sciences, VIT University, Vellore (India)

    2016-10-01

    Concave shape with variable size target volume makes treatment planning for the breast/chest wall a challenge. Conventional techniques used for the breast/chest wall cancer treatment provided better sparing of organs at risk (OARs), with poor conformity and uniformity to the target volume. Advanced technologies such as intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) improve the target coverage at the cost of higher low dose volumes to OARs. Novel hybrid techniques present promising results in breast/chest wall irradiation in terms of target coverage as well as OARs sparing. Several published data compared these technologies for the benefit of the breast/chest wall with or without nodal volumes. The aim of this article is to review relevant data and identify the scope for further research in developing optimal treatment plan for breast/chest wall cancer treatment.

  10. Primary radiation therapy for early breast cancer: the experience at the joint center for radiation therapy

    International Nuclear Information System (INIS)

    Harris, J.R.; Botnick, L.; Bloomer, W.D.; Chaffey, J.T.; Hellman, S.

    1981-01-01

    The results of primary radiation therapy in 176 consecutive patients with clinical State I and II carcinoma of the breast were reviewed. Median follow-up time was 47 months. The overall breast relapse rate was 7%. Patients undergoing interstitial implantation had a significantly lower breast relapse rate (1%) than patients not undergoing implantation (11%). Breast relapse was more common in patients undergoing incisional or needle biopsy (17%), compared to patients treated after excisional biopsy (5%). In patients undergoing excisional biopsy, but not interstitial implantation, breast relapse was related to external beam dose. Twelve percent of the patients who received less than 1600 ret dose relapsed in the breast, compared to none of the 19 patients who received more than 1700 ret dose. These results imply that supplemental irradiation to the primary tumor area is required following excisional biopsy of a primary breast cancer when 4500-5000 rad is delivered to the entire breast

  11. Coronary artery calcium in breast cancer survivors after radiation therapy

    NARCIS (Netherlands)

    Takx, Richard A P; Vliegenthart, Rozemarijn; Schoepf, U Joseph; Pilz, Lothar R; Schoenberg, Stefan O; Morris, Pamela B; Henzler, Thomas; Apfaltrer, Paul

    The purpose of the current study is to investigate whether breast cancer survivors after radiation therapy have a higher burden of coronary artery calcium as a potential surrogate of radiation-induced accelerated coronary artery disease. 333 patients were included. 54 patients underwent chest CT ae

  12. Analysis of radiation pneumonitis outside the radiation field in breast conserving therapy for early breast cancer

    International Nuclear Information System (INIS)

    Ogo, Etsuyo; Fujimoto, Kiminori; Hayabuchi, Naofumi

    2002-01-01

    In a retrospective study of radiation-induced pulmonary changes for patients with breast conserving therapy for early breast cancer, we sent questionnaires to the main hospitals in Japan. In this study, we analyzed pulmonary changes after tangential whole-breast irradiation. The purpose of this study was to determine the incidence and risk factors for radiation pneumonitis outside the radiation field. The questionnaires included patients data, therapy data, and lung injury information between August 1999 and May 2000. On the first questionnaires, answer letters were received from 107 institutions out of 158 (67.7%). On the second questionnaires, response rate (hospitals which had radiation pneumonitis outside the radiation field) was 21.7% (23/106). We could find no risk factors of this type of pneumonitis. We suggested that lung irradiation might trigger this type of pneumonitis which is clinically similar to BOOP (bronchiolitis obliterans organizing pneumonia). It developed in 1.5-2.1% among the patients with breast conserving surgery and tangential whole-breast irradiation. And it is likely appeared within 6 months after radiotherapy. (author)

  13. Exclusive radical radiation therapy in breast carcinoma

    International Nuclear Information System (INIS)

    Dubois, J.B.; Salomon, A.; Gary-Bobo, J.; Pourquier, H.; Pujol, H.

    1991-01-01

    The results are presented of 186 breast cancer patients treated initially for locoregional disease by radiotherapy alone, combining cobalt therapy with external electron beam or interstitial iridium implants. According to the TNM classification, the patients were distributed as follows: 3 T 1 N 0 , 2 T 1 N 1 , 33 T 2 N 0 , 36 T 2 N 1 , 16 T 3 N 0 , 26 T 3 N 1 , 6 T 3 N 2 , 14 T 4 N 0 , 29 T 4 N 1 , 9 T 4 N 2 and 12 T 4 N 3 . The 5- and 10-year survival rates (52.7 and 36.5 per cent respectively, for all patients) were directly correlated with the size and location of the breast tumor, and the extent of lymph node involvement. Locoregional recurrence was observed in 39.8 per cent of the cases, metastases alone in 26.8 per cent, and a combination of local recurrence and distant metastasis in 14.5 per cent of the cases. The local recurrences and metastases were directly correlated with the extent of locoregional involvement. Late complications and sequelae were mostly minor and occurred in less than 25 per cent of the cases; severe sequelae in no more than 2 per cent. They depended on the initial tumor volume and the tumor dose. The results, along with those in the literature, indicate that radiotherapy administered alone is a valid therapeutic option in breast cancer. (author). 23 refs.; 5 tabs

  14. Breast Cancer After Chest Radiation Therapy for Childhood Cancer

    Science.gov (United States)

    Moskowitz, Chaya S.; Chou, Joanne F.; Wolden, Suzanne L.; Bernstein, Jonine L.; Malhotra, Jyoti; Friedman, Danielle Novetsky; Mubdi, Nidha Z.; Leisenring, Wendy M.; Stovall, Marilyn; Hammond, Sue; Smith, Susan A.; Henderson, Tara O.; Boice, John D.; Hudson, Melissa M.; Diller, Lisa R.; Bhatia, Smita; Kenney, Lisa B.; Neglia, Joseph P.; Begg, Colin B.; Robison, Leslie L.; Oeffinger, Kevin C.

    2014-01-01

    Purpose The risk of breast cancer is high in women treated for a childhood cancer with chest irradiation. We sought to examine variations in risk resulting from irradiation field and radiation dose. Patients and Methods We evaluated cumulative breast cancer risk in 1,230 female childhood cancer survivors treated with chest irradiation who were participants in the CCSS (Childhood Cancer Survivor Study). Results Childhood cancer survivors treated with lower delivered doses of radiation (median, 14 Gy; range, 2 to 20 Gy) to a large volume (whole-lung field) had a high risk of breast cancer (standardized incidence ratio [SIR], 43.6; 95% CI, 27.2 to 70.3), as did survivors treated with high doses of delivered radiation (median, 40 Gy) to the mantle field (SIR, 24.2; 95% CI, 20.7 to 28.3). The cumulative incidence of breast cancer by age 50 years was 30% (95% CI, 25 to 34), with a 35% incidence among Hodgkin lymphoma survivors (95% CI, 29 to 40). Breast cancer–specific mortality at 5 and 10 years was 12% (95% CI, 8 to 18) and 19% (95% CI, 13 to 25), respectively. Conclusion Among women treated for childhood cancer with chest radiation therapy, those treated with whole-lung irradiation have a greater risk of breast cancer than previously recognized, demonstrating the importance of radiation volume. Importantly, mortality associated with breast cancer after childhood cancer is substantial. PMID:24752044

  15. The role of a prone setup in breast radiation therapy.

    Science.gov (United States)

    Huppert, Nelly; Jozsef, Gabor; Dewyngaert, Keith; Formenti, Silvia Chiara

    2011-01-01

    Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  16. The role of a prone setup in breast radiation therapy

    Directory of Open Access Journals (Sweden)

    Nelly eHuppert

    2011-10-01

    Full Text Available Most patients undergoing breast conservation therapy (BCT receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy (IMRT and image-guided radiation therapy (IGRT have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  17. The Role of a Prone Setup in Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Huppert, Nelly; Jozsef, Gabor; DeWyngaert, Keith; Formenti, Silvia Chiara, E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York University Langone Medical Center, New York, NY (United States)

    2011-10-11

    Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  18. Radiation therapy as definitive treatment of breast cancer

    International Nuclear Information System (INIS)

    Findlay, P.A.

    1988-01-01

    Like surgery, radiation therapy is a local treatment modality, and also like surgery, the objective of therapy is to eradicate all cancer in the treated area, ensuring no recurrence. In addition, this objective should be achieved with maintenance of a cosmetically intact breast. If these two goals can be attained simultaneously, the ultimate result should be a substantial reduction in the physical and psychologic morbidity of treatment and an improvement in the patients's quality of life. It is to be hoped that by reducing women's fear of potentially disfiguring surgery, they will be encouraged to seek medical attention for breast cancer at an earlier, and hence potentially more curable, stage of the disease

  19. Modern Radiation Therapy and Cardiac Outcomes in Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Boero, Isabel J.; Paravati, Anthony J.; Triplett, Daniel P.; Hwang, Lindsay; Matsuno, Rayna K.; Gillespie, Erin F.; Yashar, Catheryn M.; Moiseenko, Vitali; Einck, John P.; Mell, Loren K. [Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California (United States); Parikh, Sahil A. [University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Murphy, James D., E-mail: j2murphy@ucsd.edu [Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, California (United States)

    2016-03-15

    Purpose: Adjuvant radiation therapy, which has proven benefit against breast cancer, has historically been associated with an increased incidence of ischemic heart disease. Modern techniques have reduced this risk, but a detailed evaluation has not recently been conducted. The present study evaluated the effect of current radiation practices on ischemia-related cardiac events and procedures in a population-based study of older women with nonmetastatic breast cancer. Methods and Materials: A total of 29,102 patients diagnosed from 2000 to 2009 were identified from the Surveillance, Epidemiology, and End Results–Medicare database. Medicare claims were used to identify the radiation therapy and cardiac outcomes. Competing risk models were used to assess the effect of radiation on these outcomes. Results: Patients with left-sided breast cancer had a small increase in their risk of percutaneous coronary intervention (PCI) after radiation therapy—the 10-year cumulative incidence for these patients was 5.5% (95% confidence interval [CI] 4.9%-6.2%) and 4.5% (95% CI 4.0%-5.0%) for right-sided patients. This risk was limited to women with previous cardiac disease. For patients who underwent PCI, those with left-sided breast cancer had a significantly increased risk of cardiac mortality with a subdistribution hazard ratio of 2.02 (95% CI 1.23-3.34). No other outcome, including cardiac mortality for the entire cohort, showed a significant relationship with tumor laterality. Conclusions: For women with a history of cardiac disease, those with left-sided breast cancer who underwent radiation therapy had increased rates of PCI and a survival decrement if treated with PCI. The results of the present study could help cardiologists and radiation oncologists better stratify patients who need more aggressive cardioprotective techniques.

  20. Modern Radiation Therapy and Cardiac Outcomes in Breast Cancer

    International Nuclear Information System (INIS)

    Boero, Isabel J.; Paravati, Anthony J.; Triplett, Daniel P.; Hwang, Lindsay; Matsuno, Rayna K.; Gillespie, Erin F.; Yashar, Catheryn M.; Moiseenko, Vitali; Einck, John P.; Mell, Loren K.; Parikh, Sahil A.; Murphy, James D.

    2016-01-01

    Purpose: Adjuvant radiation therapy, which has proven benefit against breast cancer, has historically been associated with an increased incidence of ischemic heart disease. Modern techniques have reduced this risk, but a detailed evaluation has not recently been conducted. The present study evaluated the effect of current radiation practices on ischemia-related cardiac events and procedures in a population-based study of older women with nonmetastatic breast cancer. Methods and Materials: A total of 29,102 patients diagnosed from 2000 to 2009 were identified from the Surveillance, Epidemiology, and End Results–Medicare database. Medicare claims were used to identify the radiation therapy and cardiac outcomes. Competing risk models were used to assess the effect of radiation on these outcomes. Results: Patients with left-sided breast cancer had a small increase in their risk of percutaneous coronary intervention (PCI) after radiation therapy—the 10-year cumulative incidence for these patients was 5.5% (95% confidence interval [CI] 4.9%-6.2%) and 4.5% (95% CI 4.0%-5.0%) for right-sided patients. This risk was limited to women with previous cardiac disease. For patients who underwent PCI, those with left-sided breast cancer had a significantly increased risk of cardiac mortality with a subdistribution hazard ratio of 2.02 (95% CI 1.23-3.34). No other outcome, including cardiac mortality for the entire cohort, showed a significant relationship with tumor laterality. Conclusions: For women with a history of cardiac disease, those with left-sided breast cancer who underwent radiation therapy had increased rates of PCI and a survival decrement if treated with PCI. The results of the present study could help cardiologists and radiation oncologists better stratify patients who need more aggressive cardioprotective techniques.

  1. Once-Daily Radiation Therapy for Inflammatory Breast Cancer

    International Nuclear Information System (INIS)

    Brown, Lindsay; Harmsen, William; Blanchard, Miran; Goetz, Matthew; Jakub, James; Mutter, Robert; Petersen, Ivy; Rooney, Jessica; Stauder, Michael; Yan, Elizabeth; Laack, Nadia

    2014-01-01

    Purpose: Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer variant treated with multimodality therapy. A variety of approaches intended to escalate the intensity and efficacy of radiation therapy have been reported, including twice-daily radiation therapy, dose escalation, and aggressive use of bolus. Herein, we examine our outcomes for patients treated with once-daily radiation therapy with aggressive bolus utilization, focusing on treatment technique. Methods and Materials: A retrospective review of patients with nonmetastatic IBC treated from January 1, 2000, through December 31, 2010, was performed. Locoregional control (LRC), disease-free survival (DFS), overall survival (OS) and predictors thereof were assessed. Results: Fifty-two women with IBC were identified, 49 (94%) of whom were treated with neoadjuvant chemotherapy. All underwent mastectomy followed by adjuvant radiation therapy. Radiation was delivered in once-daily fractions of 1.8 to 2.25 Gy (median, 2 Gy). Patients were typically treated with daily 1-cm bolus throughout treatment, and 33 (63%) received a subsequent boost to the mastectomy scar. Five-year Kaplan Meier survival estimates for LRC, DFS, and OS were 81%, 56%, and 64%, respectively. Locoregional recurrence was associated with poorer OS (P<.001; hazard ratio [HR], 4.1). Extracapsular extension was associated with worse LRC (P=.02), DFS (P=.007), and OS (P=.002). Age greater than 50 years was associated with better DFS (P=.03). Pathologic complete response was associated with a trend toward improved LRC (P=.06). Conclusions: Once-daily radiation therapy with aggressive use of bolus for IBC results in outcomes consistent with previous reports using various intensified radiation therapy regimens. LRC remains a challenge despite modern systemic therapy. Extracapsular extension, age ≤50 years, and lack of complete response to chemotherapy appear to be associated with worse outcomes. Novel strategies are needed in IBC

  2. Reversible brachial plexopathy following primary radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Salner, A.L.; Botnick, L.E.; Herzog, A.G.; Goldstein, M.A.; Harris, J.R.; Levene, M.B.; Hellman, S.

    1981-01-01

    Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen

  3. Thyroid and hypophysial function in radiation therapy of breast cancer

    International Nuclear Information System (INIS)

    Yakimova, T.P.; Lozinskaya, I.N.

    1984-01-01

    In breast cancer a decrease in triiodothyronine concentration was revealed with the normal level of thyroxine that may be associated with the disturbed peripharal metabolism into triiodothyronine. The lowering of thyroid functional activity is noted during radiation therapy of patients at menopause. Administration of thyroidin during radiation therapy to elderly patients with the 3 stage of the disease compensated for hormone deficiency producing a sparing effect on the thyroid, and influenced the therapeutic results favorably. A high level of the somatotropic hormone was observed in patients, of the reproductive age and at menopause, the level of insulin was increased in all the patients

  4. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    International Nuclear Information System (INIS)

    Osa, Etin-Osa O.; DeWyngaert, Keith; Roses, Daniel; Speyer, James; Guth, Amber; Axelrod, Deborah; Fenton Kerimian, Maria; Goldberg, Judith D.; Formenti, Silvia C.

    2014-01-01

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm 3 , mean 19.65 cm 3 . In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm 3 , mean 1.59 cm 3 . There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and fractionation

  5. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    Energy Technology Data Exchange (ETDEWEB)

    Osa, Etin-Osa O.; DeWyngaert, Keith [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Roses, Daniel [Department of Surgery, New York University School of Medicine, New York, New York (United States); Speyer, James [Department of Medical Oncology, New York University School of Medicine, New York, New York (United States); Guth, Amber; Axelrod, Deborah [Department of Surgery, New York University School of Medicine, New York, New York (United States); Fenton Kerimian, Maria [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Goldberg, Judith D. [Department of Population Health, New York University School of Medicine, New York, New York (United States); Formenti, Silvia C., E-mail: Silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States)

    2014-07-15

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm{sup 3}, mean 19.65 cm{sup 3}. In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm{sup 3}, mean 1.59 cm{sup 3}. There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and

  6. Changes in skin microcirculation during radiation therapy for breast cancer.

    Science.gov (United States)

    Tesselaar, Erik; Flejmer, Anna M; Farnebo, Simon; Dasu, Alexandru

    2017-08-01

    The majority of breast cancer patients who receive radiation treatment are affected by acute radiation-induced skin changes. The assessment of these changes is usually done by subjective methods, which complicates the comparison between different treatments or patient groups. This study investigates the feasibility of new robust methods for monitoring skin microcirculation to objectively assess and quantify acute skin reactions during radiation treatment. Laser Doppler flowmetry, laser speckle contrast imaging, and polarized light spectroscopy imaging were used to measure radiation-induced changes in microvascular perfusion and red blood cell concentration (RBC) in the skin of 15 patients undergoing adjuvant radiation therapy for breast cancer. Measurements were made before treatment, once a week during treatment, and directly after the last fraction. In the treated breast, perfusion and RBC concentration were increased after 1-5 fractions (2.66-13.3 Gy) compared to baseline. The largest effects were seen in the areola and the medial area. No changes in perfusion and RBC concentration were seen in the untreated breast. In contrast, Radiation Therapy Oncology Group (RTOG) scores were increased only after 2 weeks of treatment, which demonstrates the potential of the proposed methods for early assessment of skin changes. Also, there was a moderate to good correlation between the perfusion (r = 0.52) and RBC concentration (r = 0.59) and the RTOG score given a week later. We conclude that radiation-induced microvascular changes in the skin can be objectively measured using novel camera-based techniques before visual changes in the skin are apparent. Objective measurement of microvascular changes in the skin may be valuable in the comparison of skin reactions between different radiation treatments and possibly in predicting acute skin effects at an earlier stage.

  7. Radiation dermatitis and pneumonitis following breast conserving therapy

    International Nuclear Information System (INIS)

    Yoden, Eisaku; Hiratsuka, Junichi; Imajo, Yoshinari

    2000-01-01

    We investigated the frequency, degree and risk factors of radiation-induced dermatitis and pneumonitis in 255 patients receiving breast conserving therapy between April 1987 and April 1998. The majority of the patients underwent a wide excision or quadrantectomy with a level I, II axillary dissection, followed by radiotherapy consisting of 50 Gy/25 Fr/5 weeks to the preserved breast with a 4 MV beam by tangentially opposed portals using the half-field technique. Eleven patients received an additional 10 Gy/5 Fr of electron therapy to the tumor bed. Most of the patients developed radiation dermatitis which was limited to reddening or dry desquamation, with the exception of 14 patients with a localized moist reaction. The skin reaction was transient in all patients and improved with conservative treatments. Radiation pneumonitis appeared on chest X-rays in 30 patients, with a slight appearance in 21 and patchy appearance in 9. Three patients presented with persistent symptoms requiring medication. They were treated with steroids, resulting in complete resolution of the symptoms. A large volume of the chest wall within the irradiation field and a large area of irradiated skin were the risk factors of radiation dermatitis. The volume of irradiated lung significantly correlated with the frequency and degree of radiation pneumonitis. It was preferable that the maximum thickness of the involved lung should not exceed 3 cm. Complicated disease, adjuvant therapy and boost irradiation had no impact on the radiation dermatitis or pneumonitis. (author)

  8. Change in Seroma Volume During Whole-Breast Radiation Therapy

    International Nuclear Information System (INIS)

    Sharma, Rajiv; Spierer, Marnee; Mutyala, Subhakar; Thawani, Nitika; Cohen, Hillel W.; Hong, Linda; Garg, Madhur K.; Kalnicki, Shalom

    2009-01-01

    Purpose: After breast-conserving surgery, a seroma often forms in the surgical cavity. If not drained, it may affect the volume of tumor bed requiring a boost after whole-breast radiation therapy (WBRT). Our objective was to evaluate the change in seroma volume that occurs during WBRT, before boost planning. Methods and Materials: A retrospective review was performed of women receiving breast-conserving therapy with evidence of seroma at the time of WBRT planning. Computed tomography (CT) simulation was performed before WBRT and before the tumor bed boost. All patients received either a hypofractionated (42.4 Gy/16 fraction + 9.6 Gy/4 fraction boost) or standard fractionated (50.4 Gy/28 fraction + 10 Gy/5 fraction boost) regimen. Seroma volumes were contoured and compared on CT at the time of WBRT simulation and tumor bed boost planning. Results: Twenty-four patients with evidence of seroma were identified and all patients received WBRT without drainage of the seroma. Mean seroma volume before WBRT and at boost planning were significantly different at 65.7 cm 3 (SD, 50.5 cm 3 ) and 35.6 cm 3 (SD, 24.8 cm 3 ), respectively (p < 0.001). Mean and median reduction in seroma volume during radiation were 39.6% (SD, 23.8%) and 46.2% (range, 10.7-76.7%), respectively. Fractionation schedule was not correlated with change in seroma volume. Length of time from surgery to start of radiation therapy showed an inverse correlation with change in seroma volume (Pearson correlation r = -0.53, p < 0.01). Conclusions: The volume of seroma changes significantly during WBRT. Consequently, the accuracy of breast boost planning is likely affected, as is the volume of normal breast tissue irradiated. CT-based boost planning before boost irradiation is suggested to ensure appropriate coverage.

  9. Adaptive Breast Radiation Therapy Using Modeling of Tissue Mechanics: A Breast Tissue Segmentation Study

    International Nuclear Information System (INIS)

    Juneja, Prabhjot; Harris, Emma J.; Kirby, Anna M.; Evans, Philip M.

    2012-01-01

    Purpose: To validate and compare the accuracy of breast tissue segmentation methods applied to computed tomography (CT) scans used for radiation therapy planning and to study the effect of tissue distribution on the segmentation accuracy for the purpose of developing models for use in adaptive breast radiation therapy. Methods and Materials: Twenty-four patients receiving postlumpectomy radiation therapy for breast cancer underwent CT imaging in prone and supine positions. The whole-breast clinical target volume was outlined. Clinical target volumes were segmented into fibroglandular and fatty tissue using the following algorithms: physical density thresholding; interactive thresholding; fuzzy c-means with 3 classes (FCM3) and 4 classes (FCM4); and k-means. The segmentation algorithms were evaluated in 2 stages: first, an approach based on the assumption that the breast composition should be the same in both prone and supine position; and second, comparison of segmentation with tissue outlines from 3 experts using the Dice similarity coefficient (DSC). Breast datasets were grouped into nonsparse and sparse fibroglandular tissue distributions according to expert assessment and used to assess the accuracy of the segmentation methods and the agreement between experts. Results: Prone and supine breast composition analysis showed differences between the methods. Validation against expert outlines found significant differences (P<.001) between FCM3 and FCM4. Fuzzy c-means with 3 classes generated segmentation results (mean DSC = 0.70) closest to the experts' outlines. There was good agreement (mean DSC = 0.85) among experts for breast tissue outlining. Segmentation accuracy and expert agreement was significantly higher (P<.005) in the nonsparse group than in the sparse group. Conclusions: The FCM3 gave the most accurate segmentation of breast tissues on CT data and could therefore be used in adaptive radiation therapy-based on tissue modeling. Breast tissue segmentation

  10. Adaptive Breast Radiation Therapy Using Modeling of Tissue Mechanics: A Breast Tissue Segmentation Study

    Energy Technology Data Exchange (ETDEWEB)

    Juneja, Prabhjot, E-mail: Prabhjot.Juneja@icr.ac.uk [Joint Department of Physics, Institute of Cancer Research, Sutton (United Kingdom); Harris, Emma J. [Joint Department of Physics, Institute of Cancer Research, Sutton (United Kingdom); Kirby, Anna M. [Department of Academic Radiotherapy, Royal Marsden National Health Service Foundation Trust, Sutton (United Kingdom); Evans, Philip M. [Joint Department of Physics, Institute of Cancer Research, Sutton (United Kingdom)

    2012-11-01

    Purpose: To validate and compare the accuracy of breast tissue segmentation methods applied to computed tomography (CT) scans used for radiation therapy planning and to study the effect of tissue distribution on the segmentation accuracy for the purpose of developing models for use in adaptive breast radiation therapy. Methods and Materials: Twenty-four patients receiving postlumpectomy radiation therapy for breast cancer underwent CT imaging in prone and supine positions. The whole-breast clinical target volume was outlined. Clinical target volumes were segmented into fibroglandular and fatty tissue using the following algorithms: physical density thresholding; interactive thresholding; fuzzy c-means with 3 classes (FCM3) and 4 classes (FCM4); and k-means. The segmentation algorithms were evaluated in 2 stages: first, an approach based on the assumption that the breast composition should be the same in both prone and supine position; and second, comparison of segmentation with tissue outlines from 3 experts using the Dice similarity coefficient (DSC). Breast datasets were grouped into nonsparse and sparse fibroglandular tissue distributions according to expert assessment and used to assess the accuracy of the segmentation methods and the agreement between experts. Results: Prone and supine breast composition analysis showed differences between the methods. Validation against expert outlines found significant differences (P<.001) between FCM3 and FCM4. Fuzzy c-means with 3 classes generated segmentation results (mean DSC = 0.70) closest to the experts' outlines. There was good agreement (mean DSC = 0.85) among experts for breast tissue outlining. Segmentation accuracy and expert agreement was significantly higher (P<.005) in the nonsparse group than in the sparse group. Conclusions: The FCM3 gave the most accurate segmentation of breast tissues on CT data and could therefore be used in adaptive radiation therapy-based on tissue modeling. Breast tissue

  11. Adjuvant radiation therapy versus surgery alone in operable breast cancer

    International Nuclear Information System (INIS)

    Rutqvist, L.E.; Pettersson, D.; Johansson, H.

    1993-01-01

    This paper presents long-term results from a randomized trial of pre- or postoperative megavoltage radiation therapy versus surgery alone in pre- and postmenopausal women with operable breast cancer. Treatment outcome after relapse among patients who developed loco-regional recurrences was also analyzed. A total of 960 patients were included in the trial. The mean follow-up was 16 years (range: 13-19 years). The radiation therapy was individually planned. It included the chest wall (and the breast in the preoperative cases) and the regional lymph nodes. The tumor dose was 45 Gy/5 weeks. No adjuvant systemic therapy was used. The results showed a significant benefit with radiation therapy in terms of recurrence-free survival during the entire follow-up period. There was also an overall survival difference - corresponding to 16% reduction of deaths - in favour of the irradiated patients which, however, was not statistically significant (p=0.09). Among those 169 patients who developed loco-regional recurrences long-term control was only achieved in about one-third of the cases. This figure was similar among those who had received adjuvant radiation therapy (34%) compared to those initially treated with surgery alone (32%). This implied that the overall proportion of patients who eventually developed uncontrolled local disease was significantly higher among those initially allocated to surgery alone (16%) compared to those allocated to pre- or postoperative radiation therapy (6%, p<0.01). These results suggest that local undertreatment may be deleterious in subgroups of patients. (author) 5 tabs

  12. Optimization of Adjuvant Radiation in Breast Conservation Therapy: Can We Minimize without Compromise?

    International Nuclear Information System (INIS)

    Edwards-Bennett, S.M.; Correa, C.R.; Harris, E.E.

    2011-01-01

    Adjuvant breast radiation therapy after breast conservation surgery is recommended as it yields significant reduction in the risk of local recurrence, and confers a potential overall survival benefit. Although the standard breast radiation regimen has historically been delivered over 57 weeks; more novel, shorter courses of breast radiation are currently being employed, offering the advantage of more convenience and less time-commitment. Herein, we review the recent literature substantiating these abbreviated radiation treatment approaches and the methods of delivery thereof. In addition, we discuss imaged guided techniques currently being utilized to further refine the delivery of adjuvant breast radiation therapy

  13. Results of conservative surgery and radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Osteen, R.T.; Smith, B.L. (Harvard Medical School, Boston, MA (USA))

    1990-10-01

    For stage I or II breast cancer, conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy. In most cases, cosmetic considerations and the availability of therapy are the primary concerns. The extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial. It appears that removal of a quadrant of the breast for small lesions is safe but excessive. It may be possible to limit the breast resection to gross tumor removal for most patients while using wider resections for patients with an extensive intraductal component or for invasive lobular carcinoma. It also appears that excluding patients from breast conservation on the basis of positive margins on the first attempt at tumor excision may be unnecessarily restrictive. Although patients with an extensive intraductal component or invasive lobular carcinoma should have negative margins, it appears that a patient with predominantly invasive ductal carcinoma can be treated without re-excision if all gross tumor has been resected and there is no reason to suspect extensive microscopic disease. Patients with indeterminate margins should have a re-excision. Axillary dissection provides prognostic information and prevents progression of the disease within the axilla. Axillary dissections limited to level I will accurately identify a substantial number of patients who have pathologically positive but clinically negative nodes. When combined with radiation therapy to the axilla, a level I dissection results in a limited number of patients with progressive axillary disease. Patients with pathologically positive axillas and patients at particularly high risk for systemic disease because of the extent of axillary node involvement can be identified by dissections of levels I and II. 60 references.

  14. Breast Intensity-Modulated Radiation Therapy Reduces Time Spent With Acute Dermatitis for Women of All Breast Sizes During Radiation

    International Nuclear Information System (INIS)

    Freedman, Gary M.; Li Tianyu; Nicolaou, Nicos; Chen Yan; Ma, Charlie C.-M.; Anderson, Penny R.

    2009-01-01

    Purpose: To study the time spent with radiation-induced dermatitis during a course of radiation therapy for breast cancer in women treated with conventional or intensity-modulated radiation therapy (IMRT). Methods and Materials: The study population consisted of 804 consecutive women with early-stage breast cancer treated with breast-conserving surgery and radiation from 2001 to 2006. All patients were treated with whole-breast radiation followed by a boost to the tumor bed. Whole-breast radiation consisted of conventional wedged photon tangents (n = 405) earlier in the study period and mostly of photon IMRT (n = 399) in later years. All patients had acute dermatitis graded each week of treatment. Results: The breakdown of the cases of maximum acute dermatitis by grade was as follows: 3%, Grade 0; 34%, Grade 1; 61%, Grade 2; and 2%, Grade 3. The breakdown of cases of maximum toxicity by technique was as follows: 48%, Grade 0/1, and 52%, Grade 2/3, for IMRT; and 25%, Grade 0/1, and 75%, Grade 2/3, for conventional radiation therapy (p < 0.0001). The IMRT patients spent 82% of weeks during treatment with Grade 0/1 dermatitis and 18% with Grade 2/3 dermatitis, compared with 29% and 71% of patients, respectively, treated with conventional radiation (p < 0.0001). Furthermore, the time spent with Grade 2/3 toxicity was decreased in IMRT patients with small (p = 0.0015), medium (p < 0.0001), and large (p < 0.0001) breasts. Conclusions: Breast IMRT is associated with a significant decrease both in the time spent during treatment with Grade 2/3 dermatitis and in the maximum severity of dermatitis compared with that associated with conventional radiation, regardless of breast size.

  15. Multiple Aperture Radiation Therapy (MART) for Breast Cancer

    National Research Council Canada - National Science Library

    Li, Tianfang

    2006-01-01

    Conventional breast radiotherapy utilizes two opposed tangential fields (OTF) can result in high radiation dose to lung and heart and inhomogeneous dose distribution in the target for large-size breast...

  16. Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy

    International Nuclear Information System (INIS)

    Brown, Lindsay C.; Diehn, Felix E.; Boughey, Judy C.; Childs, Stephanie K.; Park, Sean S.; Yan, Elizabeth S.; Petersen, Ivy A.; Mutter, Robert W.

    2015-01-01

    Purpose: To map the location of gross supraclavicular metastases in patients with breast cancer, in order to determine areas at highest risk of harboring subclinical disease. Methods and Materials: Patients with axial imaging of gross supraclavicular disease were identified from an institutional breast cancer registry. Locations of the metastatic lymph nodes were transferred onto representative axial computed tomography images of the supraclavicular region and compared with the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Results: Sixty-two patients with 161 supraclavicular nodal metastases were eligible for study inclusion. At the time of diagnosis, 117 nodal metastases were present in 44 patients. Forty-four nodal metastases in 18 patients were detected at disease recurrence, 4 of whom had received prior radiation to the supraclavicular fossa. Of the 161 nodal metastases, 95 (59%) were within the RTOG consensus volume, 4 nodal metastases (2%) in 3 patients were marginally within the volume, and 62 nodal metastases (39%) in 30 patients were outside the volume. Supraclavicular disease outside the RTOG consensus volume was located in 3 regions: at the level of the cricoid and thyroid cartilage (superior to the RTOG volume), in the posterolateral supraclavicular fossa (posterolateral to the RTOG volume), and in the lateral low supraclavicular fossa (lateral to the RTOG volume). Only women with multiple supraclavicular metastases had nodal disease that extended superiorly to the level of the thyroid cartilage. Conclusions: For women with risk of harboring subclinical supraclavicular disease warranting the addition of supraclavicular radiation, coverage of the posterior triangle and the lateral low supraclavicular region should be considered. For women with known supraclavicular disease, extension of neck coverage superior to the cricoid cartilage may be warranted

  17. Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Lindsay C. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Diehn, Felix E. [Department of Radiology, Mayo Clinic, Rochester, Minnesota (United States); Boughey, Judy C. [Department of Surgery, Mayo Clinic, Rochester, Minnesota (United States); Childs, Stephanie K.; Park, Sean S.; Yan, Elizabeth S.; Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Mutter, Robert W., E-mail: mutter.robert@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2015-07-01

    Purpose: To map the location of gross supraclavicular metastases in patients with breast cancer, in order to determine areas at highest risk of harboring subclinical disease. Methods and Materials: Patients with axial imaging of gross supraclavicular disease were identified from an institutional breast cancer registry. Locations of the metastatic lymph nodes were transferred onto representative axial computed tomography images of the supraclavicular region and compared with the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Results: Sixty-two patients with 161 supraclavicular nodal metastases were eligible for study inclusion. At the time of diagnosis, 117 nodal metastases were present in 44 patients. Forty-four nodal metastases in 18 patients were detected at disease recurrence, 4 of whom had received prior radiation to the supraclavicular fossa. Of the 161 nodal metastases, 95 (59%) were within the RTOG consensus volume, 4 nodal metastases (2%) in 3 patients were marginally within the volume, and 62 nodal metastases (39%) in 30 patients were outside the volume. Supraclavicular disease outside the RTOG consensus volume was located in 3 regions: at the level of the cricoid and thyroid cartilage (superior to the RTOG volume), in the posterolateral supraclavicular fossa (posterolateral to the RTOG volume), and in the lateral low supraclavicular fossa (lateral to the RTOG volume). Only women with multiple supraclavicular metastases had nodal disease that extended superiorly to the level of the thyroid cartilage. Conclusions: For women with risk of harboring subclinical supraclavicular disease warranting the addition of supraclavicular radiation, coverage of the posterior triangle and the lateral low supraclavicular region should be considered. For women with known supraclavicular disease, extension of neck coverage superior to the cricoid cartilage may be warranted.

  18. COMPARISON OF HYPOFRACTIONATED RADIATION THERAPY VERSUS CONVENTIONAL RADIATION THERAPY IN POST MASTECTOMY BREAST CANCER

    Directory of Open Access Journals (Sweden)

    Abhilash

    2016-03-01

    Full Text Available INTRODUCTION Breast cancer is the most common cancer in women worldwide and a leading cause of cancer death in females and accounts for 1.8 million new cases and approximately 0.5 million deaths annually. Patients who present with locally advanced breast cancer (LABC require multidisciplinary team approach that incorporates diagnostic imaging, surgery, chemotherapy and histopathological assessment, including molecular-based studies, radiation, and, if indicated, biologic and hormonal therapies. Hypofractionated radiation therapy following mastectomy has been used in many institutions for several decades and have demonstrated equivalent local control, cosmetic and normal tissues between 50 Gy in 25 fractions and various hypofractionated radiotherapy prescriptions employing 13-16 fractions. Evidence suggests that hypofractionated radiotherapy may also be safe and effective for regional nodal disease. AIMS AND OBJECTIVES To compare the local control and side effects of hypofractionated radiation therapy with conventional radiation therapy in post mastectomy carcinoma breast with stage II and III and to compare the tolerability and compliance of both schedules. MATERIALS AND METHODS The study was conducted on 60 histopathologically proven patients of carcinoma of breast, treated surgically with modified radical mastectomy. Group I patients were given external radiation to chest flap and drainage areas, a dose of 39 Gy/13 fractions/3.1 weeks, a daily dose 3 Gy for 13 fractions in 4 days a week schedule and Group II patients were given external radiation to chest flap and drainage areas, a dose of 50 Gy/25 fractions/5 weeks, to receive a daily dose 2 Gy for 25 fractions in a 5 days a week schedule. RESULTS The median age at presentation in Group I and II was 48 and 50 years respectively. Locoregional control after completion of radiotherapy in Group I vs. Group II was 26/30 (86.7% vs. 27/30 (90% respectively. Acute reactions and their grades in Group

  19. Systemic scleroderma diagnosed after undergoing radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Sasaki, Tetsuo; Kakei, Masae

    1994-01-01

    A case of systemic scleroderma in which the symptoms became prominent after undergoing radiation therapy for breast cancer is reported. A 68-year-old woman, who had undergone a radical mastectomy for breast carcinoma at the age of 63 and thereafter received radiotherapy at 65, 66 and 67 years of age, visited our clinic complaining of skin sclerosis and Raynaud's phenomenon which she had noticed since the age of 65. The physical examination revealed not only postirradiation fibrosis and pigmentation, but also edematous sclerosis and the pigmentation of her extremities, as well as short frenulum of the tongue and digital pitting scars. She demonstrated serum anti-topoisomerase I antibodies, esophageal dysfunction and lung fibrosis. The histopathology of the forearm skin showed edema of the upper dermis as well as increased and homogenized collagen bundles in the middle and lower dermis. Since similar cases have been reported, it is considerable that radiation therapy may have thus worsened the lesions of scleroderma in this patient as well. (author)

  20. Systemic scleroderma diagnosed after undergoing radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Tetsuo; Kakei, Masae (Yokohama City Univ. (Japan). Faculty of Medicine)

    1994-10-01

    A case of systemic scleroderma in which the symptoms became prominent after undergoing radiation therapy for breast cancer is reported. A 68-year-old woman, who had undergone a radical mastectomy for breast carcinoma at the age of 63 and thereafter received radiotherapy at 65, 66 and 67 years of age, visited our clinic complaining of skin sclerosis and Raynaud's phenomenon which she had noticed since the age of 65. The physical examination revealed not only postirradiation fibrosis and pigmentation, but also edematous sclerosis and the pigmentation of her extremities, as well as short frenulum of the tongue and digital pitting scars. She demonstrated serum anti-topoisomerase I antibodies, esophageal dysfunction and lung fibrosis. The histopathology of the forearm skin showed edema of the upper dermis as well as increased and homogenized collagen bundles in the middle and lower dermis. Since similar cases have been reported, it is considerable that radiation therapy may have thus worsened the lesions of scleroderma in this patient as well. (author).

  1. A prospective study of quality of life in breast cancer patients undergoing radiation therapy

    Directory of Open Access Journals (Sweden)

    Canhua Xiao, PhD, RN

    2016-01-01

    Conclusions: Radiation therapy did not worsen QOL in breast cancer patients. However, pre-radiation therapy patient characteristics including BMI and perceived stress may be used to identify women who may experience decreased physical and mental function during and up to 1 year after radiation therapy.

  2. Radiation Induced Rib Fractures on Bone Scan after Breast Cancer Surgery and Radiation Therapy

    International Nuclear Information System (INIS)

    Kim, Hae Won; Won, Kyoung Sook; Zeon, Seok Kil; Kim, Jin Hee

    2009-01-01

    This study is to evaluate rib fractures on bone scan in breast cancer patients treated with breast cancer surgery and radiation therapy and to evaluate its relation with radiation therapy and operation modality. Two hundred seventy cases that underwent serial bone scan after breast cancer surgery and radiation therapy were enrolled. Bone scan and chest CT findings of rib fracture were analyzed. The rib uptake was seen in 74 of 270 cases (27.4%) on bone scan and 50 cases (18.5%) were confirmed to have rib fracture by chest CT. The rate of modified radical mastectomy in patients with rib fracture was significantly higher than that in patients without rib fracture (66.0% vs. 27.0%, p=0.000). The rate of additional radiation therapy to axillar or supraclavicular regions in patients with rib fracture was significantly higher than that in patients without rib fracture (62.0% vs. 28.6%, p=0.000). Rib fracture was seen most frequently at 1-2 years after radiation therapy (51.9%) and single rib fracture was seen most frequently (55.2%). Of total 106 rib fractures, focal rib uptake was seen in 94 ribs (88.7%) and diffuse rib uptake was seen in 12 ribs (11.3%). On one year follow-up bone scan, complete resolution of rib uptake was seen in 15 ribs (14.2%). On chest CT, the rate of fracture line in ribs with intense uptake was significantly higher than that in ribs with mild or moderate uptake (p=0.000). The rate of presence of fracture line in ribs with focal uptake was significantly higher than that in ribs with diffuse uptake (p=0.001). Rib fracture in breast cancer patients after radiation therapy was related to radiation portal and operation modality. It should be interpreted carefully as a differential diagnosis of bone metastasis

  3. Radiation Induced Rib Fractures on Bone Scan after Breast Cancer Surgery and Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hae Won; Won, Kyoung Sook; Zeon, Seok Kil; Kim, Jin Hee [Keimyung University, School of Medicine, Daegu (Korea, Republic of)

    2009-08-15

    This study is to evaluate rib fractures on bone scan in breast cancer patients treated with breast cancer surgery and radiation therapy and to evaluate its relation with radiation therapy and operation modality. Two hundred seventy cases that underwent serial bone scan after breast cancer surgery and radiation therapy were enrolled. Bone scan and chest CT findings of rib fracture were analyzed. The rib uptake was seen in 74 of 270 cases (27.4%) on bone scan and 50 cases (18.5%) were confirmed to have rib fracture by chest CT. The rate of modified radical mastectomy in patients with rib fracture was significantly higher than that in patients without rib fracture (66.0% vs. 27.0%, p=0.000). The rate of additional radiation therapy to axillar or supraclavicular regions in patients with rib fracture was significantly higher than that in patients without rib fracture (62.0% vs. 28.6%, p=0.000). Rib fracture was seen most frequently at 1-2 years after radiation therapy (51.9%) and single rib fracture was seen most frequently (55.2%). Of total 106 rib fractures, focal rib uptake was seen in 94 ribs (88.7%) and diffuse rib uptake was seen in 12 ribs (11.3%). On one year follow-up bone scan, complete resolution of rib uptake was seen in 15 ribs (14.2%). On chest CT, the rate of fracture line in ribs with intense uptake was significantly higher than that in ribs with mild or moderate uptake (p=0.000). The rate of presence of fracture line in ribs with focal uptake was significantly higher than that in ribs with diffuse uptake (p=0.001). Rib fracture in breast cancer patients after radiation therapy was related to radiation portal and operation modality. It should be interpreted carefully as a differential diagnosis of bone metastasis.

  4. Radiation therapy for metastatic lesions from breast cancer. Breast cancer metastasis to bone

    International Nuclear Information System (INIS)

    Hayashi, Shinya; Hoshi, Hiroaki

    2000-01-01

    This paper summarizes radiation therapy in the treatment of bone metastases from breast cancer. Bone metastasis occurs in approximately 70% of breast cancer patients, and the goals of radiation therapy for bone metastasis are: palliation of pain, prevention and treatment of neuropathic symptoms, and prevention of pathologic fractures. The prognosis of bone metastasis from breast cancer is known to be better than that of bone metastasis from other solid tumors. Local-field radiation, hemibody (or wide-field) radiation, and systemic radionuclide treatment are the major methods of radiation therapy for pain palliation. Although many studies have shown that breast cancer is more responsive to radiation therapy for pain palliation than other solid tumors, some studies found no significant difference. Local-field radiation therapy, which includes multi-fraction irradiation and single-fraction irradiation, is currently the most generally used method of radiotherapy for pain palliation. Pain palliation has been reported to be achieved in approximately 80% to 90% of patients treated with local-field external beam irradiation. Three types of multi-fraction irradiation therapy are administered depending on the prognosis: high-dose fraction irradiation (36-50 Gy/12-25 Fr/2.4-5 wk), short-course irradiation (20-30 Gy/10-15 Fr/2-3 wk), and ultra-short-course irradiation (15-25 Gy/2-5 Fr/1 wk). The most common irradiation schedule is 30 Gy/10 Fr/2 wk. Although many reports indicate no significant difference in pain palliation according to the dose, the percentage of patients who show a complete cure is significantly higher in those treated with doses of 30 Gy or more, and thus the total irradiation dose should be at least 30 Gy. High-dose fraction irradiation is indicated for patients with an expected survival time of 6 months or more while short-course or single-fraction irradiation is indicated for those with an expected survival time of 3 months or more. Single

  5. A case of sarcoma of the chest wall after radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Izumi, Junko; Nishi, Tsunehiro; Fukuuchi, Atsushi; Takanashi, Riichiro

    1998-01-01

    A case of radiation-induced sarcoma of the chest wall after radiation therapy for breast cancer is reported. A 69-year-old woman underwent mastectomy with axillary lymph node dissection followed by linac therapy of 50 Gy delivered to the left axilla, left supraclavicular area, and parasternal area. During therapy for bone and liver metastases, a tumor was noted in the left chest wall 15 years after radiation therapy. Incisional biopsy was performed. Histological diagnosis was spindle cell sarcoma. Radiation-induced sarcoma was suspected because the tumor developed 15 years after radiation therapy within the same area. Radiation-induced sarcoma is a rare tumor, but radiation therapy following breast-conserving therapy is widely employed. It is important to be aware of the possibility of radiation-induced sarcoma. (author)

  6. Dosimetric evaluation of whole-breast radiation therapy: Clinical experience

    International Nuclear Information System (INIS)

    Osei, Ernest; Darko, Johnson; Fleck, Andre; White, Jana; Kiciak, Alexander; Redekop, Rachel; Gopaul, Darin

    2015-01-01

    Radiation therapy of the intact breast is the standard therapy for preventing local recurrence of early-stage breast cancer following breast conservation surgery. To improve patient standard of care, there is a need to define a consistent and transparent treatment path for all patients that reduces significance variations in the acceptability of treatment plans. There is lack of consistency among institutions or individuals about what is considered an acceptable treatment plan: target coverage vis-à-vis dose to organs at risk (OAR). Clinical trials usually resolve these issues, as the criteria for an acceptable plan within the trial (target coverage and doses to OAR) are well defined. We developed an institutional criterion for accepting breast treatment plans in 2006 after analyzing treatment data of approximately 200 patients. The purpose of this article is to report on the dosimetric review of 623 patients treated in the last 18 months to evaluate the effectiveness of the previously developed plan acceptability criteria and any possible changes necessary to further improve patient care. The mean patient age is 61.6 years (range: 25.2 to 93.0 years). The mean breast separation for all the patients is 21.0 cm (range: 12.4 to 34.9 cm), and the mean planning target volume (PTV-eval) (breast volume for evaluation) is 884.0 cm"3 (range: 73.6 to 3684.6 cm"3). Overall, 314 (50.4%) patients had the disease in the left breast and 309 (49.6%) had it in the right breast. A total of 147 (23.6%) patients were treated using the deep inspiration breath-hold (DIBH) technique. The mean normalized PTV-eval receiving at least 92% (V_9_2_% _P_D) and 95% (V_9_5_% _P_D) of the prescribed dose (PD) are more than 99% and 97%, respectively, for all patients. The mean normalized PTV-eval receiving at least 105% (V_1_0_5_% _P_D) of the PD is less than 1% for all groups. The mean homogeneity index (HI), uniformity index (UI), and conformity index (CI) for the PTV-eval are 0.09 (range: 0

  7. Radiation therapy for metastatic lesions from breast cancer. Breast cancer metastasis to bone

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Shinya; Hoshi, Hiroaki [Gifu Univ. (Japan). School of Medicine

    2000-10-01

    This paper summarizes radiation therapy in the treatment of bone metastases from breast cancer. Bone metastasis occurs in approximately 70% of breast cancer patients, and the goals of radiation therapy for bone metastasis are: palliation of pain, prevention and treatment of neuropathic symptoms, and prevention of pathologic fractures. The prognosis of bone metastasis from breast cancer is known to be better than that of bone metastasis from other solid tumors. Local-field radiation, hemibody (or wide-field) radiation, and systemic radionuclide treatment are the major methods of radiation therapy for pain palliation. Although many studies have shown that breast cancer is more responsive to radiation therapy for pain palliation than other solid tumors, some studies found no significant difference. Local-field radiation therapy, which includes multi-fraction irradiation and single-fraction irradiation, is currently the most generally used method of radiotherapy for pain palliation. Pain palliation has been reported to be achieved in approximately 80% to 90% of patients treated with local-field external beam irradiation. Three types of multi-fraction irradiation therapy are administered depending on the prognosis: high-dose fraction irradiation (36-50 Gy/12-25 Fr/2.4-5 wk), short-course irradiation (20-30 Gy/10-15 Fr/2-3 wk), and ultra-short-course irradiation (15-25 Gy/2-5 Fr/1 wk). The most common irradiation schedule is 30 Gy/10 Fr/2 wk. Although many reports indicate no significant difference in pain palliation according to the dose, the percentage of patients who show a complete cure is significantly higher in those treated with doses of 30 Gy or more, and thus the total irradiation dose should be at least 30 Gy. High-dose fraction irradiation is indicated for patients with an expected survival time of 6 months or more while short-course or single-fraction irradiation is indicated for those with an expected survival time of 3 months or more. Single

  8. Radiation therapy for unresectable locally advanced breast cancer

    International Nuclear Information System (INIS)

    Horikawa, Noriko; Inoue, Masayoshi; Uehara, Tomoko; Miyasaka, T.; Miyasaka, M.; Tabata, Yoji; Sakamoto, Nobuyuki; Nakagawa, Y.

    2013-01-01

    Thirteen cases of inoperable advanced breast cancer were treated with radiotherapy between 2002 to 2012 at Nara Prefectural Hospital. All cases were treated by radiotherapy and chemo-endocrine therapy. Patients received 60-81 Gy (median 60 Gy) to the primary breast tumor. Response of the breast tumors were complete response in 3 cases (23%), partial response in 8 cases (62%) and stable disease in 2 cases (15%) (response rate: 85%). All breast tumors had been controlled and skin troubles were reduced. Radiotherapy for breast cancer is useful for primary tumor control and improved quality of life (QOL). Radiotherapy should be considered to be useful modality in the treatment of advanced breast cancer. (author)

  9. Influence of accompanying immunocorrecting therapy on the quality of life of breast cancer patients at post-operative radiation therapy

    International Nuclear Information System (INIS)

    Prokhach, N.E.

    2013-01-01

    To investigate the influence of accompanying immunotherapy on the parameters of the quality of life of the patients with breast cancer with various profiles of cytokines at post-operative radiation therapy. The study was performed on 30 breast cancer patients at stages of combination therapy

  10. Bolus effect to reduce skin dose of the caontralateral breast during breast cancer radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Won, Young Jin [Dept. of Radiation Oncology, InJe University Ilsan Paik Hospital, Goyang (Korea, Republic of); Kim, Jong Won; Kim, Jung Hoon [Dept. of Radiology, Radiation Oncology, KonYang University Hospital, Daejeon (Korea, Republic of)

    2017-06-15

    The aim of this study was to evaluate the dose comparison using Radon phantom with 5 mm and 10 mm tissue equivalent materials, FIF, Wedge(15, 30 angle) and IMRT, to reduce the skin dose of the contralateral breast during breast cancer radiation therapy(Total dose: 50.4Gy). The dose was measured for each treatment plan by attaching to the 8 point of the contralateral breast of the treated region using a optical-stimulated luminance dosimeter(OSLD) as a comparative dose evaluation method. Of the OSLD used in the study, 10 were used with reproducibility within 3%. As a result, the average reduction rates of 5 mm and 10 mm in the FIF treatment plan were 37.23 cGy and 41.77 cGy, respectively, and the average reduction rates in the treatment plan using Wedge 15 degrees were 70.69 cGy and 87.57 cGy, respectively. The IMRT showed a reduction of 67.37 cGy and 83.17 cGy, respectively. The results of using bolus showed that as the thickness of the bolus increased in all treatments, the dose reduction increased. We concluded that mastectomy as well as general radiotherapy for breast cancer would be very effective for patients who are more likely to be exposed to scattered radiation due to a more demanding or complex treatment plan.

  11. Intrafractional baseline drift during free breathing breast cancer radiation therapy.

    Science.gov (United States)

    Jensen, Christer Andre; Acosta Roa, Ana María; Lund, Jo-Åsmund; Frengen, Jomar

    2017-06-01

    Intrafraction motion in breast cancer radiation therapy (BCRT) has not yet been thoroughly described in the literature. It has been observed that baseline drift occurs as part of the intrafraction motion. This study aims to measure baseline drift and its incidence in free-breathing BCRT patients using an in-house developed laser system for tracking the position of the sternum. Baseline drift was monitored in 20 right-sided breast cancer patients receiving free breathing 3D-conformal RT by using an in-house developed laser system which measures one-dimensional distance in the AP direction. A total of 357 patient respiratory traces from treatment sessions were logged and analysed. Baseline drift was compared to patient positioning error measured from in-field portal imaging. The mean overall baseline drift at end of treatment sessions was -1.3 mm for the patient population. Relatively small baseline drift was observed during the first fraction; however it was clearly detected already at the second fraction. Over 90% of the baseline drift occurs during the first 3 min of each treatment session. The baseline drift rate for the population was -0.5 ± 0.2 mm/min in the posterior direction the first minute after localization. Only 4% of the treatment sessions had a 5 mm or larger baseline drift at 5 min, all towards the posterior direction. Mean baseline drift in the posterior direction in free breathing BCRT was observed in 18 of 20 patients over all treatment sessions. This study shows that there is a substantial baseline drift in free breathing BCRT patients. No clear baseline drift was observed during the first treatment session; however, baseline drift was markedly present at the rest of the sessions. Intrafraction motion due to baseline drift should be accounted for in margin calculations.

  12. Protection of the contralateral breast during radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Garrigo, E.; Zunino, S.; Germanier, A.

    2008-01-01

    Conformal Radiation Therapy (3DCRT) and Intensity Modulated Radiotherapy (IMRT) improve the relationship between tumor control and complications in normal tissue. However, these techniques may cause an increase of the normal tissue volume irradiated with low doses or an increase of the doses outside the beam. The aim of this work was to measure and compare the scatter dose to the contralateral breast using both the conventional two-field technique and the 3DCRT technique with blocks. The contralateral breast dose was measured with thermoluminescent dosimeters. The present work is divided in three parts: 1)Characterization of the radiation field outside the treatment beam; 2) Determination of the dose to the contralateral breast; 3) Design and construction of a shield to reduce the scatter dose to the contralateral breast. Treatment using 3DCRT technique was delivered to a phantom. From one to ten 2 mm thick lead sheets were placed on the dosimeters to attenuate radiation to the contralateral breast from the head, without blocking the treatment beam. Using the conventional technique the average dose to the contralateral breast was 2.09 Gy,4.18%(2.9%-19%) of the 50 Gy prescribed dose. The contribution of the medial field was 3.36% (2.3%-21.1%) and of the lateral field 0.86%(0.4%-3.7%). When using 3DCRT technique the average dose to the opposite breast was 5,9 Gy,11.8% (7.9%-24%) of the prescribed dose. The contribution of the medial field was 10.3% (6.7%-20%) and of the lateral field 1.6% (1.1%-3.8%). A 2 mm thick lead shield with a 0.2 g/cm2 thick wax coat was constructed which reduced the dose from 11.8% to less than 2%. The blocks increase the dose to the contralateral breast, the highest dose being attributed to the medial field. Our shield reduced the dose, which allowed the regular use of 3DCRT with blocks. In addition, we found that this shield was comfortable for the patients and easy to position for the therapists. (author)

  13. Risk of secondary malignancies after radiation therapy for breast cancer: Comprehensive results.

    Science.gov (United States)

    Burt, Lindsay M; Ying, Jian; Poppe, Matthew M; Suneja, Gita; Gaffney, David K

    2017-10-01

    To assess risks of secondary malignancies in breast cancer patients who received radiation therapy compared to patients who did not. The SEER database was used to identify females with a primary diagnosis of breast cancer as their first malignancy, during 1973-2008. We excluded patients with metastatic disease, age breast cancer recurrence, or who developed a secondary malignancy within 1 year of diagnosis. Standardized incidence ratios and absolute excess risk were calculated using SEER*Stat, version 8.2.1 and SAS, version 9.4. There were 374,993 patients meeting the inclusion criteria, with 154,697 who received radiation therapy. With a median follow-up of 8.9 years, 13% of patients (49,867) developed a secondary malignancy. The rate of secondary malignancies was significantly greater than the endemic rate in breast cancer patients treated without radiation therapy, (O/E 1.2, 95% CI 1.19-1.22) and with radiation therapy (O/E 1.33, 95% CI 1.31-1.35). Approximately 3.4% of secondary malignancies were attributable to radiation therapy. The increased risk of secondary malignancies in breast cancer patients treated with radiation therapy compared to those without was significant regardless of age at breast cancer diagnosis (p breast cancer patients both with and without radiation therapy compared to the general population. There was an increased risk in specific sites for patients treated with radiation therapy. This risk was most evident in young patients and who had longer latency periods. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy.

    Science.gov (United States)

    Eftekhari, Mohammad; Anbiaei, Robabeh; Zamani, Hanie; Fallahi, Babak; Beiki, Davood; Ameri, Ahmad; Emami-Ardekani, Alireza; Fard-Esfahani, Armaghan; Gholamrezanezhad, Ali; Seid Ratki, Kazem Razavi; Roknabadi, Alireza Momen

    2015-01-01

    Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right-sided cancer. To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the

  15. Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy

    Directory of Open Access Journals (Sweden)

    Mohammad Eftekhari

    2015-01-01

    Full Text Available Objective(s: Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed and 36 patients with right-sided cancer (controls] were enrolled. Dose-volume histogram (DVH [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46. In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03 and anterolateral (17.1% versus 2.8%, P=0.049 walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS of>3 was observed in twelve cases (34.3%, while in five of the controls (13.9%,(Odds ratio=1.3. There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial

  16. Impact of prognostic factors for postmastectomy radiation therapy of breast cancer patients

    Science.gov (United States)

    Simonov, K. A.; Startseva, Zh. A.; Slonimskaya, E. M.; Velikaya, V. V.

    2017-09-01

    The study included 196 breast cancer patients with stages T1-3N0-3M0. The comprehensive therapy for breast cancer included surgical operation, chemotherapy, and radiotherapy. Multivariate analysis showed that multifocality growth of tumor (p = 0.004), high grade III (p = 0.008), two metastatic lymph nodes (p = 0.02) were associated with an increased risk of regional node failure in the patients with one to three positive lymph nodes. The prognostic models describing the probability of local recurrences of breast cancer were developed for individualization of the radiation therapy tactics. Postmastectomy radiation therapy in the patients with high-risk breast cancer treated with modified radical mastectomy improves locoregional control, breast cancer-specific survival, does not increase late toxicity.

  17. A treatment planning study comparing whole breast radiation therapy against conformal, IMRT and tomotherapy for accelerated partial breast irradiation

    International Nuclear Information System (INIS)

    Oliver, Mike; Chen, Jeff; Wong, Eugene; Van Dyk, Jake; Perera, Francisco

    2007-01-01

    Purpose and background: Conventional early breast cancer treatment consists of a lumpectomy followed by whole breast radiation therapy. Accelerated partial breast irradiation (APBI) is an investigational approach to post-lumpectomy radiation for early breast cancer. The purpose of this study is to compare four external beam APBI techniques, including tomotherapy, with conventional whole breast irradiation for their radiation conformity index, dose homogeneity index, and dose to organs at risk. Methods and materials: Small-field tangents, three-dimensional conformal radiation therapy, intensity-modulated radiation therapy and helical tomotherapy were compared for each of 15 patients (7 right, 8 left). One radiation conformity and two dose homogeneity indices were used to evaluate the dose to the target. The mean dose to organs at risk was also evaluated. Results: All proposed APBI techniques improved the conformity index significantly over whole breast tangents while maintaining dose homogeneity and without a significant increase in dose to organs at risk. Conclusion: The four-field IMRT plan produced the best dosimetric results; however this technique would require appropriate respiratory motion management. An alternative would be to use a four-field conformal technique that is less sensitive to the effects of respiratory motion

  18. Radiation therapy and patient age in the survival from early-stage breast cancer

    International Nuclear Information System (INIS)

    Joslyn, Sue A.

    1999-01-01

    Purpose: To analyze the use of radiation therapy following local excision of invasive localized breast cancer and subsequent survival by 5-year age category. Methods: Data for 27,399 women diagnosed with localized stage of breast cancer and treated with local excision surgery from 1983 through 1992 were collected and provided by the national Surveillance, Epidemiology, and End Results (SEER) program. Use of radiation therapy was analyzed by race, ethnic background, geographic location, and age at diagnosis. Survival for women treated with local excision plus radiation therapy was compared to that of women treated with local excision alone for each 5-year age category. Results: Subjects in older age groups were significantly less likely (p < 0.001) to receive radiation following local excision compared to younger age groups. Statistically significant survival advantages were conferred on women receiving radiation therapy in each 5-year age category from age 35 to 84 years (ranging from p = 0.02 to p < 0.0001). Conclusion: While the use of radiation therapy following local excision of early-stage breast tumors drops significantly in older age groups, women aged 35-84 years receiving radiation therapy had significant reductions in mortality. These results did not appear to be influenced by the presence of mortal comorbid conditions. These results strongly suggest the need to consider carefully patient characteristics other than age in deciding the course of treatment for early-stage breast cancer

  19. An analysis of the incidence and related factors for radiation dermatitis in breast cancer patients who receive radiation therapy

    International Nuclear Information System (INIS)

    Lee, Sun Young; Kwon, Hyoung Cheol; Kim, Jung Soo; Lee, Heui Kwan

    2010-01-01

    We analyzed the incidence and related factors of radiation dermatitis; at first, to recognize whether a decrease in radiation dermatitis is possible or not in breast cancer patients who received radiation therapy. Of 338 patients, 284 with invasive breast cancer who received breast conservation surgery with radiotherapy at Chonbuk National University Hospital from January 2007 to June 2009 were evaluated. Patients who also underwent bolus, previous contralateral breast irradiation and irradiation on both breasts were excluded. For patients who appeared to have greater than moderate radiation dermatitis, the incidence and relating factors for radiation dermatitis were analyzed retrospectively. A total of 207 and 77 patients appeared to have RTOG grade 0/1 or above RTOG grade 2 radiation dermatitis, respectively. The factors found to be statistically significant for the 77 patients who appeared to have greater than moderate radiation dermatitis include the presence of lymphocele due to the stasis of lymph and lymph edema which affect the healing disturbance of radiation dermatitis (p=0.003, p=0.001). Moreover, an allergic reaction to plaster due to the immune cells of skin and the activation of cytokine and concomitant hormonal therapy were also statistically significant factors (p=0.001, p=0.025). Most of the breast cancer patients who received radiation therapy appeared to have a greater than mild case of radiation dermatitis. Lymphocele, lymphedema, an allergy to plaster and concomitant hormonal therapy which affect radiation dermatitis were found to be significant factors. Consequently, we should eliminate lymphocele prior to radiation treatment for patients who appear to have an allergic reaction to plaster. We should also instruct patients of methods to maintain skin moisture if they appear to have a greater than moderate case of radiation dermatitis.

