FIVE-YEAR RESULTS OF ADJUVANT RADIOTHER
Identifieur interne : 002A96 ( Main/Exploration ); précédent : 002A95; suivant : 002A97FIVE-YEAR RESULTS OF ADJUVANT RADIOTHER
Auteurs : Etin-Osa O. Osa ; Keith Dewyngaert ; Daniel Roses ; James Speyer ; Amber Guth ; Deborah Axelrod ; Maria Fenton Kerimian ; Judith D. Goldberg ; Silvia C. FormentiSource :
- International journal of radiation oncology, biology, physics [ 0360-3016 ] ; 2014.
Abstract
A technique of prone breast radiotherapy delivered by a regimen of accelerated intensity modulated radiation therapy (IMRT) with a concurrent boost to the tumor bed, was developed at our institution. We report the five year results of this approach.
Between 2003–2006, 404 patients with Stage I–II breast cancer were prospectively enrolled into two consecutive protocols, institutional trials 03–30 and 05–181, that used the same regimen of 40.5Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5Gy (total dose=48Gy). All patients were treated after segmental mastectomy, had negative margins, and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine set-up attempted, and chosen if found to better spare these organs.
92% of patients were treated prone, 8% supine. 72% had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 –228.27cc, mean: 19.65cc. In-field heart volume for left breast cancer patients ranged from 0–21.24cc, mean: 1.59cc. There was no heart in the field for right breast cancer patients. At a median follow-up of five years, the five-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% CI: 0.65–1.04). The five-year cumulative incidence of regional recurrence was 0.53% (95% CI:0.41–0.69) and the five-year overall cumulative death rate was 1.28% (95% CI: 0.48–3.38). 82% (95% CI: 77–85) of patients judged their final cosmetic result as excellent/good.
Prone accelerated IMRT with a concomitant boost results in excellent local control, optimal sparing of heart and lung, with good cosmesis. RTOG 10–05, a phase III, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and fractionation approach to standard six weeks radiotherapy with a sequential boost.
Url:
DOI: 10.1016/j.ijrobp.2014.03.036
PubMed: 24867535
PubMed Central: 4684090
Affiliations:
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Le document en format XML
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<author><name sortKey="Dewyngaert, Keith" sort="Dewyngaert, Keith" uniqKey="Dewyngaert K" first="Keith" last="Dewyngaert">Keith Dewyngaert</name>
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<author><name sortKey="Roses, Daniel" sort="Roses, Daniel" uniqKey="Roses D" first="Daniel" last="Roses">Daniel Roses</name>
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<author><name sortKey="Speyer, James" sort="Speyer, James" uniqKey="Speyer J" first="James" last="Speyer">James Speyer</name>
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<author><name sortKey="Guth, Amber" sort="Guth, Amber" uniqKey="Guth A" first="Amber" last="Guth">Amber Guth</name>
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<author><name sortKey="Axelrod, Deborah" sort="Axelrod, Deborah" uniqKey="Axelrod D" first="Deborah" last="Axelrod">Deborah Axelrod</name>
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<author><name sortKey="Kerimian, Maria Fenton" sort="Kerimian, Maria Fenton" uniqKey="Kerimian M" first="Maria Fenton" last="Kerimian">Maria Fenton Kerimian</name>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Purpose/Objective</title>
<p id="P1">A technique of prone breast radiotherapy delivered by a regimen of accelerated intensity modulated radiation therapy (IMRT) with a concurrent boost to the tumor bed, was developed at our institution. We report the five year results of this approach.</p>
</sec>
<sec id="S2"><title>Methods and Materials</title>
<p id="P2">Between 2003–2006, 404 patients with Stage I–II breast cancer were prospectively enrolled into two consecutive protocols, institutional trials 03–30 and 05–181, that used the same regimen of 40.5Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5Gy (total dose=48Gy). All patients were treated after segmental mastectomy, had negative margins, and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine set-up attempted, and chosen if found to better spare these organs.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">92% of patients were treated prone, 8% supine. 72% had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 –228.27cc, mean: 19.65cc. In-field heart volume for left breast cancer patients ranged from 0–21.24cc, mean: 1.59cc. There was no heart in the field for right breast cancer patients. At a median follow-up of five years, the five-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% CI: 0.65–1.04). The five-year cumulative incidence of regional recurrence was 0.53% (95% CI:0.41–0.69) and the five-year overall cumulative death rate was 1.28% (95% CI: 0.48–3.38). 82% (95% CI: 77–85) of patients judged their final cosmetic result as excellent/good.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Prone accelerated IMRT with a concomitant boost results in excellent local control, optimal sparing of heart and lung, with good cosmesis. RTOG 10–05, a phase III, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and fractionation approach to standard six weeks radiotherapy with a sequential boost.</p>
</sec>
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<name sortKey="Formenti, Silvia C" sort="Formenti, Silvia C" uniqKey="Formenti S" first="Silvia C." last="Formenti">Silvia C. Formenti</name>
<name sortKey="Goldberg, Judith D" sort="Goldberg, Judith D" uniqKey="Goldberg J" first="Judith D." last="Goldberg">Judith D. Goldberg</name>
<name sortKey="Guth, Amber" sort="Guth, Amber" uniqKey="Guth A" first="Amber" last="Guth">Amber Guth</name>
<name sortKey="Kerimian, Maria Fenton" sort="Kerimian, Maria Fenton" uniqKey="Kerimian M" first="Maria Fenton" last="Kerimian">Maria Fenton Kerimian</name>
<name sortKey="Osa, Etin Osa O" sort="Osa, Etin Osa O" uniqKey="Osa E" first="Etin-Osa O." last="Osa">Etin-Osa O. Osa</name>
<name sortKey="Roses, Daniel" sort="Roses, Daniel" uniqKey="Roses D" first="Daniel" last="Roses">Daniel Roses</name>
<name sortKey="Speyer, James" sort="Speyer, James" uniqKey="Speyer J" first="James" last="Speyer">James Speyer</name>
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