  20. Four cases of radiation pneumonia after breast conservative therapy for breast cancer

    International Nuclear Information System (INIS)

    Horii, Rie; Fukuuchi, Atushi; Nishi, Tsunehiro

    1997-01-01

    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)

  1. Increased risk of breast cancer in splenectomized patients undergoing radiation therapy for Hodgkin's disease

    International Nuclear Information System (INIS)

    Chung, Chung T.; Bogart, Jeffrey A.; Adams, James F.; Sagerman, Robert H.; Numann, Patricia J.; Tassiopoulos, Apostolos; Duggan, David B.

    1997-01-01

    Purpose: Second malignancies have been reported among patients who were treated by radiation therapy or chemotherapy alone or in combination. Studies have implied an increased risk of breast cancer in women who received radiotherapy as part of their treatment for Hodgkin's disease. This review was performed to determine if there is an association between splenectomy and subsequent breast cancer. Methods and Materials: One hundred and thirty-six female patients with histologically proven Hodgkin's disease were seen in the Division of Radiation Oncology between 1962 and 1985. All patients received mantle or mediastinal irradiation as part of their therapy. The risk of breast cancer was assessed and multiple linear regression analysis was performed on the following variables: patient age, stage, dose and extent of radiation field, time after completing radiation therapy, splenectomy, and chemotheraphy. Results: Breast cancer was observed in 11 of 74 splenectomized patients and in none of 62 patients not splenectomized. The mean follow-up was 13 years in splenectomized patients and 16 years, 7 months in nonsplenectomized patients. Nine patients developed invasive breast cancer and two developed ductal carcinoma in situ. Splenectomy was the only variable independently associated with an increased risk of breast cancer (p < 0.005) in multiple linear regression analysis; age, latency, and splenectomy considered together were also associated with an increased risk of breast cancer (p < 0.01). Conclusion: Our data show an increased risk of breast cancer in splenectomized patients who had treatment for Hodgkin's disease. A multiinstitutional survey may better define the influence of splenectomy relative to developing breast cancer in patients treated for Hodgkin's disease. The risk of breast cancer should be considered when recommending staging laparotomy, and we recommend close follow-up examination including routine mammograms for female patients successfully treated for

  2. Surgeons' Knowledge and Practices Regarding the Role of Radiation Therapy in Breast Cancer Management

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Jessica [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Hawley, Sarah T.; Zikmund-Fisher, Brian J. [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Janz, Nancy K. [Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan (United States); Sabel, Michael S. [Department of Surgery, University of Michigan, Ann Arbor, Michigan (United States); Katz, Steven J. [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2013-12-01

    Purpose: Population-based studies suggest underuse of radiation therapy, especially after mastectomy. Because radiation oncology is a referral-based specialty, knowledge and attitudes of upstream providers, specifically surgeons, may influence patients' decisions regarding radiation, including whether it is even considered. Therefore, we sought to evaluate surgeons' knowledge of pertinent risk information, their patterns of referral, and the correlates of surgeon knowledge and referral in specific breast cancer scenarios. Methods and Materials: We surveyed a national sample of 750 surgeons, with a 67% response rate. We analyzed responses from those who had seen at least 1 breast cancer patient in the past year (n=403), using logistic regression models to identify correlates of knowledge and appropriate referral. Results: Overall, 87% of respondents were general surgeons, and 64% saw >10 breast cancer patients in the previous year. In a scenario involving a 45-year-old undergoing lumpectomy, only 45% correctly estimated the risk of locoregional recurrence without radiation therapy, but 97% would refer to radiation oncology. In a patient with 2 of 20 nodes involved after mastectomy, 30% would neither refer to radiation oncology nor provide accurate information to make radiation decisions. In a patient with 4 of 20 nodes involved after mastectomy, 9% would not refer to radiation oncology. Fewer than half knew that the Oxford meta-analysis revealed a survival benefit from radiation therapy after lumpectomy (45%) or mastectomy (32%). Only 16% passed a 7-item knowledge test; female and more-experienced surgeons were more likely to pass. Factors significantly associated with appropriate referral to radiation oncology included breast cancer volume, tumor board participation, and knowledge. Conclusions: Many surgeons have inadequate knowledge regarding the role of radiation in breast cancer management, especially after mastectomy. Targeted educational

  3. Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Yan Lin

    2018-05-01

    Full Text Available Few studies of breast cancer treatment have focused on the Northern Plains of the United States, an area with a high mastectomy rate. This study examined the association between geographic access to radiation therapy facilities and receipt of breast cancer treatments among early-stage breast cancer patients in South Dakota. Based on 4,209 early-stage breast cancer patients diagnosed between 2001 and 2012 in South Dakota, the study measured geographic proximity to radiation therapy facilities using the shortest travel time for patients to the closest radiation therapy facility. Two-level logistic regression models were used to estimate for early stage cases i the odds of mastectomy versus breast conserving surgery (BCS; ii the odds of not receiving radiation therapy after BCS versus receiving follow-up radiation therapy. Covariates included race/ethnicity, age at diagnosis, tumour grade, tumour sequence, year of diagnosis, census tract-level poverty rate and urban/rural residence. The spatial scan statistic method was used to identify geographic areas with significantly higher likelihood of experiencing mastectomy. The study found that geographic accessibility to radiation therapy facilities was negatively associated with the likelihood of receiving mastectomy after adjustment for other covariates, but not associated with radiation therapy use among patients receiving BCS. Compared with patients travelling less than 30 minutes to a radiation therapy facility, patients travelling more than 90 minutes were about 1.5 times more likely to receive mastectomy (odds ratio, 1.51; 95% confidence interval, 1.08-2.11 and patients travelling more than 120 minutes were 1.7 times more likely to receive mastectomy (odds ratio, 1.70; 95% confidence interval, 1.19-2.42. The study also identified a statistically significant cluster of patients receiving mastectomy who were located in south-eastern South Dakota, after adjustment for other factors. Because

  4. Evaluation of long-term cosmetic results and complications following breast conserving surgery and radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Fujishiro, Satsuki; Mitsumori, Michihide; Kokubo, Masaki; Nagata, Yasushi; Sasai, Keisuke; Hiraoka, Masahiro; Kodama, Hiroshi

    1999-01-01

    Long-term cosmetic outcomes and complications were evaluated in 109 patients with breast cancer who had been treated by breast conservation therapy. Patients received radiation therapy at Kyoto University Hospital following quadrantectomy and level II or III axillary node dissection. Factors that might influence long-term cosmetic results were also analyzed. Irradiation to the breast was administered in 2 Gy fractions, 5 times a week for a total of 50 Gy in all patients. Cobalt-60 γ-rays were used in 108 patients with the exception of 1 patient who received 6 Mev X-ray. Some patients with positive or close margins received boost irradiation of 10 Gy using electron beams to the primary tumor bed. Cosmetic outcome was assessed by both a scoring method and breast retraction assessment (BRA). Forty-seven percent of patients were assessed as excellent to good before radiation therapy. The percent of excellent to good decreased shortly after termination of radiation therapy, but gradually improved and stabilized by 3 years. Seventy percent of patients showed a score of excellent to good 5 years after treatment. The average BRA of the 109 patients was 3.0 cm. This did not change between 3 and 5 years after treatment. A significant correlation between cosmetic score and BRA was shown at all follow-up times. Factors such as age over 50 years (p=0.008), tumor location in the outer quadrant (p=0.02) and boost irradiation (p=0.03) significantly affected the cosmetic score. Arm edema and restriction of shoulder movement were observed in 22% and 49% at the start of radiation therapy, these improved within approximately 3 years and 1 year after treatment, respectively. Mild skin change was observed in 60% of patients even 5 years after treatment. The results indicate that cosmetic outcome after breast conservation therapy is clinically acceptable, and the complication rate is low. (author)

  5. The effects of sequence and type of chemotherapy and radiation therapy on cosmesis and complications after breast conservation therapy

    International Nuclear Information System (INIS)

    Markiewicz, Deborah A.; Schultz, Delray J.; Haas, Jonathan A.; Harris, Eleanor E. R.; Fox, Kevin R.; Glick, John H.; Solin, Lawrence J.

    1996-01-01

    Purpose: Chemotherapy plays an increasingly important role in the treatment of both node-negative and node-positive breast cancer patients, but the optimal sequencing of chemotherapy and radiation therapy is not well established. The purpose of this study is to evaluate the interaction of sequence and type of chemotherapy and hormonal therapy given with radiation therapy on the cosmetic outcome and the incidence of complications of Stage I and II breast cancer patients treated with breast-conserving therapy. Methods and Materials: The records of 1053 Stage I and II breast cancer patients treated with curative intent with breast-conserving surgery, axillary dissection, and radiation therapy between 1977-1991 were reviewed. Median follow-up after treatment was 6.7 years. Two hundred fourteen patients received chemotherapy alone, 141 patients received hormonal therapy alone, 86 patients received both, and 612 patients received no adjuvant therapy. Patients who received chemotherapy ± hormonal therapy were grouped according to sequence of chemotherapy: (a) concurrent = concurrent chemotherapy with radiation therapy followed by chemotherapy; (b) sequential = radiation followed by chemotherapy or chemotherapy followed by radiation; and (c) sandwich = chemotherapy followed by concurrent chemotherapy and radiation followed by chemotherapy. Compared to node negative patients, node-positive patients more commonly received chemotherapy (77 vs. 9%, p < 0.0001) and/or hormonal therapy (40 vs. 14%, p < 0.0001). Among patients who received chemotherapy, the majority (243 patients) received concurrent chemotherapy and radiation therapy with two cycles of cytoxan and 5-fluorouracil (5-FU) administered during radiation followed by six cycles of chemotherapy with cytoxan, 5-fluorouracil and either methotrexate(CMF) or doxorubicin(CAF). For analysis of cosmesis, patients included were relapse free with 3 years minimum follow-up. Results: The use of chemotherapy had an adverse effect

  6. Breast Cancer Risk After Radiation Therapy for Hodgkin Lymphoma : Influence of Gonadal Hormone Exposure

    NARCIS (Netherlands)

    Krul, Inge M; Opstal-van Winden, Annemieke W J; Aleman, Berthe M P; Janus, Cécile P M; van Eggermond, Anna M; De Bruin, Marie L; Hauptmann, Michael; Krol, Augustinus D G; Schaapveld, Michael; Broeks, Annegien; Kooijman, Karen R; Fase, Sandra; Lybeert, Marnix L; Zijlstra, Josée M; van der Maazen, Richard W M; Kesminiene, Ausrele; Diallo, Ibrahima; de Vathaire, Florent; Russell, Nicola S; van Leeuwen, Flora E

    2017-01-01

    BACKGROUND: Young women treated with chest radiation therapy (RT) for Hodgkin lymphoma (HL) experience a strongly increased risk of breast cancer (BC). It is unknown whether endogenous and exogenous gonadal hormones affect RT-associated BC risk. METHODS: We conducted a nested case-control study

  7. The breast cancer patient's experience of making radiation therapy treatment decisions

    International Nuclear Information System (INIS)

    Halkett, Georgia; Scutter, Sheila; Arbon, Paul; Borg, Martin

    2005-01-01

    Women who are diagnosed with breast cancer have many decisions to make during the course of their treatment. The aims of this paper are to describe the women's experience of making radiation therapy treatment decisions for early breast cancer and to explore how women feel about receiving radiation therapy. An in-depth understanding of the women's experience was developed using a qualitative research approach underpinned by hermeneutic phenomenology. In-depth interviews were conducted with 18 women who had completed treatment for early breast cancer. The themes that emerged from the data were: being challenged, getting ready, beyond control, regaining a sense of control and getting through it. This study provides health professionals with an initial understanding of the women's perspective of the experience of making radiation therapy treatment decisions for early breast cancer. This study concludes by suggesting that further research needs to be conducted to gain an understanding of how other patients feel about treatment decision making and radiation therapy. Copyright (2005) Australian Institute of Radiography

  8. Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions.

    Science.gov (United States)

    Wang, Shi-Yi; Kelly, Gabrielle; Gross, Cary; Killelea, Brigid K; Mougalian, Sarah; Presley, Carolyn; Fraenkel, Liana; Evans, Suzanne B

    2017-07-15

    To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker. We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker. The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018). Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Three-Year Outcomes of Breast Intensity-Modulated Radiation Therapy With Simultaneous Integrated Boost

    International Nuclear Information System (INIS)

    McDonald, Mark W.; Godette, Karen D.; Whitaker, Daisy J.; Davis, Lawrence W.; Johnstone, Peter A.S.

    2010-01-01

    Purpose: To report our clinical experience using breast intensity-modulated radiation therapy with simultaneous integrated boost (SIB-IMRT). Methods and Materials: Retrospective review identified 354 Stage 0 to III breast cancer patients treated with SIB-IMRT after conservative surgery between 2003 and 2006. The most common fractionation (89%) simultaneously delivered 1.8 Gy to the ipsilateral breast tissue and 2.14 Gy to the resection cavity, yielding a breast dose of 45 Gy (25 fractions) and cavity dose 59.92 Gy (28 fractions), biologically equivalent for tumor control to 45 Gy to the breast with sequential 16-Gy boost (33 fractions). Results: A total of 356 breasts in 354 patients were treated: 282 with invasive breast cancer, and 74 with ductal carcinoma in situ (DCIS). For left breast radiation, median cardiac V 15 was 2.9% and left ventricular V 15 1.7%. Median follow-up was 33 months (range, 4-73 months). Acute toxicity was Grade 1 in 57% of cases, Grade 2 in 43%, and Grade 3 in <1%. For invasive breast cancer, the 3-year overall survival was 97.6% and risk of any locoregional recurrence was 2.8%. For ductal carcinoma in situ, 3-year overall survival was 98% and risk of locoregional recurrence 1.4%. In 142 cases at a minimum of 3 years follow-up, global breast cosmesis was judged by physicians as good or excellent in 96.5% and fair in 3.5%. Conclusions: Breast SIB-IMRT reduced treatment duration by five fractions with a favorable acute toxicity profile and low cardiac dose for left breast treatment. At 3 years, locoregional control was excellent, and initial assessment suggested good or excellent cosmesis in a high percentage of evaluable patients.

  10. Radiation therapy in the management of locally advanced and disseminated breast cancer

    International Nuclear Information System (INIS)

    Chu, F.C.H.

    1980-01-01

    Radiation theraoy should be fully used in the management of advanced breast cancer. Locally advanced primary or recurrent carcinoma, with limited extent, should be treated aggressively, aimed at permanent control. Palliative treatment of incurable or metastatic lesions relieves symptoms and improves patient's quality of survival. Some metastatic lesions involving vital structures may create emergencies. Prompt institution of radiation therapy may reverse the serious complication and save the patient's life

  11. Muscular pseudotumor of the breast following doxorubicin and radiation therapy for oat cell carcinoma of the lung

    International Nuclear Information System (INIS)

    Wergowske, G.; Chang, J.C.; Marger, D.

    1982-01-01

    Two male patients developed muscular pseudotumor of the breast following combined treatment of radiation and chemotherapy with cyclophosphamide, doxorubicin, methotrexate and procarbazine for oat cell carcinoma of the lung. The pathologic findings of the biopsy specimens revealed muscle and capillary changes similar to previously reported myocardiotoxicity from doxorubicin and radiation therapy. Discussed is a possible additive or synergistic toxic effect of doxorubicin and radiation therapy in the development of muscular pseudotumor of the breast

  12. Prospective Study of Local Control and Late Radiation Toxicity After Intraoperative Radiation Therapy Boost for Early Breast Cancer

    International Nuclear Information System (INIS)

    Chang, David W.; Marvelde, Luc te; Chua, Boon H.

    2014-01-01

    Purpose: To report the local recurrence rate and late toxicity of intraoperative radiation therapy (IORT) boost to the tumor bed using the Intrabeam System followed by external-beam whole-breast irradiation (WBI) in women with early-stage breast cancer in a prospective single-institution study. Methods and Materials: Women with breast cancer ≤3 cm were recruited between February 2003 and May 2005. After breast-conserving surgery, a single dose of 5 Gy IORT boost was delivered using 50-kV x-rays to a depth of 10 mm from the applicator surface. This was followed by WBI to a total dose of 50 Gy in 25 fractions. Patients were reviewed at regular, predefined intervals. Late toxicities were recorded using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring systems. Results: Fifty-five patients completed both IORT boost and external-beam WBI. Median follow-up was 3.3 years (range, 1.4-4.1 years). There was no reported locoregional recurrence or death. One patient developed distant metastases. Grade 2 and 3 subcutaneous fibrosis was detected in 29 (53%) and 8 patients (15%), respectively. Conclusions: The use of IORT as a tumor bed boost using kV x-rays in breast-conserving therapy was associated with good local control but a clinically significant rate of grade 2 and 3 subcutaneous fibrosis

  13. Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer

    International Nuclear Information System (INIS)

    Senthi, Sashendra; Link, Emma; Chua, Boon H.

    2012-01-01

    Purpose: To evaluate cosmetic outcome and its association with breast wound seroma after breast-conserving surgery (BCS) with targeted intraoperative radiation therapy (tIORT) boost for early breast cancer. Methods and Materials: An analysis of a single-arm prospective study of 55 patients with early breast cancer treated with BCS and tIORT boost followed by conventional whole breast radiation therapy (WBRT) between August 2003 and January 2006 was performed. A seroma was defined as a fluid collection at the primary tumor resection site identified clinically or radiologically. Cosmetic assessments using the European Organization for Research and Treatment of Cancer rating system were performed at baseline before BCS and 30 months after WBRT was completed. Results: Twenty-eight patients (51%) developed a seroma, with 18 patients (33%) requiring at least 1 aspiration. Tumor location was significantly associated with seroma formation (P=.001). Ten of 11 patients with an upper inner quadrant tumor developed a seroma. Excellent or good overall cosmetic outcome at 30 months was observed in 34 patients (62%, 95% confidence interval 53%-80%). Seroma formation was not associated with the overall cosmetic result (P=.54). Conclusion: BCS with tIORT boost followed by WBRT was associated with an acceptable cosmetic outcome. Seroma formation was not significantly associated with an adverse cosmetic outcome.

  14. Preliminary results of the use of photon-magnetic therapy in prevention and treatment of skin radiation reactions of patients with breast cancer with adjuvant radiation therapy

    International Nuclear Information System (INIS)

    Syimonova, L.Yi.; Gertman, V.Z.; Byilogurova, L.V.; Kulyinyich, G.V.; Lavrik, V.P.

    2012-01-01

    The authors report preliminary findings of the investigation of the effect of combination photon-magnetic therapy with successive application of red and blue light to the skin of breast cancer patients during the course of post-operative radiation therapy. It was established that photonmagnetic therapy positively influenced the state of the skin in the irradiated areas. Addition of the magnetic factor significantly improved the efficacy of phototherapy. The patients receiving photon-magnetic therapy finished the course of radiation therapy with almost unchanged skin.

  15. The incidence of breast cancer following mantle field radiation therapy as a function of dose and technique

    International Nuclear Information System (INIS)

    Tinger, Alfred; Wasserman, Todd H.; Klein, Eric E.; Miller, Elizabeth A.; Roberts, Tracy; Piephoff, James V.; Kucik, Nancy A.

    1997-01-01

    Purpose: There is an increased incidence of breast cancer following mantle field radiation therapy for Hodgkin's disease (HD). We reviewed the experience at the Mallinckrodt Institute of Radiology (MIR) for radiation factors related to the development of breast cancer after mantle field radiation therapy for HD. Methods: The radiation therapy records of 152 women treated with mantle field irradiation for HD at MIR between 1966-1985 were reviewed for the development of breast cancer and treatment-related factors. All patients had a minimum of 5 years of follow-up. The treatment era (1966-1974 vs. 1975-1985), stage of HD, mediastinal dose, axillary dose, maximum dose from the anterior field (anterior d max dose), the anterior-posterior:posterior-anterior (AP:PA) ratio, age at the time of treatment, length of follow-up, and history of splenectomy were analyzed as possible contributing factors for the development of breast cancer. The observed number of breast cancers was compared to the expected number based on age-adjusted incidences from the Connecticut Tumor Registry. Results: Ten breast cancers occurred in the population. Eight involved an upper outer quadrant. In a multivariate analysis, the development of breast cancer was significantly associated with axillary dose. Patients in the early treatment era were at an increased risk for the development of breast cancer due to high anterior d max and breast doses from weighting the fields anteriorly on a low energy linear accelerator. The use of current radiation therapy techniques was not related to an increased risk of breast cancer with a median follow-up of 13 years. Conclusions: A high dose to the axilla and the anterior d max point is significantly associated with the development of breast cancer after mantle field irradiation for HD. Efforts to protect the breast from high doses will likely lessen the increased risk of breast cancer in women treated with radiation therapy for HD

  16. Mometasone Furoate Cream Reduces Acute Radiation Dermatitis in Patients Receiving Breast Radiation Therapy: Results of a Randomized Trial

    International Nuclear Information System (INIS)

    Hindley, Andrew; Zain, Zakiyah; Wood, Lisa; Whitehead, Anne; Sanneh, Alison; Barber, David; Hornsby, Ruth

    2014-01-01

    Purpose: We wanted to confirm the benefit of mometasone furoate (MF) in preventing acute radiation reactions, as shown in a previous study (Boström et al, Radiother Oncol 2001;59:257-265). Methods and Materials: The study was a double-blind comparison of MF with D (Diprobase), administered daily from the start of radiation therapy for 5 weeks in patients receiving breast radiation therapy, 40 Gy in 2.67-Gy fractions daily over 3 weeks. The primary endpoint was mean modified Radiation Therapy Oncology Group (RTOG) score. Results: Mean RTOG scores were significantly less for MF than for D (P=.046). Maximum RTOG and mean erythema scores were significantly less for MF than for D (P=.018 and P=.012, respectively). The Dermatology Life Quality Index (DLQI) score was significantly less for MF than for D at weeks 4 and 5 when corrected for Hospital Anxiety and Depression (HAD) questionnaire scores. Conclusions: MF cream significantly reduces radiation dermatitis when applied to the breast during and after radiation therapy. For the first time, we have shown a significantly beneficial effect on quality of life using a validated instrument (DLQI), for a topical steroid cream. We believe that application of this cream should be the standard of care where radiation dermatitis is expected

  17. Mometasone Furoate Cream Reduces Acute Radiation Dermatitis in Patients Receiving Breast Radiation Therapy: Results of a Randomized Trial

    Energy Technology Data Exchange (ETDEWEB)

    Hindley, Andrew, E-mail: andrew.hindley@lthtr.nhs.uk [Rosemere Cancer Centre, Royal Preston Hospital, Preston (United Kingdom); Zain, Zakiyah [College of Arts and Sciences, Universiti Utara Malaysia, Kedah (Malaysia); Wood, Lisa [Department of Social Sciences, Lancaster Medical School, Lancaster (United Kingdom); Whitehead, Anne [Medical and Pharmaceutical Statistics Research Unit, Lancaster University, Lancaster (United Kingdom); Sanneh, Alison; Barber, David; Hornsby, Ruth [Rosemere Cancer Centre, Royal Preston Hospital, Preston (United Kingdom)

    2014-11-15

    Purpose: We wanted to confirm the benefit of mometasone furoate (MF) in preventing acute radiation reactions, as shown in a previous study (Boström et al, Radiother Oncol 2001;59:257-265). Methods and Materials: The study was a double-blind comparison of MF with D (Diprobase), administered daily from the start of radiation therapy for 5 weeks in patients receiving breast radiation therapy, 40 Gy in 2.67-Gy fractions daily over 3 weeks. The primary endpoint was mean modified Radiation Therapy Oncology Group (RTOG) score. Results: Mean RTOG scores were significantly less for MF than for D (P=.046). Maximum RTOG and mean erythema scores were significantly less for MF than for D (P=.018 and P=.012, respectively). The Dermatology Life Quality Index (DLQI) score was significantly less for MF than for D at weeks 4 and 5 when corrected for Hospital Anxiety and Depression (HAD) questionnaire scores. Conclusions: MF cream significantly reduces radiation dermatitis when applied to the breast during and after radiation therapy. For the first time, we have shown a significantly beneficial effect on quality of life using a validated instrument (DLQI), for a topical steroid cream. We believe that application of this cream should be the standard of care where radiation dermatitis is expected.

  18. Four-Week Course of Radiation for Breast Cancer Using Hypofractionated Intensity Modulated Radiation Therapy With an Incorporated Boost

    International Nuclear Information System (INIS)

    Freedman, Gary M.; Anderson, Penny R.; Goldstein, Lori J.; Ma Changming; Li Jinsheng; Swaby, Ramona F.; Litwin, Samuel; Watkins-Bruner, Deborah; Sigurdson, Elin R.; Morrow, Monica

    2007-01-01

    Purpose: Standard radiation for early breast cancer requires daily treatment for 6 to 7 weeks. This is an inconvenience to many women, and for some a barrier for breast conservation. We present the acute toxicity of a 4-week course of hypofractionated radiation. Methods and Materials: A total of 75 patients completed radiation on a Phase II trial approved by the hospital institutional review board. Eligibility criteria were broad to include any patient normally eligible for standard radiation: age ≥18 years, invasive or in situ cancer, American Joint Committee on Cancer Stage 0 to II, breast-conserving surgery, and any systemic therapy not given concurrently. The median age was 52 years (range, 31-81 years). Of the patients, 15% had ductal carcinoma in situ, 67% T1, and 19% T2; 71% were N0, 17% N1, and 12% NX. Chemotherapy was given before radiation in 44%. Using photon intensity-modulated radiation therapy and incorporated electron beam boost, the whole breast received 45 Gy and the lumpectomy bed 56 Gy in 20 treatments over 4 weeks. Results: The maximum acute skin toxicity by the end of treatment was Grade 0 in 9 patients (12%), Grade 1 in 49 (65%) and Grade 2 in 17 (23%). There was no Grade 3 or higher skin toxicity. After radiation, all Grade 2 toxicity had resolved by 6 weeks. Hematologic toxicity was Grade 0 in most patients except for Grade 1 neutropenia in 2 patients, and Grade 1 anemia in 11 patients. There were no significant differences in baseline vs. 6-week posttreatment patient-reported or physician-reported cosmetic scores. Conclusions: This 4-week course of postoperative radiation using intensity-modulated radiation therapy is feasible and is associated with acceptable acute skin toxicity and quality of life. Long-term follow-up data are needed. This radiation schedule may represent an alternative both to longer 6-week to 7-week standard whole-breast radiation and more radically shortened 1-week, partial-breast treatment schedules

  19. Estimated risk for secondary cancer in the contra-lateral breast following radiation therapy of breast cancer

    International Nuclear Information System (INIS)

    Johansen, Safora; Danielsen, Turi; Olsen, Dag Rune

    2008-01-01

    Purpose. To facilitate a discussion about the impact of dose heterogeneity on the risk for secondary contralateral breast (CB) cancer predicted with linear and non linear models associated with primary breast irradiation. Methods and materials. Dose volume statistics of the CB calculated for eight patients using a collapsed cone algorithm were used to predict the excess relative risk (ERR) for cancer induction in CB. Both linear and non-linear models were employed. A sensitivity analysis demonstrating the impact of different parameter values on calculated ERR for the eight patients was also included in this study. Results. A proportionality assumption was established to make the calculations with a linear and non-linear model comparable. ERR of secondary cancer predicted by the linear model varied considerably between the patients, while the predicted ERR for the same patients using the non-linear model showed very small variation. The predicted ERRs by the two models were indistinguishable for small doses, i.e. below ∼3 Gy. The sensitivity analysis showed that the quadratic component of the radiation-induction pre-malignant cell term is negligible for lower dose level. The ERR is highly sensitive to the value of agr1 and agr2. Conclusions. Optimization of breast cancer radiation therapy, where also the risk for radiation induced secondary malignancies in the contralateral breast is taken into account, requires robust and valid risk assessment. The linear dose-risk model does not account for the complexity in the mechanisms underlying the development of secondary malignancies following exposure to radiation; this is particularly important when estimating risk associated with highly heterogeneous dose distributions as is the case in the contralateral breast of women receiving breast cancer irradiation

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

    International Nuclear Information System (INIS)

    Offersen, Birgitte V.; Boersma, Liesbeth J.; Kirkove, Carine; Hol, Sandra; Aznar, Marianne C.; Biete Sola, Albert; Kirova, Youlia M.; Pignol, Jean-Philippe; Remouchamps, Vincent; Verhoeven, Karolien; Weltens, Caroline; Arenas, Meritxell; Gabrys, Dorota; Kopek, Neil; Krause, Mechthild; Lundstedt, Dan; Marinko, Tanja

    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. 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

  1. Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Koyama, Hiroki

    1998-01-01

    To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ''occult'' inflammatory breast cancer. (author)

  2. Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki [Kumamoto City Hospital (Japan); Koyama, Hiroki

    1998-09-01

    To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ``occult`` inflammatory breast cancer. (author)

  3. Proposed protocol for imaging breast carcinoma patients treated with lumpectomy and radiation therapy

    International Nuclear Information System (INIS)

    Mendelson, E.B.; Bhagwanani, D.G.; Bohm-Velez, M.; Rishi, U.S.

    1989-01-01

    Alterations in conservatively treated breasts have been described and include masses (hematomas, seromas), spiculated densities, architectural distortion, increased breast density and edema, skin thickening, and calcifications. Misinterpretations of these findings might result in unnecessary biopsy or delayed diagnosis of tumor recurrence. Changes after lumpectomy and radiation therapy must be evaluated within a temporal context, best defined from a careful review of sequential follow-up studies. From a review of interval studies of 110 cases of conservatively treated breast cancer during a 4-year period, the chronology of findings after lumpectomy and radiation therapy was determined. Of particular importance is the evolution of changes at the lumpectomy site, which was the location of the six recurrences in our series, all developing 36--48 months after surgery. Based on the sequential findings that the authors observed as well s the reported frequency of tumor recurrence over time, the authors propose a protocol for follow-up mammography and offer indications for supplemental sonography in managing patients with conservatively treated breast cancer

  4. Automation of the solution type of intensity modulated radiation therapy with direct planning neoplastic breast lesions

    International Nuclear Information System (INIS)

    Fuente Rosales, Liset De La; Larrinaga Cortina, Eduardo Francisco

    2009-01-01

    Breast cancer ranks first among the lesions malignancies involving the Cuban women and the second in mortality only surpassed by lung injury. The breast-conserving surgery is becoming less appeal, with an increase in the choice of radiotherapy to the breast operated, and the surgical bed. Intensity Modulated Radiation Therapy, IMRT has demonstrated better results in the dose distribution for irradiation dimensional treatment breast shaping, 3DCRT. We developed a MATLAB application to obtain the solution type to direct planning IMRT for breast neoplasm. The technique was implemented in the Planning System Treatment Plus Theraplan v3.8 and Precise1 ELEKTA linear accelerator. Static segments are constructed for each portal of incidence and Excel files are exported as the positions of the blades. The technique was validated with a patient, which he performed a radiographic study of computerized axial tomography planning purposes. The standard solution built is consistent with those reported internationally and consists of a segment type and at least two segments of type B. The assignment of the relative weights of the segments is done manually by trial and error procedure, with the general rule of 90% by weight assigned to segment A and the remaining 10% divided equally between B-type segments IMRT breast obtained in a dose 17% homogeneity better than 3DCRT and reduced the average dose in the lung ipsilateral 15%. (author)

  5. Preoperative Single-Fraction Partial Breast Radiation Therapy: A Novel Phase 1, Dose-Escalation Protocol With Radiation Response Biomarkers

    International Nuclear Information System (INIS)

    Horton, Janet K.; Blitzblau, Rachel C.; Yoo, Sua; Geradts, Joseph; Chang, Zheng; Baker, Jay A.; Georgiade, Gregory S.; Chen, Wei; Siamakpour-Reihani, Sharareh; Wang, Chunhao; Broadwater, Gloria; Groth, Jeff; Palta, Manisha; Dewhirst, Mark; Barry, William T.; Duffy, Eileen A.

    2015-01-01

    Purpose: Women with biologically favorable early-stage breast cancer are increasingly treated with accelerated partial breast radiation (PBI). However, treatment-related morbidities have been linked to the large postoperative treatment volumes required for external beam PBI. Relative to external beam delivery, alternative PBI techniques require equipment that is not universally available. To address these issues, we designed a phase 1 trial utilizing widely available technology to 1) evaluate the safety of a single radiation treatment delivered preoperatively to the small-volume, intact breast tumor and 2) identify imaging and genomic markers of radiation response. Methods and Materials: Women aged ≥55 years with clinically node-negative, estrogen receptor–positive, and/or progesterone receptor–positive HER2−, T1 invasive carcinomas, or low- to intermediate-grade in situ disease ≤2 cm were enrolled (n=32). Intensity modulated radiation therapy was used to deliver 15 Gy (n=8), 18 Gy (n=8), or 21 Gy (n=16) to the tumor with a 1.5-cm margin. Lumpectomy was performed within 10 days. Paired pre- and postradiation magnetic resonance images and patient tumor samples were analyzed. Results: No dose-limiting toxicity was observed. At a median follow-up of 23 months, there have been no recurrences. Physician-rated cosmetic outcomes were good/excellent, and chronic toxicities were grade 1 to 2 (fibrosis, hyperpigmentation) in patients receiving preoperative radiation only. Evidence of dose-dependent changes in vascular permeability, cell density, and expression of genes regulating immunity and cell death were seen in response to radiation. Conclusions: Preoperative single-dose radiation therapy to intact breast tumors is well tolerated. Radiation response is marked by early indicators of cell death in this biologically favorable patient cohort. This study represents a first step toward a novel partial breast radiation approach. Preoperative radiation should

  6. Preoperative Single-Fraction Partial Breast Radiation Therapy: A Novel Phase 1, Dose-Escalation Protocol With Radiation Response Biomarkers

    Energy Technology Data Exchange (ETDEWEB)

    Horton, Janet K., E-mail: janet.horton@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Blitzblau, Rachel C.; Yoo, Sua [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Geradts, Joseph [Department of Pathology, Duke University Medical Center, Durham, North Carolina (United States); Chang, Zheng [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Baker, Jay A. [Department of Radiology, Duke University Medical Center, Durham, North Carolina (United States); Georgiade, Gregory S. [Department of Surgery, Duke University Medical Center, Durham, North Carolina (United States); Chen, Wei [Department of Bioinformatics: Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina (United States); Siamakpour-Reihani, Sharareh; Wang, Chunhao [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Broadwater, Gloria [Department of Biostatistics: Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina (United States); Groth, Jeff [Department of Pathology, Duke University Medical Center, Durham, North Carolina (United States); Palta, Manisha; Dewhirst, Mark [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Barry, William T. [Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (United States); Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Duffy, Eileen A. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); and others

    2015-07-15

    Purpose: Women with biologically favorable early-stage breast cancer are increasingly treated with accelerated partial breast radiation (PBI). However, treatment-related morbidities have been linked to the large postoperative treatment volumes required for external beam PBI. Relative to external beam delivery, alternative PBI techniques require equipment that is not universally available. To address these issues, we designed a phase 1 trial utilizing widely available technology to 1) evaluate the safety of a single radiation treatment delivered preoperatively to the small-volume, intact breast tumor and 2) identify imaging and genomic markers of radiation response. Methods and Materials: Women aged ≥55 years with clinically node-negative, estrogen receptor–positive, and/or progesterone receptor–positive HER2−, T1 invasive carcinomas, or low- to intermediate-grade in situ disease ≤2 cm were enrolled (n=32). Intensity modulated radiation therapy was used to deliver 15 Gy (n=8), 18 Gy (n=8), or 21 Gy (n=16) to the tumor with a 1.5-cm margin. Lumpectomy was performed within 10 days. Paired pre- and postradiation magnetic resonance images and patient tumor samples were analyzed. Results: No dose-limiting toxicity was observed. At a median follow-up of 23 months, there have been no recurrences. Physician-rated cosmetic outcomes were good/excellent, and chronic toxicities were grade 1 to 2 (fibrosis, hyperpigmentation) in patients receiving preoperative radiation only. Evidence of dose-dependent changes in vascular permeability, cell density, and expression of genes regulating immunity and cell death were seen in response to radiation. Conclusions: Preoperative single-dose radiation therapy to intact breast tumors is well tolerated. Radiation response is marked by early indicators of cell death in this biologically favorable patient cohort. This study represents a first step toward a novel partial breast radiation approach. Preoperative radiation should

  7. Radiation efficacy and biological risk from whole-breast irradiation via intensity modulated radiation therapy (IMRT)

    Science.gov (United States)

    Desantis, David M.

    Radiotherapy is an established modality for women with breast cancer. During the delivery of external beam radiation to the breast, leakage, scattered x-rays from the patient and the linear accelerator also expose healthy tissues and organs outside of the breast, thereby increasing the patient's whole-body dose, which then increases the chance of developing a secondary, radiation-induced cancer. Generally, there are three IntensityModulated Radiotherapy (IMRT) delivery techniques from a conventional linear accelerator; forward planned (FMLC), inverse planned 'sliding window' (DMLC), and inverse planned 'step-and-shoot' (SMLC). The goal of this study was to determine which of these three techniques delivers an optimal dose to the breast with the least chance of causing a fatal, secondary, radiation-induced cancer. A conventional, non-IMRT, 'Wedge' plan also was compared. Computerized Tomography (CT) data sets for both a large and small sized patient were used in this study. With Varian's Eclipse AAA algorithm, the organ doses specified in the revised ICRP 60 publication were used to calculate the whole-body dose. Also, an anthropomorphic phantom was irradiated with thermoluminescent dosimeters (TLD) at each organ site for measured doses. The risk coefficient from the Biological Effects of Ionizing Radiation (BEIR) VII report of 4.69 x 10-2 deaths per Gy was used to convert whole-body dose to risk of a fatal, secondary, radiation-induced cancer. The FMLC IMRT delivered superior tumor coverage over the 3D conventional plan and the inverse DMLC or SMLC treatment plans delivered clinically equivalent tumor coverage. However, the FMLC plan had the least likelihood of inadvertently causing a fatal, secondary, radiation-induced cancer compared to the inverse DMLC, SMLC, and Wedge plans.

  8. XRCC1 Polymorphism Associated With Late Toxicity After Radiation Therapy in Breast Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Seibold, Petra; Behrens, Sabine [Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg (Germany); Schmezer, Peter [Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center, Heidelberg (Germany); Helmbold, Irmgard [Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg (Germany); Barnett, Gillian; Coles, Charlotte [Department of Oncology, Oncology Centre, Cambridge University Hospital NHS Foundation Trust, United Kingdom (UK) (United Kingdom); Yarnold, John [Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London (United Kingdom); Talbot, Christopher J. [Department of Genetics, University of Leicester, Leicester (United Kingdom); Imai, Takashi [Advanced Radiation Biology Research Program, National Institute of Radiological Sciences, Chiba (Japan); Azria, David [Department of Radiation Oncology and Medical Physics, I.C.M. – Institut regional du Cancer Montpellier, Montpellier (France); Koch, C. Anne [Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario (Canada); Dunning, Alison M. [Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Cambridge (United Kingdom); Burnet, Neil [Department of Oncology, Oncology Centre, Cambridge University Hospital NHS Foundation Trust, University of Cambridge, Cambridge (United Kingdom); Bliss, Judith M. [The Institute of Cancer Research, Clinical Trials and Statistics Unit, Sutton (United Kingdom); Symonds, R. Paul; Rattay, Tim [Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester (United Kingdom); Suga, Tomo [Advanced Radiation Biology Research Program, National Institute of Radiological Sciences, Chiba (Japan); Kerns, Sarah L. [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NH (United States); and others

    2015-08-01

    Purpose: To identify single-nucleotide polymorphisms (SNPs) in oxidative stress–related genes associated with risk of late toxicities in breast cancer patients receiving radiation therapy. Methods and Materials: Using a 2-stage design, 305 SNPs in 59 candidate genes were investigated in the discovery phase in 753 breast cancer patients from 2 prospective cohorts from Germany. The 10 most promising SNPs in 4 genes were evaluated in the replication phase in up to 1883 breast cancer patients from 6 cohorts identified through the Radiogenomics Consortium. Outcomes of interest were late skin toxicity and fibrosis of the breast, as well as an overall toxicity score (Standardized Total Average Toxicity). Multivariable logistic and linear regression models were used to assess associations between SNPs and late toxicity. A meta-analysis approach was used to summarize evidence. Results: The association of a genetic variant in the base excision repair gene XRCC1, rs2682585, with normal tissue late radiation toxicity was replicated in all tested studies. In the combined analysis of discovery and replication cohorts, carrying the rare allele was associated with a significantly lower risk of skin toxicities (multivariate odds ratio 0.77, 95% confidence interval 0.61-0.96, P=.02) and a decrease in Standardized Total Average Toxicity scores (−0.08, 95% confidence interval −0.15 to −0.02, P=.016). Conclusions: Using a stage design with replication, we identified a variant allele in the base excision repair gene XRCC1 that could be used in combination with additional variants for developing a test to predict late toxicities after radiation therapy in breast cancer patients.

  9. XRCC1 Polymorphism Associated With Late Toxicity After Radiation Therapy in Breast Cancer Patients

    International Nuclear Information System (INIS)

    Seibold, Petra; Behrens, Sabine; Schmezer, Peter; Helmbold, Irmgard; Barnett, Gillian; Coles, Charlotte; Yarnold, John; Talbot, Christopher J.; Imai, Takashi; Azria, David; Koch, C. Anne; Dunning, Alison M.; Burnet, Neil; Bliss, Judith M.; Symonds, R. Paul; Rattay, Tim; Suga, Tomo; Kerns, Sarah L.

    2015-01-01

    Purpose: To identify single-nucleotide polymorphisms (SNPs) in oxidative stress–related genes associated with risk of late toxicities in breast cancer patients receiving radiation therapy. Methods and Materials: Using a 2-stage design, 305 SNPs in 59 candidate genes were investigated in the discovery phase in 753 breast cancer patients from 2 prospective cohorts from Germany. The 10 most promising SNPs in 4 genes were evaluated in the replication phase in up to 1883 breast cancer patients from 6 cohorts identified through the Radiogenomics Consortium. Outcomes of interest were late skin toxicity and fibrosis of the breast, as well as an overall toxicity score (Standardized Total Average Toxicity). Multivariable logistic and linear regression models were used to assess associations between SNPs and late toxicity. A meta-analysis approach was used to summarize evidence. Results: The association of a genetic variant in the base excision repair gene XRCC1, rs2682585, with normal tissue late radiation toxicity was replicated in all tested studies. In the combined analysis of discovery and replication cohorts, carrying the rare allele was associated with a significantly lower risk of skin toxicities (multivariate odds ratio 0.77, 95% confidence interval 0.61-0.96, P=.02) and a decrease in Standardized Total Average Toxicity scores (−0.08, 95% confidence interval −0.15 to −0.02, P=.016). Conclusions: Using a stage design with replication, we identified a variant allele in the base excision repair gene XRCC1 that could be used in combination with additional variants for developing a test to predict late toxicities after radiation therapy in breast cancer patients

  10. Radiation binary targeted therapy for HER-2 positive breast cancers: assumptions, theoretical assessment and future directions

    Energy Technology Data Exchange (ETDEWEB)

    Mundy, Daniel W [School of Nuclear Engineering, Purdue University, 400 Central Drive, West Lafayette, IN 47909 (United States); Harb, Wael [Horizon Oncology, The Care Group, Unity Medical Center, Lafayette, IN 47901 (United States); Jevremovic, Tatjana [School of Nuclear Engineering, Purdue University, 400 Central Drive, West Lafayette, IN 47909 (United States)

    2006-03-21

    A novel radiation targeted therapy is investigated for HER-2 positive breast cancers. The proposed concept combines two known approaches, but never used together for the treatment of advanced, relapsed or metastasized HER-2 positive breast cancers. The proposed radiation binary targeted concept is based on the anti HER-2 monoclonal antibodies (MABs) that would be used as vehicles to transport the nontoxic agent to cancer cells. The anti HER-2 MABs have been successful in targeting HER-2 positive breast cancers with high affinity. The proposed concept would utilize a neutral nontoxic boron-10 predicting that anti HER-2 MABs would assure its selective delivery to cancer cells. MABs against HER-2 have been a widely researched strategy in the clinical setting. The most promising antibody is Trastuzumab (Herceptin (registered) ). Targeting HER-2 with the MAB Trastuzumab has been proven to be a successful strategy in inducing tumour regression and improving patient survival. Unfortunately, these tumours become resistant and afflicted women succumb to breast cancer. In the proposed concept, when the tumour region is loaded with boron-10 it is irradiated with neutrons (treatment used for head and neck cancers, melanoma and glioblastoma for over 40 years in Japan and Europe). The irradiation process takes less than an hour producing minimal side effects. This paper summarizes our recent theoretical assessments of radiation binary targeted therapy for HER-2 positive breast cancers on: the effective drug delivery mechanism, the numerical model to evaluate the targeted radiation delivery and the survey study to find the neutron facility in the world that might be capable of producing the radiation effect as needed. A novel method of drug delivery utilizing Trastuzumab is described, followed by the description of a computational Monte Carlo based breast model used to determine radiation dose distributions. The total flux and neutron energy spectra of five currently available

  11. Thermography in the follow-up of breast cancer patients after breast-conserving treatment by tumorectomy and radiation therapy

    International Nuclear Information System (INIS)

    Ulmer, H.U.; Brinkmann, M.; Frischbier, H.J.

    1990-01-01

    It is often suggested in the literature that thermography is able to diagnose a recurrence in the breast after breast-conserving therapy by a rise in breast temperature much earlier than other diagnostic tools, but no thermographic values are presented. The thermographic data of a prospective study of 309 women after breast-conserving therapy were evaluated. Seventeen of these women had an intramammary recurrence. A total of 2432 individual measured values were evaluated from 292 patients without evidence of a recurrence and 146 measured values from 17 patients with intramammary recurrence. The thermographic behavior of the breast after breast-conserving therapy is not uniform. However, the breast temperatures of the patients with intramammary recurrences were not significantly different from those without recurrences. This means that thermography is of no value in the care after breast-conserving therapy

  12. Promoting effects of adipose-derived stem cells on breast cancer cells are reversed by radiation therapy.

    Science.gov (United States)

    Baaße, Annemarie; Juerß, Dajana; Reape, Elaine; Manda, Katrin; Hildebrandt, Guido

    2018-04-01

    Partial breast irradiation of early breast cancer patients after lumpectomy and the use of endogenous adipose tissue (AT) for breast reconstruction are promising applications to reduce the side effects of breast cancer therapy. This study tries to investigate the possible risks associated with these therapeutic approaches. It also examines the influence of adipose derived stem cells (ADSCs) as part of the breast cancer microenvironment, and endogenous AT on breast cancer cells following radiation therapy. ADSCs, isolated from human reduction mammoplasties of healthy female donors, exhibited multilineage capacity and specific surface markers. The promoting effects of ADSCs on the growth and survival fraction of breast cancer cells were reversed by treatment with high (8 Gy) or medium (2 Gy) radiation doses. In addition, a suppressing influence on breast cancer growth could be detected by co-culturing with irradiated ADSCs (8 Gy). Furthermore the clonogenic survival of unirradiated tumor cells was reduced by medium of irradiated ADSCs. In conclusion, radiation therapy changed the interactions of ADSCs and breast cancer cells. On the basis of our work, the importance of further studies to exclude potential risks of ADSCs in regenerative applications and radiotherapy has been emphasized.

  13. Adoption of Intensity Modulated Radiation Therapy For Early-Stage Breast Cancer From 2004 Through 2011

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Elyn H. [Yale School of Medicine, New Haven, Connecticut (United States); Mougalian, Sarah S. [Yale School of Medicine, New Haven, Connecticut (United States); Yale Cancer Center, 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, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Smith, Benjamin D. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Haffty, Bruce G. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Gross, Cary P. [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 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, 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)

    2015-02-01

    Purpose: Intensity modulated radiation therapy (IMRT) is a newer method of radiation therapy (RT) that has been increasingly adopted as an adjuvant treatment after breast-conserving surgery (BCS). IMRT may result in improved cosmesis compared to standard RT, although at greater expense. To investigate the adoption of IMRT, we examined trends and factors associated with IMRT in women under the age of 65 with early stage breast cancer. Methods and Materials: We performed a retrospective study of early stage breast cancer patients treated with BCS followed by whole-breast irradiation (WBI) who were ≤65 years old in the National Cancer Data Base from 2004 to 2011. We used logistic regression to identify factors associated with receipt of IMRT (vs standard RT). Results: We identified 11,089 women with early breast cancer (9.6%) who were treated with IMRT and 104,448 (90.4%) who were treated with standard RT, after BCS. The proportion of WBI patients receiving IMRT increased yearly from 2004 to 2009, with 5.3% of WBI patients receiving IMRT in 2004 and 11.6% receiving IMRT in 2009. Further use of IMRT declined afterward, with the proportion remaining steady at 11.0% and 10.7% in 2010 and 2011, respectively. Patients treated in nonacademic community centers were more likely to receive IMRT (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.30-1.43 for nonacademic vs academic center). Compared to privately insured patients, the uninsured patients (OR, 0.81; 95% CI, 0.70-0.95) and those with Medicaid insurance (OR, 0.87; 95% CI, 0.79-0.95) were less likely to receive IMRT. Conclusions: The use of IMRT rose from 2004 to 2009 and then stabilized. Important nonclinical factors associated with IMRT use included facility type and insurance status.

  14. Adoption of Intensity Modulated Radiation Therapy For Early-Stage Breast Cancer From 2004 Through 2011

    International Nuclear Information System (INIS)

    Wang, Elyn H.; Mougalian, Sarah S.; Soulos, Pamela R.; Smith, Benjamin D.; Haffty, Bruce G.; Gross, Cary P.; Yu, James B.

    2015-01-01

    Purpose: Intensity modulated radiation therapy (IMRT) is a newer method of radiation therapy (RT) that has been increasingly adopted as an adjuvant treatment after breast-conserving surgery (BCS). IMRT may result in improved cosmesis compared to standard RT, although at greater expense. To investigate the adoption of IMRT, we examined trends and factors associated with IMRT in women under the age of 65 with early stage breast cancer. Methods and Materials: We performed a retrospective study of early stage breast cancer patients treated with BCS followed by whole-breast irradiation (WBI) who were ≤65 years old in the National Cancer Data Base from 2004 to 2011. We used logistic regression to identify factors associated with receipt of IMRT (vs standard RT). Results: We identified 11,089 women with early breast cancer (9.6%) who were treated with IMRT and 104,448 (90.4%) who were treated with standard RT, after BCS. The proportion of WBI patients receiving IMRT increased yearly from 2004 to 2009, with 5.3% of WBI patients receiving IMRT in 2004 and 11.6% receiving IMRT in 2009. Further use of IMRT declined afterward, with the proportion remaining steady at 11.0% and 10.7% in 2010 and 2011, respectively. Patients treated in nonacademic community centers were more likely to receive IMRT (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.30-1.43 for nonacademic vs academic center). Compared to privately insured patients, the uninsured patients (OR, 0.81; 95% CI, 0.70-0.95) and those with Medicaid insurance (OR, 0.87; 95% CI, 0.79-0.95) were less likely to receive IMRT. Conclusions: The use of IMRT rose from 2004 to 2009 and then stabilized. Important nonclinical factors associated with IMRT use included facility type and insurance status

  15. Treatment with intensity-modulated radiation therapy (IMRT) for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Marta, G.N.; Hanna, S.A.; Gadia, R.

    2014-11-15

    Through the development of four relevant clinical questions related with the proposed subject, we tried to present the main evidence for safety, toxicity and effectiveness using different radiotherapy techniques. The study population consisted of female patients of all ages with primary breast cancer treated with radiation therapy to the whole breast, regardless of histological type, staging, context of treatment (radical, adjuvant or palliative) and whether comorbidities were present or not. For this, a systematic review of the literature was performed in primary scientific research databases (Medline - Pubmed; Embase - Elsevier; Lilacs - Bireme; Cochrane Library - Central Register of Controlled Trials). All articles available until July 22, 2013, were included. The search strategy used for Medline research is described in Appendix. Articles were selected based on critical evaluation in search of the best available evidence. Recommendations were prepared based on discussion with the writing group, composed of three members of the Brazilian Society of Radiotherapy. The guideline was reviewed by an independent group specializing in evidence-based clinical guidelines. After completion, the guideline was made available for public consultation for 15 days and the suggestions forwarded to the writers for evaluation and consideration into the final text. Objective: to assess the most appropriate method of radiation therapy for treating patients with primary breast tumors. (author)

  16. Partial Breast Radiation Therapy With Proton Beam: 5-Year Results With Cosmetic Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Bush, David A., E-mail: dbush@llu.edu [Department of Radiation Oncology, Loma Linda University Medical Center, Loma Linda, California (United States); Do, Sharon [Department of Radiation Oncology, Loma Linda University Medical Center, Loma Linda, California (United States); Lum, Sharon; Garberoglio, Carlos [Department of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, California (United States); Mirshahidi, Hamid [Department of Medical Oncology, Loma Linda University Medical Center, Loma Linda, California (United States); Patyal, Baldev; Grove, Roger; Slater, Jerry D. [Department of Radiation Oncology, Loma Linda University Medical Center, Loma Linda, California (United States)

    2014-11-01

    Purpose: We updated our previous report of a phase 2 trial using proton beam radiation therapy to deliver partial breast irradiation (PBI) in patients with early stage breast cancer. Methods and Materials: Eligible subjects had invasive nonlobular carcinoma with a maximal dimension of 3 cm. Patients underwent partial mastectomy with negative margins; axillary lymph nodes were negative on sampling. Subjects received postoperative proton beam radiation therapy to the surgical bed. The dose delivered was 40 Gy in 10 fractions, once daily over 2 weeks. Multiple fields were treated daily, and skin-sparing techniques were used. Following treatment, patients were evaluated with clinical assessments and annual mammograms to monitor toxicity, tumor recurrence, and cosmesis. Results: One hundred subjects were enrolled and treated. All patients completed the assigned treatment and were available for post-treatment analysis. The median follow-up was 60 months. Patients had a mean age of 63 years; 90% had ductal histology; the average tumor size was 1.3 cm. Actuarial data at 5 years included ipsilateral breast tumor recurrence-free survival of 97% (95% confidence interval: 100%-93%); disease-free survival of 94%; and overall survival of 95%. There were no cases of grade 3 or higher acute skin reactions, and late skin reactions included 7 cases of grade 1 telangiectasia. Patient- and physician-reported cosmesis was good to excellent in 90% of responses, was not changed from baseline measurements, and was well maintained throughout the entire 5-year follow-up period. Conclusions: Proton beam radiation therapy for PBI produced excellent ipsilateral breast recurrence-free survival with minimal toxicity. The treatment proved to be adaptable to all breast sizes and lumpectomy cavity configurations. Cosmetic results appear to be excellent and unchanged from baseline out to 5 years following treatment. Cosmetic results may be improved over those reported with photon

  17. Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans

    International Nuclear Information System (INIS)

    Purdie, Thomas G.; Dinniwell, Robert E.; Fyles, Anthony; Sharpe, Michael B.

    2014-01-01

    Purpose: To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to define and simplify the technical aspects of the treatment planning process. Results: Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Conclusions: Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented

  18. A case of fat necrosis with ulceration after breast-conserving surgery and postoperative radiation therapy

    International Nuclear Information System (INIS)

    Nomoto, Yuki; Kijima, Yuko; Hirata, Munetsugu; Shinden, Yoshiaki; Arima, Hideo; Nakajo, Akihiro; Hiraki, Tsubasa; Natsugoe, Shoji

    2017-01-01

    An 82 year-old woman was diagnosed with right breast cancer, and partial mastectomy with sentinel lymph node biopsy was performed in another hospital. Lateral subcutaneous fat was mobilized and used to fill mammary gland defect. Two months after surgery, she received postoperative radiation therapy and endocrine therapy. Two years and six months after surgery, induration of the left breast was marked and skin redness appeared. It then became exposed, and the lesion was diagnosed as fat necrosis and abscess the core needle biopsy. Conservative observation was then conducted. Pain developed and pus exudatation continued from the necrotic tissue. Two years and nine months after surgery, she was admitted to our hospital for treatment. Deformity, induration with a fistula, and skin redness were found in the surgically treated and irradiated right breast. The lesion was diagnosed as fat necrosis based on several imaging examinations. Simple mastectomy was performed for pain reduction and to treat the continuous fistula leakage. Since the mass showed firm adhesion with the major pectoral muscle, a part of the muscle was excised. Histology revealed necrotic fat and an abscess with a skin fistula, but not malignancy. The endocrine therapy has been continued, and she has survived without recurrent disease for a year and eight months since surgery. (author)

  19. Spontaneous pneumothorax after radiation therapy for breast cancer. A case report

    International Nuclear Information System (INIS)

    Tsuboshima, Kenji; Kishimoto, Koji; Oda, Teiji

    2010-01-01

    A 41-year-old asymptomatic woman was referred to our hospital for a right pneumothorax noted incidentally on a chest radiograph. She had undergone surgery, radiation at a total dose of 60 Gy, and adjuvant chemotherapy therapy for right breast cancer 14 months previously. A chest tube was inserted into the right pleural cavity. Although the right lung expanded immediately, air leakage increased gradually and the right lung collapsed again three days after drainage. Computed tomography (CT) revealed the thickening of the frontal pleura of the right lower lobe, which resulted from radiation therapy, with chest tube compression and no blebs. We selected video-assisted thoracic surgery (VATS). The thoracoscopic view showed air leakage from the pleural fissures compressed by the chest tube. Plication was performed for this lesion and air leakage was stopped. No findings of recurrence have been noted since the operation. (author)

  20. Postoperative radiation therapy and adjuvant chemoimmunotherapy in breast cancer. Aspects of timing and immune competence

    Energy Technology Data Exchange (ETDEWEB)

    Klefstroem, P.; Nuortio, L.; Taskinen, E.

    The effects of radiation therapy and adjuvant chemoimmunotherapy on the immune competence of patients with breast cancer were investigated. The tests performed included intradermal tuberculin tests, T- and B-lymphocyte counts, and lymphocyte blast transformation tests; phytohemagglutinin (PHA), concanavalin A (ConA) and pokeweed mitogen (PMW) were used as mitogens. Enhancement in lymphocyte proliferative response to mitogenic stimulation by PHA and PMW was seen in patients after 3 courses of chemotherapy + levamisole, whereas irradiation given after chemotherapy caused long-lasting depression in response to PHA and PWM (not significant). T-lymphocyte counts were also lower after irradiation than after chemoimmunotherapy. Clinically, the 16 patients treated with radiation therapy after chemotherapy exhibited a higher recurrence rate than the 24 patients treated first by irradiation. Enhanced reactivity to tuberculin tests occurred generally in patients receiving a planned treatment including irradiation, chemotherapy (5-fluorouracil, doxorubicin, cyclophosphamide) and levamisole. Enhancement of reactivity was seen more often in patients who had not relapsed.

  1. Debate: Pro intraoperative radiation therapy in breast cancer; Debat: pour la radiotherapie peroperatoire dans le cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Dubois, J.B.; Lemanski, C.; Azria, D. [Departement de radiotherapie, CRLC Val-d' Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5 (France); Gutowski, M.; Rouanet, P.; Saint-Aubert, B. [Departement de chirurgie, CRLC Val-d' Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5 (France)

    2011-10-15

    The use of intraoperative radiation therapy in breast cancer patients started about 20 years ago. Several retrospective and prospective studies have been published. Intraoperative radiation therapy was initially given as a boost to the tumour bed, followed by whole-breast irradiation. These studies have demonstrated the feasibility of the technique, with local control rates and cosmetic results similar to those obtained with standard treatments. Accelerated partial breast irradiation yields local recurrence rates as low as those observed after whole-breast irradiation. Intraoperative radiation therapy as a single irradiation modality with a unique dose has been investigated in recent prospective studies showing satisfactory local results. Intraoperative radiation therapy can be proposed either as a boost or as a unique treatment in selected cases (tumour size, nodal and hormonal status, patient's age). Intraoperative radiation therapy can be delivered by orthovoltage (50 kV) X-rays from mobile generators, or by electrons from linear accelerators, mobile or fixed, dedicated or not to intraoperative radiation therapy. (authors)

  2. Cancer of the breast: Conservation surgery and curative radiation therapy - Technique

    International Nuclear Information System (INIS)

    Brady, L.W.; Bedwinek, J.M.; Markoe, A.M.; Micaily, B.; Damsker, J.I.; Karlsson, U.L.

    1987-01-01

    Current evidence strongly suggests that radiation therapy following conservation surgery in the primary local management of stage I and stage II breast cancer can achieve survival and local-regional control rates that are comparable to those obtained by radical and modified radical mastectomy. Since primary radiation therapy has the benefit of leaving the patient with intact and cosmetically acceptable breasts, it should be considered as a viable and reasonable alternative to radical mastectomy. An analysis of current series of primary radiation data suggests that total excision of the tumor should be carried out. An axillary node sampling or dissection including level 1 and level 2 axillary nodes (those lying beneath and lateral to the pectoralis minor muscle) should be carried out in addition to tumor excision since knowledge of the axillary nodal status serves as a prognostic indicator and facilitates the intelligent selection of those patients for adjuvant hormonal or chemotherapy. Technique then becomes a critical and important part of the management of the patient. No effort should be spared to insure that the volumes irradiated are properly chosen, receive the appropriate dose to maximize the potential for local-regional control and done within the context of minimization of complication from the treatment program. It is only under these circumstances that the best in terms of long-term survival and cosmetic can be achieved

  3. Trends in primary surgical and radiation therapy for localized breast cancer in the detroit metropolitan area 1973-1992

    International Nuclear Information System (INIS)

    Chuba, Paul J.; Simon, Michael S.

    1997-01-01

    Purpose: The purpose of this report is to describe trends in primary surgical and radiation therapy for localized breast cancer from 1973 through 1992 among residents of the Detroit Metropolitan area. Methods and Materials: Data on surgical and radiation therapy procedures for women with local stage breast cancer were obtained from the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). Results: Women age 75 years and older were treated less aggressively than younger women (< age 75) as evidenced by higher rates of simple mastectomy or no treatment among older women. Younger women (< age 75) were more likely to have had optimal breast conservation therapy which consisted of partial mastectomy, axillary lymph node dissection (ALND), and radiation therapy, than were women who were older than 75. Partial mastectomy has increased proportionally from 4% of all breast cancer surgeries in the time period 1973 to 1977, to 39% of all surgeries from 1988 through 1992. Conclusion: A marked difference in surgical treatment of breast cancer exists for younger vs. older women. Despite changes in surgical treatment trends for breast cancer, a large proportion of women who are candidates for conservative therapy continue to undergo mastectomy

  4. Cytokines, Fatigue, and Cutaneous Erythema in Early Stage Breast Cancer Patients Receiving Adjuvant Radiation Therapy

    Directory of Open Access Journals (Sweden)

    Vitaliana De Sanctis

    2014-01-01

    Full Text Available We investigated the hypothesis that patients developing high-grade erythema of the breast skin during radiation treatment could be more likely to present increased levels of proinflammatory cytokines which may lead, in turn, to associated fatigue. Forty women with early stage breast cancer who received adjuvant radiotherapy were enrolled from 2007 to 2010. Fatigue symptoms, erythema, and cytokine levels (IL-1β, IL-2, IL6, IL-8, TNF-α, and MCP-1 were registered at baseline, during treatment, and after radiotherapy completion. Seven (17.5% patients presented fatigue without associated depression/anxiety. Grade ≥2 erythema was observed in 5 of these 7 patients. IL-1β, IL-2, IL-6, and TNF-α were statistically increased 4 weeks after radiotherapy (P<0.05. After the Heckman two-step analysis, a statistically significant influence of skin erythema on proinflammatory markers increase (P = 0.00001 was recorded; in the second step, these blood markers showed a significant impact on fatigue (P = 0.026. A seeming increase of fatigue, erythema, and proinflammatory markers was observed between the fourth and the fifth week of treatment followed by a decrease after RT. There were no significant effects of hormone therapy, breast volume, and anemia on fatigue. Our study seems to suggest that fatigue is related to high-grade breast skin erythema during radiotherapy through the increase of cytokines levels.

  5. Potential risk and benefit of the combination of trastuzumab to chemotherapy and radiation therapy in non-metastatic breast cancer

    International Nuclear Information System (INIS)

    Belkacemi, Y.; Laharie-Mineur, H.; Gligorov, J.; Azria, D.

    2007-01-01

    Trastuzumab (Herceptin) is the first humanized monoclonal antibody targeting the HER2 antigen in breast cancer. HER2 receptor has been individualised 20 years ago. During the past 10 years, trastuzumab administration has radically modified the prognosis of the patients that are treated for HER2 positive breast cancer. Its efficacy has been demonstrated in the metastatic and adjuvant settings. While, trastuzumab based-regimens became the standard of care in the treatment of HER2/neu positive breast cancer, the optimal combination (concurrently or sequentially) to chemotherapy and radiation therapy is still unknown. Indeed, while the concurrent administration of trastuzumab and anthracyclines is not recommended because of a high risk of cardiac toxicity, there is no published data on the best sequence of trastuzumab and radiation therapy administration, particularly when internal mammary chain is involved. The benefit/risk ratio of the concurrent and sequential administration of trastuzumab with chemotherapy and radiation therapy will be discussed in this review. (authors)

  6. The Impact of Radiation Therapy on the Risk of Lymphedema After Treatment for Breast Cancer: A Prospective Cohort Study

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G.; Miller, Cynthia L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Horick, Nora [Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts (United States); Skolny, Melissa N.; Jammallo, Lauren S.; Sadek, Betro T.; Shenouda, Mina N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); O' Toole, Jean A. [Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts (United States); MacDonald, Shannon M. [Department of Radiation Oncology, 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)

    2014-03-01

    Purpose/Objective: Lymphedema after breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiation therapy-related risk factors for lymphedema. Methods and Materials: From 2005 to 2012, we prospectively performed arm volume measurements on 1476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099 of 1501 patients (73%) received radiation therapy. Arm measurements were performed preoperatively and postoperatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months postoperatively. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema. Results: At a median follow-up time of 25.4 months (range, 3.4-82.6 months), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiation therapy type was as follows: 3.0% no radiation therapy, 3.1% breast or chest wall alone, 21.9% supraclavicular (SC), and 21.1% SC and posterior axillary boost (PAB). On multivariate analysis, the hazard ratio for regional lymph node radiation (RLNR) (SC ± PAB) was 1.7 (P=.025) compared with breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC + PAB (P=.96). Other independent risk factors included early postoperative swelling (P<.0001), higher body mass index (P<.0001), greater number of lymph nodes dissected (P=.018), and axillary lymph node dissection (P=.0001). Conclusions: In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased the risk of lymphedema compared with breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease against the increased risk of lymphedema.

  7. The Adoption of New Adjuvant Radiation Therapy Modalities Among Medicare Beneficiaries With Breast Cancer: Clinical Correlates and Cost Implications

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, Kenneth B. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Soulos, Pamela R. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (United States); Herrin, Jeph [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Health Research and Educational Trust, Chicago, Illinois (United States); Yu, James B. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Long, Jessica B. [Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut (United States); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (United States); Dostaler, Edward [Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (United States); and others

    2013-04-01

    Purpose: New radiation therapy modalities have broadened treatment options for older women with breast cancer, but it is unclear how clinical factors, geographic region, and physician preference affect the choice of radiation therapy modality. Methods and Materials: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify women diagnosed with stage I-III breast cancer from 1998 to 2007 who underwent breast-conserving surgery. We assessed the temporal trends in, and costs of, the adoption of intensity modulated radiation therapy (IMRT) and brachytherapy. Using hierarchical logistic regression, we evaluated the relationship between the use of these new modalities and patient and regional characteristics. Results: Of 35,060 patients, 69.9% received conventional external beam radiation therapy (EBRT). Although overall radiation therapy use remained constant, the use of IMRT increased from 0.0% to 12.6% from 1998 to 2007, and brachytherapy increased from 0.7% to 9.0%. The statistical variation in brachytherapy use attributable to the radiation oncologist and geographic region was 41.4% and 9.5%, respectively (for IMRT: 23.8% and 22.1%, respectively). Women undergoing treatment at a free-standing radiation facility were significantly more likely to receive IMRT than were women treated at a hospital-based facility (odds ratio for IMRT vs EBRT: 3.89 [95% confidence interval, 2.78-5.45]). No such association was seen for brachytherapy. The median radiation therapy cost per treated patient increased from $5389 in 2001 to $8539 in 2007. Conclusions: IMRT and brachytherapy use increased substantially from 1998 to 2007; overall, radiation therapy costs increased by more than 50%. Radiation oncologists played an important role in treatment choice for both types of radiation therapy, whereas geographic region played a bigger role in the use of IMRT than brachytherapy.

  8. The Adoption of New Adjuvant Radiation Therapy Modalities Among Medicare Beneficiaries With Breast Cancer: Clinical Correlates and Cost Implications

    International Nuclear Information System (INIS)

    Roberts, Kenneth B.; Soulos, Pamela R.; Herrin, Jeph; Yu, James B.; Long, Jessica B.; Dostaler, Edward

    2013-01-01

    Purpose: New radiation therapy modalities have broadened treatment options for older women with breast cancer, but it is unclear how clinical factors, geographic region, and physician preference affect the choice of radiation therapy modality. Methods and Materials: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify women diagnosed with stage I-III breast cancer from 1998 to 2007 who underwent breast-conserving surgery. We assessed the temporal trends in, and costs of, the adoption of intensity modulated radiation therapy (IMRT) and brachytherapy. Using hierarchical logistic regression, we evaluated the relationship between the use of these new modalities and patient and regional characteristics. Results: Of 35,060 patients, 69.9% received conventional external beam radiation therapy (EBRT). Although overall radiation therapy use remained constant, the use of IMRT increased from 0.0% to 12.6% from 1998 to 2007, and brachytherapy increased from 0.7% to 9.0%. The statistical variation in brachytherapy use attributable to the radiation oncologist and geographic region was 41.4% and 9.5%, respectively (for IMRT: 23.8% and 22.1%, respectively). Women undergoing treatment at a free-standing radiation facility were significantly more likely to receive IMRT than were women treated at a hospital-based facility (odds ratio for IMRT vs EBRT: 3.89 [95% confidence interval, 2.78-5.45]). No such association was seen for brachytherapy. The median radiation therapy cost per treated patient increased from $5389 in 2001 to $8539 in 2007. Conclusions: IMRT and brachytherapy use increased substantially from 1998 to 2007; overall, radiation therapy costs increased by more than 50%. Radiation oncologists played an important role in treatment choice for both types of radiation therapy, whereas geographic region played a bigger role in the use of IMRT than brachytherapy

  9. Radiation therapy in the management of patients with breast cancer: why, where, and when

    International Nuclear Information System (INIS)

    Webber, B.M.; Giicksman, A.S.

    1974-01-01

    The applications of radiaition therapy in the management of all stages of breast cancer has been reviewed. It is obvious that, as the disease progresses through its spectrum from early subclinical cancer to far-advanced incurable disease, the uses of radiation vary. In the very early case irradiation is a valuable primary therapeutic method and when properly administered, offers the probability of long-term local control which is equivalent to that offered by radical surgery. It is advised that radiation treatment be reserved for those who ultimately manifest evidences of local tumor recurrence on the chest wall or in the regional node-bearing areas. When such manifestations occur, intensive radiation to the appropriate areas is indicated and has a high probability of eradicating the local tumor. In patients in whom the disease is moderately advanced so that they are essentially inoperable by reasonable standards, radiation therapy can play an important role in preparing the local field for surgical intervention. A combination of preoperative irradiation and mastectomy in these patients offers the highest probability of permanent local control of tumor. It is postulated that the addition of prolonged chemotherapeutic management in such patients may be of value in reducing the tumor burden within the inevitable metastatic deposits which are present. Whether or not treatment of this sort can completely eliminate these metastases remains to be seen. In the patient with far-advanced metastatic disease, radiation therapy is a valuable local method of palliation, offering an excellent therapy controlling symptoms in such areas as the eye and the central nervous system. Tumor which recurs on the chest wall following prior treatment with supervoltage irradiation can often be well managed by re-irradiation with the electron beam. (U.S.)

  10. Radiation Therapy, Cardiac Risk Factors, and Cardiac Toxicity in Early-Stage Breast Cancer Patients

    International Nuclear Information System (INIS)

    Doyle, John J.; Neugut, Alfred I.; Jacobson, Judith S.; Wang Jian; McBride, Russell; Grann, Alison; Grann, Victor R.; Hershman, Dawn

    2007-01-01

    Purpose: The benefits of adjuvant radiation therapy (RT) for breast cancer may be counterbalanced by the risk of cardiac toxicity. We studied the cardiac effects of RT and the impact of pre-existing cardiac risk factors (CRFs) in a population-based sample of older patients with breast cancer. Methods and Materials: In the Surveillance, Epidemiology and End-Results (SEER)-Medicare database of women ≥65 years diagnosed with Stages I to III breast cancer from January 1, 1992 to December 31, 2000, we used multivariable logistic regression to model the associations of demographic and clinical variables with postmastectomy and postlumpectomy RT. Using Cox proportional hazards regression, we then modeled the association between treatment and myocardial infarction (MI) and ischemia in the 10 or more years after diagnosis, taking the predictors of treatment into account. Results: Among 48,353 women with breast cancer; 19,897 (42%) were treated with lumpectomy and 26,534 (55%) with mastectomy; the remainder had unknown surgery type (3%). Receipt of RT was associated with later year of diagnosis, younger age, fewer comorbidities, nonrural residence, and chemotherapy. Postlumpectomy RT was also associated with white ethnicity and no prior history of heart disease (HD). The RT did not increase the risk of MI. Presence of MI was associated with age, African American ethnicity, advanced stage, nonrural residence, more than one comorbid condition, a hormone receptor-negative tumor, CRFs and HD. Among patients who received RT, tumor laterality was not associated with MI outcome. The effect of RT on the heart was not influenced by HD or CRFs. Conclusion: It appears unlikely that RT would increase the risk of MI in elderly women with breast cancer, regardless of type of surgery, tumor laterality, or history of CRFs or HD, for at least 10 years

  11. Individualized Selection of Beam Angles and Treatment Isocenter in Tangential Breast Intensity Modulated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Penninkhof, Joan, E-mail: j.penninkhof@erasmusmc.nl [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Spadola, Sara [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Department of Physics and Astronomy, Alma Mater Studiorum, University of Bologna, Bologna (Italy); Breedveld, Sebastiaan; Baaijens, Margreet [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Lanconelli, Nico [Department of Physics and Astronomy, Alma Mater Studiorum, University of Bologna, Bologna (Italy); Heijmen, Ben [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands)

    2017-06-01

    Purpose and Objective: Propose a novel method for individualized selection of beam angles and treatment isocenter in tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: For each patient, beam and isocenter selection starts with the fully automatic generation of a large database of IMRT plans (up to 847 in this study); each of these plans belongs to a unique combination of isocenter position, lateral beam angle, and medial beam angle. The imposed hard planning constraint on patient maximum dose may result in plans with unacceptable target dose delivery. Such plans are excluded from further analyses. Owing to differences in beam setup, database plans differ in mean doses to organs at risk (OARs). These mean doses are used to construct 2-dimensional graphs, showing relationships between: (1) contralateral breast dose and ipsilateral lung dose; and (2) contralateral breast dose and heart dose (analyzed only for left-sided). The graphs can be used for selection of the isocenter and beam angles with the optimal, patient-specific tradeoffs between the mean OAR doses. For 30 previously treated patients (15 left-sided and 15 right-sided tumors), graphs were generated considering only the clinically applied isocenter with 121 tangential beam angle pairs. For 20 of the 30 patients, 6 alternative isocenters were also investigated. Results: Computation time for automatic generation of 121 IMRT plans took on average 30 minutes. The generated graphs demonstrated large variations in tradeoffs between conflicting OAR objectives, depending on beam angles and patient anatomy. For patients with isocenter optimization, 847 IMRT plans were considered. Adding isocenter position optimization next to beam angle optimization had a small impact on the final plan quality. Conclusion: A method is proposed for individualized selection of beam angles in tangential breast IMRT. This may be especially important for patients with cardiac risk factors or an

  12. Clinical investigation of predictors of radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy

    International Nuclear Information System (INIS)

    Matsuyama, Tomohiko; Furusawa, Mitsuhiro; Yasunaga, Tadamasa; Nishimura, Reiki; Ohya, Natsuo

    2011-01-01

    We investigated 710 patients with breast cancer who received radiotherapy after breast-conserving surgery at our institution to evaluate the incidence of radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome focusing on the interval from irradiation to onset and the clinical presentation. The predictive value of age (≤50 or >50), chemotherapy and hormone therapy was statistically analyzed to determine whether these are risk factors for BOOP syndrome. Radiation-induced BOOP syndrome was seen in 1.3% (9/710). In most cases, the symptoms were mild and none of the patients required hospitalization. Eight patients (88.9%) responded well to steroid administration, but 5 of these patients relapsed after or during tapering of steroids. Although we could not detect significant risk factors for BOOP syndrome, a higher patient age was associated with a higher incidence of radiation-induced BOOP syndrome after breast-conserving therapy. (author)

  13. Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013

    International Nuclear Information System (INIS)

    Taylor, Carolyn W.; Wang, Zhe; Macaulay, Elizabeth; Jagsi, Reshma; Duane, Frances; Darby, Sarah C.

    2015-01-01

    Purpose: Breast cancer radiation therapy cures many women, but where the heart is exposed, it can cause heart disease. We report a systematic review of heart doses from breast cancer radiation therapy that were published during 2003 to 2013. Methods and Materials: Eligible studies were those reporting whole-heart dose (ie, dose averaged over the whole heart). Analyses considered the arithmetic mean of the whole-heart doses for the CT plans for each regimen in each study. We termed this “mean heart dose.” Results: In left-sided breast cancer, mean heart dose averaged over all 398 regimens reported in 149 studies from 28 countries was 5.4 Gy (range, <0.1-28.6 Gy). In regimens that did not include the internal mammary chain (IMC), average mean heart dose was 4.2 Gy and varied with the target tissues irradiated. The lowest average mean heart doses were from tangential radiation therapy with either breathing control (1.3 Gy; range, 0.4-2.5 Gy) or treatment in the lateral decubitus position (1.2 Gy; range, 0.8-1.7 Gy), or from proton radiation therapy (0.5 Gy; range, 0.1-0.8 Gy). For intensity modulated radiation therapy mean heart dose was 5.6 Gy (range, <0.1-23.0 Gy). Where the IMC was irradiated, average mean heart dose was around 8 Gy and varied little according to which other targets were irradiated. Proton radiation therapy delivered the lowest average mean heart dose (2.6 Gy, range, 1.0-6.0 Gy), and tangential radiation therapy with a separate IMC field the highest (9.2 Gy, range, 1.9-21.0 Gy). In right-sided breast cancer, the average mean heart dose was 3.3 Gy based on 45 regimens in 23 studies. Conclusions: Recent estimates of typical heart doses from left breast cancer radiation therapy vary widely between studies, even for apparently similar regimens. Maneuvers to reduce heart dose in left tangential radiation therapy were successful. Proton radiation therapy delivered the lowest doses. Inclusion of the IMC doubled typical heart dose.

  14. Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer.

    Science.gov (United States)

    Albuquerque, Kevin; Tell, Dina; Lobo, Philip; Millbrandt, Linda; Mathews, Herbert L; Janusek, Linda Witek

    2012-06-18

    This pilot study used a prospective longitudinal design to compare the effect of adjuvant whole breast radiation therapy (WBRT) versus partial breast radiation therapy (PBRT) on fatigue, perceived stress, quality of life and natural killer cell activity (NKCA) in women receiving radiation after breast cancer surgery. Women (N = 30) with early-stage breast cancer received either PBRT, Mammosite brachytherapy at dose of 34 Gy 10 fractions/5 days, (N = 15) or WBRT, 3-D conformal techniques at dose of 50 Gy +10 Gy Boost/30 fractions, (N = 15). Treatment was determined by the attending oncologist after discussion with the patient and the choice was based on tumor stage and clinical need. Women were assessed prior to initiation of radiation therapy and twice after completion of radiation therapy. At each assessment, blood was obtained for determination of NKCA and the following instruments were administered: Perceived Stress Scale (PSS), Functional Assessment of Cancer Therapy-Fatigue (FACT-F), and Functional Assessment of Cancer Therapy-General (FACT-G). Hierarchical linear modeling (HLM) was used to evaluate group differences in initial outcomes and change in outcomes over time. Fatigue (FACT-F) levels, which were similar prior to radiation therapy, demonstrated a significant difference in trajectory. Women who received PBRT reported progressively lower fatigue; conversely fatigue worsened over time for women who received WBRT. No difference in perceived stress was observed between women who received PBRT or WBRT. Both groups of women reported similar levels of quality of life (FACT-G) prior to initiation of radiation therapy. However, HLM analysis revealed significant group differences in the trajectory of quality of life, such that women receiving PBRT exhibited a linear increase in quality of life over time after completion of radiation therapy; whereas women receiving WBRT showed a decreasing trajectory. NKCA was also similar between therapy

  15. Association between skin phototype and radiation dermatitis in patients with breast cancer treated with breast-conserving therapy. Suntan reaction could be a good predictor for radiation pigmentation

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Nishimura, Takuya; Kobayashi, Kana; Tsubokura, Takuji; Kodani, Naohiro; Aibe, Norihiro; Nishimura, Tsunehiko; Yoshida, Ken

    2011-01-01

    The purpose of this study was to evaluate the significance of skin phototype (suntan or sunburn type) in association with radiation dermatitis in patients with breast cancer who underwent postoperative radiotherapy after breast-conserving surgery because phototype could predict sunlight reaction. We divided patients into two phototypes (58 suntan/darkening and 28 sunburn/reddening types) according to self-reports before radiotherapy. We examined skin color changes in 86 patients who underwent breast-conserving surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost radiation (10 Gy/5 fractions). Color change was assessed according to CIE L*a*b* space, which is defined by the Commission Internationale de l'Eclairage (CIE) in 1976 for quantitative color assessment. The patients were also assessed by individual typology angle (ITA deg; indicator of skin color calculated by L*a*b* space) and Common Terminology Criteria for Adverse Event v3.0 (CTCAE v3). Radiation therapy changed all values except the b* value, and the suntan type showed a greater darkening response associated with radiation dermatitis than did the sunburn type in terms of ITA deg value change (p=0.04), whereas the sunburn type did not show higher a* value (reddening). By CTCAE v3 classifications, a Grade 2 reaction appeared in 14% sunburn patients and in 31% of the suntan group, respectively (p=0.16). Suntan type predicted higher pigmentation associated with radiation dermatitis. Self-reported phototype has the potential to be a good predictor of skin sensitivity to radiation exposure for clinical screening. (author)

  16. Disparities in the Use of Postmastectomy Radiation Therapy for Inflammatory Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Loveland-Jones, Catherine [MD Anderson Cancer Center at Cooper, Camden, New Jersey (United States); Lin, Heather; Shen, Yu; Bedrosian, Isabelle; Shaitelman, Simona; Kuerer, Henry [University of Texas, MD Anderson Cancer Center, Houston, Texas (United States); Woodward, Wendy; Ueno, Naoto; Valero, Vicente [University of Texas, MD Anderson Cancer Center, Houston, Texas (United States); MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas (United States); Babiera, Gildy, E-mail: gvbabiera@mdanderson.org [University of Texas, MD Anderson Cancer Center, Houston, Texas (United States); MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas (United States)

    2016-07-15

    Purpose: Although radiation therapy improves locoregional control and survival for inflammatory breast cancer (IBC), it is underused in this population. The purpose of this study was to identify variables associated with the underuse of postmastectomy radiation therapy (PMRT) for IBC. Methods and Materials: Using the 1998 to 2011 National Cancer Data Base, we identified 8273 women who underwent mastectomy for nonmetastatic IBC. We used logistic regression modeling to determine the demographic, tumor, and treatment variables associated with the underuse of PMRT. Results: Although the use of PMRT increased over time, a total of 30.3% of our cohort did not receive PMRT. On multivariate analysis, variables associated with the underuse of PMRT for IBC included the following (all P<.05): Medicare insurance (odds ratio [OR] = 0.70), annual income <$34,999 (<$30,000: OR=0.79; $30,000-$34,999: OR=0.82), cN2 and cN0 disease (cN2: OR=0.71; cN0: OR=0.63), failure to receive chemotherapy and hormone therapy (chemotherapy: OR=0.15; hormone therapy: OR=0.35), treatment at lower-volume centers (OR=0.83), and treatment in the South and West (South: OR=0.73; West: OR=0.80). Greater distance between patient's residence and radiation facility was also associated with the underuse of PMRT (P=.0001). Conclusions: Although the use of PMRT for IBC has increased over time, it continues to be underused. Disparities related to a variety of variables impact which IBC patients receive PMRT. A concerted effort must be made to address these disparities in order to optimize the outcomes for IBC.

  17. Radiation therapy for primary breast lymphoma in male gynecomastia: a rare case report and review of the literature.

    Science.gov (United States)

    Ishibashi, Naoya; Hata, Masaharu; Mochizuki, Takao; Ogawa, Kogi; Sugiura, Hiroaki; Takekawa, Yoshinori; Maebayashi, Toshiya; Aizawa, Takuya; Sakaguchi, Masakuni; Abe, Osamu

    2016-10-01

    Primary breast lymphoma is a rare type of non-Hodgkin lymphoma and usually affects women, although a few cases have been reported in men. Chemotherapy and radiation therapy, or a combination of both, are frequently administered for treatment of primary breast lymphoma, as local control by surgical resection is poor. No standard therapy has been established, and the optimal radiation dose and irradiation field for male patients are unknown. The present report describes a 75-year-old man with bilateral cirrhosis-induced gynecomastia who was diagnosed with primary breast lymphoma; specifically, diffuse large B-cell lymphoma. Because of his hepatic dysfunction, he was treated with radiation therapy alone. Radiation therapy was followed by eight cycles of rituximab monotherapy. Clinical response was good, with no signs of relapse. Clinicians may benefit from knowledge regarding effective treatment of primary breast lymphoma in male patients, which has been rarely reported owing to the low incidence of this condition. The outcome in the present case may help to establish effective treatment guidelines in similar cases.

  18. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    International Nuclear Information System (INIS)

    Bondiau, Pierre-Yves; Courdi, Adel; Bahadoran, Phillipe; Chamorey, Emmanuel; Queille-Roussel, Catherine; Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc

    2013-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial

  19. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bondiau, Pierre-Yves, E-mail: pierre-yves.bondiau@nice.unicancer.fr [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Courdi, Adel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Bahadoran, Phillipe [Department of Dermatology, University Hospital of Nice, Nice (France); Chamorey, Emmanuel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Queille-Roussel, Catherine [Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice (France); Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France)

    2013-04-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial.

  20. Prognostic factors in breast cancer with extracranial oligometastases and the appropriate role of radiation therapy.

    Science.gov (United States)

    Yoo, Gyu Sang; Yu, Jeong Il; Park, Won; Huh, Seung Jae; Choi, Doo Ho

    2015-12-01

    To identify prognostic factors for disease progression and survival of patients with extracranial oligometastatic breast cancer (EOMBC), and to investigate the role of radiation therapy (RT) for metastatic lesions. We retrospectively reviewed the medical records of 50 patients who had been diagnosed with EOMBC following standard treatment for primary breast cancer initially, and received RT for metastatic lesions, with or without other systemic therapy between January 2004 and December 2008. EOMBC was defined as breast cancer with five or less metastases involving any organs except the brain. All patients had bone metastasis (BM) and seven patients had pulmonary, hepatic, or lymph node metastasis. Median RT dose applied to metastatic lesions was 30 Gy (range, 20 to 60 Gy). The 5-year tumor local control (LC) and 3-year distant progression-free survival (DPFS) rate were 66.1% and 36.8%, respectively. High RT dose (≥50 Gy10) was significantly associated with improved LC. The 5-year overall survival (OS) rate was 49%. Positive hormone receptor status, pathologic nodal stage of primary cancer, solitary BM, and whole-lesion RT (WLRT), defined as RT whose field encompassed entire extent of disease, were associated with better survival. On analysis for subgroup of solitary BM, high RT dose was significantly associated with improved LC and DPFS, shorter metastasis-to-RT interval (≤1 month) with improved DPFS, and WLRT with improved DPFS and OS, respectively. High-dose RT in solitary BM status and WLRT have the potential to improve the progression-free survival and OS of patients with EOMBC.

  1. Prognostic factors in breast cancer with extracranial oligometastases and the appropriate role of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Gyu Sang; Yu, Jeong Il; Park, Won; Huh, Seung Jae; Choi, Doo Ho [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    To identify prognostic factors for disease progression and survival of patients with extracranial oligometastatic breast cancer (EOMBC), and to investigate the role of radiation therapy (RT) for metastatic lesions. We retrospectively reviewed the medical records of 50 patients who had been diagnosed with EOMBC following standard treatment for primary breast cancer initially, and received RT for metastatic lesions, with or without other systemic therapy between January 2004 and December 2008. EOMBC was defined as breast cancer with five or less metastases involving any organs except the brain. All patients had bone metastasis (BM) and seven patients had pulmonary, hepatic, or lymph node metastasis. Median RT dose applied to metastatic lesions was 30 Gy (range, 20 to 60 Gy). The 5-year tumor local control (LC) and 3-year distant progression-free survival (DPFS) rate were 66.1% and 36.8%, respectively. High RT dose (> or =50 Gy10) was significantly associated with improved LC. The 5-year overall survival (OS) rate was 49%. Positive hormone receptor status, pathologic nodal stage of primary cancer, solitary BM, and whole-lesion RT (WLRT), defined as RT whose field encompassed entire extent of disease, were associated with better survival. On analysis for subgroup of solitary BM, high RT dose was significantly associated with improved LC and DPFS, shorter metastasis-to-RT interval (< or =1 month) with improved DPFS, and WLRT with improved DPFS and OS, respectively. High-dose RT in solitary BM status and WLRT have the potential to improve the progression-free survival and OS of patients with EOMBC.

  2. A multicenter investigation of late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated whole-breast radiation therapy

    International Nuclear Information System (INIS)

    Nozaki, Miwako; Kagami, Yoshikazu; Mitsumori, Michihide; Hiraoka, Masahiro

    2012-01-01

    The objective of this study was to investigate late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated radiation therapy in 24 hospitals. This is a prospective investigation into patients who have been followed for 3 years or more after the completion of radiation therapy. The women visited hospitals for routine medical follow-up between 1 March and 31 May 2008. All patients underwent interviews and visual/palpating examinations. Their clinical chart, past chest X-rays and laboratory findings were reviewed. Evaluation criteria for late adverse events and breast cosmetic outcome were based on the Common Terminology Criteria for Adverse Events v.3 and the European Organization for Research and Treatment of Cancer Global Cosmetic Rating System. Seven hundred and three women, including 448 treated with whole-breast irradiation and 255 treated with whole-breast and boost irradiation, were examined by radiation oncologists in 24 hospitals. The frequent adverse events were breast pain (Grade 1, 115; Grade 2, 2), breast fibrosis (Grade 1, 72; Grade 2, 8), chest wall pain (Grade 1, 67; Grade 2, 3), telangiectasia (Grade 1, 29; Grade 2, 5) and pneumonitis (Grade 1, 20; Grade 2, 6; Grade 3, 3). Adverse events of Grade 2 or 3 were found in 27 patients (3.8%); 3 presented with radiation pneumonitis of Grade 3. The percentage of patients with an excellent or good cosmetic outcome was 69.1%. In the first multicenter investigation for Japanese women after breast-conserving therapy, the evaluation of late adverse events and breast cosmetic outcome was similar to several other reports from clinical trials in North America and Europe. (author)

  3. Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume.

    Science.gov (United States)

    Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Sundberg, Agnetha; Wilderäng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

    2015-06-01

    To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand. After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V40 Gy ≥ 13.5 cm(3), compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes

    International Nuclear Information System (INIS)

    Chan, Elisa K.; Woods, Ryan; McBride, Mary L.; Virani, Sean; Nichol, Alan; Speers, Caroline; Wai, Elaine S.; Tyldesley, Scott

    2014-01-01

    Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast

  5. Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Elisa K. [Department of Oncology, Saint John Regional Hospital, Saint John (Canada); Woods, Ryan; McBride, Mary L. [Cancer Control Research Department, BC Cancer Agency, Vancouver (Canada); Virani, Sean [Division of Cardiology, University of British Columbia, Vancouver (Canada); Nichol, Alan [Radiation Therapy Program, BC Cancer Agency, Vancouver (Canada); Speers, Caroline [Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver (Canada); Wai, Elaine S. [Radiation Therapy Program, BC Cancer Agency, Vancouver (Canada); Tyldesley, Scott, E-mail: styldesl@bccancer.bc.ca [Radiation Therapy Program, BC Cancer Agency, Vancouver (Canada)

    2014-03-15

    Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast

  6. A case of recurrent breast cancer with intramedullary spinal cord metastasis and symptomatic improvement by Radiation Therapy

    International Nuclear Information System (INIS)

    Wakahara, Makoto; Hosoya, Keiko; Hirooka, Yumi

    2017-01-01

    A 65-year-old woman underwent surgery for right breast cancer (TIN1aM0) in December 2005. In March 2011, the breast cancer recurred with multiple lung and lymph node metastases. In February 2013, because of multiple brain metastases whole-brain radiation therapy was performed. In January 2014, she developed paralysis of the left leg. Spinal cord magnetic resonance imaging revealed a mass lesion (Th12 to L1 level) in the spinal cord, and she was diagnosed with intramedullary spinal cord metastasis (ISCM) from the breast cancer. Spinal cord irradiation reduced the metastasis and improved her paralysis. Although pharmacotherapy was continued, her metastases, with the exception of ISCM, progressed and she died of the disease in November 2014. It is necessary to diagnose ISCM at the time of its onset. Additionally immediate therapeutic intervention can significantly reduce the volume of ISCM, resulting in symptomatic relief from neurological deficit; in this case, radiation therapy was effective. (author)

  7. The effect of laughter therapy on radiation dermatitis in patients with breast cancer: a single-blind prospective pilot study

    Science.gov (United States)

    Kong, Moonkyoo; Shin, Sung Hee; Lee, Eunmi; Yun, Eun Kyoung

    2014-01-01

    Background There have not yet been any published studies on the effects of laughter therapy on radiation-induced dermatitis in breast cancer patients treated with radiotherapy (RT). We assessed the effectiveness of laughter therapy in preventing radiation dermatitis in patients with breast cancer. Methods Thirty-seven patients were prospectively enrolled in this study. Eighteen patients were assigned to the experimental group and the other 19 patients were assigned to the control group. The patients who were assigned to the experimental group received laughter therapy during RT. Laughter therapy was started at the onset of RT and was provided twice a week until completion of RT. The patients who were assigned to the control group only received RT without laughter therapy. The grade of radiation dermatitis was scored by a radiation oncologist who was blinded to subject assignment. The patients’ evaluation of pain within the RT field was also assessed. Results In the experimental group, radiation dermatitis of grade 3, 2, and 1 developed in five (33.3%), five (33.3%), and five patients (33.3%), respectively. In comparison, in the control group, radiation dermatitis of grade 3, 2, 1, and 0 developed in seven (36.8%), nine (47.4%), two (10.5%), and one patient (5.3%), respectively. The experimental group exhibited a lower incidence of grade 2 or worse radiation dermatitis than the control group (33.3% versus 47.4%). The mean maximal pain scores in the experimental and control group were 2.53 and 3.95, respectively. The experimental group complained of less severe pain than the control group during RT. However, these differences were not statistically significant. Conclusion The results of this study show that laughter therapy can have a beneficial role in preventing radiation dermatitis in patients with breast cancer. To confirm the results of our study, well-designed randomized studies with large sample sizes are required. PMID:25395864

  8. The Effect of Reflexology on the Pain-Insomnia-Fatigue Disturbance Cluster of Breast Cancer Patients During Adjuvant Radiation Therapy.

    Science.gov (United States)

    Tarrasch, Ricardo; Carmel-Neiderman, Narin N; Ben-Ami, Sarah; Kaufman, Bella; Pfeffer, Raphi; Ben-David, Merav; Gamus, Dorit

    2018-01-01

    To evaluate the effects of reflexology treatment on quality of life, sleep disturbances, and fatigue in breast cancer patients during radiation therapy. A total of 72 women with breast cancer (stages 1-3) scheduled for radiation therapy were recruited. Women were allocated upon their preference either to the group receiving reflexology treatments once a week concurrently with radiotherapy and continued for 10 weeks or to the control group (usual care). The Lee Fatigue Scale, General Sleep Disturbance Scale, and Multidimensional Quality of Life Scale Cancer were completed by each patient in both arms at the beginning of the radiation treatment, after 5 weeks, and after 10 weeks of reflexology treatment. The final analysis included 58 women. The reflexology treated group demonstrated statistically significant lower levels of fatigue after 5 weeks of radiation therapy (p fatigue, quality of sleep, pain, and quality of life in breast cancer patients during radiation therapy. Reflexology prevented the decline in quality of life and significantly ameliorated the fatigue and quality of sleep of these patients. An encouraging trend was also noted in amelioration of pain levels.

  9. Evaluation of Breast Sentinel Lymph Node Coverage by Standard Radiation Therapy Fields

    International Nuclear Information System (INIS)

    Rabinovitch, Rachel; Ballonoff, Ari; Newman, Francis M.S.; Finlayson, Christina

    2008-01-01

    Background: Biopsy of the breast sentinel lymph node (SLN) is now a standard staging procedure for early-stage invasive breast cancer. The anatomic location of the breast SLN and its relationship to standard radiation fields has not been described. Methods and Materials: A retrospective review of radiotherapy treatment planning data sets was performed in patients with breast cancer who had undergone SLN biopsy, and those with a surgical clip at the SLN biopsy site were identified. The location of the clip was evaluated relative to vertebral body level on an anterior-posterior digitally reconstructed radiograph, treated whole-breast tangential radiation fields, and standard axillary fields in 106 data sets meeting these criteria. Results: The breast SLN varied in vertebral body level position, ranging from T2 to T7 but most commonly opposite T4. The SLN clip was located below the base of the clavicle in 90%, and hence would be excluded from standard axillary radiotherapy fields where the inferior border is placed at this level. The clip was within the irradiated whole-breast tangent fields in 78%, beneath the superior-posterior corner multileaf collimators in 12%, and outside the tangent field borders in 10%. Conclusions: Standard axillary fields do not encompass the lymph nodes at highest risk of containing tumor in breast cancer patients. Elimination of the superior-posterior corner MLCs from the tangent field design would result in inclusion of the breast SLN in 90% of patients treated with standard whole-breast irradiation

  10. Accelerated Radiation Therapy After Surgery in Treating Patients With Breast Cancer

    Science.gov (United States)

    2017-11-15

    Inflammatory Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Tubular Ductal Breast Carcinoma

  11. Cosmesis and Breast-Related Quality of Life Outcomes After Intraoperative Radiation Therapy for Early Breast Cancer: A Substudy of the TARGIT-A Trial

    Energy Technology Data Exchange (ETDEWEB)

    Corica, Tammy, E-mail: Tammy.Corica@health.wa.gov.au [Radiation Oncology Clinical Trials and Research Unit, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia (Australia); Nowak, Anna K. [School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia (Australia); Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); Saunders, Christobel M. [School of Surgery, University of Western Australia, Crawley, Western Australia (Australia); Department of Surgery Fiona Stanley Hospital, Western Australia (Australia); Bulsara, Max [Institute for Health Research, University of Notre Dame, Fremantle, Western Australia (Australia); Taylor, Mandy [Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital Nedlands, Western Australia (Australia); Vaidya, Jayant S. [Department of Surgery, Royal Free Hospital, London (United Kingdom); Clinical Trials Group, Division of Surgery and Interventional Science, University College, London, London (United Kingdom); Department of Surgery, Whittington Health, London (United Kingdom); Baum, Michael [Clinical Trials Group, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Joseph, David J. [School of Surgery, University of Western Australia, Western Australia (Australia); Genesis Cancer Care, Western Australia (Australia); Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Western Australia (Australia)

    2016-09-01

    Purpose: To report the first comprehensive investigation of patient-reported cosmesis and breast-related quality of life (QOL) outcomes comparing patients randomized to risk-adapted single-dose intraoperative radiation therapy (TARGIT-IORT) versus external beam radiation therapy (EBRT) on the TARGIT-A trial. Methods and Materials: Longitudinal cosmesis and QOL data were collected from a subset of TARGIT-A participants who received TARGIT-IORT as a separate procedure (postpathology). Patients completed a cosmetic assessment before radiation therapy and annually thereafter for at least 5 years. Patients also completed the combined European Organization for Research and Treatment of Cancer (EORTC) core questionnaire and Breast-Specific Module in addition to the Body Image after Breast Cancer Questionnaire at baseline and annually thereafter. The combined EORTC questionnaires were also collected 3, 6, and 9 months after wide local excision. Results: An Excellent–Good cosmetic result was scored more often than a Fair–Poor result for both treatment groups across all time points. The TARGIT-IORT patients reported better breast-related QOL than EBRT patients. Statistically and clinically significant differences were seen at month 6 and year 1, with EBRT patients having moderately worse breast symptoms (a statistically significant difference of more than 10 in a 100-point scale) than TARGIT-IORT patients at these time points. Conclusion: Patients treated with TARGIT-IORT on the TARGIT-A trial have similar self-reported cosmetic outcome but better breast-related QOL outcomes than patients treated with EBRT. This important evidence can facilitate the treatment decision-making process for patients who have early breast cancer suitable for breast-conserving surgery and inform their clinicians.

  12. Cosmesis and Breast-Related Quality of Life Outcomes After Intraoperative Radiation Therapy for Early Breast Cancer: A Substudy of the TARGIT-A Trial

    International Nuclear Information System (INIS)

    Corica, Tammy; Nowak, Anna K.; Saunders, Christobel M.; Bulsara, Max; Taylor, Mandy; Vaidya, Jayant S.; Baum, Michael; Joseph, David J.

    2016-01-01

    Purpose: To report the first comprehensive investigation of patient-reported cosmesis and breast-related quality of life (QOL) outcomes comparing patients randomized to risk-adapted single-dose intraoperative radiation therapy (TARGIT-IORT) versus external beam radiation therapy (EBRT) on the TARGIT-A trial. Methods and Materials: Longitudinal cosmesis and QOL data were collected from a subset of TARGIT-A participants who received TARGIT-IORT as a separate procedure (postpathology). Patients completed a cosmetic assessment before radiation therapy and annually thereafter for at least 5 years. Patients also completed the combined European Organization for Research and Treatment of Cancer (EORTC) core questionnaire and Breast-Specific Module in addition to the Body Image after Breast Cancer Questionnaire at baseline and annually thereafter. The combined EORTC questionnaires were also collected 3, 6, and 9 months after wide local excision. Results: An Excellent–Good cosmetic result was scored more often than a Fair–Poor result for both treatment groups across all time points. The TARGIT-IORT patients reported better breast-related QOL than EBRT patients. Statistically and clinically significant differences were seen at month 6 and year 1, with EBRT patients having moderately worse breast symptoms (a statistically significant difference of more than 10 in a 100-point scale) than TARGIT-IORT patients at these time points. Conclusion: Patients treated with TARGIT-IORT on the TARGIT-A trial have similar self-reported cosmetic outcome but better breast-related QOL outcomes than patients treated with EBRT. This important evidence can facilitate the treatment decision-making process for patients who have early breast cancer suitable for breast-conserving surgery and inform their clinicians.

  13. Reduction mammaplasty and radiation therapy can allow breast conservation in patients with breast cancers not initially treatable by tumor-ectomy

    International Nuclear Information System (INIS)

    Otmezguine, Y.; Calitchi, E.; Cothier, I.; Feuilhade, F.; Le Bourgeois, J.P.; Baruch, J.

    1997-01-01

    A protocol combining reduction mammaplasty (RM) and radiation therapy was developed as an alternative of mastectomy in patients with breast cancers larger than 3 cm in diameter. This protocol was used in 51 patients between 1983 and 1990. Indications were extensive microcalcifications (n = 17; 33 %) ; residual tumor after neo-adjuvant therapy larger than 4 cm in diameter (n 18 ; 35 %); extensive DCIS (n = 4; 8 %) or tumor located within an area of fibrocystic disease (n = 6; 12 %); presence of a bifocal lesion (n = 12 %. area of fibrocystic disease (n = 6; 12 %); and presence of bifocal lesion (n 6; 12 %). Surgery consisted of tumor-ectomy removing a wide margin of skin and mammary gland, followed by immediate remodeling of the breast, same-side axillary node clearance, and symmetrization of the other breast. A radiation dose of 45 Gy was delivered to the entire mammary gland. Adjuvant therapy was given before and/or after therapy according to the institution's routine breast cancer protocol. During the mean follow-up of 8.1 years, four patients (8 %) developed a local recurrence, which has treated surgically. The five-year disease-free survival rate was 76 %. The cosmetic result was good or very good in 78% of cases. RM plus RT is a reasonable alternative to mastectomy in patients with large breast cancers, although further work is needed to refine its indications. (authors)

  14. Dosimetric comparison of three intensity-modulated radiation therapies for left breast cancer after breast-conserving surgery.

    Science.gov (United States)

    Zhang, Huai-Wen; Hu, Bo; Xie, Chen; Wang, Yun-Lai

    2018-05-01

    This study aimed to evaluate dosimetric differences of intensity-modulated radiation therapy (IMRT) in target and normal tissues after breast-conserving surgery. IMRT five-field plan I, IMRT six-field plan II, and field-in-field-direct machine parameter optimization-IMRT plan III were designed for each of the 50 patients. One-way analysis of variance was performed to compare differences, and P mean dose (D mean ) for the heart (P optimization-IMRT plans III can reduce doses and volumes to the lungs and heart better while maintaining satisfying conformity index and homogeneity index of target. Nevertheless, plan II neglects target movements caused by respiration. In the same manner, plan III can substantially reduce MU and shorten patient treatment time. Therefore, plan III, which considers target movement caused by respiration, is a more practical radiation mode. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  15. Adoption of Hypofractionated Radiation Therapy for Breast Cancer After Publication of Randomized Trials

    International Nuclear Information System (INIS)

    Jagsi, Reshma; Falchook, Aaron D.; Hendrix, Laura H.; Curry, Heather; Chen, Ronald C.

    2014-01-01

    Purpose: Large randomized trials have established the noninferiority of shorter courses of “hypofractionated” radiation therapy (RT) to the whole breast compared to conventional courses using smaller daily doses in the adjuvant treatment of selected breast cancer patients undergoing lumpectomy. Hypofractionation is more convenient and less costly. Therefore, we sought to determine uptake of hypofractionated breast RT over time. Methods and Materials: In the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database, we identified 16,096 women with node-negative breast cancer and 4269 with ductal carcinoma in situ (DCIS) who received lumpectomy followed by more than 12 fractions of RT between 2004 and 2010. Based on Medicare claims, we determined the number of RT treatments given and grouped patients into those receiving hypofractionation (13-24) or those receiving conventional fractionation (≥25). We also determined RT technique (intensity modulated RT or not) using Medicare claims. We evaluated patterns and correlates of hypofractionation receipt using bivariate and multivariable analyses. Results: Hypofractionation use was similar in patients with DCIS and those with invasive disease. Overall, the use of hypofractionation increased from 3.8% in 2006 to 5.4% in 2007, to 9.4% in 2008, and to 13.6% in 2009 and 2010. Multivariable analysis showed increased use of hypofractionation in recent years and in patients with older age, smaller tumors, increased comorbidity, higher regional education, and Western SEER regions. However, even in patients over the age of 80, the hypofractionation rate in 2009 to 2010 was only 25%. Use of intensity modulated RT (IMRT) also increased over time (from 9.4% in 2004 to 22.7% in 2009-2010) and did not vary significantly between patients receiving hypofractionation and those receiving traditional fractionation. Conclusions: Hypofractionation use increased among low-risk older US breast cancer patients with

  16. Adoption of Hypofractionated Radiation Therapy for Breast Cancer After Publication of Randomized Trials

    Energy Technology Data Exchange (ETDEWEB)

    Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan (United States); Falchook, Aaron D.; Hendrix, Laura H. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Curry, Heather [Radiation Oncology, Eviti, Inc, Philadelphia, Pennsylvania (United States); Chen, Ronald C. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States)

    2014-12-01

    Purpose: Large randomized trials have established the noninferiority of shorter courses of “hypofractionated” radiation therapy (RT) to the whole breast compared to conventional courses using smaller daily doses in the adjuvant treatment of selected breast cancer patients undergoing lumpectomy. Hypofractionation is more convenient and less costly. Therefore, we sought to determine uptake of hypofractionated breast RT over time. Methods and Materials: In the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database, we identified 16,096 women with node-negative breast cancer and 4269 with ductal carcinoma in situ (DCIS) who received lumpectomy followed by more than 12 fractions of RT between 2004 and 2010. Based on Medicare claims, we determined the number of RT treatments given and grouped patients into those receiving hypofractionation (13-24) or those receiving conventional fractionation (≥25). We also determined RT technique (intensity modulated RT or not) using Medicare claims. We evaluated patterns and correlates of hypofractionation receipt using bivariate and multivariable analyses. Results: Hypofractionation use was similar in patients with DCIS and those with invasive disease. Overall, the use of hypofractionation increased from 3.8% in 2006 to 5.4% in 2007, to 9.4% in 2008, and to 13.6% in 2009 and 2010. Multivariable analysis showed increased use of hypofractionation in recent years and in patients with older age, smaller tumors, increased comorbidity, higher regional education, and Western SEER regions. However, even in patients over the age of 80, the hypofractionation rate in 2009 to 2010 was only 25%. Use of intensity modulated RT (IMRT) also increased over time (from 9.4% in 2004 to 22.7% in 2009-2010) and did not vary significantly between patients receiving hypofractionation and those receiving traditional fractionation. Conclusions: Hypofractionation use increased among low-risk older US breast cancer patients with

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

    Energy Technology Data Exchange (ETDEWEB)

    Farace, Paolo [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.

  18. Planning hybrid intensity modulated radiation therapy for whole-breast irradiation.

    Science.gov (United States)

    Farace, Paolo; Zucca, Sergio; Solla, Ignazio; Fadda, Giuseppina; Durzu, Silvia; Porru, Sergio; Meleddu, Gianfranco; Deidda, Maria Assunta; Possanzini, Marco; Orrù, Sivia; Lay, Giancarlo

    2012-09-01

    To test tangential and not-tangential hybrid intensity modulated radiation therapy (IMRT) for whole-breast irradiation. 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. 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 (∼5 Gy) distribution in the contralateral tissue, heart, and lungs but with no significant increase of higher doses (∼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. 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. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

    Farace, Paolo; Zucca, Sergio; Solla, Ignazio; Fadda, Giuseppina; Durzu, Silvia; Porru, Sergio; Meleddu, Gianfranco; Deidda, Maria Assunta; Possanzini, Marco; Orrù, Sivia; Lay, Giancarlo

    2012-01-01

    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 (∼5 Gy) distribution in the contralateral tissue, heart, and lungs but with no significant increase of higher doses (∼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.

  20. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast

    International Nuclear Information System (INIS)

    Harris, J.R.; Levene, M.B.; Svensson, G.; Hellman, S.

    1979-01-01

    In 31 cases of Stages I or II carcinoma of the breast treated by primary radiation therapy, the cosmetic results were analyzed with regard to the details of treatment. Three principal treatment factors were identified which influenced the cosmetic outcome: (1) the extent and location of the biopsy procedure; (2) the time/dose factors of the radiation therapy; and (3) the technique of the radiation therapy. Cosmetic results were lessened when the biopsy procedure included a wide resection of adjacent breast tissue or when the biopsy scar was obvious. Increasing doses of external beam radiation were associated with greater degrees of retraction and fibrosis of the treated breast. All 6 patients who received 6000 rad by external beam had significant retraction, and fibrosis while patients who received 5000 rad rarely showed significant changes. Local boost doses by interstitial implantation did not diminsh the cosmetic outcome. All patients were treated using supervoltage equipment without bolus and skin changes secondary to treatment were infrequent. Seventeen patients developed localized areas of fibrosis and skin changes at the matchline between adjacent radiation fields. Recommendations are made for improved cosmetic results based on these findings

  1. The effect of laughter therapy on radiation dermatitis in patients with breast cancer: a single-blind prospective pilot study

    Directory of Open Access Journals (Sweden)

    Kong M

    2014-11-01

    Full Text Available Moonkyoo Kong,1 Sung Hee Shin,2 Eunmi Lee,3 Eun Kyoung Yun2 1Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, 2College of Nursing Science, Kyung Hee University, 3Department of Quality Improvement, Kyung Hee University Medical Center, Seoul, Republic of Korea Background: There have not yet been any published studies on the effects of laughter therapy on radiation-induced dermatitis in breast cancer patients treated with radiotherapy (RT. We assessed the effectiveness of laughter therapy in preventing radiation dermatitis in patients with breast cancer. Methods: Thirty-seven patients were prospectively enrolled in this study. Eighteen patients were assigned to the experimental group and the other 19 patients were assigned to the control group. The patients who were assigned to the experimental group received laughter therapy during RT. Laughter therapy was started at the onset of RT and was provided twice a week until completion of RT. The patients who were assigned to the control group only received RT without laughter therapy. The grade of radiation dermatitis was scored by a radiation oncologist who was blinded to subject assignment. The patients' evaluation of pain within the RT field was also assessed. Results: In the experimental group, radiation dermatitis of grade 3, 2, and 1 developed in five (33.3%, five (33.3%, and five patients (33.3%, respectively. In comparison, in the control group, radiation dermatitis of grade 3, 2, 1, and 0 developed in seven (36.8%, nine (47.4%, two (10.5%, and one patient (5.3%, respectively. The experimental group exhibited a lower incidence of grade 2 or worse radiation dermatitis than the control group (33.3% versus 47.4%. The mean maximal pain scores in the experimental and control group were 2.53 and 3.95, respectively. The experimental group complained of less severe pain than the control group during RT. However, these differences were not

  2. Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy

    International Nuclear Information System (INIS)

    DiBiase, Steven J.; Komarnicky, Lydia T.; Heron, Dwight E.; Schwartz, Gordon F.; Mansfield, Carl M.

    2002-01-01

    Purpose: Positive surgical margins adversely influence local tumor control in breast conservation therapy (BCT). However, reports have conflicted regarding whether an increased radiation dose can overcome this poor prognostic factor. In this study, we evaluated the influence of an increased radiation dose on tumor control in women with positive surgical margins undergoing BCT. Methods and Materials: Between 1978 and 1994, 733 women with pathologic Stage I-II breast cancer and known surgical margin status were treated at Thomas Jefferson University Hospital with BCT. Of these 733 patients, 641 women had a minimal tumor bed dose of 60 Gy and had documentation of their margin status; 509 had negative surgical margins, and 132 had positive surgical margins before definitive radiotherapy. Complete gross excision of the tumor and axillary lymph node sampling was obtained in all patients. The median radiation dose to the primary site was 65.0 Gy (range 60-76). Of the women with positive margins (n=132), the influence of higher doses of radiotherapy was evaluated. The median follow-up time was 52 months. Results: The local tumor control rate for patients with negative margins at 5 and 10 years was 94% and 88%, respectively, compared with 85% and 67%, respectively, for those women with positive margins (p=0.001). The disease-free survival rate for the negative margin group at 5 and 10 years was 91% and 82%, respectively, compared with 76% and 71%, respectively, for the positive margin group (p = 0.001). The overall survival rate of women with negative margins at 5 and 10 years was 95% and 90%, respectively. By comparison, for women with positive surgical margins, the overall survival rate at 5 and 10 years was 86% and 79%, respectively (p=0.008). A comparison of the positive and negative margin groups revealed that an increased radiation dose (whether entered as a dichotomous or a continuous variable) >65.0 Gy did not improve local tumor control (p=0.776). On Cox

  3. Breast-Conserving Surgery Followed by Radiation Therapy With MRI-Detected Stage I or Stage II Breast Cancer

    Science.gov (United States)

    2011-12-07

    Ductal Breast Carcinoma in Situ; Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; HER2-positive Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Progesterone Receptor-negative Breast Cancer; Progesterone Receptor-positive Breast Cancer; Stage I Breast Cancer; Stage II Breast Cancer; Tubular Ductal Breast Carcinoma

  4. The effects of radiation therapy on quality of life in women with breast cancer: Results of a randomized trial

    International Nuclear Information System (INIS)

    Whelan, T.; Levine, M.; Julian, J.; Skingley, P.; Kirkbride, P.; Clark, R.; Lipa, M.; Wilkinson, R.

    1997-01-01

    Purpose/Objective: The effects of radiation therapy on quality of life of women with breast cancer are not well known. The purpose of this study was to evaluate the effect of breast irradiation on quality of life including cosmetic outcome in the context of a randomized controlled trial. Methods: Between 1984 and 1989 a randomized trial was conducted in Ontario in which women with node-negative breast cancer who had undergone lumpectomy and axillary section were randomized either to postoperative radiation (4000 cGy in 16 fractions to the whole breast, followed by a boost of 1250 cGy in five fractions to the primary site) or no further treatment (J Natl Cancer Inst 1996; 88:1659). A modified version of the breast cancer chemotherapy questionnaire (J Clin Oncol 1988; 6:1798) containing 17 items was administered to women at baseline, one month and two months postrandomization. Each item was scored on a Likert scale from ''1'' All of the Time to ''7'' None of the Time. Patient assessments of breast pain and cosmetic outcome were also evaluated every three months for the first two years of the study. Results: Of 837 patients, 416 were randomly allocated to radiation therapy and 421 to no further treatment. The groups were comparable in terms of baseline characteristics. Factor analysis identified three different domains of the quality of life instrument: emotional/social, fatigue, and physical/inconvenience. There was a significant difference in the physical/inconvenience and fatigue domain scores between the radiation and control groups over time. The differences in scores between groups at two months post randomization were 0.97, p = 0.0001; 0.33, p=0.0001; and 0.03, p=0.62 for the physical/inconvenience, fatigue and emotional/social domains respectively. The percentage of patients who were troubled by breast pain differed between radiation and control groups up to one year (33.3% vs 19.9%, p = 0.001 at 6 months). Beyond one year, no difference was detected. The

  5. Radiation therapy planning of patients with breast cancer with the aid of parasternal lymphoscintigraphy

    International Nuclear Information System (INIS)

    Ohtake, Eiji

    1982-01-01

    This investigation was undertaken to establish the basis of the precise radiotherapy planning of the parasternal lymph nodes for patients with breast cancer. Twenty-four female patients with breast cancer were examined by parasternal lymphoscintigraphy. Their ages ranged from 26 to 76 years (average: 51.8 yrs). The parasternal lymphoscintigram was obtained 4 hours after bilateral subcostal injection of sup(99m)Tc-sulfur colloid or sup(99m)Tc-antimony sulfide colloid. The three-dimensional location of the lymph nodes was observed using both a conventional parallel hole collimator and a bilateral collimator. The following results were obtained. 1) The widest distance between the right and left chains of the parasternal lymph nodes was 5.6 +- 1.0 cm (n = 17, range: 4.1 - 7.7 cm). 2) The average lateral distance of the lymph nodes from the midsternal line was 2.3 +- 0.8 cm (n = 88, range: 0.7 - 5.2 cm). The lateral distance tended to be longer on the right side than on the left side. 3) The average depth of the lymph nodes from the surface of the skin was 2.3 +- 0.7 cm (n = 116, range: 0.9 - 4.3 cm). 4) The more the patients were obese, the more deeply seated the parasternal lymph nodes tended to be. 5) In the retrospective analysis of the conventional radiotherapy planning at the Tokyo Metropolitan Geriatric Hospital, it was found that about 59% of the parasternal lymph nodes were located in the radiation field and about 19% of the lymph nodes were seated within +-1 cm of the objective depth. In this paper, the author tries to emphasize that it might be important to examine the exact location and depth of the parasternal lymph nodes in each patient for the radiation therapy planning. (author)

  6. Pilot study of breast sensation after breast reconstruction: evaluating the effects of radiation therapy and perforator flap neurotization on sensory recovery.

    Science.gov (United States)

    Magarakis, Michael; Venkat, Raghunandan; Dellon, A Lee; Shridharani, Sachin M; Bellamy, Justin; Vaca, Elbert E; Jeter, Stacie C; Zoras, Odysseas; Manahan, Michele A; Rosson, Gedge D

    2013-09-01

    Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation. Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy (minimum follow-up, 18 months; range, 18-61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions. Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps. Copyright © 2013 Wiley Periodicals, Inc.

  7. Sarcomas following radiation therapy for breast cancer: a report of three cases and a review of the literature

    International Nuclear Information System (INIS)

    Pendlebury, Susan C.; Bilous, Michael; Langlands, Allan O.

    1995-01-01

    Purpose: First to describe clinical and pathologic features of sarcomas arising after radiation therapy for breast cancer and to report three cases of sarcoma arising 7, 15, and 20 years following radiation therapy for breast cancer. Second, to review the literature on this treatment complication. Methods and Materials: Medline literature search. Results: The most frequent histology is osteosarcoma and bone is affected more commonly than soft tissue at a median latency of 11 years. The scapula is the most frequently affected bone. The most frequently affected soft tissue site is now the conserved breast with a median latency of 5.5 years. The aetiologic factors relating to these sarcomas are not fully defined with factors of beam energy, radiation dose, chemotherapy and regional edema being inconsistently reported. Conclusion: The frequency of radiation-induced sarcoma at 10 years of follow-up is approximately 0.2%. This is an overestimate by an unknown factor because of the description of sarcomas arising metachromously in breast cancer patients, in nonirradiated areas

  8. Choosing Wisely? Patterns and Correlates of the Use of Hypofractionated Whole-Breast Radiation Therapy in the State of Michigan

    Energy Technology Data Exchange (ETDEWEB)

    Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [University of Michigan, Ann Arbor, Michigan (United States); Heimburger, David [Munson Medical Center, Traverse City, Michigan (United States); Walker, Eleanor M. [Henry Ford Hospital, Detroit, Michigan (United States); Grills, Inga S. [Beaumont Health System, Royal Oak, Michigan (United States); Boike, Thomas [McLaren Northern Michigan, Petoskey, Michigan (United States); Feng, Mary; Moran, Jean M.; Hayman, James; Pierce, Lori J. [University of Michigan, Ann Arbor, Michigan (United States)

    2014-12-01

    Purpose: Given evidence from randomized trials that have established the non-inferiority of more convenient and less costly courses of hypofractionated radiotherapy to the whole breast in selected breast cancer patients who receive lumpectomy, we sought to investigate the use of hypofractionated radiation therapy and factors associated with its use in a consortium of radiation oncology practices in Michigan. We sought to determine the extent to which variation in use occurs at the physician or practice level versus the extent to which use reflects individualization based on potentially relevant patient characteristics (such as habitus, age, chemotherapy receipt, or laterality). Methods and Materials: We evaluated associations between receipt of hypofractionated radiation therapy and various patient, provider, and practice characteristics in a multilevel model. Results: Of 1477 patients who received lumpectomy and whole-breast radiation therapy and were registered by the Michigan Radiation Oncology Quality Consortium (MROQC) from October 2011 to December 2013, 913 had T1-2, N0 breast cancer. Of these 913, 283 (31%) received hypofractionated radiation therapy. Among the 13 practices, hypofractionated radiation therapy use ranged from 2% to 80%. On multilevel analysis, 51% of the variation in the rate of hypofractionation was attributable to the practice level, 21% to the provider level, and 28% to the patient level. On multivariable analysis, hypofractionation was more likely in patients who were older (odds ratio [OR] 2.16 for age ≥50 years, P=.007), less likely in those with larger body habitus (OR 0.52 if separation between tangent entry and exit ≥25 cm, P=.002), and more likely without chemotherapy receipt (OR 3.82, P<.001). Hypofractionation use was not higher in the last 6 months analyzed: 79 of 252 (31%) from June 2013 to December 2013 and 204 of 661 (31%) from October 2011 to May 2013 (P=.9). Conclusions: Hypofractionated regimens of whole-breast

  9. The Impact of Axillary Lymph Node Surgery on Breast Skin Thickening During and After Radiation Therapy for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Mylin A., E-mail: matorre@emory.edu [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Yang, Xiaofeng [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Noreen, Samantha [Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia (United States); Chen, Hao [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Provision Center for Proton Therapy, Knoxville, Tennessee (United States); Han, Tatiana; Henry, Simone; Mister, Donna [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Andic, Fundagal [Department of Radiation Oncology, Cukurova University School of Medicine, Adana (Turkey); Long, Qi [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia (United States); Liu, Tian [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2016-06-01

    Purpose: This prospective study was conducted to determine predictors of epidermal thickening during and after whole-breast radiation therapy (XRT) using objective measurements acquired with ultrasound. Methods and Materials: After breast-conserving surgery, 70 women received a definitive course of whole-breast XRT (50 Gy plus boost). Prior to XRT, at week 6 of XRT, and 6 weeks after XRT, patients underwent objective ultrasound measurements of epidermal thickness over the lumpectomy cavity and all 4 quadrants of the treated breast. A skin thickness ratio (STRA) was then generated normalizing for corresponding measurements taken of the untreated breast. Results: Baseline measurements indicated that 87% of patients had skin thickening in the treated versus untreated breast (mean increase, 27%; SD, 0.29) prior to XRT. The STRA increased significantly by week 6 of XRT (mean, 25%; SD, 0.46) and continued to increase significantly 6 weeks after XRT (mean, 33%; SD, 0.46) above baseline measurements (P<.001 for both time points). On multivariate analysis, breast volume (P=.003) and surgical evaluation of the axilla with full lymph node dissection (P<.05) predicted for more severe changes in the STRA 6 weeks after XRT compared with baseline. STRA measurements correlated with physician ratings of skin toxicity according to Radiation Therapy Oncology Group grading criteria. Conclusions: This is one of the first studies to objectively document that lymph node surgery affects XRT-induced skin thickening in patients with breast cancer. Surgical evaluation of the axilla with complete lymph node dissection was associated with the most severe XRT-induced skin changes after XRT completion. These results may inform future studies aimed at minimizing side effects of XRT and surgery, particularly when surgical lymph node assessments may not alter breast cancer management or outcome.

  10. The Impact of Axillary Lymph Node Surgery on Breast Skin Thickening During and After Radiation Therapy for Breast Cancer

    International Nuclear Information System (INIS)

    Torres, Mylin A.; Yang, Xiaofeng; Noreen, Samantha; Chen, Hao; Han, Tatiana; Henry, Simone; Mister, Donna; Andic, Fundagal; Long, Qi; Liu, Tian

    2016-01-01

    Purpose: This prospective study was conducted to determine predictors of epidermal thickening during and after whole-breast radiation therapy (XRT) using objective measurements acquired with ultrasound. Methods and Materials: After breast-conserving surgery, 70 women received a definitive course of whole-breast XRT (50 Gy plus boost). Prior to XRT, at week 6 of XRT, and 6 weeks after XRT, patients underwent objective ultrasound measurements of epidermal thickness over the lumpectomy cavity and all 4 quadrants of the treated breast. A skin thickness ratio (STRA) was then generated normalizing for corresponding measurements taken of the untreated breast. Results: Baseline measurements indicated that 87% of patients had skin thickening in the treated versus untreated breast (mean increase, 27%; SD, 0.29) prior to XRT. The STRA increased significantly by week 6 of XRT (mean, 25%; SD, 0.46) and continued to increase significantly 6 weeks after XRT (mean, 33%; SD, 0.46) above baseline measurements (P<.001 for both time points). On multivariate analysis, breast volume (P=.003) and surgical evaluation of the axilla with full lymph node dissection (P<.05) predicted for more severe changes in the STRA 6 weeks after XRT compared with baseline. STRA measurements correlated with physician ratings of skin toxicity according to Radiation Therapy Oncology Group grading criteria. Conclusions: This is one of the first studies to objectively document that lymph node surgery affects XRT-induced skin thickening in patients with breast cancer. Surgical evaluation of the axilla with complete lymph node dissection was associated with the most severe XRT-induced skin changes after XRT completion. These results may inform future studies aimed at minimizing side effects of XRT and surgery, particularly when surgical lymph node assessments may not alter breast cancer management or outcome.

  11. Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy – PROCAB guidelines

    International Nuclear Information System (INIS)

    Verhoeven, Karolien; Weltens, Caroline; Remouchamps, Vincent; Mahjoubi, Khalil; Veldeman, Liv; Lengele, Benoit; Hortobagyi, Eszter; Kirkove, Carine

    2015-01-01

    Objective: A national project to improve the quality of breast radiation therapy was started, named PROCAB (PROject on CAncer of the Breast). One of the objectives was to reach a national consensus guideline for the delineation of the regional lymph node areas in breast radiation therapy. Methods: The realization of the new guidelines was a step by step process that started with multiple expert meetings where the existing guidelines were analyzed and the delineations of the lymph node regions were performed together with a surgeon, specialized in the anatomy of the drainage of the breast. Results: The delineation guidelines are vessel-based. Since the occurrence of pathological lymph nodes is typically around the veins, the cranial and caudal borders of all different nodal regions are based on a 5 mm margin around the veins, except for the parasternal lymph node area. Compared to the existing guidelines there are some major changes. Conclusion: With this project a national as well as a European (ESTRO) consensus guideline for the delineation of the regional lymph node areas in breast RT is reached. The new delineation atlas is vessel-based and no longer field-based

  12. Radiation therapy planning of a breast cancer patient with in situ pacemaker-challenges and lessons

    Energy Technology Data Exchange (ETDEWEB)

    Munshi, Anusheel; Wadasadawala, Tabassum; Budrukkar, Ashwini; Jalali, Rakesh; Dinshaw, Ketayun A [Dept. of Radiation Oncology, Tata Memorial Hospital, Mumbai (India); Sharma, Pramod Kumar; Sharma, Dayananda [Dept. of Radiation Physics, Tata Memorial Hospital, Mumbai (India)

    2008-02-15

    A postmenopausal lady with an in situ pacemaker developed a lump in the left breast and was diagnosed to have breast cancer. The patient underwent breast conservative surgery and was planned for post operative radiotherapy. The location of the tumor relative to the pacemaker provided a unique challenge in planning radiotherapy and the patient had an uneventful post radiotherapy course. A literature review revealed that modern generation pacemakers are very sensitive to radiation compared to their older counterparts. The present article makes suggestions towards reducing dose in radiotherapy planning in pacemaker patients

  13. Radiation therapy planning of a breast cancer patient with in situ pacemaker-challenges and lessons

    International Nuclear Information System (INIS)

    Munshi, Anusheel; Wadasadawala, Tabassum; Budrukkar, Ashwini; Jalali, Rakesh; Dinshaw, Ketayun A.; Sharma, Pramod Kumar; Sharma, Dayananda

    2008-01-01

    A postmenopausal lady with an in situ pacemaker developed a lump in the left breast and was diagnosed to have breast cancer. The patient underwent breast conservative surgery and was planned for post operative radiotherapy. The location of the tumor relative to the pacemaker provided a unique challenge in planning radiotherapy and the patient had an uneventful post radiotherapy course. A literature review revealed that modern generation pacemakers are very sensitive to radiation compared to their older counterparts. The present article makes suggestions towards reducing dose in radiotherapy planning in pacemaker patients

  14. Simultaneous adjuvant radiation therapy and chemotherapy in high-risk breast cancer--toxicity and dose modification: a trans-tasman radiation oncology group multi-institution study

    International Nuclear Information System (INIS)

    Denham, James W.; Hamilton, Christopher S.; Christie, David; O'Brien, Maree; Bonaventura, Antonino; Stewart, John F.; Ackland, Stephen P.; Lamb, David S.; Spry, Nigel A.; Dady, Peter; Atkinson, Christopher H.; Wynne, Christopher; Joseph, David J.

    1995-01-01

    Purpose: To establish the toxicity profile of simultaneously administered postoperative radiation therapy and CMF chemotherapy as a prelude to a randomized controlled study addressing the sequencing of the two modalities. Methods and Materials: One hundred and thirty eight breast cancer patients at high risk of locoregional, as well as systemic relapse, who were referred to three centers in Australia and New Zealand were treated with postoperative radiation therapy and chemotherapy simultaneously. Acute toxicity and dose modifications in these patients were compared with 83 patients treated over the same time frame with chemotherapy alone. In a separate study the long-term radiation and surgical effects in 24 patients treated simultaneously with radiation therapy and chemotherapy at Newcastle (Australia) following conservative surgery were compared with 23 matched patients treated at Newcastle with radiation therapy alone. Results: Myelotoxicity was increased in patients treated simultaneously with radiation therapy and chemotherapy. The effect was not great, but may have contributed to chemotherapy dose reductions. Lymphopenia was observed to be the largest factor in total white cell depressions caused by the simultaneous administration of radiation therapy. Postsurgical appearances were found to so dominate long-term treatment effects on the treated breast that the effect of radiation therapy dose and additional chemotherapy was difficult to detect. Conclusion: Studies addressing the sequencing of radiation therapy and chemotherapy will necessarily be large because adverse effects from administering the two modalities simultaneously are not great. The present study has endorsed the importance in future studies of stratification according to the extent and type of surgery and adherence to a single strict policy of chemotherapy dose modification

  15. The sequencing of radiation therapy and chemotherapy after mastectomy in premenopausal women with breast cancer

    International Nuclear Information System (INIS)

    Cakir, S.; Gursel, B.; Meydan, D.; Yildiz, L.

    2003-01-01

    The purpose of this study was to evaluate the prognostic importance of the sequencing of radiation therapy and chemotherapy after mastectomy in high-risk premenopausal women with breast cancer in addition to other known prognostic factors in the literature. In this retrospective study, 176 premenopausal women with breast cancer were evaluated. The median age at referral was 39 years (range, 28-59 years); 106 patients had stage II and 70 had stage III disease. All were subjected to mastectomy. The median number of lymph nodes removed was 19. The influence of age, histological grade, number of nodes removed, number of positive nodes, tumor size, estrogen receptor status, lymphovascular invasion and sequencing of radiotherapy and chemotherapy on 5-year locoregional disease-free survival, 5-year systemic disease-free survival, 5-year disease-free survival and 5-year cancer-specific survival were studied. The 5-year locoregional disease-free survival was 94% for the entire patient population. Because of the small number of locoregional recurrences, none of the evaluated factors was prognostically significant for locoregional recurrence. The 5-year systemic disease-free, disease-free and cancer-specific survival rates were 72, 70 and 77%, respectively. On multi-variate analysis of host, tumor and treatment-related factors, the number of positive nodes [risk ratio (RR) 1.9 (95% confidence interval (CI): 1.36-2.63), RR 2 (1.46-2.84) and RR 1.8 (1.3-2.71), respectively], histopathological grade [RR 1.8 (95% CI: 1.24-2.65), RR 1.9 (1.34-2.88), RR 2.5 (1.65-4.07), respectively], estrogen receptor status [RR 3.5 (95% CI: 1.5-8.6), RR 3.9 (1.64-9.41), RR 2.5 (1.05-6.24), respectively] and the sequencing of radiotherapy and chemotherapy [RR 1.6 (95% CI: 1.17-2.39), RR 1.7 (1.25-2.54), RR 1.6 (1.14-2.43), respectively] were all significant independent predictors of outcome. Our results show that in addition to traditional prognostic factors, the sequencing of radiation therapy

  16. Adjuvant Radiation Therapy and Survival for Pure Tubular Breast Carcinoma-Experience From the SEER Database

    Energy Technology Data Exchange (ETDEWEB)

    Li Baoqing, E-mail: bal9018@med.cornell.edu [Department of Radiation Oncology, Weill Cornell Medical College, New York, New York (United States); Chen, Margaret [Department of Surgery, Weill Cornell Medical College, New York, New York (United States); Nori, Dattatreyudu; Chao, K.S. Clifford [Department of Radiation Oncology, Weill Cornell Medical College, New York, New York (United States); Chen, Allen M. [Department of Radiation Oncology, University of California Davis Cancer Center, Sacramento, California (United States); Chen, Steven L. [Department of Surgery, University of California Davis Cancer Center, Sacramento, California (United States)

    2012-09-01

    Purpose: Pure tubular carcinoma of the breast (PTCB) represents a distinct subtype of invasive ductal carcinoma (IDC) that is generally thought to be associated with better prognosis than even low-grade IDC. There has been controversy as to the role of adjuvant radiation therapy (RT) in this population. We hypothesized that adjuvant RT would demonstrate a survival improvement. Methods and Materials: We queried the Surveillance, Epidemiology and End Results database for the years 1992-2007 to identify patients with pure tubular carcinomas of the breast. Patient demographics, tumor characteristics, and surgical and RT treatments were collected. Survival analysis was performed using the Kaplan-Meier method for univariate comparisons and Cox proportional hazards modeling for multivariate comparisons, stratifying on the basis of age with a cutoff age of 65. Results: A total of 6465 patients were identified: 3624 (56.1%) patients underwent lumpectomy with RT (LUMP+RT), 1525 (23.6%) patients underwent lumpectomy alone (LUMP), 1266 (19.6%) patients received mastectomy alone (MAST), and 50 (0.8%) patients underwent mastectomy with RT (MAST+RT). When we compared the LUMP+RT and LUMP groups directly, those receiving adjuvant RT tended to be younger and were less likely to be hormone receptor-positive. Overall survival was 95% for LUMP+RT and 90% for LUMP patients at 5 years. For those 65 or younger, the absolute overall survival benefit of LUMP+RT over LUMP was 1% at 5 years and 3% at 10 years. On stratified multivariate analysis, adjuvant RT remained a significant predictor in both age groups (P=.003 in age {<=}65 and P=.04 in age >65 patients). Other significant unfavorable factors were older age and higher T stage (age >65 only). Conclusions: Since sufficiently powered large scale clinical trials are unlikely, we would recommend that adjuvant radiation be considered in PTCB patients age 65 or younger, although consideration of the small absolute survival benefit is

  17. Delineation of Internal Mammary Nodal Target Volumes in Breast Cancer Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jethwa, Krishan R.; Kahila, Mohamed M. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Hunt, Katie N. [Department of Radiology, Mayo Clinic, Rochester, Minnesota (United States); Brown, Lindsay C.; Corbin, Kimberly S.; Park, Sean S.; Yan, Elizabeth S. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Boughey, Judy C. [Department of Surgery, Mayo Clinic, Rochester, Minnesota (United States); Mutter, Robert W., E-mail: mutter.robert@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2017-03-15

    Purpose: The optimal clinical target volume for internal mammary (IM) node irradiation is uncertain in an era of increasingly conformal volume-based treatment planning for breast cancer. We mapped the location of gross internal mammary lymph node (IMN) metastases to identify areas at highest risk of harboring occult disease. Methods and Materials: Patients with axial imaging of IMN disease were identified from a breast cancer registry. The IMN location was transferred onto the corresponding anatomic position on representative axial computed tomography images of a patient in the treatment position and compared with consensus group guidelines of IMN target delineation. Results: The IMN location in 67 patients with 130 IMN metastases was mapped. The location was in the first 3 intercostal spaces in 102 of 130 nodal metastases (78%), whereas 18 of 130 IMNs (14%) were located caudal to the third intercostal space and 10 of 130 IMNs (8%) were located cranial to the first intercostal space. Of the 102 nodal metastases within the first 3 intercostal spaces, 54 (53%) were located within the Radiation Therapy Oncology Group consensus volume. Relative to the IM vessels, 19 nodal metastases (19%) were located medially with a mean distance of 2.2 mm (SD, 2.9 mm) whereas 29 (28%) were located laterally with a mean distance of 3.6 mm (SD, 2.5 mm). Ninety percent of lymph nodes within the first 3 intercostal spaces would have been encompassed within a 4-mm medial and lateral expansion on the IM vessels. Conclusions: In women with indications for elective IMN irradiation, a 4-mm medial and lateral expansion on the IM vessels may be appropriate. In women with known IMN involvement, cranial extension to the confluence of the IM vein with the brachiocephalic vein with or without caudal extension to the fourth or fifth interspace may be considered provided that normal tissue constraints are met.

  18. Internal Radiation Therapy for Cancer

    Science.gov (United States)

    When getting internal radiation therapy, a source of radiation is put inside your body, in either liquid or solid form. It can be used treat different kinds of cancer, including thyroid, head and neck, breast, cervix, prostate, and eye. Learn more about how what to expect when getting internal radiation therapy.

  19. Squamous cell carcinoma of the trachea in a non-smoking woman after radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ishiwa, Naoki; Yamada, Kouzou; Nakayama, Haruhiko; Noda, Kazumasa [Kanagawa Cancer Center, Yokohama (Japan); Kameda, Youichi; Maehara, Takamitsu

    2000-04-01

    Few cases of squamous cell carcinoma of the trachea have been reported in non-smoking women. We report one case which was probably due to radiation therapy. A 50-year-old non-smoking woman was referred to our hospital because wheezing and dyspnea had been aggravated for 3 months. She had received radiation therapy ({sup 60}Cobalt) after standard radical mastectomy for right breast cancer 13 years previously. Bronchoscopic findings and chest CT scan showed tracheal stenosis due to the tumor. Sleeve resection of the trachea was performed, and the tumor was histologically diagnosed as poorly differentiated squamous cell carcinoma. We may consider this case to be radiation-induced cancer compatible with the most strict criteria of radiation induced malignancy. (author)

  20. Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer

    International Nuclear Information System (INIS)

    Gillespie, Erin F.; Matsuno, Rayna K.; Xu, Beibei; Triplett, Daniel P.; Hwang, Lindsay; Boero, Isabel J.; Einck, John P.; Yashar, Catheryn; Murphy, James D.

    2016-01-01

    Purpose: To evaluate geographic heterogeneity in the delivery of hypofractionated radiation therapy (RT) for breast cancer among Medicare beneficiaries across the United States. Methods and Materials: We identified 190,193 patients from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The study included patients aged >65 years diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency ZIP code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT. Results: Over the entire study period we found substantial geographic heterogeneity in the use of hypofractionated RT. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements. Conclusions: This study demonstrates substantial geographic heterogeneity in the use of hypofractionated RT among elderly women with invasive breast cancer treated with lumpectomy in the United States. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared with standard fractionation, and highlights possible inefficiency in health care delivery.

  1. Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gillespie, Erin F.; Matsuno, Rayna K.; Xu, Beibei; Triplett, Daniel P.; Hwang, Lindsay; Boero, Isabel J.; Einck, John P.; Yashar, Catheryn; Murphy, James D., E-mail: j2murphy@ucsd.edu

    2016-10-01

    Purpose: To evaluate geographic heterogeneity in the delivery of hypofractionated radiation therapy (RT) for breast cancer among Medicare beneficiaries across the United States. Methods and Materials: We identified 190,193 patients from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The study included patients aged >65 years diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency ZIP code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT. Results: Over the entire study period we found substantial geographic heterogeneity in the use of hypofractionated RT. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements. Conclusions: This study demonstrates substantial geographic heterogeneity in the use of hypofractionated RT among elderly women with invasive breast cancer treated with lumpectomy in the United States. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared with standard fractionation, and highlights possible inefficiency in health care delivery.

  2. Caloric Restriction in Treating Patients With Stage 0-I Breast Cancer Undergoing Surgery and Radiation Therapy

    Science.gov (United States)

    2017-09-25

    Ductal Breast Carcinoma in Situ; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Lobular Breast Carcinoma in Situ; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer

  3. Comparative accuracy of different techniques in planning radiation therapy of breast cancer

    International Nuclear Information System (INIS)

    Bignardi, M.; Frata, P.; Barbera, F.; Moretti, R.

    1991-01-01

    The authors report the results of the analysis of several factors contributing to the accuracy of treatment planning in the radiation therapy of breast cancer. Different techniques (non-radiological vs CT-based) were used for the acquisition of patients' data; different methods (manual vs computerized) were employed for dose calculation. As for geometric parameters describing the external outline and target volume, mean differences were lower than 4%. Switching from a completely manual method to a CT-based one with computerized calculation, a 3.56% mean decrease in the value of reference isodose (p<0.01) was observed, togheter with a 3.87% mean increase in the estimated inhomogeneity (p<0.001). The non-CT-based outline of target volume exhibited geographic missing of inner portions of the target in 8/16 patients. Our results demonstarte that treatment planning procedures can be a significant source of clinically relevant inaccuracy, which may affect treatment outcome and tumor control

  4. Evaluation of a Thermoplastic Immobilization System for Breast and Chest Wall Radiation Therapy

    International Nuclear Information System (INIS)

    Strydhorst, Jared H.; Caudrelier, Jean-Michel; Clark, Brenda G.; Montgomery, Lynn A.; Fox, Greg; MacPherson, Miller S.

    2011-01-01

    We report on the impact of a thermoplastic immobilization system on intra- and interfraction motion for patients undergoing breast or chest wall radiation therapy. Patients for this study were treated using helical tomotherapy. All patients were immobilized using a thermoplastic shell extending from the shoulders to the ribcage. Intrafraction motion was assessed by measuring maximum displacement of the skin, heart, and chest wall on a pretreatment 4D computed tomography, while inter-fraction motion was inferred from patient shift data arising from daily image guidance procedures on tomotherapy. Using thermoplastic immobilization, the average maximum motion of the external contour was 1.3 ± 1.6 mm, whereas the chest wall was found to be 1.6 ± 1.9 mm. The day-to-day setup variation was found to be large, with random errors of 4.0, 12.0, and 4.5 mm in the left-right, superior-inferior, and anterior-posterior directions, respectively, and the standard deviations of the systematic errors were found to be 2.7, 9.8, and 4.1 mm. These errors would be expected to dominate any respiratory motion but can be mitigated by daily online image guidance. Using thermoplastic immobilization can effectively reduce respiratory motion of the chest wall and external contour, but these gains can only be realized if daily image guidance is used.

  5. The effect of post-mastectomy radiation therapy on breast implants: Unveiling biomaterial alterations with potential implications on capsular contracture

    Energy Technology Data Exchange (ETDEWEB)

    Ribuffo, Diego; Lo Torto, Federico [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Giannitelli, Sara M. [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Urbini, Marco; Tortora, Luca [Surface Analysis Laboratory, Department of Mathematics and Physics, University “Roma Tre”, Via della Vasca Navale 84, 00146 Rome (Italy); INFN — National Institute of Nuclear Physics, Section of Roma Tre, Via della Vasca Navale 84, 00146 Rome (Italy); Mozetic, Pamela; Trombetta, Marcella [Tissue Engineering Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome (Italy); Basoli, Francesco; Licoccia, Silvia [Department of Chemical Science and Technologies, University of Rome “Tor Vergata”, Via della Ricerca Scientifica 1, 00173 Rome (Italy); Tombolini, Vincenzo [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Spencer-Lorillard Foundation, Viale Regina Elena 291, 00161 Rome (Italy); Cassese, Raffaele [Department of Radiation Oncology, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); Scuderi, Nicolò [Department of Plastic Surgery, “Sapienza” University of Rome, Viale del Policlinico 155, 00166 Rome (Italy); and others

    2015-12-01

    Post-mastectomy breast reconstruction with expanders and implants is recognized as an integral part of breast cancer treatment. Its main complication is represented by capsular contracture, which leads to poor expansion, breast deformation, and pain, often requiring additional surgery. In such a scenario, the debate continues as to whether the second stage of breast reconstruction should be performed before or after post-mastectomy radiation therapy, in light of potential alterations induced by irradiation to silicone biomaterial. This work provides a novel, multi-technique approach to unveil the role of radiotherapy in biomaterial alterations, with potential involvement in capsular contracture. Following irradiation, implant shells underwent mechanical, chemical, and microstructural evaluation by means of tensile testing, Attenuated Total Reflectance Fourier Transform InfraRed spectroscopy (ATR/FTIR), Scanning Electron Microscopy (SEM), high resolution stylus profilometry, and Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS). Our findings are consistent with radiation-induced modifications of silicone that, although not detectable at the microscale, can be evidenced by more sophisticated nanoscale surface analyses. In light of these results, biomaterial irradiation cannot be ruled out as one of the possible co-factors underlying capsular contracture. - Highlights: • The debate continues whether to perform breast reconstruction before or after PMRT. • Radiation therapy may alter implant material, concurring to capsular contracture. • In this work, irradiated implants were investigated by a multi-technique approach. • Radiation-induced alterations could be evidenced by ATR/FTIR and ToF-SIMS. • Reported alteration might represent a co-factor underlying capsular contracture.

  6. Cardiovascular event-free survival after adjuvant radiation therapy in breast cancer patients stratified by cardiovascular risk

    International Nuclear Information System (INIS)

    Onwudiwe, Nneka C; Kwok, Young; Onukwugha, Eberechukwu; Sorkin, John D; Zuckerman, Ilene H; Shaya, Fadia T; Daniel Mullins, C

    2014-01-01

    The objective of this study was to estimate the risk of a cardiovascular event or death associated with modern radiation in a population of elderly female breast cancer patients with varying baseline cardiovascular risk. The data used for this analysis are from the linked Surveillance, Epidemiology, and End-Results (SEER)-Medicare database. The retrospective cohort study included women aged 66 years and older with stage 0–III breast cancer diagnosed between 2000 and 2005. Women were grouped as low, intermediate, or high cardiovascular risk based on the presence of certain clinical diagnoses. The risk for the combined outcome of a hospitalization for a cardiovascular event or death within 6 months and 24 months of diagnosis was estimated using a multivariable Cox model. The median follow-up time was 24 months. Among the 91,612 women with American Joint Committee on Cancer (AJCC) stage 0–III breast cancer: 39,555 (43.2%) were treated with radiation therapy and 52,057 (56.8%) were not. The receipt of radiation therapy in the first 6 months was associated with a statistically significant increased risk for the combined outcome in women categorized as high risk (HR = 1.510; 95% CI, 1.396–1.634) or intermediate risk (HR = 1.415; 95% CI, 1.188–1.686) but not low risk (HR = 1.027; 95% CI, 0.798–1.321). Women with a prior medical history of cardiovascular disease treated with radiation therapy are at increased risk for an event and should be monitored for at least 6 months following treatment with radiation therapy

  7. Radiation Therapy of Large Intact Breasts Using a Beam Spoiler or Photons with Mixed Energies

    International Nuclear Information System (INIS)

    Lief, Eugene P.; Hunt, Margie A.; Hong, Linda X.; Amols, Howard I.

    2007-01-01

    Radiation treatment of large intact breasts with separations of more than 24 cm is typically performed using x-rays with energies of 10 MV and higher, to eliminate high-dose regions in tissue. The disadvantage of the higher energy beams is the reduced dose to superficial tissue in the buildup region. We evaluated 2 methods of avoiding this underdosage: (1) a beam spoiler: 1.7-cm-thick Lucite plate positioned in the blocking tray 35 cm from the isocenter, with 15-MV x-rays; and (2) combining 6- and 15-MV x-rays through the same portal. For the beam with the spoiler, we measured the dose distribution for normal and oblique incidence using a film and ion chamber in polystyrene, as well as a scanning diode in a water tank. In the mixed-energy approach, we calculated the dose distributions in the buildup region for different proportions of 6- and 15-MV beams. The dose enhancement due to the beam spoiler exhibited significant dependence upon the source-to-skin distance (SSD), field size, and the angle of incidence. In the center of a 20 x 20-cm 2 field at 90-cm SSD, the beam spoiler raises the dose at 5-mm depth from 77% to 87% of the prescription, while maintaining the skin dose below 57%. Comparison of calculated dose with measurements suggested a practical way of treatment planning with the spoiler-usage of 2-mm 'beam' bolus-a special option offered by in-house treatment planning system. A second method of increasing buildup doses is to mix 6- and 15-MV beams. For example, in the case of a parallel-opposed irradiation of a 27-cm-thick phantom, dose to D max for each energy, with respect to midplane, is 114% for pure 6-, 107% for 15-MV beam with the spoiler, and 108% for a 3:1 mixture of 15- and 6-MV beams. Both methods are practical for radiation therapy of large intact breasts

  8. Assessment of radiation dermatitis using objective analysis for patients with breast cancer treated with breast-conserving therapy. Influence of body weight

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Kobayashi, Kana; Tsubokura, Takuji; Kodani, Naohiro; Aibe, Norihiro; Ikeno, Hiroyasu; Nishimura, Takuya; Yoshida, Ken

    2012-01-01

    The purpose of this study was to evaluate the effect of patient factors on radiation dermatitis for patients with breast cancer who underwent postoperative radiotherapy after breast-conserving surgery. The study population comprised 87 patients who underwent breast-conserving surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost radiation (10 Gy/5 fractions). We examined their treated and contralateral breast skin color by use of an objective analyzer, and expressed findings as L*, a*, b* ratios by dividing by pre-radiotherapy (RT) values. Next, we examined correlation between patient factors (age, height, body weight, and body mass index, BMI) and change of L* and a* values by use of correlation coefficients. Radiation therapy caused changes in a* and L* ratios (p<0.0001) but not in b* ratio. The a* ratio (reddish) increased 1.4-fold and peaked after radiotherapy. The L* ratio (darkening) decreased by 10% and reached a minimum value between completion of radiotherapy and 1 month after treatment. Although, age and height did not affect Δ value, body weight and BMI correlated significantly with Δa* value (p=0.0012 and 0.0017) not with ΔL* value. Body weight and BMI predict degree of radiation dermatitis, and more reddish dermatitis was observed for heavier patients than for their lighter counterparts. (author)

  9. Radiation Therapy in Treating Post-Menopausal Women With Early Stage Breast Cancer Undergoing Surgery

    Science.gov (United States)

    2017-06-07

    Ductal Breast Carcinoma In Situ; Estrogen Receptor Negative; Estrogen Receptor Positive; HER2/Neu Negative; Invasive Cribriform Breast Carcinoma; Invasive Ductal Carcinoma, Not Otherwise Specified; Lobular Breast Carcinoma In Situ; Mucinous Breast Carcinoma; Papillary Breast Carcinoma; Progesterone Receptor Positive; Stage I Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIC Breast Cancer; Tubular Breast Carcinoma

  10. Photobiomodulation therapy for the management of radiation-induced dermatitis. A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery

    International Nuclear Information System (INIS)

    Strouthos, Iosif; Chatzikonstantinou, Georgios; Tselis, Nikolaos; Bon, Dimitra; Karagiannis, Efstratios; Zoga, Eleni; Ferentinos, Konstantinos; Maximenko, Julia; Nikolettou-Fischer, Vassiliki; Zamboglou, Nikolaos

    2017-01-01

    Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT. Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a ''matched'' group (n = 25) was generated from the control group based on propensity for potentially confounding variables. In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5. PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery. (orig.) [de

  11. The role and place of radiation therapy in early treatment of breast cancer in patients with endoprosthesis

    International Nuclear Information System (INIS)

    Sokolovs'ka, M.V.

    2014-01-01

    Radiotherapy reconstructed breast cancer surgery will not different from the traditional methods of irradiation is not operated breast cancer, so do not cause difficulties when conducting pre-radiation prepare patients, dose calculation and technique of procedures. At the same time chemoradiotherapy/radiotherapy of breast cancer patients Stages I-II after radical surgical intervention with the primary reconstruction improves performance a ten-year total survival rate and improved far remote oncological outcomes (local recurrence-free survival and remote recurrence-free survival) in comparison with the independent operational intervention. But in the complex and combined treatment simultaneously postoperative surgical complications have had increased that require prevention and related additional therapy

  12. Radiation therapy

    International Nuclear Information System (INIS)

    Peschel, R.E; Fisher, J.J.

    1986-01-01

    The new insights and controversies concerning the radiobiological properties of malignant melanoma and how these relate to new clinical approaches are reviewed. The recent clinical experience with large individual fraction sizes is analyzed. The treatment of malignant melanoma in certain specialized sites is also described. An attempt is made to place in perspective the usefulness of radiation therapy in the treatment of this complex disease. Finally, certain new applications for radiation therapy both alone and in combustion with other treatment modalities are proposed that may ultimately prove appropriate for clinical trials

  13. A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer

    International Nuclear Information System (INIS)

    Lim, May; Bellon, Jennifer R.; Gelman, Rebecca; Silver, Barbara B.A.; Recht, Abram; Schnitt, Stuart J.; Harris, Jay R.

    2006-01-01

    Purpose: The effectiveness of radiation therapy (RT) in reducing local recurrence after breast-conserving surgery (BCS) in unselected patients with early stage invasive breast cancer has been demonstrated in multiple randomized trials. Whether a subset of women can achieve local control without RT is unknown. In 1986, we initiated a prospective one-arm trial of BCS alone for highly selected breast-cancer patients. This report updates those results. Methods and Materials: Eighty-seven (of 90 planned) patients enrolled from 1986 until closure in 1992, when a predefined stopping boundary was crossed. Patients were required to have a unicentric, T1, pathologic node-negative invasive ductal, mucinous, or tubular carcinoma without an extensive intraductal component or lymphatic-vessel invasion. Surgery included local excision with margins of at least 1 cm or a negative re-excision. No RT or systemic therapy was given. Results: Results are available on 81 patients (median follow-up, 86 months). Nineteen patients (23%) had local recurrence (LR) as a first site of failure (average annual LR: 3.5 per 100 patient-years of follow-up). Other sites of first failure included 1 ipsilateral axilla, 2 contralateral breast cancers, and 4 distant metastases. Six patients developed other (nonbreast) malignancies. Nine patients have died, 4 of metastatic breast cancer and 5 of unrelated causes. Conclusions: Even in this highly selected cohort, a substantial risk of local recurrence occurred after BCS alone with margins of 1.0 cm or more. These results suggest that with the possible exception of elderly women with comorbid conditions, radiation therapy after BCS remains standard treatment

  14. Hypofractionated Image Guided Radiation Therapy in Treating Patients With Stage IV Breast Cancer

    Science.gov (United States)

    2017-06-26

    Central Nervous System Metastases; Invasive Ductal Breast Carcinoma; Invasive Ductal Breast Carcinoma With Predominant Intraductal Component; Invasive Lobular Breast Carcinoma; Invasive Lobular Breast Carcinoma With Predominant in Situ Component; Liver Metastases; Lobular Breast Carcinoma in Situ; Lung Metastases; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Recurrent Breast Cancer; Stage IV Breast Cancer; Tubular Ductal Breast Carcinoma; Tumors Metastatic to Brain

  15. Radiation Dose to the Esophagus From Breast Cancer Radiation Therapy, 1943-1996: An International Population-Based Study of 414 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lamart, Stephanie, E-mail: stephanie.lamart@nih.gov [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States); Stovall, Marilyn [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Simon, Steven L. [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States); Smith, Susan A.; Weathers, Rita E.; Howell, Rebecca M. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Curtis, Rochelle E. [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States); Aleman, Berthe M.P. [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Travis, Lois [Rubin Center for Cancer Survivorship and Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States); Kwon, Deukwoo [Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida (United States); Morton, Lindsay M. [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States)

    2013-07-15

    Purpose: To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. Methods and Materials: We abstracted the radiation therapy treatment parameters from each patient’s radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were {sup 60}Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Results: Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Conclusions: Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower

  16. Radiation Dose to the Esophagus From Breast Cancer Radiation Therapy, 1943-1996: An International Population-Based Study of 414 Patients

    International Nuclear Information System (INIS)

    Lamart, Stephanie; Stovall, Marilyn; Simon, Steven L.; Smith, Susan A.; Weathers, Rita E.; Howell, Rebecca M.; Curtis, Rochelle E.; Aleman, Berthe M.P.; Travis, Lois; Kwon, Deukwoo; Morton, Lindsay M.

    2013-01-01

    Purpose: To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. Methods and Materials: We abstracted the radiation therapy treatment parameters from each patient’s radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were 60 Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Results: Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Conclusions: Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower doses

  17. Radiation dose to the esophagus from breast cancer radiation therapy, 1943-1996: an international population-based study of 414 patients.

    Science.gov (United States)

    Lamart, Stephanie; Stovall, Marilyn; Simon, Steven L; Smith, Susan A; Weathers, Rita E; Howell, Rebecca M; Curtis, Rochelle E; Aleman, Berthe M P; Travis, Lois; Kwon, Deukwoo; Morton, Lindsay M

    2013-07-15

    To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. We abstracted the radiation therapy treatment parameters from each patient's radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were (60)Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower doses. Published by Elsevier Inc.

  18. Radiation therapy

    International Nuclear Information System (INIS)

    Bader, J.L.; Glatstein, E.

    1987-01-01

    The radiation oncologist encounters the critically ill immunosuppressed patient in four settings. First, the newly diagnosed cancer patient presents for initial evaluation and treatment, with immunosuppression from the cancer itself, malnutrition, concomitant infectious disease, prior drug or alcohol abuse or other medical problems. Second, the previously treated cancer patient presents with metastatic or recurrent primary cancer causing local symptoms. Immune dysfunction in this setting may be due to prior chemotherapy and/or radiation as well as any of the original factors. Third, the patient previously treated with radiation presents with a life-threatening problem possibly due to complications of prior therapy. In this setting, the radiation oncologist is asked to evaluate the clinical problem and to suggest whether radiation might be causing part or all of the problem and what can be done to treat these sequelae of radiation. Fourth, the patient with a benign diagnosis (not cancer) is seen with a problem potentially emeliorated by radiation (e.g., kidney transplant rejection, preparation for transplant, or intractable rheumatoid arthritis). This chapter reviews these four issues and presents clinical and radiobiologic principles on which recommendations for therapy are based

  19. Resistance Exercise and Inflammation in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: Mediation Analysis From a Randomized, Controlled Intervention Trial

    International Nuclear Information System (INIS)

    Schmidt, Martina E.; Meynköhn, Anna; Habermann, Nina; Wiskemann, Joachim; Oelmann, Jan; Hof, Holger; Wessels, Sabine; Klassen, Oliver; Debus, Jürgen; Potthoff, Karin; Steindorf, Karen; Ulrich, Cornelia M.

    2016-01-01

    Purpose: To explore the mediating role of inflammatory parameters in the development of fatigue, pain, and potentially related depressive symptoms during radiation therapy for breast cancer and its mitigation by resistance exercise. Methods and Materials: Breast cancer patients scheduled for adjuvant radiation therapy were randomized to 12-week progressive resistance exercise training (EX) or a relaxation control group. Interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were measured in serum samples collected before, at the end, and 6 weeks after radiation therapy from 103 chemotherapy-naïve participants. Fatigue was assessed with the multidimensional Fatigue Assessment Questionnaire, pain with the European Organization for Research and Treatment of Cancer QLQ-C30, and depressive symptoms with the Center for Epidemiologic Studies Depression Scale. Analysis of covariance models, partial correlations, Freedman-Schatzkin tests, and R"2 effect-size measures for mediation were calculated. Results: The analysis of covariance models revealed a significant intervention effect on IL-6 (P=.010) and the IL-6/IL-1ra ratio (P=.018), characterized by a marked increase during radiation therapy among controls, but no significant change in EX. Interleukin-1 receptor antagonist did not change significantly in either group (P=.88). Increased IL-6 and IL-6/IL-1ra levels at the end of radiation therapy were significantly associated with increased physical fatigue and pain 6 weeks after radiation. We observed significant partial mediation by IL-6 and IL-6/IL-1ra of the effect of resistance exercise on physical fatigue (Freedman-Schatzkin P=.023 and P<.001) and pain (both P<.001). Hereby IL-6 and IL-6/IL-1ra mediated between 15% and 24% of the variance of physical fatigue and pain explained by the intervention. Conclusions: This randomized, controlled trial showed a significantly increased proinflammatory cytokine level after adjuvant radiation therapy in breast

  20. Resistance Exercise and Inflammation in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: Mediation Analysis From a Randomized, Controlled Intervention Trial

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Martina E., E-mail: m.schmidt@dkfz.de [Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg (Germany); Meynköhn, Anna; Habermann, Nina [Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg (Germany); Wiskemann, Joachim [Division of Medical Oncology, National Center for Tumor Diseases and University Hospital, Heidelberg (Germany); Oelmann, Jan; Hof, Holger; Wessels, Sabine [Department of Radiation Oncology, National Center for Tumor Diseases and University Hospital, Heidelberg (Germany); Klassen, Oliver [Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg (Germany); Debus, Jürgen; Potthoff, Karin [Department of Radiation Oncology, National Center for Tumor Diseases and University Hospital, Heidelberg (Germany); Steindorf, Karen; Ulrich, Cornelia M. [Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg (Germany)

    2016-02-01

    Purpose: To explore the mediating role of inflammatory parameters in the development of fatigue, pain, and potentially related depressive symptoms during radiation therapy for breast cancer and its mitigation by resistance exercise. Methods and Materials: Breast cancer patients scheduled for adjuvant radiation therapy were randomized to 12-week progressive resistance exercise training (EX) or a relaxation control group. Interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were measured in serum samples collected before, at the end, and 6 weeks after radiation therapy from 103 chemotherapy-naïve participants. Fatigue was assessed with the multidimensional Fatigue Assessment Questionnaire, pain with the European Organization for Research and Treatment of Cancer QLQ-C30, and depressive symptoms with the Center for Epidemiologic Studies Depression Scale. Analysis of covariance models, partial correlations, Freedman-Schatzkin tests, and R{sup 2} effect-size measures for mediation were calculated. Results: The analysis of covariance models revealed a significant intervention effect on IL-6 (P=.010) and the IL-6/IL-1ra ratio (P=.018), characterized by a marked increase during radiation therapy among controls, but no significant change in EX. Interleukin-1 receptor antagonist did not change significantly in either group (P=.88). Increased IL-6 and IL-6/IL-1ra levels at the end of radiation therapy were significantly associated with increased physical fatigue and pain 6 weeks after radiation. We observed significant partial mediation by IL-6 and IL-6/IL-1ra of the effect of resistance exercise on physical fatigue (Freedman-Schatzkin P=.023 and P<.001) and pain (both P<.001). Hereby IL-6 and IL-6/IL-1ra mediated between 15% and 24% of the variance of physical fatigue and pain explained by the intervention. Conclusions: This randomized, controlled trial showed a significantly increased proinflammatory cytokine level after adjuvant radiation therapy in breast

  1. Validity and reliability testing of two instruments to measure breast cancer patients' concerns and information needs relating to radiation therapy

    Directory of Open Access Journals (Sweden)

    Kristjanson Linda J

    2007-11-01

    Full Text Available Abstract Background It is difficult to determine the most effective approach to patient education or tailor education interventions for patients in radiotherapy without tools that assess patients' specific radiation therapy information needs and concerns. Therefore, the aim of this study was to develop psychometrically sound tools to adequately determine the concerns and information needs of cancer patients during radiation therapy. Patients and Methods Two tools were developed to (1 determine patients concerns about radiation therapy (RT Concerns Scale and (2 ascertain patient's information needs at different time point during their radiation therapy (RT Information Needs Scale. Tools were based on previous research by the authors, published literature on breast cancer and radiation therapy and information behaviour research. Thirty-one breast cancer patients completed the questionnaire on one occasion and thirty participants completed the questionnaire on a second occasion to facilitate test-retest reliability. One participant's responses were removed from the analysis. Results were analysed for content validity, internal consistency and stability over time. Results Both tools demonstrated high internal consistency and adequate stability over time. The nine items in the RT Concerns Scale were retained because they met all pre-set psychometric criteria. Two items were deleted from the RT Information Needs Scale because they did not meet content validity criteria and did not achieve pre-specified criteria for internal consistency. This tool now contains 22 items. Conclusion This paper provides preliminary data suggesting that the two tools presented are reliable and valid and would be suitable for use in trials or in the clinical setting.

  2. Disparities in the Use of Radiation Therapy in Patients With Local-Regionally Advanced Breast Cancer

    International Nuclear Information System (INIS)

    Martinez, Steve R.; Beal, Shannon H.; Chen, Steven L.; Canter, Robert J.; Khatri, Vijay P.; Chen, Allen; Bold, Richard J.

    2010-01-01

    Background: Radiation therapy (RT) is indicated for the treatment of local-regionally advanced breast cancer (BCa). Hypothesis: We hypothesized that black and Hispanic patients with local-regionally advanced BCa would receive lower rates of RT than their white counterparts. Methods: The Surveillance Epidemiology and End Results database was used to identify white, black, Hispanic, and Asian patients with invasive BCa and ≥10 metastatic lymph nodes diagnosed between 1988 and 2005. Univariate and multivariate logistic regression evaluated the relationship of race/ethnicity with use of RT. Multivariate models stratified for those undergoing mastectomy or lumpectomy. Results: Entry criteria were met by 12,653 patients. Approximately half of the patients did not receive RT. Most patients were white (72%); the remainder were Hispanic (10.4%), black (10.3%), and Asian (7.3%). On univariate analysis, Hispanics (odd ratio [OR] 0.89; 95% confidence interval [CI], 0.79-1.00) and blacks (OR 0.79; 95% CI, 0.70-0.89) were less likely to receive RT than whites. On multivariate analysis, blacks (OR 0.76; 95% CI, 0.67-0.86) and Hispanics (OR 0.80; 95% CI, 0.70-0.90) were less likely than whites to receive RT. Disparities persisted for blacks (OR 0.74; 95% CI, 0.64-0.85) and Hispanics (OR 0.77; 95% CI, 0.67-0.89) who received mastectomy, but not for those who received lumpectomy. Conclusions: Many patients with local-regionally advanced BCa do not receive RT. Blacks and Hispanics were less likely than whites to receive RT. This disparity was noted predominately in patients who received mastectomy. Future efforts at improving rates of RT are warranted. Efforts at eliminating racial/ethnic disparities should focus on black and Hispanic candidates for postmastectomy RT.

  3. Potential of Hybrid Computational Phantoms for Retrospective Heart Dosimetry After Breast Radiation Therapy: A Feasibility Study

    Energy Technology Data Exchange (ETDEWEB)

    Moignier, Alexandra, E-mail: alexandra.moignier@irsn.fr [Institut de Radioprotection et de Surete Nucleaire, Fontenay-aux-Roses (France); Derreumaux, Sylvie; Broggio, David; Beurrier, Julien [Institut de Radioprotection et de Surete Nucleaire, Fontenay-aux-Roses (France); Chea, Michel; Boisserie, Gilbert [Groupe Hospitalier Pitie Salpetriere, Service de Radiotherapie, Paris (France); Franck, Didier; Aubert, Bernard [Institut de Radioprotection et de Surete Nucleaire, Fontenay-aux-Roses (France); Mazeron, Jean-Jacques [Groupe Hospitalier Pitie Salpetriere, Service de Radiotherapie, Paris (France)

    2013-02-01

    Purpose: Current retrospective cardiovascular dosimetry studies are based on a representative patient or simple mathematic phantoms. Here, a process of patient modeling was developed to personalize the anatomy of the thorax and to include a heart model with coronary arteries. Methods and Materials: The patient models were hybrid computational phantoms (HCPs) with an inserted detailed heart model. A computed tomography (CT) acquisition (pseudo-CT) was derived from HCP and imported into a treatment planning system where treatment conditions were reproduced. Six current patients were selected: 3 were modeled from their CT images (A patients) and the others were modelled from 2 orthogonal radiographs (B patients). The method performance and limitation were investigated by quantitative comparison between the initial CT and the pseudo-CT, namely, the morphology and the dose calculation were compared. For the B patients, a comparison with 2 kinds of representative patients was also conducted. Finally, dose assessment was focused on the whole coronary artery tree and the left anterior descending coronary. Results: When 3-dimensional anatomic information was available, the dose calculations performed on the initial CT and the pseudo-CT were in good agreement. For the B patients, comparison of doses derived from HCP and representative patients showed that the HCP doses were either better or equivalent. In the left breast radiation therapy context and for the studied cases, coronary mean doses were at least 5-fold higher than heart mean doses. Conclusions: For retrospective dose studies, it is suggested that HCP offers a better surrogate, in terms of dose accuracy, than representative patients. The use of a detailed heart model eliminates the problem of identifying the coronaries on the patient's CT.

  4. Feasibility of a pedometer-based walking program for survivors of breast and head and neck cancer undergoing radiation therapy.

    Science.gov (United States)

    Javaheri, Pantea Amin; Nekolaichuk, Cheryl; Haennel, Robert; Parliament, Matthew B; McNeely, Margaret L

    2015-01-01

    This pilot study assessed the feasibility and acceptability of a pedometer-based walking program for people with breast cancer and head and neck cancer (HNC) undergoing radiation therapy treatment. Participants were given a pedometer and prescribed a home-based walking program that included an individualized weekly step-count goal during the 3- to 5-week course of radiation therapy. Feasibility was determined by calculating recruitment rate, completion rate, and rate of adherence. Secondary outcomes included 6-minute walk test (6MWT) distance, step count, physical activity level, and psychological outcomes of depression, happiness, self-esteem, and sleep quality. A total of 21 participants were recruited. All participants completed the study; adherence to prescribed step counts was 91% at follow-up. Analysis found a significant improvement in happiness, as measured by the Oxford Happiness Questionnaire (mean difference 0.3, p=0.003), and a borderline significant improvement in 6MWT distance (mean difference 35 m, p=0.008). This pilot study demonstrated the feasibility of a pedometer-based walking program for survivors of breast cancer and HNC undergoing radiation therapy.

  5. Chemotherapy and radiation therapy elicits tumor specific T cell responses in a breast cancer patient

    International Nuclear Information System (INIS)

    Bernal-Estévez, David; Sánchez, Ramiro; Tejada, Rafael E.; Parra-López, Carlos

    2016-01-01

    Experimental evidence and clinical studies in breast cancer suggest that some anti-tumor therapy regimens generate stimulation of the immune system that accounts for tumor clinical responses, however, demonstration of the immunostimulatory power of these therapies on cancer patients continues to be a formidable challenge. Here we present experimental evidence from a breast cancer patient with complete clinical response after 7 years, associated with responsiveness of tumor specific T cells. T cells were obtained before and after anti-tumor therapy from peripheral blood of a 63-years old woman diagnosed with ductal breast cancer (HER2/neu+++, ER-, PR-, HLA-A*02:01) treated with surgery, followed by paclitaxel, trastuzumab (suspended due to cardiac toxicity), and radiotherapy. We obtained a leukapheresis before surgery and after 8 months of treatment. Using in vitro cell cultures stimulated with autologous monocyte-derived dendritic cells (DCs) that produce high levels of IL-12, we characterize by flow cytometry the phenotype of tumor associated antigens (TAAs) HER2/neu and NY-ESO 1 specific T cells. The ex vivo analysis of the TCR-Vβ repertoire of TAA specific T cells in blood and Tumor Infiltrating Lymphocytes (TILs) were performed in order to correlate both repertoires prior and after therapy. We evidence a functional recovery of T cell responsiveness to polyclonal stimuli and expansion of TAAs specific CD8+ T cells using peptide pulsed DCs, with an increase of CTLA-4 and memory effector phenotype after anti-tumor therapy. The ex vivo analysis of the TCR-Vβ repertoire of TAA specific T cells in blood and TILs showed that whereas the TCR-Vβ04-02 clonotype is highly expressed in TILs the HER2/neu specific T cells are expressed mainly in blood after therapy, suggesting that this particular TCR was selectively enriched in blood after anti-tumor therapy. Our results show the benefits of anti-tumor therapy in a breast cancer patient with clinical complete response in

  6. The influence of optic radiation on the state of the system of homeostasis in patients with breast cancer during radiation therapy

    International Nuclear Information System (INIS)

    Syimonova, L.Yi.; Byilogurova, L.V.; Gertman, V.Z.; Kulyinyich, G.V.; Pushkar, S.M.

    2011-01-01

    The influence of phototherapy with red and blue light as well as their combination on the state of homeostasis in patients with breast cancer was investigated during the course of postoperative radiation therapy. It was established that phototherapy possessed multisystemic effect and positively influenced the state of homeostasis system with all schemes of optic treatment. The most pronounced was the effect of blue light as well as its combination with red.

  7. Evaluation of anxiety and salivary chromogranin a secretion in women receiving breast conserving surgery followed by radiation therapy

    International Nuclear Information System (INIS)

    Seki-Nakamura, Kaori; Maebayashi, Katsuya; Nasu-Izumi, Sachiko; Akimoto, Tetsuo; Mitsuhashi, Norio

    2011-01-01

    We conducted a prospective study to assess the anxiety and salivary Chromogranin A (CgA), which is considered to be a biomarker of the stress response, in outpatients receiving breast conserving surgery followed by radiation therapy (RT) to the whole breast. Fifty consecutive patients who received whole-breast RT were enrolled in this study. The anxiety levels were measured by the State-Trait Anxiety Inventory (STAI) at the beginning of RT (baseline), 30 Gy, completion of RT, and 1 and 3 months after RT. Salivary CgA levels were also measured at the same time. The mean state anxiety score for all patients was 46.16 with a standard error (SE) of 1.57 at the beginning of RT (baseline) which continued to decline during and after RT. It reached its lowest score with 36.34±1.56 at 3 months after RT (p<0.0001). The mean trait anxiety score for all patients was 43.10±1.54 at baseline and remained constant during RT but began to decline after completion of RT and reached a low level at 3 months after RT (p=0.0021). The mean salivary CgA concentration for all patients demonstrated no consistent trends over time, but at 30 Gy the concentration showed a significant decreasing pattern (p=0.0473). Salivary CgA concentrations and state anxiety and trait anxiety scores at all time points showed no correlation. The mean anxiety scores measured by State Trait Anxiety Inventory (STAI) showed no positive correlation with salivary CgA concentration for breast cancer patients undergoing radiation therapy following breast conserving surgery. (author)

  8. Breast abscesses after breast conserving therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, Kazuhisa [National Kyoto Hospital (Japan)

    2001-09-01

    Breast abscess after breast conserving therapy is a rare complication and the study of this cause has not been reported. A retrospective review of 190 patients undergoing breast conserving therapy in our institution revealed 4 patients with breast abscess (mean age, 50.6 years; range, 47-57 years and median follow up 4 months; 1-11 months). Risk factors which were common to all patients were: fine needle aspiration (FNA), surgical treatment; wide excision, adjuvant therapy; oral administration of tamoxifen (TAM), radiation therapy (RT) to ipsilateral whole breast; total dose of 50 Gy and skin desquamation by RT; level I or II. Other important risk factors in 3 patients were repeated aspirations of seroma post operatively and 2 patients received chemotherapy; CAF. Cultures from one abscess grew staphylococcus aureus, one grew staphylococcus epidermidis, and two were sterile. Breast abscess may be caused by a variety of factors and it is often difficult to specify the cause. This suggests that careful observation will be necessary to determine the cause. (author)

  9. Breast abscesses after breast conserving therapy for breast cancer

    International Nuclear Information System (INIS)

    Fujiwara, Kazuhisa

    2001-01-01

    Breast abscess after breast conserving therapy is a rare complication and the study of this cause has not been reported. A retrospective review of 190 patients undergoing breast conserving therapy in our institution revealed 4 patients with breast abscess (mean age, 50.6 years; range, 47-57 years and median follow up 4 months; 1-11 months). Risk factors which were common to all patients were: fine needle aspiration (FNA), surgical treatment; wide excision, adjuvant therapy; oral administration of tamoxifen (TAM), radiation therapy (RT) to ipsilateral whole breast; total dose of 50 Gy and skin desquamation by RT; level I or II. Other important risk factors in 3 patients were repeated aspirations of seroma post operatively and 2 patients received chemotherapy; CAF. Cultures from one abscess grew staphylococcus aureus, one grew staphylococcus epidermidis, and two were sterile. Breast abscess may be caused by a variety of factors and it is often difficult to specify the cause. This suggests that careful observation will be necessary to determine the cause. (author)

  10. Spiritual well-being and quality of life in Iranian women with breast cancer undergoing radiation therapy.

    Science.gov (United States)

    Jafari, Najmeh; Farajzadegan, Ziba; Zamani, Ahmadreza; Bahrami, Fatemeh; Emami, Hamid; Loghmani, Amir

    2013-05-01

    Psychological distress and morbidity are common consequences of diagnosis and treatment of breast cancer and associated with poor quality of life (QOL). Spiritual well-being is an important aspect of QOL, but little is known about the spiritual well-being and its relationship with QOL in patients of different cultures such as Iranian Muslim patients. The aim of this study was to investigate the association of QOL and spirituality among patients with breast cancer undergoing radiation therapy. This was a cross-sectional study which was conducted in the Breast Cancer Research Center of St. S. Al-Shohada Hospital, Isfahan, Iran. Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp12). The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) and its supplementary breast cancer questionnaire (QLQ-BR23) were used to assess the quality of life of patients. Descriptive analysis, Pearson's correlation, and multiple regression analysis were performed for statistical assessment. In all, 68 patients fulfilled the study's inclusion criteria and were interviewed. The mean global QOL was 41.42 (SD = 18.02), and the mean spiritual well-being was 28.41 (SD = 6.95). There was a significant positive correlation between general QOL and total spiritual well-being scores. Also, spiritual well-being, social functioning, pain, and arm symptoms were significant predictors of global QOL. The results of this study provide evidence that breast cancer survivors in Iran experience a poor quality of life across a broad spectrum of health domains, particularly social, emotional, and spiritual, indicating that psychosocial-spiritual support should be considered in caring for patients with breast cancer.

  11. Contralateral breast cancer and other second malignancies in patients treated by breast-conserving therapy with radiation

    International Nuclear Information System (INIS)

    Kurtz, J.M.; Amalric, R.; Brandone, H.; Ayme, Y.; Spitalier, J.M.

    1988-01-01

    Metachronous contralateral breast cancers and other second malignancies were evaluated in 2,850 patients treated between 1960 and 1981 primarily with radiotherapy (RT) either alone or following breast-conserving surgery. One hundred eighty-four contralateral cancers were observed in 22,491 patient-years of observation (818 per 10(5) patient-years), with a cumulative probability of 4.5% at 5, 7.9% at 10, and 11% at 15 and 20 years. Compared to patients with unilateral tumors, those destined to develop contralateral cancers were younger (mean age 51.9 vs 56.6) and more often gave a family history of breast cancer. Contralateral breast cancers were more frequent for more extensive tumors (T3 10% vs T1-26%; with inflammatory signs 10.6% without 6%), and in patients with ipsilateral local recurrence (with 9.1%, without 5.6%). Patients with contralateral cancers had a significantly less favorable survival experience (15-year actuarial survival after primary therapy 42%) than patients without contralateral cancer (15-year survival 65.5%). In early stage patients treated with conservative surgery and RT, contralateral cancer was not prognostically more favorable than ipsilateral breast recurrence. Among 72 other second malignancies (320 per 10(5) patient-years) were 2 soft tissue sarcomas in the irradiated area. This corresponds to an incidence of 21 cases per 10(5) patient-years for survivors beyond the fifth year. The possible influence of RT on contralateral cancers and other second malignancies is discussed

  12. A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy.

    Directory of Open Access Journals (Sweden)

    So-Yeon Park

    Full Text Available The aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique.We used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected.There was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm.The 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.

  13. A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy.

    Science.gov (United States)

    Park, So-Yeon; Choi, Chang Heon; Park, Jong Min; Chun, MinSoo; Han, Ji Hye; Kim, Jung-In

    2016-01-01

    The aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique. We used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA) bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected. There was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm). The 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.

  14. NRG Oncology-Radiation Therapy Oncology Group Study 1014: 1-Year Toxicity Report From a Phase 2 Study of Repeat Breast-Preserving Surgery and 3-Dimensional Conformal Partial-Breast Reirradiation for In-Breast Recurrence.

    Science.gov (United States)

    Arthur, Douglas W; Winter, Kathryn A; Kuerer, Henry M; Haffty, Bruce G; Cuttino, Laurie W; Todor, Dorin A; Simone, Nicole L; Hayes, Shelly B; Woodward, Wendy A; McCormick, Beryl; Cohen, Randi J; Sahijdak, Walter M; Canaday, Daniel J; Brown, Doris R; Currey, Adam D; Fisher, Christine M; Jagsi, Reshma; White, Julia

    2017-08-01

    To determine the associated toxicity, tolerance, and safety of partial-breast reirradiation. Eligibility criteria included in-breast recurrence occurring >1 year after whole-breast irradiation, 1 to ≤2 cm, and 1 >2 cm. All patients were clinically node negative. Systemic therapy was delivered in 51%. All treatment plans underwent quality review for contouring accuracy and dosimetric compliance. All treatment plans scored acceptable for tumor volume contouring and tumor volume dose-volume analysis. Only 4 (7%) scored unacceptable for organs at risk contouring and organs at risk dose-volume analysis. Treatment-related skin, fibrosis, and/or breast pain AEs were recorded as grade 1 in 64% and grade 2 in 7%, with only 1 (<2%) grade ≥3 and identified as grade 3 fibrosis of deep connective tissue. Partial-breast reirradiation with 3-dimensional conformal radiation therapy after second lumpectomy for patients experiencing in-breast failures after whole-breast irradiation is safe and feasible, with acceptable treatment quality achieved. Skin, fibrosis, and breast pain toxicity was acceptable, and grade 3 toxicity was rare. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Breast cancer: a study of the psychosocial issues faced by women undergoing radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Burnie, C. [Hamilton Regional Cancer Centre, Hamilton, Ontario (Canada)

    2000-09-30

    The purpose of this study was to determine the psychosocial issues faced by post lumpectomy women with early stage breast cancer undergoing radical radiation to the affected breast. Twenty-five women in their second to fifth week of treatment were given the survey to determine these issues. Responses were then grouped by age category and results compiled. Regardless of age, a majority of women felt that they and their spouses had become closer since their diagnosis and described their spouses as being supportive. Scheduling appointment times around childcare was important for some women. Almost half of the women experienced a change in employment status as a result of their diagnosis. Appointment times and work schedules were important for some women still working. In all age groups, women experienced fatigue at least sometimes. (author)

  16. Breast cancer: a study of the psychosocial issues faced by women undergoing radiation therapy

    International Nuclear Information System (INIS)

    Burnie, C.

    2000-01-01

    The purpose of this study was to determine the psychosocial issues faced by post lumpectomy women with early stage breast cancer undergoing radical radiation to the affected breast. Twenty-five women in their second to fifth week of treatment were given the survey to determine these issues. Responses were then grouped by age category and results compiled. Regardless of age, a majority of women felt that they and their spouses had become closer since their diagnosis and described their spouses as being supportive. Scheduling appointment times around childcare was important for some women. Almost half of the women experienced a change in employment status as a result of their diagnosis. Appointment times and work schedules were important for some women still working. In all age groups, women experienced fatigue at least sometimes. (author)

  17. Clinical outcome and cosmetic results of conservative surgery plus radiation therapy in early stage breast cancer patients

    International Nuclear Information System (INIS)

    Jin Yening; Wang Yajie; Zhang Xiaoqing; Meng Yan; Li Rongqing; Shi Junyi

    2005-01-01

    Objective: To evaluate the clinical outcome and cosmetic results in early stage breast cancer patients treated with conservative surgery plus radiation therapy. Methods: From May 1995 to December 2002, 109 such patients were so treated. The post-operative radiotherapy consisted of whole-breast 6 MV linear accelerator irradiation with two tangential half-fields to a total dose of 45-52 Gy (mean 48.6 Gy), followed by a boost irradiation to the tumor bed. Among them, 79 patients received 10-12 Gy (DB) boost by interstitial implantation brachytherapy ( 192 Ir HDR, Nucletron), with single plane implantation for T1 and double plane implantation for T2 tumor. Thirty patients received 15 Gy boost by electron beam. Adjuvant/concurrent chemotherapy (CMF or CEF) and hormonotherapy were also used according to the patients' clinical characteristics. The cosmetic results were scored by both the doctor and the patients. Results: The overall actuarial 5-year survival was 93.8%, with local recurrence of 6.5%. No radiation-induced ulcer was observed in the breast except for acute inflammation at skin pinholes in 5 patients treated by interstitial implant brachytherapy. Among the 75 patients who had had breast examination, cosmetic result scored as good by patient and doctor were 81% and 87%, respectively. The good rate assessed by doctor in brachytherapy boost group and electron beam boost group were 81.2% (39/48) and 85.2% (23/27), There was no significant difference between these two boost techniques (P>0.05). Conclusions: Tumor bed boost irradiation by either brachytherapy or electron beam technique can provide satisfactory local control in early breast cancer treated with conservative surgery plus radiotherapy without increasing the side effects. There is no significant difference in cosmetic result between these two boost techniques. (authors)

  18. Eradication of breast cancer with bone metastasis by autologous formalin-fixed tumor vaccine (AFTV) combined with palliative radiation therapy and adjuvant chemotherapy: a case report.

    Science.gov (United States)

    Kuranishi, Fumito; Ohno, Tadao

    2013-06-04

    Skeletal metastasis of breast carcinoma is refractory to intensive chemo-radiation therapy and therefore is assumed impossible to cure. Here, we report an advanced case of breast cancer with vertebra-Th7 metastasis that showed complete response to combined treatments with formalin-fixed autologous tumor vaccine (AFTV), palliative radiation therapy with 36 Gy, and adjuvant chemotherapy with standardized CEF (cyclophosphamide, epirubicin, and 5FU), zoledronic acid, and aromatase inhibitors following mastectomy for the breast tumor. The patient has been disease-free for more than 4 years after the mammary surgery and remains well with no evidence of metastasis or local recurrence. Thus, a combination of AFTV, palliative radiation therapy, and adjuvant chemotherapy may be an effective treatment for this devastating disease.

  19. Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients

    International Nuclear Information System (INIS)

    Hsi, R. Alex; Antell, Andrew; Schultz, Delray J.; Solin, Lawrence J.

    1998-01-01

    Purpose: Long-term outcome after radiation therapy for local-regional recurrence of breast cancer after mastectomy is generally poor. This study was performed to evaluate the long-term outcome for a potentially favorable subgroup of patients with chest wall recurrence. Methods and Materials: Of 71 patients with an isolated local-regional recurrence of breast cancer after mastectomy, 18 were identified who met the following favorable selection criteria: 1) a disease-free interval after mastectomy of 2 years or more, 2) an isolated chest wall recurrence, and 3) tumor size < 3 cm or complete excision of the recurrent disease. All 18 patients were treated with local-regional irradiation between 1967 and 1988. Radiotherapy (RT) was delivered to the chest wall to a median total dose of 60 Gy (range 30-66 Gy). Four patients received adjuvant chemotherapy and six patients received adjuvant hormonal therapy. Results: With a median follow-up of 8.4 years, nine of 18 patients were alive and free of disease. The 10-year actuarial overall and cause-specific survivals were 72% and 77%, respectively. The 10-year actuarial relapse-free survival and local control were 42% and 86%, respectively. Conclusion: Treatment for a local-regional recurrence of breast cancer after mastectomy in a favorable subgroup of patients results in a high rate of long-term survival as well as excellent local control. Aggressive treatment is warranted in this favorable subgroup of patients. 1998 Elsevier Science Inc

  20. Radiation therapy

    International Nuclear Information System (INIS)

    Matsuura, Keiichi; Miyoshi, Makoto; Jinguu, Ken-ichi

    1982-01-01

    Of the cases of lung cancer in which radiation therapy was given between 1961 and November 1981, 399 cases for which histological type was confirmed, and irradiated as follows were reviewed. The cases of squamous cell carcinoma and adenocarcinoma irradiated with more than 5,000 rad or more, those of undifferentiated carcinoma irradiated with 3,000 rad or more, and those irradiated pre- and post-operatively with 3,000 rad or more. The actual 5 year survival rate for stages I, II, III and IV were 29.6, 9.3, 7.5 and 1.9% respectively, and the survival rate tended to be better for adenocarcinoma than squamous cell carcinoma at stages I, II and III, but not different at stage IV. There was no difference between large cell, small cell and squamous cell carcinomas. Irradiation with 200 rad every other day or 150 rad daily was better than that with 200 rad, and daily irradiation with 150 rad was used since 1976. The therapy of stage III small cell carcinoma at the age of up to 80 years was improved with the combination of anticancer agents, maintenance therapy and immunotherapy, but these combined therapies were not significantly effective for the cancers with other histological types or at other stages. Although there was no significant difference in statistics for resectable cases, clinically, the results were experienced to be better after resection, and surgery was done in combination as much as possible. (Kaihara, S.)

  1. Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

    International Nuclear Information System (INIS)

    Nelson, Carl; Bai, Harrison; Neboori, Hanmanth; Takita, Cristiane; Motwani, Sabin; Wright, Jean L.; Hobeika, Georges; Haffty, Bruce G.; Jones, Tiffanie; Goyal, Sharad; Moran, Meena S.

    2012-01-01

    Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

  2. Long-term radiation sequelae after breast-conserving therapy in women with early-stage breast cancer: an observational study using the LENT-SOMA scoring system

    International Nuclear Information System (INIS)

    Fehlauer, Fabian; Tribius, Silke; Hoeller, Ulrike; Rades, Dirk; Kuhlmey, Antje; Bajrovic, Amira; Alberti, Winfried

    2003-01-01

    Purpose: To evaluate the long-term toxicity after breast-conserving therapy in women with early-stage breast cancer. Methods and Materials: Late toxicity according to the late effects of normal tissue-subjective, objective, management, and analytic (LENT-SOMA) criteria and cosmetic outcome (graded by physicians) were evaluated in 590 of 2943 women with early-stage breast cancer who were irradiated between 1983 and 1995 using the following fractionation schedules: group A, 1983-1987, 2.5 Gy 4x/wk to 60 Gy; group B, 1988-1993, 2.5 Gy 4x/wk to 55 Gy, group C, 1994-1995, 2.0 Gy 5x/wk to 55 Gy. Results: LENT-SOMA Grade 3-4 toxicity was observed as follows: group A (median follow-up 171 months; range 154-222 months), fibrosis 16% (7 of 45), telangiectasia 18% (8 of 45), and atrophy 4% (2 of 45); group B (median follow-up 113 months; range 78-164 months), pain 2% (8 of 345), fibrosis 10% (34 of 345), telangiectasia 10% (33 of 345), arm edema 1% (2 of 345), and atrophy 8% (27 of 345); and group C (median follow-up 75 months, range 51-96 months, n = 200), occurrence of Grade 3-4 late morbidity ≤2%. The cosmetic outcome was very good to acceptable in 78% (35 of 45) of patients in group A, 83% (286 of 345) in group B, and 94% (187 of 200) in group C. Conclusion: In our population, the long-term side effects after breast-conserving therapy were not rare, but were mainly asymptomatic. The LENT-SOMA breast module is a practical tool to assess radiation-induced long-term toxicity

  3. Clinical features of brain metastases in breast cancer: an implication for hippocampal-sparing whole-brain radiation therapy

    Directory of Open Access Journals (Sweden)

    Wu S

    2016-12-01

    Full Text Available San-Gang Wu,1,* Jia-Yuan Sun,2,* Qin Tong,3 Feng-Yan Li,2 Zhen-Yu He2 1Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, 2Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 3Department of Radiation Oncology, The First Affiliated Hospital of University of South China, Hengyang, People’s Republic of China *These authors contributed equally to this work Objective: The objectives of this study were to describe the distribution of brain metastases (BM in breast cancer patients and investigate the risk factors for perihippocampal metastases (PHM. Patients and methods: Retrospective analysis of the clinicopathological characteristics and patterns of BM was performed. Associations between clinicopathological characteristics and PHM (the hippocampus plus 5 mm margin were evaluated using logistic regression analyses. Results: A total of 1,356 brain metastatic lesions were identified in 192 patients. Patients with 1–3 BM, 4–9 BM, and ≥10 BM accounted for 63.0%, 18.8%, and 18.2%, respectively. There were only 7 (3.6% patients with hippocampal metastases (HM and 14 (7.3% patients with PHM. On logistic regression, the number of BM was an independent risk factor for PHM. Patients with ≥10 BM had a significantly higher risk of PHM compared with those with <10 BM. Breast cancer subtype (BCS was not associated with PHM. The number of BM was significantly correlated with various BCSs. Patients with hormone receptor (HR+/human epidermal growth factor receptor 2 (HER2+, HR-/HER2+, and HR-/HER2- subtypes had a higher probability of ≥10 BM, relative to patients with an HR+/HER2- subtype. Conclusion: Our study suggests that a low incidence of PHM may be acceptable to perform hippocampal-sparing whole-brain radiation therapy for breast cancer patients

  4. Second Malignancies After Adjuvant Radiation Therapy for Early Stage Breast Cancer: Is There Increased Risk With Addition of Regional Radiation to Local Radiation?

    Energy Technology Data Exchange (ETDEWEB)

    Hamilton, Sarah Nicole [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia (Canada); Tyldesley, Scott, E-mail: styldesl@bccancer.bc.ca [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia (Canada); Li, Dongdong [Cancer Control Research Department, British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia (Canada); Olson, Robert [Department of Radiation Oncology, British Columbia Cancer Agency-Centre for the North, Prince George, British Columbia (Canada); McBride, Mary [Cancer Control Research Department, British Columbia Cancer Agency-Vancouver Centre, Vancouver, British Columbia (Canada)

    2015-04-01

    Purpose: This study was undertaken to determine whether there was an increased risk of second malignancies (SM), particularly lung cancer, in early stage breast cancer patients treated with the addition of nodal fields to breast and/or chest wall radiation therapy (RT). Materials and Methods: Subjects were stage I/II female breast cancer patients 20 to 79 years of age, diagnosed between 1989 and 2005 and treated with adjuvant RT at our institution. Patients were included if they survived and did not have SM within 3 years of diagnosis. Standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated to compare SM incidence to cancer incidence in the general sex- and age-matched populations. Secondary malignancy risks in patients treated with local RT (LRT) to the breast/chest wall were compared to those in patients treated with locoregional RT (LRRT) to the breast/chest wall and regional nodes, using multivariate regression analysis (MVA) to account for covariates. Results: The cohort included 12,836 patients with a median follow-up of 8.4 years. LRRT was used in 18% of patients. The SIR comparing patients treated with LRT to the general population was 1.29 (CI: 1.21-1.38). No statistically significant increased incidence of in-field malignancies (SIR, 1.04; CI: 0.87-1.23) and lung cancers (SIR, 1.06; CI: 0.88-1.26) was detected. The SIR comparing patients treated with LRRT to the general population was 1.39 (CI: 1.17-1.64). No statistically significant increased incidence of in-field malignancies (SIR, 1.26; CI: 0.77-1.94) and lung cancers (SIR, 1.27; CI: 0.76-1.98) was detected. On MVA comparing LRRT to LRT, the adjusted hazard ratio was 1.20 for in-field malignancies (CI: 0.68-2.16) and 1.26 for lung cancer (CI: 0.67-2.36). The excess attributable risk (EAR) to regional RT was 3.1 per 10,000 person years (CI: −8.7 to 9.9). Conclusions: No statistically significant increased risk of second malignancy was detected after LRRT relative to

  5. Mild Lung Restriction in Breast Cancer Patients After Hypofractionated and Conventional Radiation Therapy: A 3-Year Follow-Up

    International Nuclear Information System (INIS)

    Verbanck, Sylvia; Hanon, Shane; Schuermans, Daniel; Van Parijs, Hilde; Vinh-Hung, Vincent; Miedema, Geertje; Verellen, Dirk; Storme, Guy; Fontaine, Christel; Lamote, Jan; De Ridder, Mark; Vincken, Walter

    2016-01-01

    Purpose: To assess the effect of radiation therapy on lung function over the course of 3 years. Methods and Materials: Evolution of restrictive and obstructive lung function parameters was investigated in 108 breast cancer participants in a randomized, controlled trial comparing conventional radiation therapy (CR) and hypofractionated tomotherapy (TT) (age at inclusion ranging 32-81 years). Spirometry, plethysmography, and hemoglobin-corrected diffusing capacity were assessed at baseline and after 3 months and 1, 2, and 3 years. Natural aging was accounted for by considering all lung function parameters in terms of percent predicted values using the most recent reference values for women aged up to 80 years. Results: In the patients with negligible history of respiratory disease or smoking (n=77), the greatest rate of functional decline was observed during the initial 3 months, this acute decrease being more marked in the CR versus the TT arm. During the remainder of the 3-year follow-up period, values (in terms of percent predicted) were maintained (diffusing capacity) or continued to decline at a slower rate (forced vital capacity). However, the average decline of the restrictive lung function parameters over a 3-year period did not exceed 9% predicted in either the TT or the CR arm. Obstructive lung function parameters remained unaffected throughout. Including also the 31 patients with a history of respiratory disease or more than 10 pack-years showed a very similar restrictive pattern. Conclusions: In women with breast cancer, both conventional radiation therapy and hypofractionated tomotherapy induce small but consistent restrictive lung patterns over the course of a 3-year period, irrespective of baseline respiratory status or smoking history. The fastest rate of lung function decline generally occurred in the first 3 months.

  6. Mild Lung Restriction in Breast Cancer Patients After Hypofractionated and Conventional Radiation Therapy: A 3-Year Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Verbanck, Sylvia, E-mail: sylvia.verbanck@uzbrussel.be [Respiratory Division, University Hospital UZ Brussel, Brussels (Belgium); Hanon, Shane; Schuermans, Daniel [Respiratory Division, University Hospital UZ Brussel, Brussels (Belgium); Van Parijs, Hilde; Vinh-Hung, Vincent; Miedema, Geertje; Verellen, Dirk; Storme, Guy [Department of Radiotherapy, University Hospital UZ Brussel, Brussels (Belgium); Fontaine, Christel; Lamote, Jan [Department of Senology and Oncologic Surgery, University Hospital UZ Brussel, Brussels (Belgium); De Ridder, Mark [Department of Radiotherapy, University Hospital UZ Brussel, Brussels (Belgium); Vincken, Walter [Respiratory Division, University Hospital UZ Brussel, Brussels (Belgium)

    2016-07-01

    Purpose: To assess the effect of radiation therapy on lung function over the course of 3 years. Methods and Materials: Evolution of restrictive and obstructive lung function parameters was investigated in 108 breast cancer participants in a randomized, controlled trial comparing conventional radiation therapy (CR) and hypofractionated tomotherapy (TT) (age at inclusion ranging 32-81 years). Spirometry, plethysmography, and hemoglobin-corrected diffusing capacity were assessed at baseline and after 3 months and 1, 2, and 3 years. Natural aging was accounted for by considering all lung function parameters in terms of percent predicted values using the most recent reference values for women aged up to 80 years. Results: In the patients with negligible history of respiratory disease or smoking (n=77), the greatest rate of functional decline was observed during the initial 3 months, this acute decrease being more marked in the CR versus the TT arm. During the remainder of the 3-year follow-up period, values (in terms of percent predicted) were maintained (diffusing capacity) or continued to decline at a slower rate (forced vital capacity). However, the average decline of the restrictive lung function parameters over a 3-year period did not exceed 9% predicted in either the TT or the CR arm. Obstructive lung function parameters remained unaffected throughout. Including also the 31 patients with a history of respiratory disease or more than 10 pack-years showed a very similar restrictive pattern. Conclusions: In women with breast cancer, both conventional radiation therapy and hypofractionated tomotherapy induce small but consistent restrictive lung patterns over the course of a 3-year period, irrespective of baseline respiratory status or smoking history. The fastest rate of lung function decline generally occurred in the first 3 months.

  7. Results of Three-Dimensional Conformal Radiation Therapy for the Treatment of a Solitary Sternal Relapse of Breast Cancer

    International Nuclear Information System (INIS)

    Kim, Hae Young; Huh, Seung Jae; Park, Won; Choi, Do Ho; Kang, Min Kyu; Yang, Jung Hyun; Nam, Seok Jin; Im, Young Hyuck

    2008-01-01

    To evaluate the response and survival rate after three-dimensional conformal radiation therapy (3D-CRT) of patients with a solitary sternal relapse of breast cancer. Seventeen patients between May 1996 and June 2005 were evaluated with the salvage 3D-CRT treatment of a solitary sternal relapse of breast cancer. The treatment fields included the gross tumor volume with 2 cm margins. The total radiation dose was 35.0 ∼61.5 Gy (biologic effective dose of 43.7 ∼76.9 Gy10 using an α/β ratio of 10 Gy), with a daily dose of 1.8∼3.0 Gy. The tumor response was evaluated by the change in maximum tumor size via follow up CT scans 1∼3 months after the completion of treatment. An objective tumor response was achieved in all patients, with a complete response in 5 patients and a partial response in 12 patients. The 5-year overall survival rate was 51.9% (median survival time: 27 months), and the most important factor affecting overall survival was the disease-free interval (interval from primary surgery of breast cancer to the development of sternal metastasis): The 5-year overall survival rate was 61.8% for patients with a disease-free interval ≥12 months and 0.0% for patients < with disease-free interval <12 months (p=0.03). The response to 3D-CRT was good in patients with solitary sternal relapse of breast cancer. Particularly, patients with long disease-free interval from primary surgery survived significantly longer than patients with short disease-free interval from primary surgery

  8. TU-F-18C-09: Mammogram Surveillance Using Texture Analysis for Breast Cancer Patients After Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kuo, H; Tome, W; FOX, J; Hong, L; Yaparpalvi, R; Mehta, K; Bodner, W; Kalnicki, S [Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (United States); Huang, Y [Memorial Sloan-Kettering Cancer Center, Great Neck, NY (United States)

    2014-06-15

    Purpose: To study the feasibility of applying cancer risk model established from treated patients to predict the risk of recurrence on follow-up mammography after radiation therapy for both ipsilateral and contralateral breast. Methods: An extensive set of textural feature functions was applied to a set of 196 Mammograms from 50 patients. 56 Mammograms from 28 patients were used as training set, 44 mammograms from 22 patients were used as test set and the rest were used for prediction. Feature functions include Histogram, Gradient, Co-Occurrence Matrix, Run-Length Matrix and Wavelet Energy. An optimum subset of the feature functions was selected by Fisher Coefficient (FO) or Mutual Information (MI) (up to top 10 features) or a method combined FO, MI and Principal Component (FMP) (up to top 30 features). One-Nearest Neighbor (1-NN), Linear Discriminant Analysis (LDA) and Nonlinear Discriminant Analysis (NDA) were utilized to build a risk model of breast cancer from the training set of mammograms at the time of diagnosis. The risk model was then used to predict the risk of recurrence from mammogram taken one year and three years after RT. Results: FPM with NDA has the best classification power in classifying the training set of the mammogram with lesions versus those without lesions. The model of FPM with NDA achieved a true positive (TP) rate of 82% compared to 45.5% of using FO with 1-NN. The best false positive (FP) rates were 0% and 3.6% in contra-lateral breast of 1-year and 3-years after RT, and 10.9% in ipsi-lateral breast of 3-years after RT. Conclusion: Texture analysis offers high dimension to differentiate breast tissue in mammogram. Using NDA to classify mammogram with lesion from mammogram without lesion, it can achieve rather high TP and low FP in the surveillance of mammogram for patient with conservative surgery combined RT.

  9. A population-based case-cohort study of the risk of myocardial infarction following radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Paszat, Lawrence F.; Vallis, Katherine A.; Benk, Veronique M.A.; Groome, Patti A.; Mackillop, William J.; Wielgosz, Andreas

    2007-01-01

    Objective: To describe the risk of acute myocardial infarction (AMI) after radiation therapy (RT) for breast cancer (BrCa) in an exposed population. Methods: We identified and validated cases of AMI (vAMI), by electrocardiographic or enzyme criteria, among all 6680 women who received post-operative RT following lumpectomy or mastectomy, within 12 months following diagnosis of BrCa between 1982 and 1988 in Ontario, Canada. We identified women without vAMI whose death certification was ascribed to AMI (dAMI). We abstracted risk factors and treatment exposures for a random sample of women from the 6680, and for all with vAMI or dAMI. The hazards of vAMI and of dAMI were estimated using multivariate Cox proportional hazards models, corrected for study design. Results: We validated 121 cases of vAMI and identified 92 cases of dAMI. The risk of vAMI associated with RT to the left breast HR = 1.96 (1.09, 3.54) among women at age ≥ 60 at time of RT, adjusted for history of smoking and prior MI. The adjusted HR dAMI = 1.90 (1.08, 3.35) for exposure to anterior internal mammary node (IMC) RT. Among women who received anterior left breast boost RT, increasing area of the boost is associated with adjusted HR vAMI = 1.02 (1.00, 1.03)/cm 2 , and adjusted HR dAMI = 1.02 (1.01, 1.03)/cm 2 . Conclusion: The risks of vAMI and dAMI following RT for BrCa are related to anatomic sites of RT (left breast, area of anterior left breast boost field, and anterior IMC field)

  10. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    International Nuclear Information System (INIS)

    Lalani, Nafisha; Paszat, Lawrence; Sutradhar, Rinku; Thiruchelvam, Deva; Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta; Done, Susan J.; Miller, Naomi; Youngson, Bruce; Tuck, Alan; Sengupta, Sandip; Elavathil, Leela; Chang, Martin C.; Jani, Prashant A.; Bonin, Michel

    2014-01-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  11. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    Energy Technology Data Exchange (ETDEWEB)

    Lalani, Nafisha; Paszat, Lawrence [University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Sutradhar, Rinku; Thiruchelvam, Deva [Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta [University of Toronto, Toronto, Ontario (Canada); Department of Anatomic Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Done, Susan J. [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Campbell Family Institute for Breast Cancer Research, Toronto, Ontario (Canada); Miller, Naomi; Youngson, Bruce [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Tuck, Alan [Pathology and Laboratory Medicine, London Health Sciences Centre and Saint Joseph' s Health Care, London, Ontario (Canada); Sengupta, Sandip [Department of Pathology and Molecular Medicine, Kingston General Hospital, Kingston, Ontario (Canada); Elavathil, Leela [Department of Anatomical Pathology, Juravinski Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Chang, Martin C. [Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Jani, Prashant A. [Department of Anatomical Pathology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario (Canada); Bonin, Michel [Pathology and Laboratory Medicine, Sudbury Regional Hospital, Sudbury, Ontario (Canada); and others

    2014-12-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  12. Conservative therapy of breast cancer in Queensland

    International Nuclear Information System (INIS)

    Burke, Marie-Frances; Allison, Roger; Tripcony, Lee

    1995-01-01

    Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy in Europe and North America for many years. In Australia, however, the history of breast conservation for early invasive breast cancer is much shorter. The purpose of this study was to evaluate the results of breast conservation in a state-wide Australian radiotherapy service. Methods and Materials: Between January 1982 and December 1989, 512 patients were treated with primary radiation therapy after breast conserving surgery. This analysis is based on a review of these patients, all of whom had Stage I or II breast cancer. Results: With a median follow-up of 50 months, the 5-year actuarial rate of overall survival was 84% and disease-free survival was 80%. There have been 22 isolated local recurrences in the breast. The time to an isolated breast recurrence ranged from 12 to 83 months (median, 26 months). The 5-year actuarial rate of an isolated breast recurrence was 4%. The recurrence rate was higher for patients with involved margins (15% vs. 2%, p < 0.01). Local recurrence was also more likely in the presence of extensive ductal carcinoma insitu (DCIS), as opposed to no extensive DCIS (10% vs. 2%, p < 0.01). Conclusion: These results affirm that primary radiation therapy after breast conserving surgery in Queensland, has been given with a low rate of local recurrence, comparable to that obtained in other centers

  13. Conservative therapy of breast cancer in Queensland

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Marie-Frances; Allison, Roger; Tripcony, Lee

    1995-01-15

    Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy in Europe and North America for many years. In Australia, however, the history of breast conservation for early invasive breast cancer is much shorter. The purpose of this study was to evaluate the results of breast conservation in a state-wide Australian radiotherapy service. Methods and Materials: Between January 1982 and December 1989, 512 patients were treated with primary radiation therapy after breast conserving surgery. This analysis is based on a review of these patients, all of whom had Stage I or II breast cancer. Results: With a median follow-up of 50 months, the 5-year actuarial rate of overall survival was 84% and disease-free survival was 80%. There have been 22 isolated local recurrences in the breast. The time to an isolated breast recurrence ranged from 12 to 83 months (median, 26 months). The 5-year actuarial rate of an isolated breast recurrence was 4%. The recurrence rate was higher for patients with involved margins (15% vs. 2%, p < 0.01). Local recurrence was also more likely in the presence of extensive ductal carcinoma insitu (DCIS), as opposed to no extensive DCIS (10% vs. 2%, p < 0.01). Conclusion: These results affirm that primary radiation therapy after breast conserving surgery in Queensland, has been given with a low rate of local recurrence, comparable to that obtained in other centers.

  14. WE-DE-209-00: Practical Implementation of Deep Inspiration Breath Hold Techniques for Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    Breast radiation therapy is associated with some risk of lung toxicity as well as cardiac toxicity for left-sided cases. Radiation doses to the lung and heart can be reduced by using the deep inspiration breath hold (DIBH) technique, in which the patient is simulated and treated during the deep inspiration phase of the breathing cycle. During DIBH, the heart is usually displaced posteriorly, inferiorly, and to the right, effectively expanding the distance between the heart and the breast/chest wall. As a result, the distance between the medial treatment field border and heart/lung is increased. Also, in a majority of DIBH patients, the air drawn into the thoracic cavity increases the total lung volume. The DIBH was discussed by an AAPM Task Group 10 years ago in the AAPM TG 76 report. However, DIBH is still not the standard of care in many clinics, which may be partially due to challenges associated with its implementation. Therefore, this seccion will focus primarily on how to clinically implement four different DIBH techniques: (1) Active Breathing Control, (2) Spirometric Motion Management, (3) 3D Surface Image-Guided, and (4) Self-held Breath Control with Respiratory Monitoring and Feedback Guidance. Learning Objectives: Describe the physical displacement of the heart and the change in lung volume during DIBH and discuss dosimetric consequences of those changes. Provide an overview of the technical aspects. Describe work flow for patient simulation and treatment. Give an overview of commissioning and routine. Provide practical tips for clinical implementation.

  15. WE-DE-209-00: Practical Implementation of Deep Inspiration Breath Hold Techniques for Breast Radiation Therapy

    International Nuclear Information System (INIS)

    2016-01-01

    Breast radiation therapy is associated with some risk of lung toxicity as well as cardiac toxicity for left-sided cases. Radiation doses to the lung and heart can be reduced by using the deep inspiration breath hold (DIBH) technique, in which the patient is simulated and treated during the deep inspiration phase of the breathing cycle. During DIBH, the heart is usually displaced posteriorly, inferiorly, and to the right, effectively expanding the distance between the heart and the breast/chest wall. As a result, the distance between the medial treatment field border and heart/lung is increased. Also, in a majority of DIBH patients, the air drawn into the thoracic cavity increases the total lung volume. The DIBH was discussed by an AAPM Task Group 10 years ago in the AAPM TG 76 report. However, DIBH is still not the standard of care in many clinics, which may be partially due to challenges associated with its implementation. Therefore, this seccion will focus primarily on how to clinically implement four different DIBH techniques: (1) Active Breathing Control, (2) Spirometric Motion Management, (3) 3D Surface Image-Guided, and (4) Self-held Breath Control with Respiratory Monitoring and Feedback Guidance. Learning Objectives: Describe the physical displacement of the heart and the change in lung volume during DIBH and discuss dosimetric consequences of those changes. Provide an overview of the technical aspects. Describe work flow for patient simulation and treatment. Give an overview of commissioning and routine. Provide practical tips for clinical implementation.

  16. The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy

    International Nuclear Information System (INIS)

    Bornstein, Bruce A.; Peiro, Gloria; Connolly, James L.; Gelman, Rebecca; Schnitt, Stuart J.; Hetelekidis, Stella; Nixon, Asa J.; Recht, Abram; Silver, Barbara; Harris, Jay R.

    1996-01-01

    PURPOSE: To examine the clinical characteristics of patients with lobular or mixed lobular-ductal histology in relation to those with pure ductal histology and to compare treatment outcome in patients in these histologic groups treated with breast-conserving surgery and radiation therapy. MATERIALS AND METHODS: Between 1970 and 1986, 1863 patients were treated for clinical Stage I or II invasive breast cancer with breast-conserving surgery and radiation therapy. The original slides were reviewed in 1536 cases (82%). Of these, 1089 patients had pure invasive ductal carcinoma, 93 had invasive lobular carcinoma, and 59 had mixed histology; these constitute the study population. The median follow-up time was 133 months. RESULTS: The distribution of clinical stage I or II, tumor stage T1 or T2, and clinical nodal stage N0 or N1 was similar in all three groups. Positive lymph nodes were found in 31% of patients with lobular cancer compared to 38% of those with ductal cancer and 48% of patients with mixed lobular-ductal histology (p=0.05). The use of adjuvant chemo/hormonal therapy followed the same pattern (20%, 29%, 37%, respectively [p=0.07]). Lymphatic vessel invasion was more common in patients with ductal cancer (38%) than in those with mixed histology (27%) or pure lobular cancer (15%, p<0.0001). Patients with ductal carcinoma tended to be younger, with a median age of 50 years compared to 51 years for patients with mixed lobular-ductal histology and 58 years for patients with lobular histology (p=0.0001). Among 410 patients with evaluable margins, margins were less likely to be positive in patients with ductal histology (39% versus 66% for pure lobular and 67% for mixed lobular-ductal histology [p=0.0004]). The 5- and 10-year crude results by site of first failure for patients evaluable at those times were similar for patients with lobular, mixed and ductal carcinomas. In a multivariate analysis for survival including established prognostic factors, neither

  17. Photobiomodulation therapy for the management of radiation-induced dermatitis. A single-institution experience of adjuvant radiotherapy in breast cancer patients after breast conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Strouthos, Iosif [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany); Medical Center - Albert Ludwigs University of Freiburg, Department of Radiotherapy and Oncology, Freiburg (Germany); Chatzikonstantinou, Georgios; Tselis, Nikolaos [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany); J.W. Goethe University, Department of Radiotherapy and Oncology, Frankfurt am Main (Germany); Bon, Dimitra [J.W. Goethe University, Institute of Biostatistics and Mathematical Modelling, Frankfurt am Main (Germany); Karagiannis, Efstratios [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany); Otto von Guericke University, Department of Radiation Oncology, Magdeburg (Germany); Zoga, Eleni; Ferentinos, Konstantinos; Maximenko, Julia; Nikolettou-Fischer, Vassiliki; Zamboglou, Nikolaos [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach (Germany)

    2017-06-15

    Radiation therapy (RT) comprises a key component in the treatment of breast cancer. Radiation-induced skin toxicity is the major adverse event experienced by patients; however, radiodermatitis (RD) prevention and management remains trivial. It is proven that photobiomodulation (PBM) therapy using light-emitting diode (LED) increases wound healing and depicts an anti-inflammatory effect. This single-institute study evaluates the beneficial role of PBM-LED in preventing/reducing RD during breast cancer RT. Of 70 consecutively treated patients, 25 patients were treated with PBM-LED twice a week prior to adjuvant 3D conformal RT after breast-conserving surgery. RD was reported using Common Toxicity Criteria for Adverse Events Version 4.0 and pain intensity using a visual analog scale (VAS). For comparison, a control group (n = 45) received RT without PBM-LED. In addition, a ''matched'' group (n = 25) was generated from the control group based on propensity for potentially confounding variables. In the PBM group, 22 patients (88%) presented grade 1 and 3 (12%) grade 2 RD. In the control group, 25 patients (55.6%) developed grade 1 reactions, 18 patients (40%) grade 2, and 2 (4.4%) patients grade 3 RD. Concerning pain intensity, 15 patients (60%) of the PBM treatment arm reported no pain, 5 patients (20%) VAS 2, and 5 (20%) VAS 3. In the control group, 13 patients (28.9%) reported no pain, 2 (4.4%) VAS 1, 7 (15.6%) VAS 2, 9 patients (20%) reported VAS 3, 12 (26.7%) patients VAS 4, and 2 (4.4%) patients VAS 5. PBM-LED therapy applied prior to RT might be effective in decreasing the incidence and sequelae of radiation-induced skin toxicity in breast cancer patients treated with breast-conserving surgery. (orig.) [German] Radiotherapie (RT) ist integrativer Bestandteil der multimodalen Therapie beim Mammakarzinom. Strahlentherapieinduzierte Hauttoxizitaet ist dabei das haeufigste unerwuenschte Ereignis; dennoch sind Praevention und Management der

  18. Timing of Chemotherapy After MammoSite Radiation Therapy System Breast Brachytherapy: Analysis of the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial

    International Nuclear Information System (INIS)

    Haffty, Bruce G.; Vicini, Frank A.; Beitsch, Peter; Quiet, Coral; Keleher, Angela; Garcia, Delia; Snider, Howard; Gittleman, Mark; Zannis, Victor; Kuerer, Henry; Whitacre, Eric; Whitworth, Pat; Fine, Richard; Keisch, Martin

    2008-01-01

    Purpose: To evaluate cosmetic outcome and radiation recall in the American Society of Breast Surgeons registry trial, as a function of the interval between accelerated partial breast irradiation (APBI) and initiation of chemotherapy (CTX). Methods and Materials: A total of 1440 patients at 97 institutions participated in this trial. After lumpectomy for early-stage breast cancer, patients received APBI (34 Gy in 10 fractions) with MammoSite RTS brachytherapy. A total of 148 patients received CTX within 90 days of APBI. Cosmetic outcome was evaluated at each follow-up visit and dichotomized as excellent/good or fair/poor. Results: Chemotherapy was initiated at a mean of 3.9 weeks after the final MammoSite procedure and was administered ≤3 weeks after APBI in 54 patients (36%) and >3 weeks after APBI in 94 patients (64%). The early and delayed groups were well balanced with respect to multiple factors that may impact on cosmetic outcome. There was a superior cosmetic outcome in those receiving chemotherapy >3 weeks after APBI (excellent/good in 72.2% at ≤3 weeks vs. excellent/good in 93.8% at >3 weeks; p = 0.01). Radiation recall in those receiving CTX at ≤3 weeks was 9 of 50 (18%), compared with 6 of 81(7.4%) in those receiving chemotherapy at >3 weeks (p = 0.09). Conclusion: The majority of patients receiving CTX after APBI have excellent/good cosmetic outcomes, with a low rate of radiation recall. Chemotherapy initiated >3 weeks after the final MammoSite procedure seems to be associated with a better cosmetic outcome and lower rate of radiation recall. An excellent/good cosmetic outcome in patients receiving CTX after 3 weeks was similar to the cosmetic outcome of the overall patient population who did not receive CTX

  19. Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume

    International Nuclear Information System (INIS)

    Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Sundberg, Agnetha; Wilderäng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

    2015-01-01

    Purpose: To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. Methods and Materials: The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand. Results: After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V 40 Gy  ≥ 13.5 cm 3 , compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). Conclusion: Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer

  20. Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume

    Energy Technology Data Exchange (ETDEWEB)

    Lundstedt, Dan, E-mail: dan.lundstedt@gu.se [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Gustafsson, Magnus [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Steineck, Gunnar [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Sundberg, Agnetha [Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Wilderäng, Ulrica [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Holmberg, Erik [Regional Cancer Center, Sahlgrenska University Hospital, Gothenburg (Sweden); Johansson, Karl-Axel [Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Karlsson, Per [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden)

    2015-06-01

    Purpose: To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. Methods and Materials: The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand. Results: After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V{sub 40} {sub Gy} ≥ 13.5 cm{sup 3}, compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). Conclusion: Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer.

  1. Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy.

    Science.gov (United States)

    Jimenez, Yobelli A; Cumming, Steven; Wang, Wei; Stuart, Kirsty; Thwaites, David I; Lewis, Sarah J

    2018-03-13

    Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients' RT knowledge and anxiety. Breast cancer patients were recruited into a control group (CG) (n = 18) who underwent the standard pre-RT education package at a targeted cancer therapy centre, followed by a VERT group (VG) (n = 19). VG patients attended a VERT-based education session detailing RT immobilisation, planning and treatment. All patients completed questionnaires at four time points throughout their treatment, with survey sub-sections on RT knowledge, experience and anxiety. For both groups, anxiety levels were highest at time point 1(T1 after initial radiation oncologist consultation) (CG, 41.2; VG, 43.1), with a gradual decrease observed thereafter at time points before simulation, at the beginning of treatment and at the end of treatment (p > 0.05). The VG's RT knowledge scores were statistically significantly higher than those of the CG scores at all time points following VERT education (p education programs in improving RT knowledge and perhaps decreasing patient anxiety. Continued efforts are required to improve patients' accessibility to VERT in Australia, and to better understand the effect of VERT's unique educational features on patients' emotional and physical needs throughout their RT.

  2. Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

    International Nuclear Information System (INIS)

    Rahimi, Asal; Thomas, Kimberly; Spangler, Ann; Rao, Roshni; Leitch, Marilyn; Wooldridge, Rachel; Rivers, Aeisha; Seiler, Stephen; Albuquerque, Kevin; Stevenson, Stella; Goudreau, Sally; Garwood, Dan; Haley, Barbara; Euhus, David; Heinzerling, John; Ding, Chuxiong; Gao, Ang; Ahn, Chul; Timmerman, Robert

    2017-01-01

    Purpose: To evaluate the tolerability of a dose-escalated 5-fraction stereotactic body radiation therapy for partial-breast irradiation (S-PBI) in treating early-stage breast cancer after partial mastectomy; the primary objective was to escalate dose utilizing a robotic stereotactic radiation system treating the lumpectomy cavity without exceeding the maximum tolerated dose. Methods and Materials: Eligible patients included those with ductal carcinoma in situ or invasive nonlobular epithelial histologies and stage 0, I, or II, with tumor size <3 cm. Patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Starting dose was 30 Gy in 5 fractions and was escalated by 2.5 Gy total for each cohort to 40 Gy. Results: In all, 75 patients were enrolled, with a median age of 62 years. Median follow-up for 5 cohorts was 49.9, 42.5, 25.7, 20.3, and 13.5 months, respectively. Only 3 grade 3 toxicities were experienced. There was 1 dose-limiting toxicity in the overall cohort. Ten patients experienced palpable fat necrosis (4 of which were symptomatic). Physicians scored cosmesis as excellent or good in 95.9%, 100%, 96.7%, and 100% at baseline and 6, 12, and 24 months after S-PBI, whereas patients scored the same periods as 86.5%, 97.1%, 95.1%, and 95.3%, respectively. The disagreement rates between MDs and patients during those periods were 9.4%, 2.9%, 1.6%, and 4.7%, respectively. There have been no recurrences or distant metastases. Conclusion: Dose was escalated to the target dose of 40 Gy in 5 fractions, with the occurrence of only 1 dose-limiting toxicity. Patients felt cosmetic results improved within the first year after surgery and stereotactic body radiation therapy. Our results show minimal toxicity with excellent cosmesis; however, further follow-up is warranted in future studies. This study is the first to show the safety, tolerability, feasibility, and cosmesis results of a 5-fraction dose-escalated S-PBI treatment for

  3. Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Rahimi, Asal, E-mail: asal.rahimi@utsouthwestern.edu [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Thomas, Kimberly; Spangler, Ann [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Rao, Roshni; Leitch, Marilyn; Wooldridge, Rachel; Rivers, Aeisha [Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Seiler, Stephen [Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Albuquerque, Kevin; Stevenson, Stella [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Goudreau, Sally [Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Garwood, Dan [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Haley, Barbara [Department of Medical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Euhus, David [Department of Surgery, Johns Hopkins University, Baltimore, Maryland (United States); Heinzerling, John [Department of Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina (United States); Ding, Chuxiong [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Gao, Ang; Ahn, Chul [Department of Statistics, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Timmerman, Robert [University of Texas Southwestern Medical Center, Dallas, Texas (United States)

    2017-05-01

    Purpose: To evaluate the tolerability of a dose-escalated 5-fraction stereotactic body radiation therapy for partial-breast irradiation (S-PBI) in treating early-stage breast cancer after partial mastectomy; the primary objective was to escalate dose utilizing a robotic stereotactic radiation system treating the lumpectomy cavity without exceeding the maximum tolerated dose. Methods and Materials: Eligible patients included those with ductal carcinoma in situ or invasive nonlobular epithelial histologies and stage 0, I, or II, with tumor size <3 cm. Patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Starting dose was 30 Gy in 5 fractions and was escalated by 2.5 Gy total for each cohort to 40 Gy. Results: In all, 75 patients were enrolled, with a median age of 62 years. Median follow-up for 5 cohorts was 49.9, 42.5, 25.7, 20.3, and 13.5 months, respectively. Only 3 grade 3 toxicities were experienced. There was 1 dose-limiting toxicity in the overall cohort. Ten patients experienced palpable fat necrosis (4 of which were symptomatic). Physicians scored cosmesis as excellent or good in 95.9%, 100%, 96.7%, and 100% at baseline and 6, 12, and 24 months after S-PBI, whereas patients scored the same periods as 86.5%, 97.1%, 95.1%, and 95.3%, respectively. The disagreement rates between MDs and patients during those periods were 9.4%, 2.9%, 1.6%, and 4.7%, respectively. There have been no recurrences or distant metastases. Conclusion: Dose was escalated to the target dose of 40 Gy in 5 fractions, with the occurrence of only 1 dose-limiting toxicity. Patients felt cosmetic results improved within the first year after surgery and stereotactic body radiation therapy. Our results show minimal toxicity with excellent cosmesis; however, further follow-up is warranted in future studies. This study is the first to show the safety, tolerability, feasibility, and cosmesis results of a 5-fraction dose-escalated S-PBI treatment for

  4. MO-C-BRB-05: Translating NIH funding to a [potential] clinical device in breast cancer radiation therapy

    International Nuclear Information System (INIS)

    Yu, C.

    2015-01-01

    Diagnostic radiology and radiation oncology are arguably two of the most technologically advanced specialties in medicine. The imaging and radiation medicine technologies in clinical use today have been continuously improved through new advances made in the commercial and academic research arenas. This symposium explores the translational path from research through clinical implementation. Dr. Pettigrew will start this discussion by sharing his perspectives as director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The NIBIB has focused on promoting research that is technological in nature and has high clinical impact. We are in the age of precision medicine, and the technological innovations and quantitative tools developed by engineers and physicists working with physicians are providing innovative tools that increase precision and improve outcomes in health care. NIBIB funded grants lead to a very high patenting rate (per grant dollar), and these patents have higher citation rates by other patents, suggesting greater clinical impact, as well. Two examples of clinical translation resulting from NIH-funded research will be presented, in radiation therapy and diagnostic imaging. Dr. Yu will describe a stereotactic radiotherapy device developed in his laboratory that is designed for treating breast cancer with the patient in the prone position. It uses 36 rotating Cobalt-60 sources positioned in an annular geometry to focus the radiation beam at the system’s isocenter. The radiation dose is delivered throughout the target volume in the breast by constantly moving the patient in a planned trajectory relative to the fixed isocenter. With this technique, the focal spot dynamically paints the dose distribution throughout the target volume in three dimensions. Dr. Jackson will conclude this symposium by describing the RSNA Quantitative Imaging Biomarkers Alliance (QIBA), which is funded in part by NIBIB and is a synergistic collaboration

  5. MO-C-BRB-05: Translating NIH funding to a [potential] clinical device in breast cancer radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yu, C. [Univ Maryland School of Medicine (United States)

    2015-06-15

    Diagnostic radiology and radiation oncology are arguably two of the most technologically advanced specialties in medicine. The imaging and radiation medicine technologies in clinical use today have been continuously improved through new advances made in the commercial and academic research arenas. This symposium explores the translational path from research through clinical implementation. Dr. Pettigrew will start this discussion by sharing his perspectives as director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The NIBIB has focused on promoting research that is technological in nature and has high clinical impact. We are in the age of precision medicine, and the technological innovations and quantitative tools developed by engineers and physicists working with physicians are providing innovative tools that increase precision and improve outcomes in health care. NIBIB funded grants lead to a very high patenting rate (per grant dollar), and these patents have higher citation rates by other patents, suggesting greater clinical impact, as well. Two examples of clinical translation resulting from NIH-funded research will be presented, in radiation therapy and diagnostic imaging. Dr. Yu will describe a stereotactic radiotherapy device developed in his laboratory that is designed for treating breast cancer with the patient in the prone position. It uses 36 rotating Cobalt-60 sources positioned in an annular geometry to focus the radiation beam at the system’s isocenter. The radiation dose is delivered throughout the target volume in the breast by constantly moving the patient in a planned trajectory relative to the fixed isocenter. With this technique, the focal spot dynamically paints the dose distribution throughout the target volume in three dimensions. Dr. Jackson will conclude this symposium by describing the RSNA Quantitative Imaging Biomarkers Alliance (QIBA), which is funded in part by NIBIB and is a synergistic collaboration

  6. Second Cancer Risk after simultaneous integrated boost radiation therapy of right sided breast cancer with and without flattening filter

    Energy Technology Data Exchange (ETDEWEB)

    Dobler, Barbara; Maier, Johannes; Knott, Bernadette; Maerz, Manuel; Koelbl, Oliver [Regensburg University Medical Center, Department of Radiotherapy, Regensburg (Germany); Loeschel, Rainer [Ostbayerische Technische Hochschule Regensburg, Faculty of Computer Science and Mathematics, Regensburg (Germany)

    2016-10-15

    The aim of this study was to investigate if the flattening filter free mode (FFF) of a linear accelerator reduces the excess absolute risk (EAR) for second cancer as compared to the flat beam mode (FF) in simultaneous integrated boost (SIB) radiation therapy of right-sided breast cancer. Six plans were generated treating the whole breast to 50.4 Gy and a SIB volume to 63 Gy on CT data of 10 patients: intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and a tangential arc VMAT (tVMAT), each with flattening filter and without. The EAR was calculated for the contralateral breast and the lungs from dose-volume histograms (DVH) based on the linear-exponential, the plateau, and the full mechanistic dose-response model. Peripheral low-dose measurements were performed to compare the EAR in more distant regions as the thyroids and the uterus. FFF reduces the EAR significantly in the contralateral and peripheral organs for tVMAT and in the peripheral organs for VMAT. No reduction was found for IMRT. The lowest EAR for the contralateral breast and lung was achieved with tVMAT FFF, reducing the EAR by 25 % and 29 % as compared to tVMAT FF, and by 44 % to 58 % as compared to VMAT and IMRT in both irradiation modes. tVMAT FFF showed also the lowest peripheral dose corresponding to the lowest EAR in the thyroids and the uterus. The use of FFF mode allows reducing the EAR significantly when tVMAT is used as the treatment technique. When second cancer risk is a major concern, tVMAT FFF is considered the preferred treatment option in SIB irradiation of right-sided breast cancer. (orig.) [German] Ziel der Studie war es zu untersuchen, ob der ausgleichskoerperfreie Modus (FFF) bei der simultan integrierten Boost-(SIB-)Bestrahlung des rechtsseitigen Mammakarzinoms eine Reduktion des strahleninduzierten Sekundaermalignomrisikos (''excess absolute risk'', EAR) im Vergleich zur Bestrahlung mit Ausgleichskoerper (FF) erlaubt. Auf CT

  7. Hypofractionated Radiation Therapy After Mastectomy in Preventing Recurrence in Patients With Stage IIa-IIIa Breast Cancer

    Science.gov (United States)

    2018-04-06

    Ductal Breast Carcinoma; Invasive Breast Carcinoma; Lobular Breast Carcinoma; Medullary Breast Carcinoma; Stage II Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Tubular Breast Carcinoma

  8. The Pattern of Use of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer in New South Wales, Australia, 2008 to 2012

    Energy Technology Data Exchange (ETDEWEB)

    Delaney, Geoff P., E-mail: Geoff.delaney@swsahs.nsw.gov.au [Liverpool Cancer Therapy Centre, Liverpool, New South Wales (Australia); Collaboration for Cancer Outcomes Research and Evaluation, University of New South Wales, Sydney (Australia); Ingham Health and Medical Research Institute, Sydney (Australia); New South Wales Cancer Institute (Australia); Gandhidasan, Senthilkumar [Peter MacCallum Cancer Centre, Melbourne (Australia); Walton, Richard; Terlich, Frances; Baker, Deborah; Currow, David [New South Wales Cancer Institute (Australia)

    2016-10-01

    Purpose: Increasing phase 3 evidence has been published about the safety and efficacy of hypofractionated radiation therapy, in comparison with standard fractionation, in early-stage, node-negative breast cancer. However, uptake of hypofractionation has not been universal. The aim of this study was to investigate the hypofractionation regimen variations in practice across public radiation oncology facilities in New South Wales (NSW). Methods and Materials: Patients with early breast cancer registered in the NSW Clinical Cancer Registry who received radiation therapy for early-stage breast cancer in a publicly funded radiation therapy department between 2008 and 2012 were identified. Data extracted and analyzed included dose and fractionation type, patient age at first fraction, address (for geocoding), year of diagnosis, year of treatment, laterality, and department of treatment. A logistic regression model was used to identify factors associated with fractionation type. Results: Of the 5880 patients fulfilling the study criteria, 3209 patients (55%) received standard fractionation and 2671 patients (45%) received hypofractionation. Overall, the use of hypofractionation increased from 37% in 2008 to 48% in 2012 (range, 7%-94% across departments). Treatment facility and the radiation oncologist prescribing the treatment were the strongest independent predictors of hypofractionation. Weaker associations were also found for age, tumor site laterality, year of treatment, and distance to facility. Conclusions: Hypofractionated regimens of whole breast radiation therapy have been variably administered in the adjuvant setting in NSW despite the publication of long-term trial results and consensus guidelines. Some factors that predict the use of hypofractionation are not based on guideline recommendations, including lower rates of left-sided treatment and increasing distance from a treatment facility.

  9. A Prospective Pathologic Study to Define the Clinical Target Volume for Partial Breast Radiation Therapy in Women With Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Brandon T., E-mail: Brandon.Nguyen@act.gov.au [Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Canberra Hospital, Radiation Oncology Department, Garran, ACT (Australia); Deb, Siddhartha [Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Victorian Cancer Biobank, Cancer Council of Victoria, Carlton, Victoria (Australia); Fox, Stephen [Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Hill, Prudence [Department of Anatomical Pathology, St. Vincent' s Hospital Melbourne, Fitzroy, Victoria (Australia); Collins, Marnie [Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); Chua, Boon H. [Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria (Australia); University of Melbourne, Parkville, Victoria (Australia)

    2012-12-01

    Purpose: To determine an appropriate clinical target volume for partial breast radiation therapy (PBRT) based on the spatial distribution of residual invasive and in situ carcinoma after wide local excision (WLE) for early breast cancer or ductal carcinoma in situ (DCIS). Methods and Materials: We performed a prospective pathologic study of women potentially eligible for PBRT who had re-excision and/or completion mastectomy after WLE for early breast cancer or DCIS. A pathologic assessment protocol was used to determine the maximum radial extension (MRE) of residual carcinoma from the margin of the initial surgical cavity. Women were stratified by the closest initial radial margin width: negative (>1 mm), close (>0 mm and {<=}1 mm), or involved. Results: The study population was composed of 133 women with a median age of 59 years (range, 27-82 years) and the following stage groups: 0 (13.5%), I (40.6%), II (38.3%), and III (7.5%). The histologic subtypes of the primary tumor were invasive ductal carcinoma (74.4%), invasive lobular carcinoma (12.0%), and DCIS alone (13.5%). Residual carcinoma was present in the re-excision and completion mastectomy specimens in 55.4%, 14.3%, and 7.2% of women with an involved, close, and negative margin, respectively. In the 77 women with a noninvolved radial margin, the MRE of residual disease, if present, was {<=}10 mm in 97.4% (95% confidence interval 91.6-99.5) of cases. Larger MRE measurements were significantly associated with an involved margin (P<.001), tumor size >30 mm (P=.03), premenopausal status (P=.03), and negative progesterone receptor status (P=.05). Conclusions: A clinical target volume margin of 10 mm would encompass microscopic residual disease in >90% of women potentially eligible for PBRT after WLE with noninvolved resection margins.

  10. A Prospective Pathologic Study to Define the Clinical Target Volume for Partial Breast Radiation Therapy in Women With Early Breast Cancer

    International Nuclear Information System (INIS)

    Nguyen, Brandon T.; Deb, Siddhartha; Fox, Stephen; Hill, Prudence; Collins, Marnie; Chua, Boon H.

    2012-01-01

    Purpose: To determine an appropriate clinical target volume for partial breast radiation therapy (PBRT) based on the spatial distribution of residual invasive and in situ carcinoma after wide local excision (WLE) for early breast cancer or ductal carcinoma in situ (DCIS). Methods and Materials: We performed a prospective pathologic study of women potentially eligible for PBRT who had re-excision and/or completion mastectomy after WLE for early breast cancer or DCIS. A pathologic assessment protocol was used to determine the maximum radial extension (MRE) of residual carcinoma from the margin of the initial surgical cavity. Women were stratified by the closest initial radial margin width: negative (>1 mm), close (>0 mm and ≤1 mm), or involved. Results: The study population was composed of 133 women with a median age of 59 years (range, 27-82 years) and the following stage groups: 0 (13.5%), I (40.6%), II (38.3%), and III (7.5%). The histologic subtypes of the primary tumor were invasive ductal carcinoma (74.4%), invasive lobular carcinoma (12.0%), and DCIS alone (13.5%). Residual carcinoma was present in the re-excision and completion mastectomy specimens in 55.4%, 14.3%, and 7.2% of women with an involved, close, and negative margin, respectively. In the 77 women with a noninvolved radial margin, the MRE of residual disease, if present, was ≤10 mm in 97.4% (95% confidence interval 91.6-99.5) of cases. Larger MRE measurements were significantly associated with an involved margin (P 30 mm (P=.03), premenopausal status (P=.03), and negative progesterone receptor status (P=.05). Conclusions: A clinical target volume margin of 10 mm would encompass microscopic residual disease in >90% of women potentially eligible for PBRT after WLE with noninvolved resection margins.

  11. Radiation therapy and herpes zoster

    International Nuclear Information System (INIS)

    Kaneko, Itsuo; Matsushima, Hideno; Yamada, Teruyo; Moriya, Hiroshi

    1975-01-01

    The relationship between herpes zoster and radiation therapy was discussed and the combination of herpes zoster with malignancies was observed. Reported were five cases of herpes zoster (four breast and one lung carcinoma) out of 317 cases of malignancies which were irradiated in our clinic and include considerations about the etiologic relationship. (J.P.N.)

  12. Influence of radiation therapy on lung tissue in breast cancer patients. CT-assessed density changes 4 years after completion of radiotherapy

    International Nuclear Information System (INIS)

    Svane, G.; Rotstein, S.; Lax, I.

    1995-01-01

    CT-assessed density changes in lung tissues were measured in 22 disease-free breast cancer patients 4 years after completion of radiation therapy. All patients had previously undergone similar CT-examinations before treatment, 3 months, and 9 months after radiotherapy. In patients with visible areas of increased lung density at earlier CT-examinations a decrease of focal findings was observed at 4 years. In patients without focal findings, an increase in density relative to that before therapy was observed. The difference between the mean lung density values among those with visible radiological findings and those without was statistically significant both at 3 and 9 months after therapy. However, this difference did not persist at 4 years. These results may indicate a 2-phase development of radiation-induced lung damages - an acute phase and a late phase; the late phase emerging slowly, and in this study detectable 4 years after completion of radiation therapy. (orig.)

  13. Clinicopathologic Significance of Excision Repair Cross-Complementation 1 Expression in Patients Treated With Breast-Conserving Surgery and Radiation Therapy

    International Nuclear Information System (INIS)

    Goyal, Sharad; Parikh, Rahul R.; Green, Camille; Schiff, Devora B.S.; Moran, Meena S.; Yang Qifeng; Haffty, Bruce G.

    2010-01-01

    Purpose: The excision repair cross-complementation 1 (ERCC1) enzyme plays a rate-limiting role in the nucleotide excision repair pathway and is associated with resistance to platinum-based chemotherapy in cancers of the head and neck and the lung. The purpose of this study was to evaluate the clinicopathologic and prognostic significance of ERCC1 expression in a cohort of early-stage breast cancer patients treated with breast conservation therapy. Methods and Materials: Paraffin specimens from 504 women with early-stage breast cancer treated with breast conservation therapy were constructed into tissue microarrays. The array was stained for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) and ERCC1. This was then correlated with clinicopathologic factors and outcomes data. Results: ERCC-1 expression was evaluable in 366 cases (72%). In this group, 32% and 38% of patients received adjuvant chemotherapy and hormonal therapy, respectively. Increased ERCC-1 expression was found to be correlated with ER positivity (p 50 (p 50. To our knowledge, this is the first study investigating ERCC1 expression in patients receiving adjuvant radiation therapy for breast cancer.

  14. Dose Specification and Quality Assurance of Radiation Therapy Oncology Group Protocol 95-17; a Cooperative Group Study of Iridium-192 Breast Implants as Sole Therapy

    International Nuclear Information System (INIS)

    Ibbott, Geoffrey S.; Hanson, W.F.; O'Meara, Elizabeth; Kuske, Robert R.; Arthur, Douglas; Rabinovitch, Rachel; White, Julia; Wilenzick, Raymond M.; Harris, Irene; Tailor, Ramesh C.

    2007-01-01

    Purpose: The Radiation Therapy Oncology Group (RTOG) protocol 95-17 was a Phase I/II trial to evaluate multicatheter brachytherapy as the sole method of adjuvant breast radiotherapy for Stage I/II breast carcinoma after breast-conserving surgery. Low- or high-dose-rate sources were allowed. Dose prescription and treatment evaluation were based on recommendations in the International Commission on Radiation Units and Measurements (ICRU), Report 58 and included the parameters mean central dose (MCD), average peripheral dose, dose homogeneity index (DHI), and the dimensions of the low- and high-dose regions. Methods and Materials: Three levels of quality assurance were implemented: (1) credentialing of institutions was required before entering patients into the study; (2) rapid review of each treatment plan was conducted before treatment; and (3) retrospective review was performed by the Radiological Physics Center in conjunction with the study chairman and RTOG dosimetry staff. Results: Credentialing focused on the accuracy of dose calculation algorithm and compliance with protocol guidelines. Rapid review was designed to identify and correct deviations from the protocol before treatment. The retrospective review involved recalculation of dosimetry parameters and review of dose distributions to evaluate the treatment. Specifying both central and peripheral doses resulted in uniform dose distributions, with a mean dose homogeneity index of 0.83 ± 0.06. Conclusions: Vigorous quality assurance resulted in a high-quality study with few deviations; only 4 of 100 patients were judged as representing minor variations from protocol, and no patient was judged as representing major deviation. This study should be considered a model for quality assurance of future trials

  15. A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Sayan, Mutlay; Nelson, Carl; Gagne, Havaleh; Rubin, Deborah; Heimann, Ruth [Dept. of Radiation Oncology, University of Vermont Medical Center, Burlington (United States); Wilson, Karen [University of Vermont Cancer Center, Burlington (United States)

    2017-03-15

    Several accelerated partial breast radiation (APBR) techniques have been investigated in patients with early-stage breast cancer (BC); however, the optimal treatment delivery techniques remain unclear. We evaluated the feasibility and toxicity of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I BC, using a novel fractionation schedule. Forty-two patients aged ≥65 years, with stage I BC who underwent breast conserving surgery were enrolled in a phase I/II study evaluating APBR using IMRT. Forty eligible patients received 40 Gy in 4 Gy daily fractions. Patients were assessed for treatment related toxicities, and cosmesis, before APBR, during, and after completion of the treatment. The median age was 73 years, median tumor size 0.8 cm and the median follow-up was 54 months. The 5-year locoregional control was 97.5% and overall survival 90%. Erythema and skin pigmentation was the most common acute adverse event, reported by 27 patients (69%). Twenty-six patients (65%) reported mild pain, rated 1-4/10. This improved at last follow-up to only 2 (15%). Overall the patient and physician reported worst late toxicities were lower than the baseline and at last follow-up, patients and physicians rated cosmesis as excellent/good in 93% and 86 %, respectively. In this prospective trial, we observed an excellent rate of tumor control with daily APBR. The acceptable toxicity profile and cosmetic results of this study support the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.

  16. 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)

    Rodríguez, Núria; Sanz, Xavier; Dengra, Josefa; Foro, Palmira; Membrive, Ismael; Reig, Anna; Quera, Jaume; Fernández-Velilla, Enric; Pera, Óscar; Lio, Jackson; Lozano, Joan; Algara, Manuel

    2013-01-01

    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 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 conventional WBI

  17. The role of total dose in conservative surgery and radiation therapy for early stage breast cancer: is there a critical level?

    Energy Technology Data Exchange (ETDEWEB)

    White, Julia; Brown, Douglas; Gustafson, Greg; Chen, Peter; Matter, Richard; Cook, Carla; Martinez, Alvaro; Vicini, Frank A

    1995-07-01

    Purpose: Over the past several years, it has been our standard policy after breast conserving surgery to treat the entire breast to 45-50 Gy followed by a supplemental boost dose to the tumor bed to a minimum of 60 Gy with standard fractionation. We reviewed patients who received < 60 Gy to the tumor bed to identify any differences in recurrence rates in the breast. Materials and Methods: From 1/1/75 through 12/31/87, 443 consecutive patients diagnosed with stage I and II breast cancer (unilateral) were treated with conservative surgery and radiation therapy (CSRT) at William Beaumont Hospital. All patients underwent at least an excisional biopsy and 268 (60%) patients were re-excised. An ipsilateral axillary lymph node dissection was performed on 420 patients (95%). All patients received whole breast irradiation to 45-50 Gy. A supplemental boost dose was delivered to the tumor bed with either an implant, electrons, or photons in 404 (91%) patients. Median follow-up of surviving patients is 88 months. Results: Thirty-three patients of the 443 have suffered a failure in the treated breast for a 5 and 10 yr actuarial rate of local recurrence of 5 and 10%, respectively. Evaluation by total dose to the tumor bed is as follows: The distribution of patient's respective histology, tumor size, hormonal status, age, re-excision status, and adjuvant systemic therapy was similar among the dose groups. On multivariate analysis (Cox), in addition to total dose to tumor bed (p=0.002), the only other factor which was significantly associated with local recurrence was patient age {<=} 35 (p=0.002). Conclusions: Patients who receive {<=} 50 Gy to the tumor bed without careful attention to excisional status are at a significantly higher risk of local failure. This underlies the importance of supplementing the tumor bed dose after whole breast radiation therapy in those patients whose status of excision is not definitely known.

  18. Investigation of conformal and intensity-modulated radiation therapy techniques to determine the absorbed fetal dose in pregnant patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Öğretici, Akın, E-mail: akinogretici@gmail.com; Akbaş, Uğur; Köksal, Canan; Bilge, Hatice

    2016-07-01

    The aim of this research was to investigate the fetal doses of pregnant patients undergoing conformal radiotherapy or intensity-modulated radiation therapy (IMRT) for breast cancers. An Alderson Rando phantom was chosen to simulate a pregnant patient with breast cancer who is receiving radiation therapy. This phantom was irradiated using the Varian Clinac DBX 600 system (Varian Medical System, Palo Alto, CA) linear accelerator, according to the standard treatment plans of both three-dimensional conformal radiation therapy (3-D CRT) and IMRT techniques. Thermoluminescent dosimeters were used to measure the irradiated phantom's virtually designated uterus area. Thermoluminescent dosimeter measurements (in the phantom) revealed that the mean cumulative fetal dose for 3-D CRT is 1.39 cGy and for IMRT it is 8.48 cGy, for a pregnant breast cancer woman who received radiation treatment of 50 Gy. The fetal dose was confirmed to increase by 70% for 3-D CRT and 40% for IMRT, if it is closer to the irradiated field by 5 cm. The mean fetal dose from 3-D CRT is 1.39 cGy and IMRT is 8.48 cGy, consistent with theoretic calculations. The IMRT technique causes the fetal dose to be 5 times more than that of 3-D CRT. Theoretic knowledge concerning the increase in the peripheral doses as the measurements approached the beam was also practically proven.

  19. MicroRNA-Related DNA Repair/Cell-Cycle Genes Independently Associated With Relapse After Radiation Therapy for Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gee, Harriet E., E-mail: harriet.gee@sydney.edu.au [The Kinghorn Cancer Centre & Cancer Research Division, Garvan Institute of Medical Research, Darlinghurst, NSW (Australia); The Chris O' Brien Lifehouse, Missenden Road, Camperdown, NSW (Australia); Central Clinical School, Sydney Medical School, University of Sydney, NSW (Australia); Buffa, Francesca M.; Harris, Adrian L. [Department of Medical Oncology, The University of Oxford, Oxford (United Kingdom); Toohey, Joanne M.; Carroll, Susan L. [The Chris O' Brien Lifehouse, Missenden Road, Camperdown, NSW (Australia); Cooper, Caroline L. [Central Clinical School, Sydney Medical School, University of Sydney, NSW (Australia); Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW (Australia); Beith, Jane [The Chris O' Brien Lifehouse, Missenden Road, Camperdown, NSW (Australia); McNeil, Catriona [The Kinghorn Cancer Centre & Cancer Research Division, Garvan Institute of Medical Research, Darlinghurst, NSW (Australia); The Chris O' Brien Lifehouse, Missenden Road, Camperdown, NSW (Australia); Carmalt, Hugh; Mak, Cindy; Warrier, Sanjay [The Chris O' Brien Lifehouse, Missenden Road, Camperdown, NSW (Australia); Holliday, Anne [The Kinghorn Cancer Centre & Cancer Research Division, Garvan Institute of Medical Research, Darlinghurst, NSW (Australia); Selinger, Christina; Beckers, Rhiannon [Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW (Australia); Kennedy, Catherine [Central Clinical School, Sydney Medical School, University of Sydney, NSW (Australia); Graham, Peter [Department of Radiation Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW (Australia); Swarbrick, Alexander [The Kinghorn Cancer Centre & Cancer Research Division, Garvan Institute of Medical Research, Darlinghurst, NSW (Australia); St Vincent' s Clinical School, Faculty of Medicine, University of NSW, Kensington, NSW (Australia); and others

    2015-12-01

    Purpose: Local recurrence and distant failure after adjuvant radiation therapy for breast cancer remain significant clinical problems, incompletely predicted by conventional clinicopathologic markers. We had previously identified microRNA-139-5p and microRNA-1274a as key regulators of breast cancer radiation response in vitro. The purpose of this study was to investigate standard clinicopathologic markers of local recurrence in a contemporary series and to establish whether putative target genes of microRNAs involved in DNA repair and cell cycle control could better predict radiation therapy response in vivo. Methods and Materials: With institutional ethics board approval, local recurrence was measured in a contemporary, prospectively collected series of 458 patients treated with radiation therapy after breast-conserving surgery. Additionally, independent publicly available mRNA/microRNA microarray expression datasets totaling >1000 early-stage breast cancer patients, treated with adjuvant radiation therapy, with >10 years of follow-up, were analyzed. The expression of putative microRNA target biomarkers—TOP2A, POLQ, RAD54L, SKP2, PLK2, and RAG1—were correlated with standard clinicopathologic variables using 2-sided nonparametric tests, and to local/distant relapse and survival using Kaplan-Meier and Cox regression analysis. Results: We found a low rate of isolated local recurrence (1.95%) in our modern series, and that few clinicopathologic variables (such as lymphovascular invasion) were significantly predictive. In multiple independent datasets (n>1000), however, high expression of RAD54L, TOP2A, POLQ, and SKP2 significantly correlated with local recurrence, survival, or both in univariate and multivariate analyses (P<.001). Low RAG1 expression significantly correlated with local recurrence (multivariate, P=.008). Additionally, RAD54L, SKP2, and PLK2 may be predictive, being prognostic in radiation therapy–treated patients but not in untreated matched

  20. Does inverse-planned intensity-modulated radiation therapy have a role in the treatment of patients with left-sided breast cancer?

    International Nuclear Information System (INIS)

    Stillie, Alison L.; Chua, Boon; Kron, Tomas; Cramb, Jim; Herschtal, Alan; Hornby, Colin; Sullivan, Kelly

    2011-01-01

    The purpose of the study was to determine if multi-field inverse-planned intensity-modulated radiation therapy (IMRT) improves on the sparing of organs at risk (heart, lungs and contralateral breast) when compared with field-in-field forward-planned RT (FiF). The planning CT scans of 10 women with left-sided breast cancer previously treated with whole-breast RT on an inclined breast board with both arms supported above the head were retrieved. The whole breast planning target volume (PTV) was defined by clinical mark-up and contoured on all relevant CT slices as were the organs at risk. For each patient, three plans were generated using FiF, five- and nine-field inverse-planned IMRT, all to a total dose of 50 Gy to the whole breast. Mean and maximum doses to the organs at risk and the homogeneity index (HI) of the whole-breast PTV were compared. The mean heart dose for the FiF plans was 2.63 Gy compared with 4.04 Gy for the five-field and 4.30 Gy for the nine-field IMRT plans, with no significant differences in the HI of the whole-breast PTV in all plans. The FiF plans resulted in a mean contralateral breast dose of 0.58 Gy compared with 0.70 and 2.08 Gy for the five- and nine-field IMRT plans, respectively. FiF resulted in a lower mean heart and contralateral breast dose with comparable HI of the whole-breast PTV in comparison with inverse-planned IMRT using five or nine fields.

  1. Postmastectomy Radiation Therapy Is Associated With Improved Survival in Node-Positive Male Breast Cancer: A Population Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Abrams, Matthew J., E-mail: mabrams@tuftsmedicalcenter.org [Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts (United States); Koffer, Paul P. [Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts (United States); Wazer, David E. [Department of Radiation Oncology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts (United States); Department of Radiation Oncology, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island (United States); Hepel, Jaroslaw T. [Department of Radiation Oncology, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island (United States)

    2017-06-01

    Purpose: Because of its rarity, there are no randomized trials investigating postmastectomy radiation therapy (PMRT) in male breast cancer. This study retrospectively examines the impact of PMRT in male breast cancer patients in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. Methods and Materials: The SEER database 8.3.2 was queried for men ages 20+ with a diagnosis of localized or regional nonmetastatic invasive ductal/lobular carcinoma from 1998 to 2013. Included patients were treated by modified radical mastectomy (MRM), with or without adjuvant external beam radiation. Univariate and multivariate analyses evaluated predictors for PMRT use after MRM. Kaplan-Meier overall survival (OS) curves of the entire cohort and a case-matched cohort were calculated and compared by the log-rank test. Cox regression was used for multivariate survival analyses. Results: A total of 1933 patients were included in the unmatched cohort. There was no difference in 5-year OS between those who received PMRT and those who did not (78% vs 77%, respectively, P=.371); however, in the case-matched analysis, PMRT was associated with improved OS at 5 years (83% vs 54%, P<.001). On subset analysis of the unmatched cohort, PMRT was associated with improved OS in men with 1 to 3 positive nodes (5-year OS 79% vs 72% P=.05) and those with 4+ positive nodes (5-year OS 73% vs 53% P<.001). On multivariate analysis of the unmatched cohort, independent predictors for improved OS were use of PMRT: HR=0.551 (0.412-0.737) and estrogen receptor–positive disease: HR=0.577 (0.339-0.983). Predictors for a survival detriment were higher grade 3/4: HR=1.825 (1.105-3.015), larger tumor T2: HR=1.783 (1.357-2.342), T3/T4: HR=2.683 (1.809-3.978), higher N-stage: N1 HR=1.574 (1.184-2.091), N2/N3: HR=2.328 (1.684-3.218), black race: HR=1.689 (1.222-2.336), and older age 81+: HR=4.164 (1.497-11.582). Conclusions: There may be a survival benefit with the

  2. Use of Combination Thermal Therapy and Radiation in Breast-Conserving Treatment of Extensive Intraductal Breast Cancer

    Science.gov (United States)

    1997-07-01

    dose reirradiation in combination with hyperthermia: a palliative treatment for patients with breast cancer recurring in previously irradiated areas...Additional monitoring: 5.61 The P.I. or a physician designated by the P.I. will be in attendance during every treatment. 5.62 The treatment nurse will...device will obtain blood pressure every 5 minutes. 5.64 General anesthesia cannot be used, but light sedation (e.g. Ativan, Percocet, etc.) can be

  3. Cost-effectiveness of radiation therapy following conservative surgery for ductal carcinoma in situ of the breast

    International Nuclear Information System (INIS)

    Suh, W. Warren; Hillner, Bruce E.; Pierce, Lori J.; Hayman, James A.

    2005-01-01

    Purpose: To assess the cost-effectiveness of radiation therapy (RT) in patients with ductal carcinoma in situ (DCIS) after breast-conserving surgery (BCS). Methods and materials: A Markov model was constructed for a theoretical cohort of 55-year-old women with DCIS over a life-time horizon. Probability estimates for local noninvasive (N-INV), local invasive (INV), and distant recurrences were obtained from National Surgical Adjuvant Breast and Bowel Project (NSABP) B-17. Utilities for eight nonmetastatic health states were collected from both healthy women and DCIS patients. Direct medical (2002 Medicare fee schedule) and nonmedical costs (time and transportation) of RT were ascertained. Results: For BCS + RT vs. BCS alone, the estimated N-INV and INV rates at 12 years were 9% and 8% vs. 16% and 18%, respectively. The incremental cost of adding RT was $3300 despite an initial RT cost of $8700 due to higher local recurrence-related salvage costs incurred with the BCS alone strategy. An increase of 0.09 quality-adjusted life-years (QALYs) primarily reflected the lower risk of INV with RT, resulting in an incremental cost-effectiveness ratio (ICER) of $36,700/QALY. Sensitivity analyses revealed the ICER to be affected by baseline probability of a local recurrence, relative efficacy of RT in preventing INV, negative impact of an INV on quality of life, and cost of initial RT. Cost of salvage BCS + RT and source of utilities (healthy women vs. DCIS patients) influenced the ICER albeit to a lesser degree. Conclusions: Addition of RT following BCS for patients with DCIS should not be withheld because of concerns regarding its cost-effectiveness

  4. Assessment of Intrafraction Breathing Motion on Left Anterior Descending Artery Dose During Left-Sided Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    El-Sherif, Omar, E-mail: Omar.ElSherif@lhsc.on.ca [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Xhaferllari, Ilma [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Gaede, Stewart [Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Physics, London Regional Cancer Program, London, Ontario (Canada); Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada)

    2016-07-01

    Purpose: To use 4-dimensional computed tomography (4D-CT) imaging to predict the level of uncertainty in cardiac dose estimates of the left anterior descending artery that arises due to breathing motion during radiation therapy for left-sided breast cancer. Methods and Materials: The fast helical CT (FH-CT) and 4D-CT of 30 left-sided breast cancer patients were retrospectively analyzed. Treatment plans were created on the FH-CT. The original treatment plan was then superimposed onto all 10 phases of the 4D-CT to quantify the dosimetric impact of respiratory motion through 4D dose accumulation (4D-dose). Dose-volume histograms for the heart, left ventricle (LV), and left anterior descending (LAD) artery obtained from the FH-CT were compared with those obtained from the 4D-dose. Results: The 95% confidence interval of 4D-dose and FH-CT differences in mean dose estimates for the heart, LV, and LAD were ±0.5 Gy, ±1.0 Gy, and ±8.7 Gy, respectively. Conclusion: Fast helical CT is a good approximation for doses to the heart and LV; however, dose estimates for the LAD are susceptible to uncertainties that arise due to intrafraction breathing motion that cannot be ascertained without the additional information obtained from 4D-CT and dose accumulation. For future clinical studies, we suggest the use of 4D-CT–derived dose-volume histograms for estimating the dose to the LAD.

  5. Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

    International Nuclear Information System (INIS)

    Karlsson, Per; Cole, Bernard F.; Price, Karen N.; Gelber, Richard D.; Coates, Alan S.; Goldhirsch, Aron; Castiglione, Monica; Colleoni, Marco; Gruber, Günther

    2016-01-01

    Purpose: To update the previous report from 2 randomized clinical trials, now with a median follow-up of 16 years, to analyze the effect of radiation therapy timing on local failure and disease-free survival. Patients and Methods: From July 1986 to April 1993, International Breast Cancer Study Group trial VI randomly assigned 1475 pre-/perimenopausal women with node-positive breast cancer to receive 3 or 6 cycles of initial chemotherapy (CT). International Breast Cancer Study Group trial VII randomly assigned 1212 postmenopausal women with node-positive breast cancer to receive tamoxifen for 5 years, or tamoxifen for 5 years with 3 early cycles of initial CT. For patients who received breast-conserving surgery (BCS), radiation therapy (RT) was delayed until initial CT was completed; 4 or 7 months after BCS for trial VI and 2 or 4 months for trial VII. We compared RT timing groups among 433 patients on trial VI and 285 patients on trial VII who received BCS plus RT. Endpoints were local failure, regional/distant failure, and disease-free survival (DFS). Results: Among pre-/perimenopausal patients there were no significant differences in disease-related outcomes. The 15-year DFS was 48.2% in the group allocated 3 months initial CT and 44.9% in the group allocated 6 months initial CT (hazard ratio [HR] 1.12; 95% confidence interval [CI] 0.87-1.45). Among postmenopausal patients, the 15-year DFS was 46.1% in the no-initial-CT group and 43.3% in the group allocated 3 months initial CT (HR 1.11; 95% CI 0.82-1.51). Corresponding HRs for local failures were 0.94 (95% CI 0.61-1.46) in trial VI and 1.51 (95% CI 0.77-2.97) in trial VII. For regional/distant failures, the respective HRs were 1.15 (95% CI 0.80-1.63) and 1.08 (95% CI 0.69-1.68). Conclusions: This study confirms that, after more than 15 years of follow-up, it is reasonable to delay radiation therapy until after the completion of standard CT.

  6. Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

    Energy Technology Data Exchange (ETDEWEB)

    Karlsson, Per, E-mail: per.karlsson@oncology.gu.se [Department of Oncology, Institute of Clinical Sciences, Sahgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg (Sweden); Cole, Bernard F. [Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont (United States); Price, Karen N. [International Breast Cancer Study Group Statistical Center, Frontier Science and Technology Research Foundation, Boston, Massachusetts (United States); Gelber, Richard D. [International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Frontier Science and Technology Research Foundation, Harvard T. F. Chan School of Public Health, Boston, Massachusetts (United States); Coates, Alan S. [International Breast Cancer Study Group and University of Sydney, Sydney (Australia); Goldhirsch, Aron [Senior Consultant Breast Cancer, European Institute of Oncology and International Breast Cancer Study Group, Milan (Italy); Castiglione, Monica [International Breast Cancer Study Group, Bern (Switzerland); Colleoni, Marco [Division of Medical Senology, European Institute of Oncology and International Breast Cancer Study Group, Milan (Italy); Gruber, Günther [Institute of Radiotherapy, Klinik Hirslanden, Zürich (Switzerland)

    2016-10-01

    Purpose: To update the previous report from 2 randomized clinical trials, now with a median follow-up of 16 years, to analyze the effect of radiation therapy timing on local failure and disease-free survival. Patients and Methods: From July 1986 to April 1993, International Breast Cancer Study Group trial VI randomly assigned 1475 pre-/perimenopausal women with node-positive breast cancer to receive 3 or 6 cycles of initial chemotherapy (CT). International Breast Cancer Study Group trial VII randomly assigned 1212 postmenopausal women with node-positive breast cancer to receive tamoxifen for 5 years, or tamoxifen for 5 years with 3 early cycles of initial CT. For patients who received breast-conserving surgery (BCS), radiation therapy (RT) was delayed until initial CT was completed; 4 or 7 months after BCS for trial VI and 2 or 4 months for trial VII. We compared RT timing groups among 433 patients on trial VI and 285 patients on trial VII who received BCS plus RT. Endpoints were local failure, regional/distant failure, and disease-free survival (DFS). Results: Among pre-/perimenopausal patients there were no significant differences in disease-related outcomes. The 15-year DFS was 48.2% in the group allocated 3 months initial CT and 44.9% in the group allocated 6 months initial CT (hazard ratio [HR] 1.12; 95% confidence interval [CI] 0.87-1.45). Among postmenopausal patients, the 15-year DFS was 46.1% in the no-initial-CT group and 43.3% in the group allocated 3 months initial CT (HR 1.11; 95% CI 0.82-1.51). Corresponding HRs for local failures were 0.94 (95% CI 0.61-1.46) in trial VI and 1.51 (95% CI 0.77-2.97) in trial VII. For regional/distant failures, the respective HRs were 1.15 (95% CI 0.80-1.63) and 1.08 (95% CI 0.69-1.68). Conclusions: This study confirms that, after more than 15 years of follow-up, it is reasonable to delay radiation therapy until after the completion of standard CT.

  7. 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.

  8. An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy

    International Nuclear Information System (INIS)

    Wong, Sharon; Kaur, Amarjit; Back, Michael; Lee, Khai Mun; Baggarley, Shaun; Lu, Jiade Jay

    2011-01-01

    To determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients. Patients treated for postmastectomy radiotherapy in National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast. The mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm) compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007). The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm) compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025). These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p < 0.05) and left irradiated chest wall p = 0.025 (p < 0.025) in comparison to the non-irradiated skin thickness investigating chronic skin reactions. Patients with grade 2 acute skin toxicity presented with thinner skin as compared to patients with grade 1 (p = 0.006). This study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2

  9. An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy

    Directory of Open Access Journals (Sweden)

    Baggarley Shaun

    2011-01-01

    Full Text Available Abstract Background To determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients. Methods Patients treated for postmastectomy radiotherapy in National University Hospital (NUH and Tan Tock Seng Hospital (TTSH, Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast. Results The mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007. The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025. These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p Conclusions This study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2.

  10. Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Khan, Atif J., E-mail: atif.j.khan@rutgers.edu [Department of Radiation Oncology, Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Rafique, Raza [Suleman Dawood School of Business, Lahore University of Management Sciences, Lahore (Pakistan); Zafar, Waleed [Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (Pakistan); Shah, Chirag [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Haffty, Bruce G. [Department of Radiation Oncology, Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Vicini, Frank [Michigan HealthCare Professionals, Farmington Hills, Michigan (United States); Jamshed, Arif [Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (Pakistan); Zhao, Yao [Rutgers University School of Business, Newark, New Jersey (United States)

    2017-02-01

    Purpose: Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system. Methods and Materials: We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population. Results: The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model. Conclusions: Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.

  11. Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis

    International Nuclear Information System (INIS)

    Khan, Atif J.; Rafique, Raza; Zafar, Waleed; Shah, Chirag; Haffty, Bruce G.; Vicini, Frank; Jamshed, Arif; Zhao, Yao

    2017-01-01

    Purpose: Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system. Methods and Materials: We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population. Results: The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model. Conclusions: Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.

  12. Prospective Randomized Trial of Prone Accelerated Intensity Modulated Breast Radiation Therapy With a Daily Versus Weekly Boost to the Tumor Bed

    International Nuclear Information System (INIS)

    Cooper, Benjamin T.; Formenti-Ujlaki, George F.; Li, Xiaochun; Shin, Samuel M.; Fenton-Kerimian, Maria; Guth, Amber; Roses, Daniel F.; Hitchen, Christine J.; Rosenstein, Barry S.; Dewyngaert, J. Keith; Goldberg, Judith D.; Formenti, Silvia C.

    2016-01-01

    Purpose: To report the results of a prospective randomized trial comparing a daily versus weekly boost to the tumor cavity during the course of accelerated radiation to the breast with patients in the prone position. Methods and Materials: From 2009 to 2012, 400 patients with stage 0 to II breast cancer who had undergone segmental mastectomy participated in an institutional review board–approved trial testing prone breast radiation therapy to 40.5 Gy in 15 fractions 5 d/wk to the whole breast, after randomization to a concomitant daily boost to the tumor bed of 0.5 Gy, or a weekly boost of 2 Gy, on Friday. The present noninferiority trial tested the primary hypothesis that a weekly boost produced no more acute toxicity than did a daily boost. The recurrence-free survival was estimated for both treatment arms using the Kaplan-Meier method; the relative risk of recurrence or death was estimated, and the 2 arms were compared using the log-rank test. Results: At a median follow-up period of 45 months, no deaths related to breast cancer had occurred. The weekly boost regimen produced no more grade ≥2 acute toxicity than did the daily boost regimen (8.1% vs 10.4%; noninferiority Z = −2.52; P=.006). No statistically significant difference was found in the cumulative incidence of long-term fibrosis or telangiectasia of grade ≥2 between the 2 arms (log-rank P=.923). Two local and two distant recurrences developed in the daily treatment arm and three local and one distant developed in the weekly arm. The 4-year recurrence-free survival rate was not different between the 2 treatment arms (98% for both arms). Conclusions: A tumor bed boost delivered either daily or weekly was tolerated similarly during accelerated prone breast radiation therapy, with excellent control of disease and comparable cosmetic results.

  13. Prospective Randomized Trial of Prone Accelerated Intensity Modulated Breast Radiation Therapy With a Daily Versus Weekly Boost to the Tumor Bed

    Energy Technology Data Exchange (ETDEWEB)

    Cooper, Benjamin T.; Formenti-Ujlaki, George F. [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Li, Xiaochun [Division of Biostatistics, Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York (United States); Shin, Samuel M.; Fenton-Kerimian, Maria [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Guth, Amber; Roses, Daniel F. [Department of Surgery, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Hitchen, Christine J. [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Rosenstein, Barry S. [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Dewyngaert, J. Keith [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Goldberg, Judith D. [Division of Biostatistics, Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York (United States); Formenti, Silvia C., E-mail: formenti@med.cornell.edu [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States)

    2016-06-01

    Purpose: To report the results of a prospective randomized trial comparing a daily versus weekly boost to the tumor cavity during the course of accelerated radiation to the breast with patients in the prone position. Methods and Materials: From 2009 to 2012, 400 patients with stage 0 to II breast cancer who had undergone segmental mastectomy participated in an institutional review board–approved trial testing prone breast radiation therapy to 40.5 Gy in 15 fractions 5 d/wk to the whole breast, after randomization to a concomitant daily boost to the tumor bed of 0.5 Gy, or a weekly boost of 2 Gy, on Friday. The present noninferiority trial tested the primary hypothesis that a weekly boost produced no more acute toxicity than did a daily boost. The recurrence-free survival was estimated for both treatment arms using the Kaplan-Meier method; the relative risk of recurrence or death was estimated, and the 2 arms were compared using the log-rank test. Results: At a median follow-up period of 45 months, no deaths related to breast cancer had occurred. The weekly boost regimen produced no more grade ≥2 acute toxicity than did the daily boost regimen (8.1% vs 10.4%; noninferiority Z = −2.52; P=.006). No statistically significant difference was found in the cumulative incidence of long-term fibrosis or telangiectasia of grade ≥2 between the 2 arms (log-rank P=.923). Two local and two distant recurrences developed in the daily treatment arm and three local and one distant developed in the weekly arm. The 4-year recurrence-free survival rate was not different between the 2 treatment arms (98% for both arms). Conclusions: A tumor bed boost delivered either daily or weekly was tolerated similarly during accelerated prone breast radiation therapy, with excellent control of disease and comparable cosmetic results.

  14. Interactive Gentle Yoga in Improving Quality of Life in Patients With Stage I-III Breast Cancer Undergoing Radiation Therapy

    Science.gov (United States)

    2017-07-28

    Anxiety Disorder; Depression; Ductal Breast Carcinoma in Situ; Fatigue; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  15. SU-F-T-654: Pacemaker Dose Estimate Using Optically Stimulated Luminescent Dosimeter for Left Breast Intraoperative Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Y; Goenka, A; Sharma, A; Wang, L; Cao, Y; Jamshidi, A [Northwell Health, Lake Success, NY (United States)

    2016-06-15

    Purpose: To assess and report the in vivo dose for a patient with a pacemaker being treated in left breast intraoperative radiation therapy (IORT). The ZEISS Intrabeam 50 kVp X-ray beam with a spherical applicator was used. Methods: The optically stimulated luminescent dosimeters (OSLDs) (Landauer nanoDots) were employed and calibrated under the conditions of the Intrabeam 50 kVp X-rays. The nanoDots were placed on the patient at approximately 15 cm away from the lumpectomy cavity both under and above a shield of lead equivalence 0.25 mm (RayShield X-Drape D-110) covering the pacemaker area during IORT with a 5 cm spherical applicator. Results: The skin surface dose near the pacemaker during the IORT with a prescription of 20 Gy was measured as 4.0±0.8 cGy. The dose behind the shield was 0.06±0.01 Gy, demonstrating more than 98% dose reduction. The in vivo skin surface doses during a typical breast IORT at a 4.5 cm spherical applicator surface were further measured at 5, 10, 15, and 20 cm away to be 159±11 cGy, 15±1 cGy, 6.6±0.5 cGy, and 1.8±0.1 cGy, respectively. A power law fit to the dose versus the distance z from the applicator surface yields the dose fall off at the skin surface following z^-2.5, which can be used to estimate skin doses in future cases. The comparison to an extrapolation of depth dose in water reveals an underestimate of far field dose using the manufactory provided data. Conclusion: The study suggests the appropriateness of OSLD as an in vivo skin dosimeter in IORT using the Intrabeam system in a wide dose range. The pacemaker dose measured during the left breast IORT was within a safe limit.

  16. 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.

  17. Breast-conserving radiation therapy using combined electron and intensity-modulated radiotherapy technique

    International Nuclear Information System (INIS)

    Li, J.G.; Williams, S.S.; Goffinet, D.R.; Boer, A.L.; Xing, L.

    2000-01-01

    An electron beam with appropriate energy was combined with four intensity modulated photon beams. The direction of the electron beam was chosen to be tilted 10-20 laterally from the anteroposterior direction. Two of the intensity-modulated photon beams had the same gantry angles as the conventional tangential fields, whereas the other two beams were rotated 15-25' toward the anteroposterior directions from the first two photon beams. An iterative algorithm was developed which optimizes the weight of the electron beam as well as the fluence profiles of the photon beams for a given patient. Two breast cancer patients with early-stage breast tumors were planned with the new technique and the results were compared with those from 3D planning using tangential fields as well as 9-field intensity-modulated radiotherapy (IMRT) techniques. The combined electron and IMRT plans showed better dose conformity to the target with significantly reduced dose to the ipsilateral lung and, in the case of the left-breast patient, reduced dose to the heart, than the tangential field plans. In both the right-sided and left-sided breast plans, the dose to other normal structures was similar to that from conventional plans and was much smaller than that from the 9-field IMRT plans. The optimized electron beam provided between 70 to 80% of the prescribed dose at the depth of maximum dose of the electron beam. The combined electron and IMRT technique showed improvement over the conventional treatment technique using tangential fields with reduced dose to the ipsilateral lung and the heart. The customized beam directions of the four IMRT fields also kept the dose to other critical structures to a minimum. (author)

  18. Cost-effectiveness of radiotherapy during surgery compared with external radiation therapy in the treatment of women with breast cancer

    Directory of Open Access Journals (Sweden)

    Hedie Mosalanezhad

    2016-04-01

    Full Text Available Introduction: Intraoperative radiation therapy device (IORT is one of the several options for partial breast irradiation. IORT is sent to the tumor bed during surgery and can be replaced with conventional standard therapy (EBRT. The aim of this study was to evaluate the safety and effectiveness of IORT machine compared with EBRT and to determine the dominant option in terms of the cost-effectiveness. Method: This study was conducted in two phases; the first phase was a comprehensive review of the electronic databases search that was extracted after extraction and selection of the articles used in this article on effectiveness outcomes. Data collection form was completed by professionals and experts to estimate the cost of treatment, intraoperative radiotherapy and radiotherapy cost when using external radiation therapy process; direct costs were considered from the perspective of service provider and they were calculated in the second phase to determine the option of cost-effective ICER. Excel software was used for data analysis and sensitivity analysis was performed to determine the strength of the results of cost-effectiveness. Results:18 studies were selected but only 8 of them were shown to have acceptable quality. The consequences like “rate of cancer recurrence”, “seroma”, “necrosis”, “toxic”, “skin disorders and delayed wound healing” and “spread the pain” were among the consequences used in the selected articles. The total costs for each patient during a course of treatment for EBRT and IORT were estimated 1398 and $5337.5, respectively. During the analysis, cost-effectiveness of the consequences of cancer recurrence, seroma, necrosis and skin disorders and delayed wound healing ICER was calculated. And IORT was found to be the dominant supplier in all cases. Also, in terms of implications of toxicity and prevalence of pain, IORT had a lower cost and better effectiveness and consequently the result was more cost

  19. Clinical Indicators of Psychosocial Distress Predict for Acute Radiation-Induced Fatigue in Patients Receiving Adjuvant Radiation Therapy for Breast Cancer: An Analysis of Patient-Reported Outcomes

    International Nuclear Information System (INIS)

    Kishan, Amar U.; Wang, Pin-Chieh; Sharif, Jamal; Kupelian, Patrick A.; Steinberg, Michael L.; McCloskey, Susan A.

    2016-01-01

    Purpose: To assess the magnitude and predictors of patient-reported fatigue among breast cancer patients receiving radiation therapy (RT). Methods and Materials: Patients receiving breast RT completed a survey querying fatigue at each weekly on-treatment visit. Patient-reported fatigue severity and interference was assessed on an ordinal scale of 0 to 4, using a validated scoring system. Baseline anxiety and depression scores were also obtained. The kinetics of mean fatigue scores per week and the maximum fatigue scores over the course of the entire treatment were assessed, and clinical predictors were identified by univariate and multivariate regression. Results: The average fatigue severity and interference scores were 0.6 and 0.46. The average fatigue scores increased to an equivalent extent from week to week, with expected increases of 0.99 in fatigue severity and 0.85 in interference over 7 weeks. Patients treated with hypofractionated RT (HF-RT) versus conventionally fractionated RT (CF-RT) had significantly fewer maximum fatigue severity or interference scores that were >2 (ie, severe or very severe; 29% vs 10% for severity, and 26% vs 8% for interference, P<.01). Age ≤45 years, presence of psychiatric/pain-related comorbidities, and baseline sadness and anxiety severity were predictive of average and maximum fatigue scores (P<.05), but variables related to treatment intensity (eg, mastectomy vs lumpectomy, chemotherapy use, radiation target volumes) and other host factors (working, children, marital status, proximity to RT facility) were not. Conclusion: Patient-reported fatigue modestly increases over RT courses, with less maximum fatigue reported with HF-RT. Younger age and baseline sadness, anxiety, and psychiatric/pain-related comorbidities are powerful predictors of fatigue, whereas other factors, such as treatment intensity, are not. Future studies will investigate interventions for patients at high risk for fatigue.

  20. Clinical Indicators of Psychosocial Distress Predict for Acute Radiation-Induced Fatigue in Patients Receiving Adjuvant Radiation Therapy for Breast Cancer: An Analysis of Patient-Reported Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kishan, Amar U.; Wang, Pin-Chieh; Sharif, Jamal; Kupelian, Patrick A.; Steinberg, Michael L.; McCloskey, Susan A., E-mail: smccloskey@mednet.ucla.edu

    2016-07-01

    Purpose: To assess the magnitude and predictors of patient-reported fatigue among breast cancer patients receiving radiation therapy (RT). Methods and Materials: Patients receiving breast RT completed a survey querying fatigue at each weekly on-treatment visit. Patient-reported fatigue severity and interference was assessed on an ordinal scale of 0 to 4, using a validated scoring system. Baseline anxiety and depression scores were also obtained. The kinetics of mean fatigue scores per week and the maximum fatigue scores over the course of the entire treatment were assessed, and clinical predictors were identified by univariate and multivariate regression. Results: The average fatigue severity and interference scores were 0.6 and 0.46. The average fatigue scores increased to an equivalent extent from week to week, with expected increases of 0.99 in fatigue severity and 0.85 in interference over 7 weeks. Patients treated with hypofractionated RT (HF-RT) versus conventionally fractionated RT (CF-RT) had significantly fewer maximum fatigue severity or interference scores that were >2 (ie, severe or very severe; 29% vs 10% for severity, and 26% vs 8% for interference, P<.01). Age ≤45 years, presence of psychiatric/pain-related comorbidities, and baseline sadness and anxiety severity were predictive of average and maximum fatigue scores (P<.05), but variables related to treatment intensity (eg, mastectomy vs lumpectomy, chemotherapy use, radiation target volumes) and other host factors (working, children, marital status, proximity to RT facility) were not. Conclusion: Patient-reported fatigue modestly increases over RT courses, with less maximum fatigue reported with HF-RT. Younger age and baseline sadness, anxiety, and psychiatric/pain-related comorbidities are powerful predictors of fatigue, whereas other factors, such as treatment intensity, are not. Future studies will investigate interventions for patients at high risk for fatigue.

  1. Adjuvant radiation therapy versus surgery alone in operable breast cancer: long-term follow-up of a randomized clinical trial.

    Science.gov (United States)

    Rutqvist, L E; Pettersson, D; Johansson, H

    1993-02-01

    This paper presents long-term results from a randomized trial of pre- or postoperative megavoltage radiation therapy versus surgery alone in pre- and postmenopausal women with operable breast cancer. Treatment outcome after relapse among patients who developed loco-regional recurrences was also analyzed. A total of 960 patients were included in the trial. The mean follow-up was 16 years (range: 13-19 years). The radiation therapy was individually planned. It included the chest wall (and the breast in the preoperative cases) and the regional lymph nodes. The tumor dose was 45 Gy/5 weeks. No adjuvant systemic therapy was used. The results showed a significant benefit with radiation therapy in terms of recurrence-free survival during the entire follow-up period. There was also an overall survival difference-corresponding to a 16% reduction of deaths-in favor of the irradiated patients which, however, was not statistically significant (p = 0.09). Among those 169 patients who developed locoregional recurrences long-term control was only achieved in about one-third of the cases. This figure was similar among those who had received adjuvant radiation therapy (34%) compared to those initially treated with surgery alone (32%). This implied that the overall proportion of patients who eventually developed uncontrolled local disease was significantly higher among those initially allocated to surgery alone (16%) compared to those allocated to pre- or postoperative radiation therapy (6%, p < 0.01). These results suggest that local undertreatment may be deleterious in subgroups of patients.

  2. Hendee's radiation therapy physics

    CERN Document Server

    Pawlicki, Todd; Starkschall, George

    2016-01-01

    The publication of this fourth edition, more than ten years on from the publication of Radiation Therapy Physics third edition, provides a comprehensive and valuable update to the educational offerings in this field. Led by a new team of highly esteemed authors, building on Dr Hendee’s tradition, Hendee’s Radiation Therapy Physics offers a succinctly written, fully modernised update. Radiation physics has undergone many changes in the past ten years: intensity-modulated radiation therapy (IMRT) has become a routine method of radiation treatment delivery, digital imaging has replaced film-screen imaging for localization and verification, image-guided radiation therapy (IGRT) is frequently used, in many centers proton therapy has become a viable mode of radiation therapy, new approaches have been introduced to radiation therapy quality assurance and safety that focus more on process analysis rather than specific performance testing, and the explosion in patient-and machine-related data has necessitated an ...

  3. Radiation Therapy for Cancer

    Science.gov (United States)

    Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. Learn about the types of radiation, why side effects happen, which ones you might have, and more.

  4. [Practice evolution of hypofractionation in breast radiation therapy and medical impact].

    Science.gov (United States)

    Dupin, C; Vilotte, F; Lagarde, P; Petit, A; Breton-Callu, C

    2016-06-01

    Whole breast irradiation after conservative surgery is the standard treatment for invasive breast cancer. Randomized studies indicate that hypofractionation can be equivalent for selected patients. This study focuses on fractionation practice evolution in a single centre, and analyses the economic impact of practice modification. All prescriptions for invasive breast cancer between January 2010 and June 2014 were analyzed. Female patients 60 years or older, pN0 were considered for the economic study. Patients included in clinical trials or patient with high-grade tumours were excluded from the hypofractionation practice study, because physician could not choose fractionation. We used data from the Medical public health system to calculate cost per fraction and transportation cost. Two thousand thirty one patients were treated; 399 were eligible for the economic study (20%) and 282 for the practice study (14%). Treatment with 25 fractions decreased from 90% to 16% in the first half of 2014. Meanwhile, treatment with 15 or 16 fractions increased from 6% in 2010 to 68% in the first half of 2014. Hypofractionated treatment proportion was 100% with 42.5Gy in 16 fractions in 2010 and 100% 40Gy in 15 fractions in 2014, according to long-term follow-up publication of START trials. Treatment with five fractions remained stable around 7% (4 to 16%), reserved for patients over 80 years (PPractice change led to an increase of hypofractionation in recent years. Hypofractionation may be currently prescribed and may concern 20% of patients. This practice evolution is beneficial for patients and the public health system. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  5. Sequence of Radiation Therapy and Chemotherapy as Adjuvant Treatment in Breast Cancer

    International Nuclear Information System (INIS)

    ABU-HAMAR, A.M.; BARAKAT, A.F.; NASEF, H.H.; ELGANTIRY, M.

    2010-01-01

    The aim of the work was to evaluate the prognostic importance of the sequence of radiotherapy (RT) and chemotherapy (CT) as adjuvant treatment in women with breast cancer who were treated with modified radical mastectomy or total mastectomy and their correlation also with other known prognostic factors. Methods: In this retrospective study, 200 women with breast cancer were evaluated. The age ranged from 25 to 73 years, with the mean age of 44 years; 125 patients had stage II and 75 had stage III disease. All were subjected to mastectomy. The influence of the following prognostic factors were evaluated: Age, histological grade, nodal status, number of positive nodes, tumor size, estrogen receptor status, menstrual status and as well as the sequence of radiotherapy and chemotherapy on 5-year locoregional disease free survival, 5-year systemic disease-free survival, and 5-year overall survival. Results: The 5-year locoregional disease free survival was 90.9% for the entire patient population. Nodal status, number of positive nodes and estrogen receptor status were prognostically significant for locoregional recurrence. The 5-year systemic disease-free survival was 67.6% for the whole group. On univariate analysis, the presence of positive axillary nodes, grade III tumor, ER-negative disease and radiotherapy first followed by chemotherapy, were independent poor risk factors for systemic recurrence. The 5-year overall survival was 71.8%. On univariate analysis, the presence of positive axillary nodes, grade III tumor, ER-negative disease and radiotherapy first followed by chemotherapy, were independent poor risk factors for death from breast cancer. Conclusions: In patients with breast cancer, a treatment protocol consisting of 6 cycles of CT followed by RT resulted in a better 5-year OS and DPS, and was easier to administer when compared with other treatment protocols. Ideal candidates are those with early-stage, age >35 years, low tumor grade, positive ER, and

  6. Lymphocyte counts and responses to PHA and PPD following radiation therapy for breast cancer in patients who develop recurrent disease and those who remain clinically disease-free

    International Nuclear Information System (INIS)

    Blomgren, H.; Wasserman, J.; Wallgren, A.; Baral, E.; Petrini, B.; Idestroem, K.

    1980-01-01

    Peripheral blood lymphocyte counts and stimulations by PHA and PPD in vitro were examined before and up to four years after local pre- or post-operative radiation therapy of 99 patients with breast cancer. The patient material was divided into those who remained clinically disease-free during a follow up period of 4.5-7 years and those who relapsed. Radiation therapy reduced the lymphocyte counts and PPD response to the same levels in both groups of patients; there were no essential differences in their recoveries, with the exception of a somewhat delayed recovery of the PPD-response in the patients who relapsed. PHA responses of the lymphocytes were not decreased following radiation therapy. The data indicate that these radiation induced changes of the peripheral lymphocyte population were similar both in patients who relapsed and those who remained symptom free. A group of 47 women with breast cancer that was treated by surgery only was examined similarly as a comparison. Patients from this group who developed local recurrences had higher lymphocyte counts than those who remained disease-free; patients who developed distant metastases had somewhat decreased PHA responses

  7. Validity and reliability testing of two instruments to measure breast cancer patients' concerns and information needs relating to radiation therapy

    International Nuclear Information System (INIS)

    Halkett, Georgia KB; Kristjanson, Linda J

    2007-01-01

    It is difficult to determine the most effective approach to patient education or tailor education interventions for patients in radiotherapy without tools that assess patients' specific radiation therapy information needs and concerns. Therefore, the aim of this study was to develop psychometrically sound tools to adequately determine the concerns and information needs of cancer patients during radiation therapy. Two tools were developed to (1) determine patients concerns about radiation therapy (RT Concerns Scale) and (2) ascertain patient's information needs at different time point during their radiation therapy (RT Information Needs Scale). Tools were based on previous research by the authors, published literature on breast cancer and radiation therapy and information behaviour research. Thirty-one breast cancer patients completed the questionnaire on one occasion and thirty participants completed the questionnaire on a second occasion to facilitate test-retest reliability. One participant's responses were removed from the analysis. Results were analysed for content validity, internal consistency and stability over time. Both tools demonstrated high internal consistency and adequate stability over time. The nine items in the RT Concerns Scale were retained because they met all pre-set psychometric criteria. Two items were deleted from the RT Information Needs Scale because they did not meet content validity criteria and did not achieve pre-specified criteria for internal consistency. This tool now contains 22 items. This paper provides preliminary data suggesting that the two tools presented are reliable and valid and would be suitable for use in trials or in the clinical setting

  8. Influence of definitive radiation therapy for primary breast cancer on ability to deliver adjuvant chemotherapy

    International Nuclear Information System (INIS)

    Lippman, M.E.; Edwards, B.K.; Findlay, P.; Danforth, D.W. Jr.; MacDonald, H.; D'Angelo, T.; Gorrell, C.

    1986-01-01

    Primary radiotherapy as a means of managing stage I and II breast cancer is receiving increasing attention. In a prospectively randomized trial comparing modified radical mastectomy to lumpectomy followed by definitive radiotherapy, we evaluated whether radiotherapy has a deleterious effect on the ability to administer adjuvant doxorubicin and cyclophosphamide to patients with histologically positive axillary lymph nodes. All patients were treated with an identical regimen, and doses were escalated to the same degree until myelosuppression occurred. There were no significant differences in the amount of chemotherapy administered to either treatment group. Patients in both groups received approximately 100% of the predicted dose of doxorubicin and approximately 117% of the predicted dose of cyclophosphamide. At present, we have no evidence that there are differences in recurrence rates as a function of the quantity of drug received, although longer follow-up is required

  9. Impact of Sequencing Radiation Therapy and Chemotherapy on Long-Term Local Toxicity for Early Breast Cancer: Results of a Randomized Study at 15-Year Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Pinnarò, Paola; Giordano, Carolina; Farneti, Alessia [Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome (Italy); Strigari, Lidia; Landoni, Valeria [Department of Physics, Regina Elena National Cancer Institute, Rome (Italy); Marucci, Laura; Petrongari, Maria Grazia [Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome (Italy); Sanguineti, Giuseppe, E-mail: sanguineti@ifo.it [Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome (Italy)

    2016-07-15

    Purpose: To compare long-term late local toxicity after either concomitant or sequential chemoradiation therapy after breast-conserving surgery. Methods and Materials: From 1997 to 2002, women aged 18 to 75 years who underwent breast-conserving surgery and axillary dissection for early breast cancer and in whom CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) chemotherapy was planned were randomized between concomitant and sequential radiation therapy. Radiation therapy was delivered to the whole breast through tangential fields to 50 Gy in 20 fractions over a period of 4 weeks, followed by an electron boost. Surviving patients were tentatively contacted and examined between March and September 2014. Patients in whom progressive disease had developed or who had undergone further breast surgery were excluded. Local toxicity (fibrosis, telangiectasia, and breast atrophy or retraction) was scored blindly to the treatment received. A logistic regression was run to investigate the effect of treatment sequence after correction for several patient-, treatment-, and tumor-related covariates on selected endpoints. The median time to cross-sectional analysis was 15.7 years (range, 12.0-17.8 years). Results: Of 206 patients randomized, 154 (74.8%) were potentially eligible. Of these, 43 (27.9%) refused participation and 4 (2.6%) had been lost to follow-up, and for 5 (3.2%), we could not restore planning data; thus, the final number of analyzed patients was 102. No grade 4 toxicity had been observed, whereas the number of grade 3 toxicity events was low (<8%) for each item, allowing pooling of grade 2 and 3 events for further analysis. Treatment sequence (concomitant vs sequential) was an independent predictor of grade 2 or 3 fibrosis according to both the National Cancer Institute Common Terminology Criteria for Adverse Events (odds ratio [OR], 4.05; 95% confidence interval [CI], 1.34-12.2; P=.013) and the SOMA (Subjective, Objective, Management and Analytic

  10. Impact of Sequencing Radiation Therapy and Chemotherapy on Long-Term Local Toxicity for Early Breast Cancer: Results of a Randomized Study at 15-Year Follow-Up

    International Nuclear Information System (INIS)

    Pinnarò, Paola; Giordano, Carolina; Farneti, Alessia; Strigari, Lidia; Landoni, Valeria; Marucci, Laura; Petrongari, Maria Grazia; Sanguineti, Giuseppe

    2016-01-01

    Purpose: To compare long-term late local toxicity after either concomitant or sequential chemoradiation therapy after breast-conserving surgery. Methods and Materials: From 1997 to 2002, women aged 18 to 75 years who underwent breast-conserving surgery and axillary dissection for early breast cancer and in whom CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) chemotherapy was planned were randomized between concomitant and sequential radiation therapy. Radiation therapy was delivered to the whole breast through tangential fields to 50 Gy in 20 fractions over a period of 4 weeks, followed by an electron boost. Surviving patients were tentatively contacted and examined between March and September 2014. Patients in whom progressive disease had developed or who had undergone further breast surgery were excluded. Local toxicity (fibrosis, telangiectasia, and breast atrophy or retraction) was scored blindly to the treatment received. A logistic regression was run to investigate the effect of treatment sequence after correction for several patient-, treatment-, and tumor-related covariates on selected endpoints. The median time to cross-sectional analysis was 15.7 years (range, 12.0-17.8 years). Results: Of 206 patients randomized, 154 (74.8%) were potentially eligible. Of these, 43 (27.9%) refused participation and 4 (2.6%) had been lost to follow-up, and for 5 (3.2%), we could not restore planning data; thus, the final number of analyzed patients was 102. No grade 4 toxicity had been observed, whereas the number of grade 3 toxicity events was low (<8%) for each item, allowing pooling of grade 2 and 3 events for further analysis. Treatment sequence (concomitant vs sequential) was an independent predictor of grade 2 or 3 fibrosis according to both the National Cancer Institute Common Terminology Criteria for Adverse Events (odds ratio [OR], 4.05; 95% confidence interval [CI], 1.34-12.2; P=.013) and the SOMA (Subjective, Objective, Management and Analytic

  11. Problems of multiple field technique in radiation therapy of cancer of the breast

    International Nuclear Information System (INIS)

    Metzger, H.; Huebener, K.H.; Voss, A.C.

    1980-01-01

    A method of adjustment frequently used for postoperative telecobalt irradiation of the mammary carcinoma was verified with the help of film-dosimetric measurements at a phantom. Special interest was taken in the regions with possible overlapping of contiguous fields requires consideration of the divergence of rays and of the mapping precision of 50%-isodoses in the radiation field, as there lie the principal reasons. For realization of a nearly homogeneous dose distribution, on the one hand, there is necessary parallelism of marginal rays of the neighbouring useful ray beams, the radiation head being tilted laterally by half the angle of aperture; on the other hand, the 50% boundary lines at the light beam localizer have to be shifted parallel by a corresponding distance. In spite of this possibility of optimization, it is distinctly more advantageous, with regard to time and technical aspects, to use a linear accelerator, being additionally applicable for electron pendulum irradiation of the thoracic wall. (orig.) [de

  12. Dose distribution in the thyroid gland following radiation therapy of breast cancer--a retrospective study.

    Science.gov (United States)

    Johansen, S; Reinertsen, K V; Knutstad, K; Olsen, D R; Fosså, S D

    2011-06-09

    To relate the development of post-treatment hypothyroidism with the dose distribution within the thyroid gland in breast cancer (BC) patients treated with loco-regional radiotherapy (RT). In two groups of BC patients postoperatively irradiated by computer tomography (CT)-based RT, the individual dose distributions in the thyroid gland were compared with each other; Cases developed post-treatment hypothyroidism after multimodal treatment including 4-field RT technique. Matched patients in Controls remained free for hypothyroidism. Based on each patient's dose volume histogram (DVH) the volume percentages of the thyroid absorbing respectively 20, 30, 40 and 50 Gy were then estimated (V20, V30, V40 and V50) together with the individual mean thyroid dose over the whole gland (MeanTotGy). The mean and median thyroid dose for the included patients was about 30 Gy, subsequently the total volume of the thyroid gland (VolTotGy) and the absolute volumes (cm3) receiving respectively thyroid gland receivingthyroid glands after loco-radiotherapy of BC, the risk of post-treatment hypothyroidism depends on the volume of the thyroid gland.

  13. 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.

  14. Dose distribution in the thyroid gland following radiation therapy of breast cancer-a retrospective study

    International Nuclear Information System (INIS)

    Johansen, S; Reinertsen, KV; Knutstad, K; Olsen, DR; Fosså, SD

    2011-01-01

    To relate the development of post-treatment hypothyroidism with the dose distribution within the thyroid gland in breast cancer (BC) patients treated with loco-regional radiotherapy (RT). In two groups of BC patients postoperatively irradiated by computer tomography (CT)-based RT, the individual dose distributions in the thyroid gland were compared with each other; Cases developed post-treatment hypothyroidism after multimodal treatment including 4-field RT technique. Matched patients in Controls remained free for hypothyroidism. Based on each patient's dose volume histogram (DVH) the volume percentages of the thyroid absorbing respectively 20, 30, 40 and 50 Gy were then estimated (V20, V30, V40 and V50) together with the individual mean thyroid dose over the whole gland (MeanTotGy). The mean and median thyroid dose for the included patients was about 30 Gy, subsequently the total volume of the thyroid gland (VolTotGy) and the absolute volumes (cm 3 ) receiving respectively < 30 Gy and ≥ 30 Gy were calculated (Vol < 30 and Vol ≥ 30) and analyzed. No statistically significant inter-group differences were found between V20, V30, V40 and V50Gy or the median of MeanTotGy. The median VolTotGy in Controls was 2.3 times above VolTotGy in Cases (ρ = 0.003), with large inter-individual variations in both groups. The volume of the thyroid gland receiving < 30 Gy in Controls was almost 2.5 times greater than the comparable figure in Cases. We concluded that in patients with small thyroid glands after loco-radiotherapy of BC, the risk of post-treatment hypothyroidism depends on the volume of the thyroid gland

  15. Five-year Local Control in a Phase II Study of Hypofractionated Intensity Modulated Radiation Therapy With an Incorporated Boost for Early Stage Breast Cancer

    International Nuclear Information System (INIS)

    Freedman, Gary M.; Anderson, Penny R.; Bleicher, Richard J.; Litwin, Samuel; Li Tianyu; Swaby, Ramona F.; Ma, Chang-Ming Charlie; Li Jinsheng; Sigurdson, Elin R.; Watkins-Bruner, Deborah; Morrow, Monica; Goldstein, Lori J.

    2012-01-01

    Purpose: Conventional radiation fractionation of 1.8-2 Gy per day for early stage breast cancer requires daily treatment for 6-7 weeks. We report the 5-year results of a phase II study of intensity modulated radiation therapy (IMRT), hypofractionation, and incorporated boost that shortened treatment time to 4 weeks. Methods and Materials: The study design was phase II with a planned accrual of 75 patients. Eligibility included patients aged ≥18 years, Tis-T2, stage 0-II, and breast conservation. Photon IMRT and an incorporated boost was used, and the whole breast received 2.25 Gy per fraction for a total of 45 Gy, and the tumor bed received 2.8 Gy per fraction for a total of 56 Gy in 20 treatments over 4 weeks. Patients were followed every 6 months for 5 years. Results: Seventy-five patients were treated from December 2003 to November 2005. The median follow-up was 69 months. Median age was 52 years (range, 31-81). Median tumor size was 1.4 cm (range, 0.1-3.5). Eighty percent of tumors were node negative; 93% of patients had negative margins, and 7% of patients had close (>0 and <2 mm) margins; 76% of cancers were invasive ductal type: 15% were ductal carcinoma in situ, 5% were lobular, and 4% were other histology types. Twenty-nine percent of patients 29% had grade 3 carcinoma, and 20% of patients had extensive in situ carcinoma; 11% of patients received chemotherapy, 36% received endocrine therapy, 33% received both, and 20% received neither. There were 3 instances of local recurrence for a 5-year actuarial rate of 2.7%. Conclusions: This 4-week course of hypofractionated radiation with incorporated boost was associated with excellent local control, comparable to historical results of 6-7 weeks of conventional whole-breast fractionation with sequential boost.

  16. Five-year Local Control in a Phase II Study of Hypofractionated Intensity Modulated Radiation Therapy With an Incorporated Boost for Early Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Freedman, Gary M., E-mail: Gary.Freedman@uphs.upenn.edu [Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Anderson, Penny R. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Bleicher, Richard J. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Litwin, Samuel; Li Tianyu [Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Swaby, Ramona F. [Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Ma, Chang-Ming Charlie; Li Jinsheng [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Sigurdson, Elin R. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Watkins-Bruner, Deborah [School of Nursing, Emory University, Atlanta, Georgia (United States); Morrow, Monica [Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Goldstein, Lori J. [Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States)

    2012-11-15

    Purpose: Conventional radiation fractionation of 1.8-2 Gy per day for early stage breast cancer requires daily treatment for 6-7 weeks. We report the 5-year results of a phase II study of intensity modulated radiation therapy (IMRT), hypofractionation, and incorporated boost that shortened treatment time to 4 weeks. Methods and Materials: The study design was phase II with a planned accrual of 75 patients. Eligibility included patients aged {>=}18 years, Tis-T2, stage 0-II, and breast conservation. Photon IMRT and an incorporated boost was used, and the whole breast received 2.25 Gy per fraction for a total of 45 Gy, and the tumor bed received 2.8 Gy per fraction for a total of 56 Gy in 20 treatments over 4 weeks. Patients were followed every 6 months for 5 years. Results: Seventy-five patients were treated from December 2003 to November 2005. The median follow-up was 69 months. Median age was 52 years (range, 31-81). Median tumor size was 1.4 cm (range, 0.1-3.5). Eighty percent of tumors were node negative; 93% of patients had negative margins, and 7% of patients had close (>0 and <2 mm) margins; 76% of cancers were invasive ductal type: 15% were ductal carcinoma in situ, 5% were lobular, and 4% were other histology types. Twenty-nine percent of patients 29% had grade 3 carcinoma, and 20% of patients had extensive in situ carcinoma; 11% of patients received chemotherapy, 36% received endocrine therapy, 33% received both, and 20% received neither. There were 3 instances of local recurrence for a 5-year actuarial rate of 2.7%. Conclusions: This 4-week course of hypofractionated radiation with incorporated boost was associated with excellent local control, comparable to historical results of 6-7 weeks of conventional whole-breast fractionation with sequential boost.

  17. Effective treatment of the brachial plexus syndrome in breast cancer patients by early detection and control of loco-regional metastases with radiation or systemic therapy

    International Nuclear Information System (INIS)

    Kamenova, B.; Braverman, A.S.; Schwartz, M.; Sohn, C.; Lange, C.; Efiom-Ekaha, D.; Rotman, M.; Yoon, H.

    2009-01-01

    In breast cancer (BC) patients the brachial plexus syndrome (BPS) has been reported to be due to loco-regional metastases or radiation plexopathy. Associated arm edema is considered more suggestive of the latter. Radiation therapy is the only effective treatment for BPS reported. The charts of all BC patients who presented to our clinic from 1982 to 2006 with homolateral arm pain and neurological deficits, without humerus, cervical spine, or brain metastases, were reviewed. There were 28 patients fulfilling these criteria for BPS. Supraclavicular, axillary or chest wall metastases developed synchronously with the BPS in 26 patients; in 21 they were recurrences, found 6-94 months (median 34 months) after primary BC treatment, while in 5 others they were progressing inoperable primary tumors and nodes. Arm edema first occurred at the same time as loco-regional metastases in 19 patients. Treatment for the BPS was administered to 22 patients; it was directed at their loco-regional metastases. The BPS was initially treated with radiation (8 patients) or chemo- or endocrine therapy (14 patients); 19 (86%) had partial or complete remission of pain and neurologic deficits, with an 8-month median duration. The BPS in BC patients is due to loco-regional metastases and is often associated with arm edema. Chemo- or endocrine therapy induced the remission of pain and deficits as frequently as radiation therapy. (author)

  18. Early detection and prediction of cardiotoxicity after radiation therapy for breast cancer: the BACCARAT prospective cohort study

    International Nuclear Information System (INIS)

    Jacob, Sophie; Pathak, Atul; Franck, Denis; Latorzeff, Igor; Jimenez, Gaelle; Fondard, Olivier; Lapeyre, Matthieu; Colombier, Daniel; Bruguiere, Eric; Lairez, Olivier; Fontenel, Benoit; Milliat, Fabien; Tamarat, Radia; Broggio, David; Derreumaux, Sylvie; Ducassou, Marianne; Ferrières, Jean; Laurier, Dominique; Benderitter, Marc; Bernier, Marie-Odile

    2016-01-01

    Radiotherapy (RT) for breast cancer presents a benefit in terms of reducing local recurrence and deaths resulting from breast cancer but it can lead to secondary effects due to the presence of neighboring cardiac normal tissues within the irradiation field. Breast RT has been shown to be associated with long-term increased risk of heart failure, coronary artery disease, myocardial infarction and finally cardiovascular death more than 10 years after RT. However, there is still a lack of knowledge for early cardiotoxicity induced by breast RT that can appear long before the onset of clinically significant cardiac events. Based on a 2-year follow-up prospective cohort of patients treated with breast RT, the BACCARAT (BreAst Cancer and CArdiotoxicity Induced by RAdioTherapy) study aims to enhance knowledge on detection and prediction of early subclinical cardiac dysfunction and lesions induced by breast RT and on biological mechanisms potentially involved, based on functional and anatomical cardiac imaging combined with simultaneous assessment of multiple circulating biomarkers and accurate heart dosimetry. BACCARAT study consists in a monocentric prospective cohort study that will finally include 120 women treated with adjuvant 3D CRT for breast cancer, and followed for 2 years after RT. Women aged 50 to 70 years, treated for breast cancer and for whom adjuvant 3D CRT is indicated, without chemotherapy are eligible for the study. Baseline (before RT) and follow-up data include measurements of functional myocardial dysfunction including strain and strain rate based on 2D-speckle tracking echocardiography, anatomical coronary lesions including description of plaques in segments of coronary arteries based on Coronary computed tomography angiography, and a wide panel of circulating biomarkers. The absorbed dose is evaluated for the whole heart and its substructures, in particular the coronary arteries. Analysis on occurrence and evolution of subclinical cardiac lesions

  19. SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Zellars, Richard, E-mail: zellari@jhmi.edu [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Bravo, Paco E. [University of Washington Medical Center, Seattle, Washington (United States); Tryggestad, Erik [Mayo Clinic, Rochester, Minnesota (United States); Hopfer, Kari [Hahnemann University, Philadelphia, Pennsylvania (United States); Myers, Lee; Tahari, Abdel; Asrari, Fariba; Ziessman, Harvey [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Garrett-Mayer, Elizabeth [Medical University of South Carolina, Charleston, South Carolina (United States)

    2014-03-15

    Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits.

  20. SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

    International Nuclear Information System (INIS)

    Zellars, Richard; Bravo, Paco E.; Tryggestad, Erik; Hopfer, Kari; Myers, Lee; Tahari, Abdel; Asrari, Fariba; Ziessman, Harvey; Garrett-Mayer, Elizabeth

    2014-01-01

    Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits

  1. The study of dose variation and change of heart volume using 4D-CT in left breast radiation therapy

    International Nuclear Information System (INIS)

    Park, Seon Mi; Cheon, Geum Seong; Heo, Gyeong Hun; Shin, Sung Pil; Kim, Kwang Seok; Kim, Chang Uk; Kim, Hoi Nam

    2013-01-01

    We investigate the results of changed heart volume and heart dose in the left breast cancer patients while considering the movements of respiration. During the months of March and May in 2012, we designated the 10 patients who had tangential irradiation with left breast cancer in the department of radiation Oncology. With acquired images of free breathing pattern through 3D and 4D CT, we had planed enough treatment filed for covered up the whole left breast. It compares the results of the exposed dose and the volume of heart by DVH (Dose Volume histogram). Although total dose was 50.4 Gy (1.8 Gy/28 fraction), reirradiated 9 Gy (1.8 Gy/5 Fraction) with PTV (Planning Target Volume) if necessary. It compares the results of heart volume and heart dose with the free breathing in 3D CT and 4D CT. It represents the maximum difference volume of heart is 40.5%. In addition, it indicated the difference volume of maximum and minimum, average are 8.8% and 27.9%, 37.4% in total absorbed dose of heart. In case of tangential irradiation (opposite beam) in left breast cancer patients, it is necessary to consider the changed heart volume by the respiration of patient and the heartbeat of patient

  2. Smoking and Breast Cancer Recurrence after Breast Conservation Therapy

    Directory of Open Access Journals (Sweden)

    Jennifer D. Bishop

    2014-01-01

    Full Text Available Background. Prior studies have shown earlier recurrence and decreased survival in patients with head and neck cancer who smoked while undergoing radiation therapy. The purpose of the current study was to determine whether smoking status at the time of partial mastectomy and radiation therapy for breast cancer affected recurrence or survival. Method. A single institution retrospective chart review was performed to correlate smoking status with patient demographics, tumor characteristics, and outcomes for patients undergoing partial mastectomy and radiation therapy. Results. There were 624 patients who underwent breast conservation surgery between 2002 and 2010 for whom smoking history and follow-up data were available. Smoking status was associated with race, patient age, and tumor stage, but not with grade, histology, or receptor status. African American women were more likely to be current smokers (22% versus 7%, P<0.001. With a mean follow-up of 45 months, recurrence was significantly higher in current smokers compared to former or never smokers (P=0.039. In a multivariate model adjusted for race and tumor stage, recurrence among current smokers was 6.7 times that of never smokers (CI 2.0–22.4. Conclusions. Although the numbers are small, this study suggests that smoking may negatively influence recurrence rates after partial mastectomy and radiation therapy. A larger study is needed to confirm these observations.

  3. Radiation Therapy Versus No Radiation Therapy to the Neo-breast Following Skin-Sparing Mastectomy and Immediate Autologous Free Flap Reconstruction for Breast Cancer: Patient-Reported and Surgical Outcomes at 1 Year-A Mastectomy Reconstruction Outcomes Consortium (MROC) Substudy.

    Science.gov (United States)

    Cooke, Andrew L; Diaz-Abele, Julian; Hayakawa, Tom; Buchel, Ed; Dalke, Kimberly; Lambert, Pascal

    2017-09-01

    To determine whether adjuvant radiation therapy (RT) is associated with adverse patient-reported outcomes and surgical complications 1 year after skin-sparing mastectomy and immediate autologous free flap reconstruction for breast cancer. We compared 24 domains of patient-reported outcome measures 1 year after autologous reconstruction between patients who received adjuvant RT and those who did not. A total of 125 patients who underwent surgery between 2012 and 2015 at our institution were included from the Mastectomy Reconstruction Outcomes Consortium study database. Adjusted multivariate models were created incorporating RT technical data, age, cancer stage, estrogen receptor, chemotherapy, breast size, body mass index, and income to determine whether RT was associated with outcomes. At 1 year after surgery, European Organisation for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire breast symptoms were significantly greater in 64 patients who received RT (8-point difference on 100-point ordinal scale, PBREAST-Q (Post-operative Reconstruction Module), Patient-Report Outcomes Measurement Information System Profile 29, McGill Pain Questionnaire-Short Form (MPQ-SF) score, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire-were not statistically different between groups. Surgical complications were uncommon and did not differ by treatment. RT to the neo-breast compared with no RT following immediate autologous free flap reconstruction for breast cancer is well tolerated at 1 year following surgery despite patients undergoing RT also having a higher cancer stage and more intensive surgical and systemic treatment. Neo-breast symptoms are more common in patients receiving RT by the EORTC Breast Cancer-Specific Quality of Life Questionnaire but not by the BREAST-Q. Patient-reported results at 1 year after surgery suggest RT following immediate autologous free flap breast reconstruction is well tolerated

  4. Radiation Therapy - Multiple Languages

    Science.gov (United States)

    ... W XYZ List of All Topics All Radiation Therapy - Multiple Languages To use the sharing features on this page, ... Information Translations Vietnamese (Tiếng Việt) Expand Section Radiation Therapy - Tiếng Việt (Vietnamese) ... Health Information Translations Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

  5. Radiation Therapy Side Effects

    Science.gov (United States)

    Radiation therapy has side effects because it not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Many people who get radiation therapy experience fatigue. Other side effects depend on the part of the body that is being treated. Learn more about possible side effects.

  6. Estimation of heart-position variability in 3D-surface-image-guided deep-inspiration breath-hold radiation therapy for left-sided breast cancer

    International Nuclear Information System (INIS)

    Alderliesten, Tanja; Betgen, Anja; Elkhuizen, Paula H.M.; Vliet-Vroegindeweij, Corine van; Remeijer, Peter

    2013-01-01

    Purpose: To investigate the heart position variability in deep-inspiration breath-hold (DIBH) radiation therapy (RT) for breast cancer when 3D surface imaging would be used for monitoring the BH depth during treatment delivery. For this purpose, surface setup data were compared with heart setup data. Materials and methods: Twenty patients treated with DIBH-RT after breast-conserving surgery were included. Retrospectively, heart registrations were performed for cone-beam computed tomography (CBCT) to planning CT. Further, breast-surface registrations were performed for a surface, captured concurrently with CBCT, to planning CT. The resulting setup errors were compared with linear regression analysis. Furthermore, geometric uncertainties of the heart (systematic [Σ] and random [σ]) were estimated relative to the surface registration. Based on these uncertainties planning organ at risk volume (PRV) margins for the heart were calculated: 1.3Σ − 0.5σ. Results: Moderate correlation between surface and heart setup errors was found: R 2 = 0.64, 0.37, 0.53 in left–right (LR), cranio-caudal (CC), and in anterior–posterior (AP) direction, respectively. When surface imaging would be used for monitoring, the geometric uncertainties of the heart (cm) are [Σ = 0.14, σ = 0.14]; [Σ = 0.66, σ = 0.38]; [Σ = 0.27, σ = 0.19] in LR; CC; AP. This results in PRV margins of 0.11; 0.67; 0.25 cm in LR; CC; AP. Conclusion: When DIBH-RT after breast-conserving surgery is guided by the breast-surface position then PRV margins should be used to take into account the heart-position variability relative to the breast-surface

  7. Role of Internal Mammary Node Radiation as a Part of Modern Breast Cancer Radiation Therapy: A Systematic Review

    International Nuclear Information System (INIS)

    Verma, Vivek; Vicini, Frank; Tendulkar, Rahul D.; Khan, Atif J.; Wobb, Jessica; Edwards-Bennett, Sophia; Desai, Anand; Shah, Chirag

    2016-01-01

    Purpose: Despite data from multiple randomized trials, the role of internal mammary lymph node irradiation as a part of regional nodal irradiation (IMLN RT–RNI) remains unanswered. Recent noteworthy data and modern RT techniques might identify a subset of patients who will benefit from IMLN RT–RNI, lending insight into the balance between improved outcomes and acceptable toxicity. We evaluated the current role of IMLN RT–RNI by analyzing randomized, prospective, and retrospective data. Methods and Materials: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a review of the published data was performed using PubMed to evaluate published studies from 1994 to 2015. The information evaluated included the number of patients, follow-up period, technical aspects of RT, and outcomes (clinical outcomes, complications/toxicity). Results: We included 16 studies (4 randomized, 4 nonrandomized, 7 retrospective, and 1 meta-analysis). Although older randomized trials failed to show differences in clinical outcomes or toxicity with IMLN RT–RNI, recent randomized data suggest the potential for improved outcomes, including overall survival, with IMLN RT–RNI. Furthermore, nonrandomized data have suggested a potential benefit for central tumors with IMLN RT–RNI. Although recent data have suggested a potential increase in pulmonary complications with IMLN RT–RNI with the use of advanced radiation techniques, toxicity rates remain low with limited cardiac toxicity data available. Conclusions: Increasing data from recent randomized trials support the use of IMLN RT–RNI. IMLN RT can be considered based on the inclusion of IMLN RT as a part of RNI in recent trials and the inclusion criteria from IMLN RT–RNI trials and for patients with central or medial tumors and axillary disease.

  8. Role of Internal Mammary Node Radiation as a Part of Modern Breast Cancer Radiation Therapy: A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Vivek [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Vicini, Frank [Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, Michigan (United States); Tendulkar, Rahul D. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Khan, Atif J. [Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School and the Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Wobb, Jessica [Department of Radiation Oncology, Ohio State University, Columbus, Ohio (United States); Edwards-Bennett, Sophia [21st Century Oncology, Myrtle Beach, South Carolina (United States); Desai, Anand [Department of Radiation Oncology, Summa Health System, Akron, Ohio (United States); Shah, Chirag, E-mail: csshah27@hotmail.com [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States)

    2016-06-01

    Purpose: Despite data from multiple randomized trials, the role of internal mammary lymph node irradiation as a part of regional nodal irradiation (IMLN RT–RNI) remains unanswered. Recent noteworthy data and modern RT techniques might identify a subset of patients who will benefit from IMLN RT–RNI, lending insight into the balance between improved outcomes and acceptable toxicity. We evaluated the current role of IMLN RT–RNI by analyzing randomized, prospective, and retrospective data. Methods and Materials: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a review of the published data was performed using PubMed to evaluate published studies from 1994 to 2015. The information evaluated included the number of patients, follow-up period, technical aspects of RT, and outcomes (clinical outcomes, complications/toxicity). Results: We included 16 studies (4 randomized, 4 nonrandomized, 7 retrospective, and 1 meta-analysis). Although older randomized trials failed to show differences in clinical outcomes or toxicity with IMLN RT–RNI, recent randomized data suggest the potential for improved outcomes, including overall survival, with IMLN RT–RNI. Furthermore, nonrandomized data have suggested a potential benefit for central tumors with IMLN RT–RNI. Although recent data have suggested a potential increase in pulmonary complications with IMLN RT–RNI with the use of advanced radiation techniques, toxicity rates remain low with limited cardiac toxicity data available. Conclusions: Increasing data from recent randomized trials support the use of IMLN RT–RNI. IMLN RT can be considered based on the inclusion of IMLN RT as a part of RNI in recent trials and the inclusion criteria from IMLN RT–RNI trials and for patients with central or medial tumors and axillary disease.

  9. Late complications of radiation therapy

    International Nuclear Information System (INIS)

    Masaki, Norie

    1998-01-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  10. Late complications of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Masaki, Norie [Osaka Prefectural Center for Adult Diseases (Japan)

    1998-03-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  11. Dosimetric reproduction of a left-breast 3DCRT field-in-field radiation therapy planning in an anthropomorphic and anthropometric phantom

    Energy Technology Data Exchange (ETDEWEB)

    Nogueira, Luciana B., E-mail: lucibn19@yahoo.com.br, E-mail: jonymarques@uol.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Anatomia e Imagem; Barsanelli, Cristiane; Geraldo, Jony M., E-mail: cbarsanelli@yahoo.com.br [Hospital Luxemburgo, Instituto Mário Penna, Belo Horizonte, MG (Brazil); Aquino, Jean Carlos; Campos, Tarcísio P. Ribeiro, E-mail: jeancarlosaquino@outlook.com, E-mail: tprcampos@yahoo.com.br [Universidade Federal de Minas Gerais (UGMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear

    2017-07-01

    The proposal of this study was to reproduce the dosimetry established in a treatment planning system (TPS) following a 3D conformational radiation therapy (3DCRT) protocol of two parallel-opposite fields applied to the left-breast in a thorax phantom, with the use of the field-in-field technique. Computed tomography (CT) images of the anthropomorphic and anthropometric phantom of the thorax with mobile breasts were generated. This phantom was developed by the NRI / UFMG research group. The generated images were transferred to the planning system XiO version-5 for the elaboration of the breast tele therapeutic planning with 2 Gy per fraction, in 25 fractions, with prescribed dose of 50 Gy. A set of ten EBT2 radiochromic films were irradiated at different doses. The values of RGB (Red, Green, Blue) of the radiochromic films were obtained by scanning and data transformed in optical density (OD), whose values were used to construct the calibration curve. EBT2 radiochromic films were positioned outside and inside of the thorax phantom: internally in the right and left lungs, on the face of the heart, in the glandular breast tissue-equivalent (TE) and in the left breast skin. After phantom radiation at the linear accelerator 6 MV Elekta Precise reproducing the 3DCRT, the radiochromic films were digitized after 24 h of exposure. The measurements of the intensities of the films in RGB were measured in the software ImageJ, transformed in optical density and converted in bidimensional dose distributions, applying the calibration curve. The experimental dosimetric data were analyzed and compared with values generated in the TPS. In addition, graphics and dose-volume histograms (DVH) were developed. The dose measurements in the glandular-TE in breast did not present statistically significant differences in relation to values at equivalent positions generated in the TPS. The organs at risk received doses below the reference values, according to TPS. It was verified the

  12. Dosimetric reproduction of a left-breast 3DCRT field-in-field radiation therapy planning in an anthropomorphic and anthropometric phantom

    International Nuclear Information System (INIS)

    Nogueira, Luciana B.; Aquino, Jean Carlos; Campos, Tarcísio P. Ribeiro

    2017-01-01

    The proposal of this study was to reproduce the dosimetry established in a treatment planning system (TPS) following a 3D conformational radiation therapy (3DCRT) protocol of two parallel-opposite fields applied to the left-breast in a thorax phantom, with the use of the field-in-field technique. Computed tomography (CT) images of the anthropomorphic and anthropometric phantom of the thorax with mobile breasts were generated. This phantom was developed by the NRI / UFMG research group. The generated images were transferred to the planning system XiO version-5 for the elaboration of the breast tele therapeutic planning with 2 Gy per fraction, in 25 fractions, with prescribed dose of 50 Gy. A set of ten EBT2 radiochromic films were irradiated at different doses. The values of RGB (Red, Green, Blue) of the radiochromic films were obtained by scanning and data transformed in optical density (OD), whose values were used to construct the calibration curve. EBT2 radiochromic films were positioned outside and inside of the thorax phantom: internally in the right and left lungs, on the face of the heart, in the glandular breast tissue-equivalent (TE) and in the left breast skin. After phantom radiation at the linear accelerator 6 MV Elekta Precise reproducing the 3DCRT, the radiochromic films were digitized after 24 h of exposure. The measurements of the intensities of the films in RGB were measured in the software ImageJ, transformed in optical density and converted in bidimensional dose distributions, applying the calibration curve. The experimental dosimetric data were analyzed and compared with values generated in the TPS. In addition, graphics and dose-volume histograms (DVH) were developed. The dose measurements in the glandular-TE in breast did not present statistically significant differences in relation to values at equivalent positions generated in the TPS. The organs at risk received doses below the reference values, according to TPS. It was verified the

  13. FDG-PET in monitoring therapy of breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Biersack, H J; Bender, H; Palmedo, H [Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn (Germany)

    2004-06-01

    Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been used successfully for the staging and re-staging of breast cancer. Another significant indication is the evaluation of therapy response. Only limited data are available on the use of FDG-PET in breast cancer after radiation therapy. The same holds true for chemotherapy. Only the therapy response in locally advanced breast cancer after chemotherapy has been investigated thoroughly. Histopathological response could be predicted with an accuracy of 88-91% after the first and second courses of therapy. A quantitative evaluation is, of course, a prerequisite when FDG-PET is used for therapy monitoring. Only a small number of studies have focussed on hormone therapy. In this context, a flare phenomenon with increasing standardised uptake values after initiation of tamoxifen therapy has been observed. More prospective multicentre trials will be needed to make FDG-PET a powerful tool in monitoring chemotherapy in breast cancer. (orig.)

  14. FDG-PET in monitoring therapy of breast cancer

    International Nuclear Information System (INIS)

    Biersack, H.J.; Bender, H.; Palmedo, H.

    2004-01-01

    Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been used successfully for the staging and re-staging of breast cancer. Another significant indication is the evaluation of therapy response. Only limited data are available on the use of FDG-PET in breast cancer after radiation therapy. The same holds true for chemotherapy. Only the therapy response in locally advanced breast cancer after chemotherapy has been investigated thoroughly. Histopathological response could be predicted with an accuracy of 88-91% after the first and second courses of therapy. A quantitative evaluation is, of course, a prerequisite when FDG-PET is used for therapy monitoring. Only a small number of studies have focussed on hormone therapy. In this context, a flare phenomenon with increasing standardised uptake values after initiation of tamoxifen therapy has been observed. More prospective multicentre trials will be needed to make FDG-PET a powerful tool in monitoring chemotherapy in breast cancer. (orig.)

  15. Study on Computerized Treatment Plan of Field-in-Field Intensity Modulated Radiation Therapy and Conventional Radiation Therapy according to PBC Algorithm and AAA on Breast Cancer Tangential Beam

    International Nuclear Information System (INIS)

    Yeom, Mi Suk; Bae, Seong Soo; Kim, Dae Sup; Back, Geum Mun

    2012-01-01

    Anisotropic Analytical Algorithm (AAA) provides more accurate dose calculation regarding impact on scatter and tissue inhomogeneity in comparison to Pencil Beam Convolution (PBC) algorithm. This study tries to analyze the difference of dose distribution according to PBC algorithm and dose calculation algorithm of AAA on breast cancer tangential plan. Computerized medical care plan using Eclipse treatment planning system (version 8.9, VARIAN, USA) has been established for the 10 breast cancer patients using 6 MV energy of Linac (CL-6EX, VARIAN, USA). After treatment plan of Conventional Radiation Therapy plan (Conventional plan) and Field-in-Field Intensity Modulated Radiation Therapy plan (FiF plan) using PBC algorithm has been established, MU has been fixed, implemented dose calculation after changing it to AAA, and compared and analyzed treatment plan using Dose Volume Histogram (DVH). Firstly, as a result of evaluating PBC algorithm of Conventional plan and the difference according to AAA, the average difference of CI value on target volume has been highly estimated by 0.295 on PBC algorithm and as a result of evaluating dose of lung, V 47 Gy and has been highly evaluated by 5.83% and 4.04% each, Mean dose, V 20 , V 5 , V 3 Gy has been highly evaluated 0.6%, 0.29%, 6.35%, 10.23% each on AAA. Secondly, in case of FiF plan, the average difference of CI value on target volume has been highly evaluated on PBC algorithm by 0.165, and dose on ipsilateral lung, V 47 , V 45 Gy, Mean dose has been highly evaluated 6.17%, 3.80%, 0.15% each on PBC algorithm, V 20 , V 5 , V 3 Gy has been highly evaluated 0.14%, 4.07%, 4.35% each on AAA. When calculating with AAA on breast cancer tangential plan, compared to PBC algorithm, Conformity on target volume of Conventional plan, FiF plan has been less evaluated by 0.295, 0.165 each. For the reason that dose of high dose region of ipsilateral lung has been showed little amount, and dose of low dose region has been showed much amount

  16. On ionising radiation and breast cancer risk

    Energy Technology Data Exchange (ETDEWEB)

    Mattson, Anders

    1999-05-01

    A cohort of 3,090 women with clinical diagnosis of benign breast disease (BBD) was studied. Of these, 1,216 were treated with radiation therapy during 1925-54 (median age 40 years). The mean dose to the breasts was 5.8 Gy (range 0-50 Gy). Among other organs the lung received the highest scattered dose (0.75 Gy; range 0.004-8.98 Gy) and the rectum the lowest (0.008 Gy; range 0-0.06 Gy). A pooled analysis of eight breast cancer incidence cohorts was done, including: tumour registry data on breast cancer incidence among women in the Life Span Study cohort of atomic bomb survivors; women in Massachusetts who received repeated chest fluoroscopic during lung collapse treatment for tuberculosis; women who received x-ray therapy for acute post-partum mastitis; women who were irradiated in infancy for enlarged thymus glands ; two Swedish cohorts of women who received radiation treatments during infancy for skin hemangioma; and the BBD cohort. Together the cohorts included almost 78,000 women (-35,000 were exposed), around 1.8 million woman-years and 1500 cases. The breast cancer incidence rate as a function of breast dose was analysed using linear-quadratic Poisson regression models. Cell-killing effects and other modifying effects were incorporated through additional log-linear terms. Additive (EAR) and multiplicative (ERR) models were compared in estimating the age-at-exposure patterns and time related excess. The carcinogenic risks associated with radiation in mammographic mass screening is evaluated. Assessment was made in terms of breast cancer mortality and years of life. Effects were related to rates not influenced by a mammographic mass screening program and based on a hypothetical cohort of 100,000 40-year old women with no history of breast cancer being followed to 100 years of age. Two radiation risk assumptions were compared. The dose-response relationship is linear with little support in data for an upward curvature at low to medium doses. The competing effect

  17. On ionising radiation and breast cancer risk

    International Nuclear Information System (INIS)

    Mattson, Anders

    1999-01-01

    A cohort of 3,090 women with clinical diagnosis of benign breast disease (BBD) was studied. Of these, 1,216 were treated with radiation therapy during 1925-54 (median age 40 years). The mean dose to the breasts was 5.8 Gy (range 0-50 Gy). Among other organs the lung received the highest scattered dose (0.75 Gy; range 0.004-8.98 Gy) and the rectum the lowest (0.008 Gy; range 0-0.06 Gy). A pooled analysis of eight breast cancer incidence cohorts was done, including: tumour registry data on breast cancer incidence among women in the Life Span Study cohort of atomic bomb survivors; women in Massachusetts who received repeated chest fluoroscopic during lung collapse treatment for tuberculosis; women who received x-ray therapy for acute post-partum mastitis; women who were irradiated in infancy for enlarged thymus glands ; two Swedish cohorts of women who received radiation treatments during infancy for skin hemangioma; and the BBD) cohort. Together the cohorts included almost 78,000 women (-35,000 were exposed), around 1.8 million woman-years and 1500 cases. The breast cancer incidence rate as a function of breast dose was analysed using linear-quadratic Poisson regression models. Cell-killing effects and other modifying effects were incorporated through additional log-linear terms. Additive (EAR) and multiplicative (ERR) models were compared in estimating the age-at-exposure patterns and time related excess. The carcinogenic risks associated with radiation in mammographic mass screening is evaluated. Assessment was made in terms of breast cancer mortality and years of life. Effects were related to rates not influenced by a mammographic mass screening program and based on a hypothetical cohort of 100,000 40-year old women with no history of breast cancer being followed to 100 years of age. Two radiation risk assumptions were compared. The dose-response relationship is linear with little support in data for an upward curvature at low to medium doses. The competing effect

  18. SU-E-T-307: Dosimetric Comparison of Prone Versus Supine Positioning for Adjuvant Breast Radiation Therapy

    International Nuclear Information System (INIS)

    Pope, C; O’Connor, B; Hayes, L; Rella, J; Ruiz, B; Yang, J

    2015-01-01

    Purpose: The prone treatment position has been used to reduce ipsilateral lung and heart dose in left breast radiation. We conducted a retrospective study to evaluate the difference in the dosimetry between prone and supine treatment positions. Methods: Eight left breast cancer patients were simulated in both the supine and prone positions as a pretreatment evaluation for the optimal treatment position. Treatment plans were created for all patients in both the supine and prone positions using a field in field three dimensional planning technique. Prescribed dose was 45 Gy delivered by two tangential photon fields. Irradiated volume (IV) was evaluated by V50, V100, and dose to lung and heart by V5, V10, V20, and the mean dose were evaluated. Results: All dosimetry metrics for both the supine and prone plans met our internal normal structure guidelines which are based on Quantec data. The average IVs (50% and 100%) were 2223cc and 1361cc prone, 2315cc and 1315cc supine. The average ipsilateral lung Mean dose (0.83Gy prone vs 5.8Gy supine), V5 (1.6% prone vs 20.9% supine), V10 (0.78% prone vs 15% supine) and V20 (0.36% prone vs 11% supine) were significantly lower in prone position. Heart Mean dose (1.4Gy prone vs 2.9Gy supine), V10 (1.4% prone vs 5.0% supine) and V20 (0.4% prone vs 3.5% supine) were found improved for all patients except one where the mean dose was the same and all other values were improved. Conclusion: The prone position offer preferable dosimetry for all patients planned in our study. These patients were chosen based on the physician’s belief that they would benefit from prone treatment either because they had large pendulous breasts or due to the amount of heart seen in the field on CT simulation

  19. Prostate Cancer (Radiation Therapy)

    Science.gov (United States)

    ... be considered carefully, balancing the advantages against the disadvantages as they relate to the individual man's age, ... therapy with photon or x-rays: Uses advanced technology to tailor the x-ray or photon radiation ...

  20. Radiation therapy with or without primary limited surgery for operable breast cancer: A 20-year experience at the Marseilles Cancer Institute

    International Nuclear Information System (INIS)

    Amalric, R.; Santamaria, F.; Robert, F.

    1982-01-01

    Since 1960 more than 3000 consecutive patients with operable infiltrating breast carcinoma were treated by radiation therapy with or without primary limited surgery, which usually consisted of local excision. For tumors smaller than or equal to 5 cm the ten-year crude survival rate is 77% for patients without palpable axillary nodes (T/sub 1-2/N 0 ) and 63% for patients having axillary adenopathy (T/sub 1-2/N 1 ). For operable tumors exceeding 5 cm in diameter (T 3 N/sub 0-1/) the ten-year crude survival is 34%. Thirty-five percent of the patients alive free of disease at ten years required a secondary operation for presumed local or regional tumor persistence or recurrence, although no residual disease was found in 24% of the operative specimens. Local-regional recurrence had no adverse effect on ten-year survival. This conservative approach offers most women with operable breast cancer an excellent chance at breast preservation with the same chance for ten-year survival as with radical mastectomy

  1. Breast radiation - discharge

    Science.gov (United States)

    ... underwire. Ask your provider about wearing your breast prosthesis, if you have one. Self-care You need ... swelling ( edema ) in your arm. You have a feeling of tightness in your arm. Rings on your ...

  2. Forward-planned intensity modulated radiation therapy using a cobalt source: A dosimetric study in breast cancer

    Directory of Open Access Journals (Sweden)

    Savino Cilla

    2013-01-01

    Full Text Available This analysis evaluates the feasibility and dosimetric results of a simplified intensity-modulated radiotherapy (IMRT treatment using a cobalt-therapy unit for post-operative breast cancer. Fourteen patients were included. Three plans per patient were produced by a cobalt-60 source: A standard plan with two wedged tangential beams, a standard tangential plan optimized without the use of wedges and a plan based on the forward-planned "field-in-field" IMRT technique (Co-FinF where the dose on each of the two tangential beams was split into two different segments and the two segments weight was determined with an iterative process. For comparison purposes, a 6-MV photon standard wedged tangential treatment plan was generated. D mean , D 98% , D 2% , V 95% , V 107%, homogeneity, and conformity indices were chosen as parameters for comparison. Co-FinF technique improved the planning target volume dose homogeneity compared to other cobalt-based techniques and reduced maximum doses (D 2% and high-dose volume (V 110% . Moreover, it showed a better lung and heart dose sparing with respect to the standard approach. The higher dose homogeneity may encourage the adoption of accelerated-hypofractionated treatments also with the cobalt sources. This approach can promote the spread of breast conservative treatment in developing countries.

  3. Novel Targeted Therapies for Inflammatory Breast Cancer

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-16-1-0461 TITLE: Novel Targeted Therapies for Inflammatory Breast Cancer PRINCIPAL INVESTIGATOR: Jose Silva CONTRACTING...CONTRACT NUMBER Novel Targeted Therapies for Inflammatory Breast Cancer 5b. GRANT NUMBER W81XWH-16-1-0461 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) l 5d...NOTES 14. ABSTRACT Inflammatory breast cancer (IBC, ~5% of all breast cancers ) is the most lethal form of breast cancer , presenting a 5- year

  4. Radiation biology and radiation therapy

    International Nuclear Information System (INIS)

    Wideroee, R.

    1975-01-01

    Radiation biology and radiation therapy can be compared with investigations in different layers of earth. Radiation biology works upwards from the elementary foundations, therapy works downwards with roots to secure and improve the clinical 'surface work'. The Ellis formula (Strandquist), which is a collection of clinical experience, is suited to form connections with radiobiology in the middle layers, and cooperation can give impulses for research. The structure and conditions of tumours and the complicated problems met with are discussed, based on the Carmel symposium of 1969. The oxygen problem in anoxic tumours is not yet solved. Experimental investigations of the effect itself give partly contradictory results. From a clinical viewpoint reoxygenation is of the utmost significance for obtaining control over the primary tumour, and advanced irradiation programmes will here give better results than the traditional ones. New chemicals, e.g. R 0 -07-0582, appear to reduce the OER value to 1.5, thereby making neutron therapy superfluous. Finally a problem from fundamental research is dealt with, wherein two hypotheses explaining the β-effect are described. The repair hypothesis gives a simple explanation but leaves many questions unanswered. The other hypothesis explains the β-effect as two neighbouring single breaks of the DNA molecule. It still presents difficulties, and is scarcely the correct explanation. (JIW)

  5. Antiangiogenic therapy for breast cancer

    DEFF Research Database (Denmark)

    Nielsen, D.L.; Andersson, M.; Andersen, Jon Alexander Lykkegaard

    2010-01-01

    tyrosine kinase activity, such as sorafenib, appear promising. While, the role of sunitinib and inhibitors of mammalian target of rapamycin (mTOR) in breast cancer has to be defined. Several unanswered questions remain, such as choice of drug(s), optimal duration of therapy and patient selection criteria...

  6. Radiation Therapy for Cancer

    Science.gov (United States)

    ... can cause pain. Radiation given to shrink a tumor near the esophagus , which can interfere with a patient’s ability to eat and drink. How is radiation therapy planned for an individual ... show the location of a patient’s tumor and the normal areas around it. These scans ...

  7. Radiation pneumonitis in breast cancer

    International Nuclear Information System (INIS)

    Ferrino, R.; Carvalho, H.A.; Gomes, H.C.; Kuang, L.F.; Aguilar, P.B.; Lederman, M.V.

    1987-01-01

    Forty-nine observations of patients with breast cancer frm 1980 to 1985 were reviewed. All of them received radiotherapy. In 44.9% radiologic findings of radiation pneumonitis were detected and only 9% presented mild or moderate respiratory symptoms. (M.A.C.) [pt

  8. Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Zagar, Timothy M., E-mail: zagar@med.unc.edu [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Kaidar-Person, Orit [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Tang, Xiaoli [Memorial Sloan Kettering Cancer Center, West Harrison, New York (United States); Jones, Ellen E.; Matney, Jason; Das, Shiva K.; Green, Rebecca L. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Sheikh, Arif [Department of Radiology, Columbia University, New York, New York (United States); Khandani, Amir H.; McCartney, William H.; Oldan, Jorge Daniel; Wong, Terence Z. [Department of Radiology, University of North Carolina, Chapel Hill, North Carolina (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)

    2017-04-01

    Purpose: To evaluate early cardiac single photon computed tomography (SPECT) findings after left breast/chest wall postoperative radiation therapy (RT) in the setting of deep inspiration breath hold (DIBH). Methods and Materials: We performed a prospective single-institution single-arm study of patients who were planned for tangential RT with DIBH to the left breast/chest wall (± internal mammary nodes). The DIBH was done by use of a controlled surface monitoring technique (AlignRT, Vision RT Ltd, London, UK). The RT was given with tangential fields and a heart block. Radiation-induced cardiac perfusion and wall motion changes were assessed by pre-RT and 6-month post-RT SPECT scans. A cumulative SPECT summed-rest score was used to quantify perfusion in predefined left ventricle segments. The incidence of wall motion abnormalities was assessed in each of these same segments. Results: A total of 20 patients with normal pre-RT scans were studied; their median age was 56 years (range, 39-72 years). Seven (35%) patients also received irradiation to the left internal mammary chain, and 5 (25%) received an additional RT field to supraclavicular nodes. The median heart dose was 94 cGy (range, 56-200 cGy), and the median V25{sub Gy} was zero (range, 0-0.1). None of the patients had post-RT perfusion or wall motion abnormalities. Conclusions: Our results suggest that DIBH and conformal cardiac blocking for patients receiving tangential RT for left-sided breast cancer is an effective means to avoid early RT-associated cardiac perfusion defects.

  9. Short-Course Hypofractionated Radiation Therapy With Boost in Women With Stages 0 to IIIa Breast Cancer: A Phase 2 Trial

    International Nuclear Information System (INIS)

    Ahlawat, Stuti; Haffty, Bruce G.; Goyal, Sharad; Kearney, Thomas; Kirstein, Laurie; Chen, Chunxia; Moore, Dirk F.; Khan, Atif J.

    2016-01-01

    Purpose: Conventionally fractionated whole-breast irradiation (WBI) with a boost takes approximately 6 to 7 weeks. We evaluated a short course of hypofractionated (HF), accelerated WBI in which therapy was completed in 3 weeks inclusive of a sequential boost. Methods and Materials: We delivered a whole-breast dose of 36.63 Gy in 11 fractions of 3.33 Gy over 11 days, followed by a lumpectomy bed boost in 4 fractions of 3.33 Gy delivered once daily for a total of 15 treatment days. Acute toxicities were scored using Common Terminology Criteria for Adverse Events version 4. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Cosmesis was scored using the Harvard Cosmesis Scale. Our primary endpoint was freedom from locoregional failure; we incorporated early stopping criteria based on predefined toxicity thresholds. Cosmesis was examined as a secondary endpoint. Results: We enrolled 83 women with stages 0 to IIIa breast cancer. After a median follow-up of 40 months, 2 cases of isolated ipsilateral breast tumor recurrence occurred (2 of 83; crude rate, 2.4%). Three-year estimated local recurrence-free survival was 95.9% (95% confidence interval [CI]: 87.8%-98.7%). The 3-year estimated distant recurrence-free survival was 97.3% (95% CI: 89.8%-99.3%). Three-year secondary malignancy-free survival was 94.3% (95% CI: 85.3%-97.8%). Twenty-nine patients (34%) had grade 2 acute toxicity, and 1 patient had a late grade 2 toxicity (fibrosis). One patient had acute grade 3 dermatitis, whereas 2 patients experienced grade 3 late skin toxicity. Ninety-four percent of evaluable patients had good or excellent cosmesis. Conclusions: Our phase 2 institutional study offers one of the shortest courses of HF therapy, delivered in 15 fractions inclusive of a sequential boost. We demonstrated expected low toxicity and high local control rates with good to excellent cosmetic outcomes. This

  10. Interaction between radiation and other breast cancer risk factors

    International Nuclear Information System (INIS)

    Boice, J.D. Jr.; Stone, B.J.

    1978-01-01

    A follow-up study was conducted of 1764 women institutionalized for pulmonary tuberculosis between 1930 and 1954. Among 1047 women exposed to fluoroscopic chest X-rays during air collapse therapy of the lung, an excess of breast cancer was observed and previously reported (41 cases observed versus 23.3 expected). Among 717 comparison patients who received other treatments, no excess breast cancer risk was apparent (15 cases observed versus 14.1 expected). To determine whether breast cancer risk factors modify the carcinogenic effect of radiation, analyses were performed evaluating the interaction of radiation with indicators of breast cancer risk. The greatest radiation risk was found when radiation exposure occurred just before and during menarche. Similarly, exposures during first pregnancy appeared substantially more hazardous than exposures occurring before or after first pregnancy, suggesting that the condition of the breast at the time of pregnancy modifies the effect of radiation in such a way as to enhance the risk. Age at menopause did not appear to influence the risk of radiation exposure. Other than radiation, benign breast disease was the most significant breast cancer risk indicator. Benign breast disease was not seen to modify the effect of radiation exposure; however, excessive radiation exposure might have increased the incidence of benign breast disease, complicating the interaction analysis. Because of the uncertainty due to small-number sampling variation, these study results will require confirmation by a larger series. They do, however, suggest that stages when breast tissue undergoes high mitotic activity, e.g. menarche and pregnancy, are times of special vulnerability to the harmful effects of ionizing radiation

  11. Efficacy of breast conservation therapy in early stage bilateral breast cancer

    International Nuclear Information System (INIS)

    Lee, Misa M.; Chen, Luci M.; Heimann, Ruth; Powers, Claire; Weichselbaum, Ralph R.

    1996-01-01

    PURPOSE: To evaluate outcome of patients with bilateral breast cancer as compared to unilateral breast cancer treated with breast conservation therapy. This is a complex issue, however, we address this by comparing (1) synchronous bilateral breast cancer patients, (2) metachronous bilateral breast cancer patients from the time of diagnosis of the second breast primary, and (3) unilateral breast cancer patients. The authors recognize that there are inherent biases in these comparisons. MATERIALS AND METHODS: A total of 60 bilateral patients and 1080 unilateral patients treated with breast conservation therapy from 1977-1994 were analyzed for outcome. Of the 60 bilateral patients, 44 were metachronous bilateral breast cancer patients (MBBC) and 16 were synchronous breast cancer patients (SBBC). Patients with bilateral breast cancer had local-regional disease with the following tumor stages: DCIS=8%, T1=80%, T2=12%, pathologic N0=90%, pathologic N+=10%. Unilateral patients had the following tumor stages: DCIS=10%, T1=66%, T2=20%, T3=1.2%, Tx=2%, pathological N0=80%, pathological N+=19%, and NX=1%. The majority of patients received lumpectomy and axillary node dissection followed by radiation therapy. The median size of the lesions were 1.4cm and 1.5cm for bilateral and unilateral patients, respectively. Median total dose to the primary tumor was 60Gy for both unilateral and bilateral patients. Of the 44 metachronous bilateral breast cancer patients, 14 patients received breast conservation for both the first and second lesions while 30 patients had breast conservation for only the second metachronous breast lesion. Thus 58 lesions in the 44 patients were treated with breast conservation therapy in the patients with metachronous bilateral breast cancer. Of the synchronous bilateral breast cancer patients, 13 out of 16 patients had breast conserving therapy for both breasts, and 3 patients received mastectomy for the second synchronous breast tumor. The median follow

  12. Clinical experience with the MammoSite[reg] radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial

    International Nuclear Information System (INIS)

    Niehoff, Peter; Polgar, Csaba; Ostertag, Horst; Major, Tibor; Sulyok, Zoltan; Kimmig, Bernhard; Kovacs, Gyoergy

    2006-01-01

    Background and purpose: In a prospective multi-center phase II trial, we investigated the MammoSite[reg] Radiation Therapy System, a new device for delivering intracavitary brachytherapy following breast conserving surgery. The MammoSite[reg] is a dual lumen, closed ended catheter with a small, spherical inflatable balloon and a port for connecting a remote afterloader to the central lumen. We analyzed the surgical procedure and placement of the MammoSite[reg], treatment planning and radiation delivery complications and cosmesis, as well the comfort for the patients. Patients and methods: Between 2002 and 2004 a total of 32 patients (pts) were implanted using the MammoSite[reg]. The reference isodose was defined 1 cm from the balloon surface. We analyzed the post-implant anatomic position of the applicator and the geometric form of the balloon via ultrasound, CT and X-ray, related side effects, cosmetic outcome and patient quality of life. Results: Twenty-three out of 32 patients (72%) were eligible for MammoSite[reg] intracavitary brachytherapy. Twenty-eight percentage had to be excluded because of different reasons. Eleven patients were treated with primary brachytherapy with a total dose of 34 Gy (2x3.4 Gy) and 12 had a boost with a mean dose of 13.3 Gy (range: 7.5-15 Gy; 2x2.5 Gy) combined with EBRT and doses ranged between 46 and 50 Gy. In three cases a balloon rupture occurred. We observed two abscesses within 3 months of implantation and serious seroma development in 10 patients (39%). Skin related side effects were erythema in 21 patients (91%), hyperpigmentation in 13 patients (56%) and teleangiectasia in six patients (26%) after mean follow-up 20 months. Conclusions: The MammoSite[reg] Radiation Therapy System is a feasible treatment modality for intracavitary brachytherapy of breast cancer after breast conserving surgery. The advantage of the system is only one applicator is necessary for the delivery of a fractionated radiotherapy. In addition, patient

  13. A Novel Form of Breast Intraoperative Radiation Therapy With CT-Guided High-Dose-Rate Brachytherapy: Results of a Prospective Phase 1 Clinical Trial

    International Nuclear Information System (INIS)

    Showalter, Shayna L.; Petroni, Gina; Trifiletti, Daniel M.; Libby, Bruce; Schroen, Anneke T.; Brenin, David R.; Dalal, Parchayi; Smolkin, Mark; Reardon, Kelli A.; Showalter, Timothy N.

    2016-01-01

    Purpose: Existing intraoperative radiation therapy (IORT) techniques are criticized for the lack of image guided treatment planning and energy deposition with, at times, poor resultant dosimetry and low radiation dose. We pioneered a novel method of IORT that incorporates customized, computed tomography (CT)-based treatment planning and high-dose-rate (HDR) brachytherapy to overcome these drawbacks: CT-HDR-IORT. Methods and Materials: A phase 1 study was conducted to demonstrate the feasibility and safety of CT-HDR-IORT. Eligibility criteria included age ≥50 years, invasive or in situ breast cancer, tumor size <3 cm, and N0 disease. Patients were eligible before or within 30 days of breast-conserving surgery (BCS). BCS was performed, and a multilumen balloon catheter was placed. CT images were obtained, a customized HDR brachytherapy plan was created, and a dose of 12.5 Gy was delivered to 1-cm depth from the balloon surface. The catheter was removed, and the skin was closed. The primary endpoints were feasibility and acute toxicity. Feasibility was defined as IORT treatment interval (time from CT acquisition until IORT completion) ≤90 minutes. The secondary endpoints included dosimetry, cosmetic outcome, quality of life, and late toxicity. Results: Twenty-eight patients were enrolled. The 6-month follow-up assessments were completed by 93% of enrollees. The median IORT treatment interval was 67.2 minutes (range, 50-108 minutes). The treatment met feasibility criteria in 26 women (93%). The dosimetric goals were met in 22 patients (79%). There were no Radiation Therapy Oncology Group grade 3+ toxicities; 6 patients (21%) experienced grade 2 events. Most patients (93%) had good/excellent cosmetic outcomes at the last follow-up visit. Conclusions: CT-HDR-IORT is feasible and safe. This promising approach for a conformal, image-based, higher-dose breast IORT is being evaluated in a phase 2 trial.

  14. A Novel Form of Breast Intraoperative Radiation Therapy With CT-Guided High-Dose-Rate Brachytherapy: Results of a Prospective Phase 1 Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Showalter, Shayna L., E-mail: snl2t@virginia.edu [Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Petroni, Gina [Division of Translation Research and Applied Statistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Trifiletti, Daniel M.; Libby, Bruce [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Schroen, Anneke T.; Brenin, David R. [Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Dalal, Parchayi [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Smolkin, Mark [Division of Translation Research and Applied Statistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Reardon, Kelli A.; Showalter, Timothy N. [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States)

    2016-09-01

    Purpose: Existing intraoperative radiation therapy (IORT) techniques are criticized for the lack of image guided treatment planning and energy deposition with, at times, poor resultant dosimetry and low radiation dose. We pioneered a novel method of IORT that incorporates customized, computed tomography (CT)-based treatment planning and high-dose-rate (HDR) brachytherapy to overcome these drawbacks: CT-HDR-IORT. Methods and Materials: A phase 1 study was conducted to demonstrate the feasibility and safety of CT-HDR-IORT. Eligibility criteria included age ≥50 years, invasive or in situ breast cancer, tumor size <3 cm, and N0 disease. Patients were eligible before or within 30 days of breast-conserving surgery (BCS). BCS was performed, and a multilumen balloon catheter was placed. CT images were obtained, a customized HDR brachytherapy plan was created, and a dose of 12.5 Gy was delivered to 1-cm depth from the balloon surface. The catheter was removed, and the skin was closed. The primary endpoints were feasibility and acute toxicity. Feasibility was defined as IORT treatment interval (time from CT acquisition until IORT completion) ≤90 minutes. The secondary endpoints included dosimetry, cosmetic outcome, quality of life, and late toxicity. Results: Twenty-eight patients were enrolled. The 6-month follow-up assessments were completed by 93% of enrollees. The median IORT treatment interval was 67.2 minutes (range, 50-108 minutes). The treatment met feasibility criteria in 26 women (93%). The dosimetric goals were met in 22 patients (79%). There were no Radiation Therapy Oncology Group grade 3+ toxicities; 6 patients (21%) experienced grade 2 events. Most patients (93%) had good/excellent cosmetic outcomes at the last follow-up visit. Conclusions: CT-HDR-IORT is feasible and safe. This promising approach for a conformal, image-based, higher-dose breast IORT is being evaluated in a phase 2 trial.

  15. Involved Node Radiation Therapy

    DEFF Research Database (Denmark)

    Maraldo, Maja V; Aznar, Marianne C; Vogelius, Ivan R

    2012-01-01

    PURPOSE: The involved node radiation therapy (INRT) strategy was introduced for patients with Hodgkin lymphoma (HL) to reduce the risk of late effects. With INRT, only the originally involved lymph nodes are irradiated. We present treatment outcome in a retrospective analysis using this strategy...... to 36 Gy). Patients attended regular follow-up visits until 5 years after therapy. RESULTS: The 4-year freedom from disease progression was 96.4% (95% confidence interval: 92.4%-100.4%), median follow-up of 50 months (range: 4-71 months). Three relapses occurred: 2 within the previous radiation field......, and 1 in a previously uninvolved region. The 4-year overall survival was 94% (95% confidence interval: 88.8%-99.1%), median follow-up of 58 months (range: 4-91 months). Early radiation therapy toxicity was limited to grade 1 (23.4%) and grade 2 (13.8%). During follow-up, 8 patients died, none from HL, 7...

  16. Radiation therapy physics

    CERN Document Server

    1995-01-01

    The aim of this book is to provide a uniquely comprehensive source of information on the entire field of radiation therapy physics. The very significant advances in imaging, computational, and accelerator technologies receive full consideration, as do such topics as the dosimetry of radiolabeled antibodies and dose calculation models. The scope of the book and the expertise of the authors make it essential reading for interested physicians and physicists and for radiation dosimetrists.

  17. Comparison study of the partial-breast irradiation techniques: Dosimetric analysis of three-dimensional conformal radiation therapy, electron beam therapy, and helical tomotherapy depending on various tumor locations

    International Nuclear Information System (INIS)

    Kim, Min-Joo; Park, So-Hyun; Son, Seok-Hyun; Cheon, Keum-Seong; Choi, Byung-Ock; Suh, Tae-Suk

    2013-01-01

    The partial-breast irradiation (PBI) technique, an alternative to whole-breast irradiation, is a beam delivery method that uses a limited range of treatment volume. The present study was designed to determine the optimal PBI treatment modalities for 8 different tumor locations. Treatment planning was performed on computed tomography (CT) data sets of 6 patients who had received lumpectomy treatments. Tumor locations were classified into 8 subsections according to breast quadrant and depth. Three-dimensional conformal radiation therapy (3D-CRT), electron beam therapy (ET), and helical tomotherapy (H-TOMO) were utilized to evaluate the dosimetric effect for each tumor location. Conformation number (CN), radical dose homogeneity index (rDHI), and dose delivered to healthy tissue were estimated. The Kruskal-Wallis, Mann-Whitney U, and Bonferroni tests were used for statistical analysis. The ET approach showed good sparing effects and acceptable target coverage for the lower inner quadrant—superficial (LIQ-S) and lower inner quadrant—deep (LIQ-D) locations. The H-TOMO method was the least effective technique as no evaluation index achieved superiority for all tumor locations except CN. The ET method is advisable for treating LIQ-S and LIQ-D tumors, as opposed to 3D-CRT or H-TOMO, because of acceptable target coverage and much lower dose applied to surrounding tissue

  18. Radiotherapy of breast cancer and dispensary control after the therapy

    International Nuclear Information System (INIS)

    Odontuya, G.

    1995-01-01

    During the last several years breast cancer is increasing in Mongolia. During 5 years(1990-1994) 142 patients with breast cancer were treated in department of radiology. The 96(77,6%) of those patients were treated by combined radiation therapy and surgery. The 46(32,4%) of those patients were treated palliative therapy. A conclusion:1.Organizing the preventive different examinations among the population in the servicing sphere, involving the family doctors to them. 2.Detection and screening breast cancer in the first period, very important for treatment every patients

  19. Trial sponsorship and self-reported conflicts of interest in breast cancer radiation therapy: An analysis of prospective clinical trials.

    Science.gov (United States)

    Leite, Elton T T; Moraes, Fabio Y; Marta, Gustavo N; Taunk, Neil K; Vieira, Marina T L; Hanna, Samir A; Silva, João Luis F; Carvalho, Heloisa A

    2017-06-01

    We aim to assess any association between study and self-reported conflict of interest (COI) or trial sponsorship in breast cancer radiation clinical trials. We searched PubMed for all clinical trials (CTs) published between 09/2004 and 09/2014 related to breast cancer. We included only radiotherapy CTs with primary clinical endpoints. We classified eligible trials according to the funding source, presence or absence of conflict of interest, study conclusion and impact factor (IF). 1,603 CTs were retrieved. 72 randomized clinical trials were included for analysis. For-profit (PO), not for profit organization (nPO), none and not reported sponsorship rates were 9/72 (12.5%), 35/72 (48.6%), 1/72 (1.4%), 27/72 (37.5%), respectively. Present, absent or not reported COI were found in 6/72 (8.3%), 43/72 (59.7%) and 23/72 (32%) of the CTs, respectively. Conclusion was positive, neutral and negative in 57/72 (79.1%), 9/72 (12.5%) and 6/72 (8.4%) of the trials, respectively. Positive conclusion was reported in 33/44 (75%) funded trials (PO and nPO) and 5/6 (83.3%) CTs with reported COI. On univariate analysis no association with funding source (P=0.178), COI (P=0.678) or trial region (P=0.567) and trial positive conclusion was found. Sponsored trials (HR 4.50, 95CI-0.1.23-16.53;P=0.0023) and positive trials (HR 4.78, 95CI- 1.16-19.63;P=0.030) were more likely to be published in higher impact factor journals in the multivariate analysis. nPO funding was reported in almost 50% of the evaluated CTs. No significant association between study conclusion and funding source, COI or trial region was identified. Sponsored trials and positive trials were more likely to be published in higher impact factor journals. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Local-Regional Recurrence With and Without Radiation Therapy After Neoadjuvant Chemotherapy and Mastectomy for Clinically Staged T3N0 Breast Cancer

    International Nuclear Information System (INIS)

    Nagar, Himanshu; Mittendorf, Elizabeth A.; Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Tereffe, Welela; Woodward, Wendy A.; Gonzalez-Angulo, Ana M.; Hunt, Kelly K.; Buchholz, Thomas A.; Yu, Tse-Kuan

    2011-01-01

    Purpose: The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy. Methodsand Materials: Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test. Results: At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval [CI], 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were ≤40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR. Conclusions: Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.

  1. Underuse of Radiation Therapy After Breast Conservation Surgery in Puerto Rico: A Puerto Rico Central Cancer Registry–Health Insurance Linkage Database Study

    Directory of Open Access Journals (Sweden)

    William W. Chance

    2017-05-01

    Full Text Available Purpose: To identify rates of postoperative radiation therapy (RT after breast conservation surgery (BCS in women with stage I or II invasive breast cancer treated in Puerto Rico and to examine the sociodemographic and health services characteristics associated with variations in receipt of RT. Methods: The Puerto Rico Central Cancer Registry–Health Insurance Linkage Database was used to identify patients diagnosed with invasive breast cancer between 2008 and 2012 in Puerto Rico. Claims codes identified the type of surgery and the use of RT. Logistic regression models were used to examine the independent association between sociodemographic and clinical covariates. Results: Among women who received BCS as their primary definitive treatment, 64% received adjuvant RT. Significant predictors of RT after BCS included enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13; P ≤ .01 and dual eligibility for Medicare and Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to 0.93; P = .02 and those with tumor size > 5.0 cm (OR, 0.37; 95% CI, 0.15 to 0.92; P = .03 were found to be significantly less likely to receive RT. Conclusion: Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in Medicare and those who were dually eligible for Medicaid and Medicare were more likely to receive RT after BCS compared with patients with Medicaid alone. There were geographic variations in the receipt of RT on the island.

  2. Breast conserving therapy: the role of surgery

    International Nuclear Information System (INIS)

    Dongen, J.A. van

    1994-01-01

    Breast conserving therapy generally is considered to be a safe alternative to mastectomy in a large proportion of operable breast cancer patients. Small tumor size, wide excisions, absence of vascular invasion and of extensive intraductal component are prognosticators for therapy success. Good results depend on technique and on patient selection. For some tumor situations specific therapy modifications are under investigation. (author)

  3. Modeling Internal Radiation Therapy

    NARCIS (Netherlands)

    van den Broek, Egon; Schouten, Theo E.; Pellegrini, M.; Fred, A.; Filipe, J.; Gamboa, H.

    2011-01-01

    A new technique is described to model (internal) radiation therapy. It is founded on morphological processing, in particular distance transforms. Its formal basis is presented as well as its implementation via the Fast Exact Euclidean Distance (FEED) transform. Its use for all variations of internal

  4. Current perspectives of radiation therapy. History of radiation therapy

    International Nuclear Information System (INIS)

    Itami, Jun

    2011-01-01

    More than 100 years have passed since the discovery of X-Strahlen by Roentgen. The history of radiation therapy has evolved under mutual stimulating relationships of the external beam radiation therapy by X-ray tubes and accelerators, and the internal radiation therapy employing radium and other radionuclides. The currently employed technologies in radiation therapy have its origin already till nineteen sixties and the development of physics and engineering have realized the original concept. (author)

  5. Evaluating the Effects of Aluminum-Containing and Non-Aluminum Containing Deodorants on Axillary Skin Toxicity During Radiation Therapy for Breast Cancer: A 3-Armed Randomized Controlled Trial

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Lucy, E-mail: Lucy.lewis@curtin.edu.au [Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); School of Nursing and Midwifery Curtin University, Perth (Australia); Carson, Sharron [Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); Bydder, Sean [Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (Australia); School of Surgery, The University of Western Australia, Crawley, Western Australia (Australia); Athifa, Mariyam [School of Nursing and Midwifery Curtin University, Perth (Australia); Williams, Anne M. [School of Nursing and Midwifery Curtin University, Perth (Australia); School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia (Australia); Bremner, Alexandra [School of Population Health, The University of Western Australia, Crawley, Western Australia (Australia)

    2014-11-15

    Purpose: Deodorant use during radiation therapy for breast cancer has been controversial as there are concerns deodorant use may exacerbate axillary skin toxicity. The present study prospectively determined the use of both aluminum-containing and non aluminum containing deodorants on axillary skin toxicity during conventionally fractionated postoperative radiation therapy for breast cancer. Methods and Materials: This 3-arm randomized controlled study was conducted at a single center, tertiary cancer hospital between March 2011 and April 2013. Participants were randomized to 1 of 2 experimental groups (aluminum-containing deodorant and soap or non–aluminum containing deodorant and soap) or a control group (soap). A total of 333 participants were randomized. Generalized estimating equations were used to estimate and compare the odds of experiencing high levels of sweating and skin toxicity in each of the deodorant groups to the odds in the control group. The study evaluated a range of endpoints including objective measurements of axilla sweating, skin toxicity, pain, itch and burning. Quality of life was assessed with a validated questionnaire. Results: Radiation characteristics were similar across all groups. Patients in the deodorant groups did not report significantly different ratings for axillary pain, itch, or burning compared with the control group. Patients in the aluminum-containing deodorant group experienced significantly less sweating than the control; the odds of their sweating being barely tolerable and frequently or always interfering with their daily activities was decreased by 85% (odds ratio, 0.15; 95% confidence interval, 0.03-0.91). Conclusions: We found no evidence that the use of either aluminum-containing or non–aluminum containing deodorant adversely effects axillary skin reaction during conventionally fractionated radiation therapy for breast cancer. Our analysis also suggests patients in the aluminum-containing deodorant arm had

  6. Evaluating the Effects of Aluminum-Containing and Non-Aluminum Containing Deodorants on Axillary Skin Toxicity During Radiation Therapy for Breast Cancer: A 3-Armed Randomized Controlled Trial

    International Nuclear Information System (INIS)

    Lewis, Lucy; Carson, Sharron; Bydder, Sean; Athifa, Mariyam; Williams, Anne M.; Bremner, Alexandra

    2014-01-01

    Purpose: Deodorant use during radiation therapy for breast cancer has been controversial as there are concerns deodorant use may exacerbate axillary skin toxicity. The present study prospectively determined the use of both aluminum-containing and non aluminum containing deodorants on axillary skin toxicity during conventionally fractionated postoperative radiation therapy for breast cancer. Methods and Materials: This 3-arm randomized controlled study was conducted at a single center, tertiary cancer hospital between March 2011 and April 2013. Participants were randomized to 1 of 2 experimental groups (aluminum-containing deodorant and soap or non–aluminum containing deodorant and soap) or a control group (soap). A total of 333 participants were randomized. Generalized estimating equations were used to estimate and compare the odds of experiencing high levels of sweating and skin toxicity in each of the deodorant groups to the odds in the control group. The study evaluated a range of endpoints including objective measurements of axilla sweating, skin toxicity, pain, itch and burning. Quality of life was assessed with a validated questionnaire. Results: Radiation characteristics were similar across all groups. Patients in the deodorant groups did not report significantly different ratings for axillary pain, itch, or burning compared with the control group. Patients in the aluminum-containing deodorant group experienced significantly less sweating than the control; the odds of their sweating being barely tolerable and frequently or always interfering with their daily activities was decreased by 85% (odds ratio, 0.15; 95% confidence interval, 0.03-0.91). Conclusions: We found no evidence that the use of either aluminum-containing or non–aluminum containing deodorant adversely effects axillary skin reaction during conventionally fractionated radiation therapy for breast cancer. Our analysis also suggests patients in the aluminum-containing deodorant arm had

  7. Treatment of acute radiodermatitis with an oil-in-water emulsion following radiation therapy for breast cancer. A controlled, randomized trial

    International Nuclear Information System (INIS)

    Jensen, Jens-Michael; Gau, Tanja; Foelster-Holst, Regina; Proksch, Ehrhardt; May, Theodor

    2011-01-01

    A side effect of radiotherapy for breast cancer is acute radiodermatitis. It is a common practice to keep irradiated skin dry on account of data from the 1950s that suggested this regimen limits dermatitis. However, severe dryness of the skin induced by irradiation results in itching and discomfort. Dry skin is characterized by scaliness, epidermal barrier dysfunction, and reduced stratum corneum hydration, and these signs and symptoms are reduced by treatment with an emulsion. We performed a randomized, controlled, open-label study with 66 patients (ITT population), treating the irradiated skin in one group (n = 34) with an oil-in-water emulsion (WO1932), while leaving the other group untreated (n = 32). Clinical scoring (ONS radiation skin reaction scoring, pruritus) and biophysical measurements (stratum corneum hydration and transepidermal water loss (TEWL), as a marker of skin barrier function) were determined at day 1 (directly after termination of the radiation therapy), day 8, and day 47 (± 7). Irradiation increased the ONS score and pruritus, whereas skin hydration and TEWL were reduced. The primary hypothesis that the increase in skin hydration was significantly greater in the emulsion-treated compared to the untreated group as early as after 8 days of treatment could not be confirmed. At the end of the study (day 47 ± 7), however, normalization of stratum corneum hydration was more advanced in the treatment group compared to the untreated group and nearly reached the values of the contralateral healthy breast skin. ONS score and pruritus also revealed an advantage for the emulsion-treated group. TEWL did not show significant changes during emulsion treatment. No adverse events were caused by the treatment regimens. Treatment of radiodermatitis with an oil-in-water emulsion was well tolerated, enhanced stratum corneum hydration, improved clinical indicators, and provided relief from itching. (orig.)

  8. Skin toxicity from external beam radiation therapy in breast cancer patients: protective effects of Resveratrol, Lycopene, Vitamin C and anthocianin (Ixor®)

    International Nuclear Information System (INIS)

    Franco, Rossella Di; Calvanese, MariaGrazia; Murino, Paola; Manzo, Roberto; Guida, Cesare; Gennaro, Davide Di; Anania, Caterina; Ravo, Vincenzo

    2012-01-01

    This is an observational study and the aim is to evaluate the effect of dietary supplements based on Resveratrol, Lycopene, Vitamin C and Anthocyanins (Ixor ® ) in reducing skin toxicity due to external beam radiotherapy in patients affected by breast cancer. 71 patients were enrolled and they were divided in two different groups: a control group (CG) of 41 patients treated with prophylactic topical therapy based on hyaluronic acid and topical steroid therapy in case of occurrence of radiodermatitis, and a Ixor-Group (IG) of 30 patients treated also with an oral therapy based on Resveratrol, Lycopene, Vitamin C and Anthocyanin (Ixor ® ) at a dose of 2 tablets/day, starting from 10 days before the radiation treatment until 10 days after the end of treatment. Skin toxicity has been related to PTV, to breast volume that received a radiation dose equal or lower than 107%, included between 107% and 110%, or greater than 110% of the prescribed dose. Moreover it's been studied the relationship between skin toxicity and the chemotherapy schedule used before treatment. We calculated in both groups the percentage of patients who had a skin toxicity of grade 2 or 3 (according to RTOG scale). Absolute risk reduction (ARR), relative risk (RR) and odds ratio (OR) have been calculated for each relationship. Control Group (CG) patients with a PTV > 500 ml presented skin toxicity G2 + G3 in 30% of cases, versus 25% of Ixor-Group (IG) [OR 0.77]. In patients with a PTV < 500 ml G2 + G3 toxicity was 0% in the IG compared to 18% in CG (OR 0.23). When Dmax was less than or equal to 107% of the prescribed dose skin toxicity was G2 + G3 in 12.5% in CG, versus 0% in IG (OR 0.73), instead when Dmax was included between 107 and 110% of the prescribed dose, G2 + G3 skin toxicity was 35% in CG and 21% in IG (OR 0.50). In patients undergoing chemotherapy with anthracyclines and taxanes, G2 + G3 toxicity was 27% in CG, against 20% in IG (OR 0.68). The protective effect of Resveratrol

  9. [Partial breast irradiation (PBI): the therapy of the future?].

    Science.gov (United States)

    Koning, Caro C E; Bijker, Nina; van Tienhoven, Geertjan

    2010-01-01

    Breast-conserving therapy with radiation therapy of 50 Gy over 5 weeks to the entire breast plus a tumour bed boost is the standard treatment for patients with early stage breast cancer. Several attempts have been made to lower the treatment burden, such as omitting either all radiotherapy or the tumour bed boost, without success. Phase III trials are now being carried out to evaluate the treatment of the primary tumour area only (PBI). Various methods for selection of patient groups and of delivering the radiation dose have been employed. Vaidya et al. report the same favourable local recurrence rates following PBI with single dose intraoperative radiotherapy as with whole-breast irradiation. As the follow-up period so far has been short, long-time results should be awaited.

  10. Antiangiogenic therapy for breast cancer

    DEFF Research Database (Denmark)

    Nielsen, D.L.; Andersson, M.; Andersen, Jon Alexander Lykkegaard

    2010-01-01

    and optimal use of these agents for the treatment of breast cancer. Currently, the most promising approach has been the use of bevacizumab, a humanized monoclonal antibody directed against the most potent pro-angiogenic factor, vascular endothelial growth factor (VEGF). Small molecular inhibitors of VEGF...... tyrosine kinase activity, such as sorafenib, appear promising. While, the role of sunitinib and inhibitors of mammalian target of rapamycin (mTOR) in breast cancer has to be defined. Several unanswered questions remain, such as choice of drug(s), optimal duration of therapy and patient selection criteria......ABSTRACT: Angiogenesis is an important component of cancer growth, invasion and metastasis. Therefore, inhibition of angiogenesis is an attractive strategy for treatment of cancer. We describe existing clinical trials of antiangiogenic agents and the challenges facing the clinical development...

  11. Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial.

    Science.gov (United States)

    Zeidan, Youssef H; Habib, Joyce G; Ameye, Lieveke; Paesmans, Marianne; de Azambuja, Evandro; Gelber, Richard D; Campbell, Ian; Nordenskjöld, Bo; Gutiérez, Jorge; Anderson, Michael; Lluch, Ana; Gnant, Michael; Goldhirsch, Aron; Di Leo, Angelo; Joseph, David J; Crown, John; Piccart-Gebhart, Martine; Francis, Prudence A

    2018-06-01

    To analyze the impact of postmastectomy radiation therapy (PMRT) for patients with T1-T2 tumors and 1 to 3 positive lymph nodes enrolled on the Breast International Group (BIG) 02-98 trial. The BIG 02-98 trial randomized patients to receive adjuvant anthracycline with or without taxane chemotherapy. Delivery of PMRT was nonrandomized and performed according to institutional preferences. The present analysis was performed on participants with T1-T2 breast cancer and 1 to 3 positive lymph nodes who had undergone mastectomy and axillary nodal dissection. The primary objective of the present study was to examine the effect of PMRT on risk of locoregional recurrence (LRR), breast cancer-specific survival, and overall survival. We identified 684 patients who met the inclusion criteria and were included in the analysis, of whom 337 (49%) had received PMRT. At 10 years, LRR risk was 2.5% in the PMRT group and 6.5% in the no-PMRT group (hazard ratio 0.29, 95% confidence interval 0.12-0.73; P = .005). Lower LRR after PMRT was noted for patients randomized to receive adjuvant chemotherapy with no taxane (10-year LRR: 3.4% vs 9.1%; P = .02). No significant differences in breast cancer-specific survival (84.3% vs 83.9%) or overall survival (81.7% vs 78.3%) were observed according to receipt of PMRT. Our analysis of the BIG 02-98 trial shows excellent outcomes in women with T1-T2 tumors and 1 to 3 positive lymph nodes found in axillary dissection. Although PMRT improved LRR in this cohort, the number of events remained low at 10 years. In all groups, 10-year rates of LRR were relatively low compared with historical studies. As such, the use of PMRT in women with 1 to 3 positive nodes should be tailored to individual patient risks. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Outcome and prognostic factors for local recurrence in mammographically detected ductal carcinoma in situ of the breast treated with conservative surgery and radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    White, Julia; Levine, Alan; Gustafson, Gregory; Wimbish, Kathryn; Ingold, John; Pettinga, Jane; Matter, Richard; Martinez, Alvaro; Vicini, Frank

    1995-02-15

    Purpose: We have retrospectively reviewed our institution's experience treating a predominantly mammographically detected population of ductal carcinoma in situ (DCIS) patients with conservative surgery and radiation therapy (CSRT) to determine outcome and prognostic factors for local recurrence. Methods and Materials: Between January 1, 1982 and December 31, 1988, 52 consecutive cases of DCIS of the breast were treated with CSRT at William Beaumont Hospital. Forty-six (88%) were mammographically detected nonpalpable lesions. All patients underwent at least an excisional biopsy and 28 (54%) were reexcised. The axilla was surgically staged in 41 (79%) and all were N0. The entire breast was irradiated to 45-50 Gy over 5-6 weeks. The tumor bed was boosted in 49 (94%) so that the minimum dose was 60 Gy. The three patients not boosted received a minimum dose of 50 Gy to the entire breast. Pathologic materials were reviewed by one of the authors. Results: The predominant DCIS pattern was comedo in 40%, cribriform in 28%, solid in 17%, and micropapillary in 15%. The predominant nuclear grade was Grade I in 51%, Grade II in 49%, and Grade III in 0%. The median follow-up is 68 months. There have been three recurrences in the treated breast at a median time to failure of 30 months. The 5- and 8-year actuarial local recurrence rate is 6%. One patient recurred with invasive ductal cancer at 28 months, and the other two recurrences were DCIS at 30 and 50 months. All three patients were treated with salvage mastectomy. The patient who recurred locally with an invasive cancer developed metastasis and died at 64 months. The 5- and 8-year actuarial cause-specific survival rates are 100% and 97%, respectively. The following pathologic factors were analyzed for an association with local recurrence: predominant DCIS histology, predominant nuclear grade, and highest nuclear grade. Of these, the predominant nuclear grade was the best predictor of local recurrence (p = 0.070). No

  13. Magnetic Resonance Image Guided Radiation Therapy for External Beam Accelerated Partial-Breast Irradiation: Evaluation of Delivered Dose and Intrafractional Cavity Motion

    Energy Technology Data Exchange (ETDEWEB)

    Acharya, Sahaja; Fischer-Valuck, Benjamin W.; Mazur, Thomas R.; Curcuru, Austen; Sona, Karl; Kashani, Rojano; Green, Olga; Ochoa, Laura; Mutic, Sasa; Zoberi, Imran; Li, H. Harold; Thomas, Maria A., E-mail: mthomas@radonc.wustl.edu

    2016-11-15

    Purpose: To use magnetic resonance image guided radiation therapy (MR-IGRT) for accelerated partial-breast irradiation (APBI) to (1) determine intrafractional motion of the breast surgical cavity; and (2) assess delivered dose versus planned dose. Methods and Materials: Thirty women with breast cancer (stages 0-I) who underwent breast-conserving surgery were enrolled in a prospective registry evaluating APBI using a 0.35-T MR-IGRT system. Clinical target volume was defined as the surgical cavity plus a 1-cm margin (excluding chest wall, pectoral muscles, and 5 mm from skin). No additional margin was added for the planning target volume (PTV). A volumetric MR image was acquired before each fraction, and patients were set up to the surgical cavity as visualized on MR imaging. To determine the delivered dose for each fraction, the electron density map and contours from the computed tomography simulation were transferred to the pretreatment MR image via rigid registration. Intrafractional motion of the surgical cavity was determined by applying a tracking algorithm to the cavity contour as visualized on cine MR. Results: Median PTV volume was reduced by 52% when using no PTV margin compared with a 1-cm PTV margin used conventionally. The mean (± standard deviation) difference between planned and delivered dose to the PTV (V95) was 0.6% ± 0.1%. The mean cavity displacement in the anterior–posterior and superior–inferior directions was 0.6 ± 0.4 mm and 0.6 ± 0.3 mm, respectively. The mean margin required for at least 90% of the cavity to be contained by the margin for 90% of the time was 0.7 mm (5th-95th percentile: 0-2.7 mm). Conclusion: Minimal intrafractional motion was observed, and the mean difference between planned and delivered dose was less than 1%. Assessment of efficacy and cosmesis of this MR-guided APBI approach is under way.

  14. Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience

    International Nuclear Information System (INIS)

    Peterson, Michael E.; Schultz, Delray J.; Reynolds, Carol; Solin, Lawrence J.

    1999-01-01

    Purpose: To evaluate the significance of final microscopic resection margin status on treatment outcomes in women with early breast cancer who are treated with breast-conserving surgery and definitive breast irradiation. Methods and Materials: An analysis was performed of 1021 consecutive women with clinical Stage I or II invasive carcinoma of the breast treated with breast-conserving surgery and definitive breast irradiation. Complete gross excision of tumor was performed in all cases, and an axillary staging procedure was performed to determine pathologic axillary lymph node status. The 1021 patients were divided into four groups based on the final microscopic margin from the tumor excision or from the re-excision if performed. These four groups were: (a) 518 patients with negative margins; (b) 124 patients with focally positive margins; (c) 96 patients with focally close margins (≤ 2 mm); and (d) 283 patients with unknown margins. Results: Local failure was not significantly different in patients with negative, focally positive, focally close or unknown final pathologic margins of resection at 8 years (8% vs. 10% vs. 17% vs. 16%, respectively, p = 0.21). The 8-year outcome also was not different among the four groups for overall survival (86% vs. 83% vs. 88% vs. 81%, respectively, p = 0.13), cause-specific survival (89% vs. 86% vs. 88% vs. 83%, respectively, p 0.14), no evidence of disease survival (81% vs. 73% vs. 86% vs. 77%, respectively, p = 0.09), and freedom from distant metastases (85% vs. 75% vs. 86% vs. 79%, respectively, p = 0.08). Conclusion: These results demonstrate that selected patients with focally positive or focally close microscopic resection margins can be treated with breast-conserving surgery and definitive breast irradiation with 8-year local control rates and survival rates that are similar to those seen in breast-conservation patients with negative or unknown final resection margins

  15. Combined conservative surgery, chemotherapy and radiation therapy in treatment of the breast cancer patient: the influence of the interval between surgery and start of irradiation

    International Nuclear Information System (INIS)

    Willers, Henning; Wuerschmidt, F.; Janik, I.; Buenemann, H.; Heilmann, H.-P.

    1996-01-01

    Purpose: To analyze our experience treating breast cancer patients with combined breast conserving surgery, chemotherapy and radiation therapy in the light of considerable discussion on the role of the interval between surgery and radiation therapy (S-RT). Materials and Methods: Between 1985 and 1992, 100 patients with invasive breast cancer underwent radiation treatment at our institution after conservative surgery with axillary dissection and some form of chemotherapy. Criteria for inclusion in this retrospective analysis were: Stage M0, no simultaneous malignancies, gross total resection of primary and involved lymph nodes, at least three cycles of postoperative polychemotherapy, complete radiation treatment, complete follow-up information. Seventy-four patients fulfilling these criteria form the basis of this report. For patients alive at last observation date, median follow-up time was five years (i.e., 59 months; range, 36-112 months). Age at diagnosis ranged between 20 and 69 years (median, 48 years). Fifty-four patients were pre- or perimenopausal (73%) and 20 were postmenopausal (27%). Tumors were staged using the AJCC-system. Distribution of T-Stage was: T1 (n=36), T2 (n=37), T3 (n=1). In 95% of patients, axillary lymph nodes were positive: 1-3 nodes (n=50), ≥ 4 nodes (n=20), and 0 nodes (n=3). Thus, 91% of patients were Stage II. In 65% of patients, final pathological margins were negative. Margins showed invasive and intraductal carcinoma in 5 and 11% of cases, respectively (margins unknown in 19%). Chemotherapy regimens and doses varied according to the referring physicians as well as during the study period. Seventy percent of patients received six cycles of chemotherapy (predominan CMF) before onset of irradiation. The median S-RT interval was 20.5 weeks (range, 8.4-31.9 weeks). Usually, the breast was treated to 50 Gy, 2 Gy per fraction, five fractions per week, using Cobalt-60 (n=66) or 5 MeV photons (n=8). Then the tumor bed was boosted with

  16. Breast carcinoma - diagnostics, therapy and resistance

    International Nuclear Information System (INIS)

    Kuzma-Richert, A.; Saczko, J.; Kulbacka, J.

    2011-01-01

    Breast cancer is a pathologically and clinically heterogeneous disease with a variable prognosis. This type of cancer is the most common female cancer in Poland. According to data collected up to 2004, approximately 12,000 new breast cancer cases per year were diagnosed in women in Poland, and approximately 5000 patients died yearly of breast cancer. The authors present the histopathology, diagnostics, classification and general types of systemic therapy of breast cancer. (authors)

  17. Intraoperative Radiation Therapy in Early Breast Cancer Using a Linear Accelerator Outside of the Operative Suite: An “Image-Guided” Approach

    International Nuclear Information System (INIS)

    Hanna, Samir Abdallah; Simões Dornellas de Barros, Alfredo Carlos; Martins de Andrade, Felipe Eduardo; Barbosa Bevilacqua, Jose Luiz; Morales Piato, José Roberto; Lopes Pelosi, Edilson; Martella, Eduardo; Fernandes da Silva, João Luis; Andrade Carvalho, Heloisa de

    2014-01-01

    Purpose: To present local control, complications, and cosmetic outcomes of intraoperative radiation therapy (IORT) for early breast cancer, as well as technical aspects related to the use of a nondedicated linear accelerator. Methods and Materials: This prospective trial began in May of 2004. Eligibility criteria were biopsy-proven breast-infiltrating ductal carcinoma, age >40 years, tumor <3 cm, and cN0. Exclusion criteria were in situ or lobular types, multicentricity, skin invasion, any contraindication for surgery and/or radiation therapy, sentinel lymph node involvement, metastasis, or another malignancy. Patients underwent classic quadrantectomy with intraoperative sentinel lymph node and margins evaluation. If both free, the patient was transferred from operative suite to linear accelerator room, and IORT was delivered (21 Gy). Primary endpoint: local recurrence (LR); secondary endpoints: toxicities and aesthetics. Quality assurance involved using a customized shield for chest wall protection, applying procedures to minimize infection caused by patient transportation, and using portal films to check collimator-shield alignment. Results: A total of 152 patients were included, with at least 1 year follow-up. Median age (range) was 58.3 (40-85.4) years, and median follow-up time was 50.7 (12-110.5) months. The likelihood of 5-year local recurrence was 3.7%. There were 3 deaths, 2 of which were cancer related. The Kaplan-Meier 5-year actuarial estimates of overall, disease-free, and local recurrence-free survivals were 97.8%, 92.5%, and 96.3%, respectively. The overall incidences of acute and late toxicities were 12.5% and 29.6%, respectively. Excellent, good, fair, and bad cosmetic results were observed in 76.9%, 15.8%, 4.3%, and 2.8% of patients, respectively. Most treatments were performed with a 5-cm collimator, and in 39.8% of the patients the electron-beam energy used was ≥12 MeV. All patients underwent portal film evaluation, and the shielding was

  18. Intraoperative Radiation Therapy in Early Breast Cancer Using a Linear Accelerator Outside of the Operative Suite: An “Image-Guided” Approach

    Energy Technology Data Exchange (ETDEWEB)

    Hanna, Samir Abdallah, E-mail: samir.hanna@hsl.org.br [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Simões Dornellas de Barros, Alfredo Carlos; Martins de Andrade, Felipe Eduardo; Barbosa Bevilacqua, Jose Luiz [Department of Mastology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Morales Piato, José Roberto [Department of Mastology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Department of Gynecology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo (Brazil); Lopes Pelosi, Edilson [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Martella, Eduardo [Department of Radiation Oncology, Hospital Perola Byington, Sao Paulo (Brazil); Fernandes da Silva, João Luis [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Andrade Carvalho, Heloisa de [Department of Radiation Oncology, Hospital Sirio-Libanes, Sao Paulo (Brazil); Department of Radiology and Oncology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo (Brazil)

    2014-08-01

    Purpose: To present local control, complications, and cosmetic outcomes of intraoperative radiation therapy (IORT) for early breast cancer, as well as technical aspects related to the use of a nondedicated linear accelerator. Methods and Materials: This prospective trial began in May of 2004. Eligibility criteria were biopsy-proven breast-infiltrating ductal carcinoma, age >40 years, tumor <3 cm, and cN0. Exclusion criteria were in situ or lobular types, multicentricity, skin invasion, any contraindication for surgery and/or radiation therapy, sentinel lymph node involvement, metastasis, or another malignancy. Patients underwent classic quadrantectomy with intraoperative sentinel lymph node and margins evaluation. If both free, the patient was transferred from operative suite to linear accelerator room, and IORT was delivered (21 Gy). Primary endpoint: local recurrence (LR); secondary endpoints: toxicities and aesthetics. Quality assurance involved using a customized shield for chest wall protection, applying procedures to minimize infection caused by patient transportation, and using portal films to check collimator-shield alignment. Results: A total of 152 patients were included, with at least 1 year follow-up. Median age (range) was 58.3 (40-85.4) years, and median follow-up time was 50.7 (12-110.5) months. The likelihood of 5-year local recurrence was 3.7%. There were 3 deaths, 2 of which were cancer related. The Kaplan-Meier 5-year actuarial estimates of overall, disease-free, and local recurrence-free survivals were 97.8%, 92.5%, and 96.3%, respectively. The overall incidences of acute and late toxicities were 12.5% and 29.6%, respectively. Excellent, good, fair, and bad cosmetic results were observed in 76.9%, 15.8%, 4.3%, and 2.8% of patients, respectively. Most treatments were performed with a 5-cm collimator, and in 39.8% of the patients the electron-beam energy used was ≥12 MeV. All patients underwent portal film evaluation, and the shielding was

  19. Principles of radiation therapy

    International Nuclear Information System (INIS)

    Richter, M.P.; Share, F.S.; Goodman, R.L.

    1985-01-01

    Radiation oncology now represents the integration of knowledge obtained over an 80-year period from the physics and biology laboratories and the medical clinic. Such integration is recent; until the supervoltage era following World War II, the chief developments in these three areas for the most part were realized independently. The physics and engineering laboratories have now developed a dependable family of sources of ionizing radiations that can be precisely directed at tumor volumes at various depths within the body. The biology laboratory has provided the basic scientific support underlying the intensive clinical experience and currently is suggesting ways of using ionizing radiations more effectively, such as modified fractionation schedules relating to cell cycle kinetics and the use of drugs and chemicals as modifiers of radiation response and normal tissue reaction. The radiation therapy clinic has provided the patient stratum on which the acute and chronic effects of irradiation have been assessed, and the patterns of treatment success and failure identified. The radiation therapist has shared with the surgeon and medical oncologist the responsibility for clarifying the natural history of a large number of human neoplasms, and through such clarifications, has developed more effective treatment strategies. Several examples of this include the improved results in the treatment of Hodgkin's disease, squamous cell carcinoma of the cervix, seminoma, and epithelial neoplasms of the upper aerodigestive tract

  20. Radiation dose to contra lateral breast during treatment of breast malignancy by radiotherapy

    Directory of Open Access Journals (Sweden)

    Chougule Arun

    2007-01-01

    Full Text Available Aims: External beam radiotherapy is being used regularly to treat the breast malignancy postoperatively. The contribution of collimator leakage and scatter radiation dose to contralateral breast is of concern because of high radio sensitivity of breast tissue for carcinogenesis. This becomes more important when the treated cancer breast patient is younger than 45 years and therefore the contralateral breast must be treated as organ at risk. Quantification of contralateral dose during primary breast irradiation is helpful to estimate the risk of radiation induced secondary breast malignancy. Materials and Methods: In present study contralateral breast dose was measured in 30 cancer breast patients undergoing external beam therapy by Co-60 teletherapy machine. Postoperative radiotherapy was delivered by medial and lateral tangential fields on alternate days in addition to supraclavicle field daily with 200 cGy/F to a total dose of 5000 cGy in 25 fractions. CaSO4: Dy themoluminescence dosimeter discs were employed for these measurements. Three TLD discs were put on the surface of skin of contra lateral breast, one at the level of nipple and two at 3 cms away from nipple on both side along the midline for each field. At the end treatment of each filed, TLD discs were removed and measured for dose after 24h on Thelmador - 6000 TLD reader. Results: The dose at the contra lateral breast nipple was to be 152.5 to 254.75 cGy for total primary breast dose of 5000 cGy in 25 equal fractions which amounted to 3.05-6.05% of total dose to diseased breast. Further it was observed that the maximum contribution of contralateral breast dose was due to medical tangential half blocked field. Conclusion: CaSO4; Dy thermoluminescence dosimetry is quite easy, accurate and convenient method to measure the contra lateral breast dose.

  1. Genetic Variants in CD44 and MAT1A Confer Susceptibility to Acute Skin Reaction in Breast Cancer Patients Undergoing Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Mumbrekar, Kamalesh Dattaram; Bola Sadashiva, Satish Rao [Department of Radiation Biology and Toxicology, School of Life Sciences, Manipal University, Manipal, Karnataka (India); Kabekkodu, Shama Prasada [Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka (India); Fernandes, Donald Jerard [Department of Radiotherapy and Oncology, Shirdi Saibaba Cancer Hospital and Research Centre, Kasturba Hospital, Manipal, Karnataka (India); Vadhiraja, Bejadi Manjunath [Department of Radiation Oncology, Manipal Hospital, Bengaluru, Karnataka (India); Suga, Tomo; Shoji, Yoshimi; Nakayama, Fumiaki; Imai, Takashi [Advanced Radiation Biology Research Program, Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Satyamoorthy, Kapaettu, E-mail: ksatyamoorthy@yahoo.com [Department of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka (India)

    2017-01-01

    Purpose: Heterogeneity in radiation therapy (RT)-induced normal tissue toxicity is observed in 10% of cancer patients, limiting the therapeutic outcomes. In addition to treatment-related factors, normal tissue adverse reactions also manifest from genetic alterations in distinct pathways majorly involving DNA damage–repair genes, inflammatory cytokine genes, cell cycle regulation, and antioxidant response. Therefore, the common sequence variants in these radioresponsive genes might modify the severity of normal tissue toxicity, and the identification of the same could have clinical relevance as a predictive biomarker. Methods and Materials: The present study was conducted in a cohort of patients with breast cancer to evaluate the possible associations between genetic variants in radioresponsive genes described previously and the risk of developing RT-induced acute skin adverse reactions. We tested 22 genetic variants reported in 18 genes (ie, NFE2L2, OGG1, NEIL3, RAD17, PTTG1, REV3L, ALAD, CD44, RAD9A, TGFβR3, MAD2L2, MAP3K7, MAT1A, RPS6KB2, ZNF830, SH3GL1, BAX, and XRCC1) using TaqMan assay-based real-time polymerase chain reaction. At the end of RT, the severity of skin damage was scored, and the subjects were dichotomized as nonoverresponders (Radiation Therapy Oncology Group grade <2) and overresponders (Radiation Therapy Oncology Group grade ≥2) for analysis. Results: Of the 22 single nucleotide polymorphisms studied, the rs8193 polymorphism lying in the micro-RNA binding site of 3′-UTR of CD44 was significantly (P=.0270) associated with RT-induced adverse skin reactions. Generalized multifactor dimensionality reduction analysis showed significant (P=.0107) gene–gene interactions between MAT1A and CD44. Furthermore, an increase in the total number of risk alleles was associated with increasing occurrence of overresponses (P=.0302). Conclusions: The genetic polymorphisms in radioresponsive genes act as genetic modifiers of acute normal tissue toxicity

  2. How Important Is a Reproducible Breath Hold for Deep Inspiration Breath Hold Breast Radiation Therapy?

    International Nuclear Information System (INIS)

    Wiant, David; Wentworth, Stacy; Liu, Han; Sintay, Benjamin

    2015-01-01

    Purpose: Deep inspiration breath hold (DIBH) for left-sided breast cancer has been shown to reduce heart dose. Surface imaging helps to ensure accurate breast positioning, but it does not guarantee a reproducible breath hold (BH) at DIBH treatments. We examine the effects of variable BH positions for DIBH treatments. Methods and Materials: Twenty-five patients who underwent free breathing (FB) and DIBH scans were reviewed. Four plans were created for each patient: FB, DIBH, FB-DIBH (the DIBH plans were copied to the FB images and recalculated, and image registration was based on breast tissue), and P-DIBH (a partial BH with the heart shifted midway between the FB and DIBH positions). The FB-DIBH plans give a “worst-case” scenario for surface imaging DIBH, where the breast is aligned by surface imaging but the patient is not holding their breath. Kolmogorov-Smirnov tests were used to compare the dose metrics. Results: The DIBH plans gave lower heart dose and comparable breast coverage versus FB in all cases. The FB-DIBH plans showed no significant difference versus FB plans for breast coverage, mean heart dose, or maximum heart dose (P≥.10). The mean heart dose differed between FB-DIBH and FB by <2 Gy for all cases, and the maximum heart dose differed by <2 Gy for 21 cases. The P-DIBH plans showed significantly lower mean heart dose than FB (P<.01). The mean heart doses for the P-DIBH plans were < FB for 22 cases, the maximum dose was < FB for 18 cases. Conclusions: A DIBH plan delivered to a FB patient setup with surface imaging will yield dosimetry similar to that of a plan created and delivered FB. A DIBH plan delivered with even a partial BH can give reduced heart dose compared with FB techniques.

  3. How Important Is a Reproducible Breath Hold for Deep Inspiration Breath Hold Breast Radiation Therapy?

    Energy Technology Data Exchange (ETDEWEB)

    Wiant, David, E-mail: David.wiant@conehealth.com; Wentworth, Stacy; Liu, Han; Sintay, Benjamin

    2015-11-15

    Purpose: Deep inspiration breath hold (DIBH) for left-sided breast cancer has been shown to reduce heart dose. Surface imaging helps to ensure accurate breast positioning, but it does not guarantee a reproducible breath hold (BH) at DIBH treatments. We examine the effects of variable BH positions for DIBH treatments. Methods and Materials: Twenty-five patients who underwent free breathing (FB) and DIBH scans were reviewed. Four plans were created for each patient: FB, DIBH, FB-DIBH (the DIBH plans were copied to the FB images and recalculated, and image registration was based on breast tissue), and P-DIBH (a partial BH with the heart shifted midway between the FB and DIBH positions). The FB-DIBH plans give a “worst-case” scenario for surface imaging DIBH, where the breast is aligned by surface imaging but the patient is not holding their breath. Kolmogorov-Smirnov tests were used to compare the dose metrics. Results: The DIBH plans gave lower heart dose and comparable breast coverage versus FB in all cases. The FB-DIBH plans showed no significant difference versus FB plans for breast coverage, mean heart dose, or maximum heart dose (P≥.10). The mean heart dose differed between FB-DIBH and FB by <2 Gy for all cases, and the maximum heart dose differed by <2 Gy for 21 cases. The P-DIBH plans showed significantly lower mean heart dose than FB (P<.01). The mean heart doses for the P-DIBH plans were

  4. Radiation therapy for digestive tumors

    International Nuclear Information System (INIS)

    Piedbois, P.; Levy, E.; Thirion, P.; Martin, L.; Calitchi, E.; Otmezguine, Y.; Le Bourgeois, J.P.

    1995-01-01

    This brief review of radiation therapy of digestive tumors in 1994 seeks to provide practical answers to the most commonly asked questions: What is the place of radiation therapy versus chemotherapy for the treatment of these patients ? What are the approved indications of radiation therapy and which avenues of research are being explored ? Radiation therapy is used in over two-thirds of patients referred to an oncology department for a gastrointestinal tract tumor. The main indications are reviewed: cancer of the rectum and anal canal and, to a lesser extent, cancer of the esophagus and pancreas. The main focuses of current research include radiation therapy-chemotherapy combinations, intraoperative radiation therapy, and radiation therapy of hepatobiliary tumors. (authors). 23 refs., 1 fig

  5. Radiation osteitis following irradiation for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Langlands, A O; Souter, W A; Samuel, E; Redpath, A T [Royal Infirmary, Edinburgh (UK)

    1977-01-01

    Radiographs of the shoulder girdle were examined in 180 women who attended the breast follow-up clinic at the Department of Radiotherapy, Edinburgh. These comprised 52 controls who had been treated by radical mastectomy alone and 128 patients who had received post-operative X-ray therapy. The significance of osteoporosis as a sequel to irradiation is doubtful as it occurred in a substantial proportion of the control cases. Osteitis of severe degree occurred in 13.3% of patients who had been irradiated and was present in a mild form in a further 8.6%. The development of severe osteitis requires an NSD of 1650 rets or more. Estimates of the frequency of radiation osteitis are of no value unless detailed information is also provided about the techniques and quality of radiation.

  6. Development of HER2-targeted nanobodies for molecular optical imaging and therapy of breast cancer

    NARCIS (Netherlands)

    Kijanka, M.M.

    2014-01-01

    Breast cancer is a complex disease and the most prevalent cancer in women worldwide. It has been estimated that 1 in 8 women and 1 in 1,000 men will develop breast cancer. Surgical-, chemical- and radiation based therapies are available to breast cancer patients. Early detection of cancer is crucial

  7. Biological Modeling Based Outcome Analysis (BMOA) in 3D Conformal Radiation Therapy (3DCRT) Treatments for Lung and Breast Cancers

    Science.gov (United States)

    Pyakuryal, Anil; Chen, Chiu-Hao; Dhungana, Sudarshan

    2010-03-01

    3DCRT treatments are the most commonly used techniques in the treatment of lung and breast cancers. The purpose of this study was to perform the BMOA of the 3DCRT plans designed for the treatment of breast and lung cancers utilizing HART program (Med. Phys. 36, p.2547(2009)). The BMOA parameters include normal tissue complication probability (NTCP), tumor control probability (TCP), and the complication-free tumor control probability (P+). The 3DCRT plans were designed for (i) the palliative treatment of 8 left lung cancer patients (CPs) at early stage (m=8), (ii) the curative treatment of 8 left lung CPs at stages II and III (k=8), and (iii) the curative treatment of 8 left breast CPs (n=8). The NTCPs were noticeably small (esophagus in lung CPs (k=8). Assessments of the TCPs and P+s also indicated good improvements in local tumor control in all plans. Homogeneous target coverage and improved dose conformality were the major advantages of such techniques in the treatment of breast cancer. These achievements support the efficacy of the 3DCRT techniques for the efficient treatment of various types of cancer.

  8. Evaluation of two tomotherapy-based techniques for the delivery of whole-breast intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Gonzalez, Victor J.; Buchholz, Daniel J.; Langen, Katja M.; Olivera, Gustavo H.; Chauhan, Bhavin; Meeks, Sanford L.; Ruchala, Kenneth J.; Haimerl, Jason; Lu Weiguo; Kupelian, Patrick A.

    2006-01-01

    Purpose: To evaluate two different techniques for whole-breast treatments delivered using the Hi-ART II tomotherapy device. Methods and Materials: Tomotherapy uses the standard rotational helical delivery. Topotherapy uses a stationary gantry while delivering intensity-modulated treatments. CT scans from 5 breast cancer patients were used. The prescription dose was 50.4 Gy. Results: On average, 99% of the target volume received 95% of prescribed dose with either technique. If treatment times are restricted to less than 9 min, the average percentage ipsilateral lung receiving ≥20 Gy was 22% for tomotherapy vs. 10% for topotherapy. The ipsilateral lung receiving ≥50.4 Gy was 4 cc for tomotherapy vs. 27 cc for topotherapy. The percentage of left ventricle receiving ≥30 Gy was 14% with tomotherapy vs. 4% for topotherapy. The average doses to the contralateral breast and lung were 0.6 and 0.8 Gy, respectively, for tomotherapy vs. 0.4 and 0.3 Gy for topotherapy. Conclusions: Tomotherapy provides improved target dose homogeneity and conformality over topotherapy. If delivery times are restricted, topotherapy reduces the amount of heart and ipsilateral lung volumes receiving low doses. For whole-breast treatments, topotherapy is an efficient technique that achieves adequate target uniformity while maintaining low doses to sensitive structures

  9. Radiation therapy for chordomas

    International Nuclear Information System (INIS)

    Ikeda, Hajime; Takahashi, Takeo; Nakamura, Yuji; Niibe, Hideo

    1995-01-01

    Chordomas are slow-growing primary malignant bone tumors which originate from remnants of the fetal notochordal system. They are difficult to control by surgery alone. Four patients with chordomas treated with radiation therapy were studied, and the effectiveness of radiotherapy was evaluated. These 4 (3.8%) patients were among 106 patients with primary malignant bone tumors referred to us from 1959 to 1987. Primary sites were the sacrococcygeal region in three patients and the clivus in one. The patients' ages ranged from 51 to 75 years. The male : female ratio was 1 : 1. Patients received 48 to 60 Gy of radiation to the primary sites. Because the radiosensitivity of the tumors was low, the responses were poor. The duration of survival was 6, 33, 68, and 125 months. The cause of death in each case was local recurrence of tumor. As a result, a dose greater than 60 Gy is thought to be necessary for curative radiotherapy. Proton beam therapy seems to be best choice for chordomas in the clivus, and mixed-beam (proton and megavolt age X-ray) therapy or multiportal irradiation, which gives an ideal spatial dose distribution, seems to be most suitable for sacrococcygeal chordomas. (author)

  10. 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)

    Liss, Adam L.; Ben-David, Merav A.; Jagsi, Reshma; Hayman, James A.; Griffith, Kent A.; Moran, Jean M.; Marsh, Robin B.; Pierce, Lori J.

    2014-01-01

    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

  11. 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.

  12. Isolated local-regional recurrence following mastectomy for adenocarcinoma of the breast treated with radiation therapy alone or combined with surgery and/or chemotherapy

    International Nuclear Information System (INIS)

    Mendenhall, N.P.; Devine, J.W.; Mendenhall, W.M.; Million, R.R.; Bland, K.I.; Copeland, E.M. III

    1988-01-01

    The results of radiation therapy alone or combined with surgery and/or chemotherapy are reported for 47 patients who presented with local and/or regional recurrence without evidence of distant metastases following initial management of adenocarcinoma of the breast with radical or modified radical mastectomy (43) or simple mastectomy (4). Patients were treated between October 1964 and March 1983 at the University of Florida; all have a 2-year minimum follow-up and 42/47 (89%) have had follow-up for ≥5 years. The overall actuarial local-regional control rates were 80% at 2 years, 68% at 5 years, and 61% at 10 years. The 5-year actuarial local-regional control rates by site and extent of disease were as follows: single chest wall nodule, 92%; multiple chest wall nodules, 49%; regional lymph nodes, 66%; and multiple sites, 64%. The 5- and 10-year actuarial determinate disease-free survival rates for all patients were 41 and 17%, respectively. The 5- and 10-year actuarial survival rates for all patients were 50 and 34%, respectively. 22 refs.; 5 figs.; 5 tabs

  13. Radiation-induced breast cancer

    International Nuclear Information System (INIS)

    Price, J.L.

    1977-01-01

    Concern is expressed over a recent U.K. newspaper report (The Times, 21 January 1977, 5) on the possible hazards of mammography, as women may over-react to the extent of refusing mammography. The problems of radiation risk estimates, particularly at low dose levels, are very briefly reviewed. Recent improvements in mammography techniques have minimised the radiation hazard. Conflicting reports of the mortality rates following mammography screening programmes are discussed. In England and Wales, breast cancer is the commonest cause of death in women aged 35 to 54, and it would be unfortunate if the possible benefits of screening were denied to this age group before the latest mammographic techniques have been fully evaluated. (U.K.)

  14. Radiation-induced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Price, J L [Hammersmith Hospital, London (UK). Postgraduate Medical School

    1977-03-12

    Concern is expressed over a recent U.K. newspaper report (The Times, 21 January 1977, 5) on the possible hazards of mammography, as women may over-react to the extent of refusing mammography. The problems of radiation risk estimates, particularly at low dose levels, are very briefly reviewed. Recent improvements in mammography techniques have minimised the radiation hazard. Conflicting reports of the mortality rates following mammography screening programmes are discussed. In England and Wales, breast cancer is the commonest cause of death in women aged 35 to 54, and it would be unfortunate if the possible benefits of screening were denied to this age group before the latest mammographic techniques have been fully evaluated.

  15. Technical advances in radiation therapy

    International Nuclear Information System (INIS)

    Sause, W.T.

    1986-01-01

    Substantial advances have been made in radiation therapy. Many of these advances can be applied in most radiation therapy departments without expensive improvements in equipment. Changes in radiation fractionation, chemotherapeutic sensitization, intraoperative radiation, and interstitial implants can be performed with experience and improved physician training in most medium-sized departments. Advances that require investments in expensive equipment such as particle radiation and hyperthermia will need to be evaluated at designated treatment centers. 106 references

  16. Nursing interventions for radiation dermatitis during breast radiotherapy

    International Nuclear Information System (INIS)

    Goto, Shiho; Nagai, Yuko

    2015-01-01

    Radiation dermatitis occurs in 95% of the women undergoing radiation therapy (RT) for breast cancer. Radiation dermatitis is one of the common acute side effects of RT and includes erythema, dry desquamation, and moist desquamation. Radiation dermatitis may cause physical distress, such as pain and itchiness, and influence individual's quality of life as well. Nurses are to reduce the distress and improve quality of life by managing the symptoms and enhancing patient's self-care ability. This article describes the supportive care for radiation dermatitis from nurse's point of view. (author)

  17. Breast carcinoma after cancer therapy in childhood

    International Nuclear Information System (INIS)

    Li, F.P.; Corkery, J.; Vawter, G.; Fine, W.; Sallan, S.E.

    1983-01-01

    Among 910 survivors of childhood cancer, four developed infiltrating carcinoma of the breast and another had noninfiltrating breast tumor. Expected frequency was 0.3 cases of breast cancer in the series. The affected women developed breast carcinoma at ages 20, 25 and 38 years, and the men at ages 38 and 39 years, respectively. Each patient had received orthovoltage chest irradiation for treatment of Wilms' tumor or bone sarcoma between seven and 34 years previously, and estimated radiation dose to the breast exceeded 300 rad in each instance. Four patients also received diverse forms of chemotherapy. Survivors of childhood cancer have increased risk of developing breast cancer and should undergo periodic screening, particularly after breast tissue had been irradiated. Individualized radiotherapy planning can help exclude the breasts from treatment fields for some thoracic neoplasms

  18. Reduction mammaplasty and radiation therapy can allow breast conservation in patients with breast cancers not initially treatable by tumor-ectomy; Apport de la plastie mammaire de reduction, associee a la radiotherapie, dans le traitement conservateur des cancers du sein non accessibles a une tumorectomie de premiere intention

    Energy Technology Data Exchange (ETDEWEB)

    Otmezguine, Y.; Calitchi, E.; Cothier, I.; Feuilhade, F.; Le Bourgeois, J.P.; Baruch, J. [Hopital Henri-Mondor, 94 - Creteil (France)

    1997-09-01

    A protocol combining reduction mammaplasty (RM) and radiation therapy was developed as an alternative of mastectomy in patients with breast cancers larger than 3 cm in diameter. This protocol was used in 51 patients between 1983 and 1990. Indications were extensive microcalcifications (n = 17; 33 %) ; residual tumor after neo-adjuvant therapy larger than 4 cm in diameter (n 18 ; 35 %); extensive DCIS (n = 4; 8 %) or tumor located within an area of fibrocystic disease (n = 6; 12 %); presence of a bifocal lesion (n = 12 %); area of fibrocystic disease (n = 6; 12 %); and presence of bifocal lesion (n 6; 12 %). Surgery consisted of tumor-ectomy removing a wide margin of skin and mammary gland, followed by immediate remodeling of the breast, same-side axillary node clearance, and symmetrization of the other breast. A radiation dose of 45 Gy was delivered to the entire mammary gland. Adjuvant therapy was given before and/or after therapy according to the institution`s routine breast cancer protocol. During the mean follow-up of 8.1 years, four patients (8 %) developed a local recurrence, which has treated surgically. The five-year disease-free survival rate was 76 %. The cosmetic result was good or very good in 78% of cases. RM plus RT is a reasonable alternative to mastectomy in patients with large breast cancers, although further work is needed to refine its indications. (authors). 15 refs.

  19. Dosimetric study comparing volumetric arc modulation with RapidArc and fixed dynamic intensity-modulated radiation therapy for breast cancer radiotherapy after breast-conserving surgery

    International Nuclear Information System (INIS)

    Tie Jian; Sun Yan; Gong Jian; Han Shukui; Jiang Fan; Wu Hao

    2011-01-01

    Objective: To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery. Methods: Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery. After target definition, treatment planning was performed by RapidArc and two fixed fields dynamic IMRT respectively on the same CT scan. The target dose distribution, homogeneity of the breast, and the irradiation dose and volume for the lungs, heart, and contralateral breast were read in the dose-volume histogram (DVH) and compared between RapidArc and IMRT. The treatment delivery time and monitor units were also compared. Results: In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV), the volume proportion of 95% prescribed dose (V 95% ) was significantly higher by 0.65% in RapidArc (t=5.16, P=0.001), and the V 105% and V 110% were lower by 10.96% and 1.48 % respectively, however, without statistical significance (t=-2.05, P=0.055 and t=-1.33, P=0.197). The conformal index of planning target volume (PTV) by the RapidArc planning was (0.88±0.02), significantly higher than that by the IMRT planning [(0.74±0.03), t=18.54, P<0.001]. The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01, significantly lower than that by the IMRT planning (1.12±0.02, t=-2.44, P=0.02). There were no significant differences in the maximum dose (D max ) and V 20 for the ipsilateral lung between the RapidArc and IMRT planning, but the values of V 10 , V 5 , D min and D mean by RapidArc planning were all significantly higher than those by the IMRT planning (all P<0.01). The values of max dose and V 30 for the heart were similar by both techniques, but the values of V 10 and V 5 by the RapidArc planning were significantly higher (by 18% and 50%, respectively). The V 5 of the contralateral breast and lung by the RapidArc planning were

  20. Radiation pneumonitis: a complication resulting from combined radiation and chemotherapy for early breast cancer

    International Nuclear Information System (INIS)

    Gez, E.; Sulkes, A.; Isacson, R.; Catane, R.; Weshler, Z.

    1985-01-01

    Described is a patient with early breast carcinoma who developed clinical radiation pneumonitis during primary radiation therapy and concomitant chemotherapy that included prednisone. This syndrome developed three days following abrupt steroid withdrawal. Retrieval of steroids brought complete resolution of the clinical and radiological findings. Although this syndrome is rare, it is recommended that steroid therapy in a patient previously irradiated to the chest be avoided

  1. OWN EXPERIENCE OF LASER THERAPY FOR THE PREVENTION AND TREATMENT OF EARLY AND LATE RADIATION-INDUCED SKIN INJURIES IN PATIENTS WITH BREAST CANCER AFTER SIMULTANEOUS RECONSTRUCTIVE PLASTIC SURGERY

    Directory of Open Access Journals (Sweden)

    S. I. Tkachev

    2017-01-01

    Full Text Available Low-energy laser radiation has a good anti-inflammatory and stimulating effect on the damaged tissues; therefore, it can be used for the prevention and treatment of both early and late radiation-induced skin injuries in patients receiving radiotherapy. So far, the effect of low-energy laser radiation in the prevention of radiation-induced skin damage remains poorly understood. This article presents a brief overview of the results obtained in the latest foreign studies as well as own experience of laser therapy for the prevention and treatment of both early and late radiation-induced skin injuries in patients with breast cancer after simultaneous reconstructive plastic surgery.

  2. Impact of Postmastectomy Radiation on Locoregional Recurrence in Breast Cancer Patients With 1-3 Positive Lymph Nodes Treated With Modern Systemic Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Tendulkar, Rahul D., E-mail: tendulr@ccf.org [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio (United States); Rehman, Sana; Shukla, Monica E.; Reddy, Chandana A. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio (United States); Moore, Halle; Budd, G. Thomas [Department of Solid Tumor Oncology, Cleveland Clinic Foundation, Cleveland, Ohio (United States); Dietz, Jill; Crowe, Joseph P. [Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio (United States); Macklis, Roger [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio (United States)

    2012-08-01

    Purpose: Postmastectomy radiation therapy (PMRT) remains controversial for patients with 1-3 positive lymph nodes (LN+). Methods and Materials: We conducted a retrospective review of all 369 breast cancer patients with 1-3 LN+ who underwent mastectomy without neoadjuvant systemic therapy between 2000 and 2007 at Cleveland Clinic. Results: We identified 271 patients with 1-3 LN+ who did not receive PMRT and 98 who did receive PMRT. The median follow-up time was 5.2 years, and the median number of LN dissected was 11. Of those not treated with PMRT, 79% received adjuvant chemotherapy (of whom 70% received a taxane), 79% received hormonal therapy, and 5% had no systemic therapy. Of the Her2/neu amplified tumors, 42% received trastuzumab. The 5-year rate of locoregional recurrence (LRR) was 8.9% without PMRT vs 0% with PMRT (P=.004). For patients who did not receive PMRT, univariate analysis showed 6 risk factors significantly (P<.05) correlated with LRR: estrogen receptor/progesterone receptor negative (hazard ratio [HR] 2.6), lymphovascular invasion (HR 2.4), 2-3 LN+ (HR 2.6), nodal ratio >25% (HR 2.7), extracapsular extension (ECE) (HR 3.7), and Bloom-Richardson grade III (HR 3.1). The 5-year LRR rate was 3.4% (95% confidence interval [CI], 0.1%-6.8%] for patients with 0-1 risk factor vs 14.6% [95% CI, 8.4%-20.9%] for patients with {>=}2 risk factors (P=.0006), respectively. On multivariate analysis, ECE (HR 4.3, P=.0006) and grade III (HR 3.6, P=.004) remained significant risk factors for LRR. The 5-year LRR was 4.1% in patients with neither grade III nor ECE, 8.1% with either grade III or ECE, and 50.4% in patients with both grade III and ECE (P<.0001); the corresponding 5-year distant metastasis-free survival rates were 91.8%, 85.4%, and 59.1% (P=.0004), respectively. Conclusions: PMRT offers excellent control for patients with 1-3 LN+, with no locoregional failures to date. Patients with 1-3 LN+ who have grade III disease and/or ECE should be strongly considered

  3. Radiation therapy: A major factor in the five-year survival analysis of women with breast cancer in Lagos, Nigeria

    International Nuclear Information System (INIS)

    Makanjuola, Samira B.L.; Popoola, Abiodun O.; Oludara, Mobolaji A.

    2014-01-01

    Purpose: This retrospective study was carried out to examine five-year survival from breast cancer cases diagnosed between 2005 and May 2008 in Nigerian women. Material and methods: Two hundred and twenty-four patients were entered into the study. Five-year survival was evaluated using proportional hazard model proposed by Cox to assess variables such as age of diagnosis, menopausal status, and stage of the disease in the two treatment groups: surgery/chemotherapy or surgery/chemotherapy/radiotherapy. Results: Findings revealed that the different staging of disease and treatment are independent predictors of disease outcome whereas age of diagnosis and menopausal status although associated with low hazards, are not significant. TNM Stage I (Hazard Ratio = 0.153, 95% CI 0.45–0.51, P = 0.003), II (Hazard Ratio = 0.245, 95% CI 0.12–0.46, P = 0.0001), and III (Hazard Ratio = 0.449, 95% CI 0.31–0.46, P = 0.0001) showed significantly greater survival rates compared to TNM Stage IV for patients receiving surgery/chemotherapy. Similarly, for patients receiving surgery/chemotherapy/radiotherapy TNM Stage II (Hazard Ratio = 0.110, 95% CI 0.02–0.46, P = 0.003) and III (Hazard Ratio = 0.238, 95% CI 0.07–0.73, P = 0.012) also showed significantly greater survival rates compared to TNM Stage IV. Treatment had a significant impact on survival independent of stage, age, and menopausal status. Patients receiving surgery/chemotherapy/radiotherapy had a significant increase in survival outcome for TNM Stage (II, P = 0.045; III, P = 0.0001); age groups (40–49, P = 0.021; 50–59, P = 0.016; 60–69, P = 0.017; >70, P = 0.025); and menopausal status (premenopausal, P = 0.049; postmenopausal, P = 0.0001) compared to those receiving surgery/chemotherapy. Conclusion: The five-year breast cancer survival rate in Lagos, Nigeria 24.1% (54/224) is relatively poor compared to most countries in the world and needs to be improved. Poor survival rates are mainly attributed to late

  4. Radiation therapy for prostate cancer

    International Nuclear Information System (INIS)

    Nakamura, Katsumasa

    2001-01-01

    In Japan, where the mortality rate of prostate cancer is lower than in Western countries, radical prostatectomy or hormonal therapy has been applied more frequently than radiation therapy. However, the number of patients with prostate cancer has been increasing recently and the importance of radiation therapy has rapidly been recognized. Although there have been no randomized trials, results from several institutions in Western countries suggest that similar results of cancer control are achieved with either radiation therapy or radical prostatectomy. For higher-risk cases, conformal high-dose therapy or adjuvant hormonal therapy is more appropriate. In this article, the results of radiation therapy for prostate cancer were reviewed, with a view to the appropriate choice of therapy in Japan. (author)

  5. Stereotactic body radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Simon S. [Univ. Hospitals Seidman Cancer Center, Cleveland, OH (United States). Dept. of Radiation Oncology; Case Western Reserve Univ., Cleveland, OH (United States). Case Comprehensive Cancer Center; Teh, Bin S. [The Methodist Hospital Cancer Center and Research Institute, Houston, TX (United States). Weill Cornell Medical College; Lu, Jiade J. [National Univ. of Singapore (Singapore). Dept. of Radiation Oncology; Schefter, Tracey E. (eds.) [Colorado Univ., Aurora, CO (United States). Dept. of Radiation Oncology

    2012-11-01

    Comprehensive an up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. Examines in detail retrospective studies and prospective clinical trials for various organ sites from around the world. Written by world-renowned experts in SBRT from North America, Asia and Europe. Stereotactic body radiation therapy (SBRT) has emerged as an innovative treatment for various primary and metastatic cancers, and the past five years have witnessed a quantum leap in its use. This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. The organ sites covered include lung, liver, spine, pancreas, prostate, adrenal, head and neck, and female reproductive tract. Retrospective studies and prospective clinical trials on SBRT for various organ sites from around the world are examined, and toxicities and normal tissue constraints are discussed. This book features unique insights from world-renowned experts in SBRT from North America, Asia, and Europe. It will be necessary reading for radiation oncologists, radiation oncology residents and fellows, medical physicists, medical physics residents, medical oncologists, surgical oncologists, and cancer scientists.

  6. Smart Radiation Therapy Biomaterials.

    Science.gov (United States)

    Ngwa, Wilfred; Boateng, Francis; Kumar, Rajiv; Irvine, Darrell J; Formenti, Silvia; Ngoma, Twalib; Herskind, Carsten; Veldwijk, Marlon R; Hildenbrand, Georg Lars; Hausmann, Michael; Wenz, Frederik; Hesser, Juergen

    2017-03-01

    Radiation therapy (RT) is a crucial component of cancer care, used in the treatment of over 50% of cancer patients. Patients undergoing image guided RT or brachytherapy routinely have inert RT biomaterials implanted into their tumors. The single function of these RT biomaterials is to ensure geometric accuracy during treatment. Recent studies have proposed that the inert biomaterials could be upgraded to "smart" RT biomaterials, designed to do more than 1 function. Such smart biomaterials include next-generation fiducial markers, brachytherapy spacers, and balloon applicators, designed to respond to stimuli and perform additional desirable functions like controlled delivery of therapy-enhancing payloads directly into the tumor subvolume while minimizing normal tissue toxicities. More broadly, smart RT biomaterials may include functionalized nanoparticles that can be activated to boost RT efficacy. This work reviews the rationale for smart RT biomaterials, the state of the art in this emerging cross-disciplinary research area, challenges and opportunities for further research and development, and a purview of potential clinical applications. Applications covered include using smart RT biomaterials for boosting cancer therapy with minimal side effects, combining RT with immunotherapy or chemotherapy, reducing treatment time or health care costs, and other incipient applications. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Radiation therapy with fast neutrons: A review

    International Nuclear Information System (INIS)

    Jones, D.T.L.; Wambersie, A.

    2007-01-01

    Because of their biological effects fast neutrons are most effective in treating large, slow-growing tumours which are resistant to conventional X-radiation. Patients are treated typically 3-4 times per week for 4-5 weeks (sometimes in combination with X-radiation) for a variety of conditions such as carcinomas of the head and neck, salivary gland, paranasal sinus and breast; soft tissue, bone and uterine sarcomas and malignant melanomas. It is estimated that about 27,000 patients have undergone fast neutron therapy to date

  8. The implications of breast cancer molecular phenotype for radiation oncology

    Directory of Open Access Journals (Sweden)

    Shirin eSioshansi

    2011-06-01

    Full Text Available The identification of distinct molecular subtypes of breast cancer has advanced the understanding and treatment of breast cancer by providing insight into prognosis, patterns of recurrence and effectiveness of therapy. The prognostic significance of molecular phenotype with regard to distant recurrences and overall survival are well established in the literature and has been readily incorporated into systemic therapy management decisions. However, despite the accumulating data suggesting similar prognostic significance for locoregional recurrence, integration of molecular phenotype into local management decision making has lagged. Although there are some conflicting reports, collectively the literature supports a low risk of local recurrence in the hormone receptor positive luminal subtypes compared to hormone receptor negative subtypes (triple negative and HER2-enriched. The development of targeted therapies, such as trastuzumab for the treatment of HER2-enriched subtype, has been shown to mitigate the increased risk of local recurrence. Unfortunately, no such remedy exists to address the increased risk of local recurrence for patients with triple negative tumors, making it a clinical challenge for radiation oncologists. In this review we discuss the correlation between molecular subtype and local recurrence following either breast conservation therapy or mastectomy. We also explore the possible mechanisms for increased local recurrence in triple negative breast cancer and radiotherapeutic implications for this population, such as the safety of breast conservation, consideration of dose escalation and the appropriateness of accelerated partial breast irradiation.

  9. The Implications of Breast Cancer Molecular Phenotype for Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Sioshansi, Shirin [Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA (United States); Department of Radiation Oncology, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, RI (United States); Huber, Kathryn E. [Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA (United States); Wazer, David E., E-mail: dwazer@tuftsmedicalcenter.org [Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA (United States); Department of Radiation Oncology, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, RI (United States)

    2011-06-28

    The identification of distinct molecular subtypes of breast cancer has advanced the understanding and treatment of breast cancer by providing insight into prognosis, patterns of recurrence, and effectiveness of therapy. The prognostic significance of molecular phenotype with regard to distant recurrences and overall survival are well established in the literature and has been readily incorporated into systemic therapy management decisions. However, despite the accumulating data suggesting similar prognostic significance for locoregional recurrence, integration of molecular phenotype into local management decision making has lagged. Although there are some conflicting reports, collectively the literature supports a low risk of local recurrence (LR) in the hormone receptor (HR) positive luminal subtypes compared to HR negative subtypes [triple negative (TN) and HER2-enriched]. The development of targeted therapies, such as trastuzumab for the treatment of HER2-enriched subtype, has been shown to mitigate the increased risk of LR. Unfortunately, no such remedy exists to address the increased risk of LR for patients with TN tumors, making it a clinical challenge for radiation oncologists. In this review we discuss the correlation between molecular subtype and LR following either breast conservation therapy or mastectomy. We also explore the possible mechanisms for increased LR in TN breast cancer and radiotherapeutic implications for this population, such as the safety of breast conservation, consideration of dose escalation, and the appropriateness of accelerated partial breast irradiation.

  10. The Implications of Breast Cancer Molecular Phenotype for Radiation Oncology

    International Nuclear Information System (INIS)

    Sioshansi, Shirin; Huber, Kathryn E.; Wazer, David E.

    2011-01-01

    The identification of distinct molecular subtypes of breast cancer has advanced the understanding and treatment of breast cancer by providing insight into prognosis, patterns of recurrence, and effectiveness of therapy. The prognostic significance of molecular phenotype with regard to distant recurrences and overall survival are well established in the literature and has been readily incorporated into systemic therapy management decisions. However, despite the accumulating data suggesting similar prognostic significance for locoregional recurrence, integration of molecular phenotype into local management decision making has lagged. Although there are some conflicting reports, collectively the literature supports a low risk of local recurrence (LR) in the hormone receptor (HR) positive luminal subtypes compared to HR negative subtypes [triple negative (TN) and HER2-enriched]. The development of targeted therapies, such as trastuzumab for the treatment of HER2-enriched subtype, has been shown to mitigate the increased risk of LR. Unfortunately, no such remedy exists to address the increased risk of LR for patients with TN tumors, making it a clinical challenge for radiation oncologists. In this review we discuss the correlation between molecular subtype and LR following either breast conservation therapy or mastectomy. We also explore the possible mechanisms for increased LR in TN breast cancer and radiotherapeutic implications for this population, such as the safety of breast conservation, consideration of dose escalation, and the appropriateness of accelerated partial breast irradiation.

  11. Results of conservative treatment with surgery and radiation therapy of 132 non-palpable ductal carcinomas in situ of the breast; Resultats du traitement par chirurgie conservatrice et irradiation de 132 carcinomes canalaires in situ non palpables du sein

    Energy Technology Data Exchange (ETDEWEB)

    Amalric, R.; Brandone, H.; Dubau, A.; Hans, D.; Brandone, J.M.; Robert, F.; Pollet, J.F.; Amalric, F.; Rouah, Y.; Thomassin, L.; Giraud, D.; Henric, A.; Martin, P.M.; Romain, S. [Academie mediterraneenne d`oncologie clinique, Polyclinique Clairval, 13 - Marseille (France)

    1998-01-01

    Retrospective analysis of results of treatment of 132 subclinical ductal carcinomas in situ, non-palpable. Patients were treated with limited surgery and 70 Gy radiation therapy (70 Gy). With a median follow-up of 7 years, the total recurrence rate was 6 % and the actuarial rate at 5 years 4 % and at 10 years 13 % at. These have no influence on recurrence on the specific actuarial survival rate which was 100 % at 10 years. In spite of five infiltrating recurrences of seven, no metastasis appeared 48 months after the salvage surgery. The global rate of breast. The global rate of breast preservation was 92 % at 7 years. Therapeutic indications were developed taking into account the present analysis and a literature review (2,338 in situ ductal carcinomas, palpable or not, treated with conservative surgery, with or without adjuvant radio-therapy). (author)

  12. A multidisciplinary protocol for planned skin-preserving delayed breast reconstruction for patients with locally advanced breast cancer requiring postmastectomy radiation therapy: 3-year follow-up.

    Science.gov (United States)

    Kronowitz, Steven J; Lam, Candace; Terefe, Welela; Hunt, Kelly K; Kuerer, Henry M; Valero, Vicente; Lance, Samuel; Robb, Geoffrey L; Feng, Lei; Buchholz, Thomas A

    2011-06-01

    The authors examined the safety of a protocol for planned skin-preserving delayed breast reconstruction after postmastectomy radiotherapy with placement of a tissue expander for patients with locally advanced breast cancer (stages IIB and III). The authors compared 47 patients treated according to the protocol between December 2003 and May 2008 with 47 disease-stage-matched control patients who underwent standard delayed reconstruction after postmastectomy radiotherapy (no skin preservation or tissue expander) during the same period. Protocol-group complication rates were 21 percent for skin-preserving mastectomy and placement of the expander (stage 1), 5 percent for postmastectomy radiotherapy, 25 percent for expander reinflation after radiotherapy, and 24 percent for skin-preserving delayed reconstruction. The complication rate for standard delayed reconstruction was 38 percent. Tissue-expander loss rates were 32 percent overall, 9 percent for stage 1, 5 percent for postmastectomy radiotherapy, and 22 percent for reinflation. Wound-healing complications after reconstruction occurred in 3 percent of protocol-group and 10 percent of control-group patients. The median follow-up time for patients still alive at last follow-up was 40 months (range, 8.5 to 85.3 months). Three-year recurrence-free survival rates were 92 percent (95 percent CI, 83 to 100 percent) and 86 percent (95 percent CI, 76 to 98 percent) for the protocol and control groups, respectively (p = 0.87). In patients with locally advanced breast cancer, skin-preserving mastectomy with a deflated tissue expander on the chest wall during postmastectomy radiotherapy does not increase locoregional recurrence risk and is associated with lower complication rates of definitive reconstruction.

  13. The accuracy of electron-boost fields in the radiation therapy of early breast cancer after lumpectomy

    International Nuclear Information System (INIS)

    Yakar, D.; Bower, D.; Kambouris, A.

    1989-01-01

    Electron boost fields used in the radiotherapy of early breast cancer may be set up either clinically (on the basis of lumpectomy scar location and other clinical data) or on location of surgical clips shown by simulation films. A comparison of these two methods has been conducted on 27 patients. In 13 patients, the clinical set up was good (margin around the clips > 1.5 cm); in four, marginal (margin = 0.5-1.5 cm) and in 10, unacceptable (< 0.5 cm margin). The authors concluded that placement of surgical clips at the margins of the tumor bed and simulation of the electron boost fields is necessary to ensure geographic miss

  14. Implementation of a forearm support to reduce the amount of irradiated lung and heart in radiation therapy of the breast

    International Nuclear Information System (INIS)

    Hurkmans, Coen W.; Borger, Jacques H.; Giersbergen, Aline van; Cho, John; Mijnheer, Ben J.

    2001-01-01

    We compared simulator images of medial tangential fields taken in two positions: (1) with the ipsilateral arm abducted, holding a 'L-bar' armrest and (2) with both arms extended above the head in a forearm support. The average maximum heart distance as well as the central lung distance decreased significantly by 3.4 (SE 0.9) and 4.7 (SE 1.1) mm, respectively, when the new forearm support was used. The estimated normal tissue complication probability for excess cardiac mortality decreased by on average 3.1% (SE 1.3%). For some patients, a greater amount of the axilla was included in the field. We recommend the use of the forearm support during breast cancer treatment with tangential fields to decrease the amount of heart and lung inside the fields

  15. The physics of radiation therapy

    CERN Document Server

    Khan, Faiz M

    2009-01-01

    Dr. Khan's classic textbook on radiation oncology physics is now in its thoroughly revised and updated Fourth Edition. It provides the entire radiation therapy team—radiation oncologists, medical physicists, dosimetrists, and radiation therapists—with a thorough understanding of the physics and practical clinical applications of advanced radiation therapy technologies, including 3D-CRT, stereotactic radiotherapy, HDR, IMRT, IGRT, and proton beam therapy. These technologies are discussed along with the physical concepts underlying treatment planning, treatment delivery, and dosimetry. This Fourth Edition includes brand-new chapters on image-guided radiation therapy (IGRT) and proton beam therapy. Other chapters have been revised to incorporate the most recent developments in the field. This edition also features more than 100 full-color illustrations throughout.

  16. The prospects of application of natural antioxidants in correction of blood coagulation in patients with breast cancer during radiation therapy

    International Nuclear Information System (INIS)

    Syimonova, L.Yi.; Byilogurova, L.V.; Gertman, V.Z.; Pushkar, S.M.; Muzikant, P.M.; Nesterenko, G.Yi.

    2008-01-01

    As an accompanying therapy of the patients with BC Bipolan produced positive effect on coagulation homeostasis. By the end of the course of treatment the indices of homeostasis normalized in the experimental group of the patients; manifestations of DIC syndrome and thromboembolic complications were controlled

  17. Intraoperative radiation therapy in early breast cancer using a linear accelerator outside of the operative suite: an "image-guided" approach.

    Science.gov (United States)

    Hanna, Samir Abdallah; de Barros, Alfredo Carlos Simões Dornellas; de Andrade, Felipe Eduardo Martins; Bevilacqua, Jose Luiz Barbosa; Piato, José Roberto Morales; Pelosi, Edilson Lopes; Martella, Eduardo; da Silva, João Luis Fernandes; Carvalho, Heloisa de Andrade

    2014-08-01

    To present local control, complications, and cosmetic outcomes of intraoperative radiation therapy (IORT) for early breast cancer, as well as technical aspects related to the use of a nondedicated linear accelerator. This prospective trial began in May of 2004. Eligibility criteria were biopsy-proven breast-infiltrating ductal carcinoma, age >40 years, tumor linear accelerator room, and IORT was delivered (21 Gy). Primary endpoint: local recurrence (LR); secondary endpoints: toxicities and aesthetics. Quality assurance involved using a customized shield for chest wall protection, applying procedures to minimize infection caused by patient transportation, and using portal films to check collimator-shield alignment. A total of 152 patients were included, with at least 1 year follow-up. Median age (range) was 58.3 (40-85.4) years, and median follow-up time was 50.7 (12-110.5) months. The likelihood of 5-year local recurrence was 3.7%. There were 3 deaths, 2 of which were cancer related. The Kaplan-Meier 5-year actuarial estimates of overall, disease-free, and local recurrence-free survivals were 97.8%, 92.5%, and 96.3%, respectively. The overall incidences of acute and late toxicities were 12.5% and 29.6%, respectively. Excellent, good, fair, and bad cosmetic results were observed in 76.9%, 15.8%, 4.3%, and 2.8% of patients, respectively. Most treatments were performed with a 5-cm collimator, and in 39.8% of the patients the electron-beam energy used was ≥12 MeV. All patients underwent portal film evaluation, and the shielding was repositioned in 39.9% of cases. No infection or anesthesia complications were observed. Local control with IORT was adequate, with low complication rates and good cosmetic outcomes. More than one-thi