The reverse hockey stick technique: postmastectomy radiation therapy for breast cancer patients with locally advanced tumor presentation or extensive loco-regional recurrence.
Identifieur interne : 005F75 ( PubMed/Corpus ); précédent : 005F74; suivant : 005F76The reverse hockey stick technique: postmastectomy radiation therapy for breast cancer patients with locally advanced tumor presentation or extensive loco-regional recurrence.
Auteurs : R D Pezner ; J A Lipsett ; B. Forell ; N L Vora ; K R Desai ; J Y Wong ; K H LukSource :
- International journal of radiation oncology, biology, physics [ 0360-3016 ] ; 1989.
English descriptors
- KwdEn :
- Adult, Aged, Breast Neoplasms (pathology), Breast Neoplasms (radiotherapy), Combined Modality Therapy, Doxorubicin (adverse effects), Esophagitis (etiology), Female, Humans, Lymphatic Metastasis, Mastectomy, Middle Aged, Neoplasm Recurrence, Local (radiotherapy), Neoplasm Staging, Palliative Care, Radiodermatitis (epidemiology), Radiotherapy (adverse effects), Radiotherapy Dosage, Retrospective Studies.
- MESH :
- chemical , adverse effects : Doxorubicin.
- adverse effects : Radiotherapy.
- epidemiology : Radiodermatitis.
- etiology : Esophagitis.
- pathology : Breast Neoplasms.
- radiotherapy : Breast Neoplasms, Neoplasm Recurrence, Local.
- Adult, Aged, Combined Modality Therapy, Female, Humans, Lymphatic Metastasis, Mastectomy, Middle Aged, Neoplasm Staging, Palliative Care, Radiotherapy Dosage, Retrospective Studies.
Abstract
A combination of photon and electron radiation therapy (RT) fields was devised to treat patients with initial or recurrent breast cancer presentations which extensively involved the chest wall (CW) and/or the axilla. The ipsilateral supraclavicular, infraclavicular, axillary, and lateral CW regions are treated in continuity by anterior and posterior opposed photon beam "reverse hockey stick" fields. The internal mammary and medial chest wall regions are treated by an anterior electron beam field which is tightly junctioned to the photon beam fields. Electron beam energy and thickness of applied bolus are selected so that the electron beam 80% depth isodose curve matches the anterior pleural surface and/or deepest extent of tumor. The goal of treatment is to deliver 4400-5000 cGy to regions at risk of microscopic tumor with local boosts to 6000-7500 cGy to sites of gross disease. Between January 1977, and June 1985, this technique was selectively used in 46 patients, 31 patients with loco-regional tumor recurrence and 15 post-mastectomy patients who initially presented with locally advanced disease. A minimum tumor dose of 4400 cGy was delivered in all except five patients. A diffuse moist skin reaction developed in 31 of the 44 (70%) patients who received at least 3800 cGy. This healed in less than 1 month in all except seven. Frequency of CW diffuse moist skin reaction within the electron beam field was related to the daily applied RT dose. Diffuse moist skin reactions were also noted to be more frequent among patients who had received prior or concurrent Adriamycin. Significant complications included symptomatic arm lymphedema in seven; CW ulcer in two; and acute radiation pneumonitis; steroid-withdrawal radiation pneumonitis, pleuritis, and marked thrombocytopenia in one patient each. With a follow-up of 36-100 months, there was no evidence of loco-regional tumor relapse in 55% of patients treated for recurrent disease and in 73% treated following mastectomy for locally advanced presentations. In summary, we find the reverse hockey stick technique to be a simple, highly reproducible and effective RT approach for postmastectomy breast cancer patients with extensive initial presentation or recurrent disease.
PubMed: 2473051
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The reverse hockey stick technique: postmastectomy radiation therapy for breast cancer patients with locally advanced tumor presentation or extensive loco-regional recurrence.</title><author><name sortKey="Pezner, R D" sort="Pezner, R D" uniqKey="Pezner R" first="R D" last="Pezner">R D Pezner</name><affiliation><nlm:affiliation>Division of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010.</nlm:affiliation></affiliation></author><author><name sortKey="Lipsett, J A" sort="Lipsett, J A" uniqKey="Lipsett J" first="J A" last="Lipsett">J A Lipsett</name></author><author><name sortKey="Forell, B" sort="Forell, B" uniqKey="Forell B" first="B" last="Forell">B. Forell</name></author><author><name sortKey="Vora, N L" sort="Vora, N L" uniqKey="Vora N" first="N L" last="Vora">N L Vora</name></author><author><name sortKey="Desai, K R" sort="Desai, K R" uniqKey="Desai K" first="K R" last="Desai">K R Desai</name></author><author><name sortKey="Wong, J Y" sort="Wong, J Y" uniqKey="Wong J" first="J Y" last="Wong">J Y Wong</name></author><author><name sortKey="Luk, K H" sort="Luk, K H" uniqKey="Luk K" first="K H" last="Luk">K H Luk</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="1989">1989</date><idno type="RBID">pubmed:2473051</idno><idno type="pmid">2473051</idno><idno type="wicri:Area/PubMed/Corpus">005F75</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">005F75</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">The reverse hockey stick technique: postmastectomy radiation therapy for breast cancer patients with locally advanced tumor presentation or extensive loco-regional recurrence.</title><author><name sortKey="Pezner, R D" sort="Pezner, R D" uniqKey="Pezner R" first="R D" last="Pezner">R D Pezner</name><affiliation><nlm:affiliation>Division of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010.</nlm:affiliation></affiliation></author><author><name sortKey="Lipsett, J A" sort="Lipsett, J A" uniqKey="Lipsett J" first="J A" last="Lipsett">J A Lipsett</name></author><author><name sortKey="Forell, B" sort="Forell, B" uniqKey="Forell B" first="B" last="Forell">B. Forell</name></author><author><name sortKey="Vora, N L" sort="Vora, N L" uniqKey="Vora N" first="N L" last="Vora">N L Vora</name></author><author><name sortKey="Desai, K R" sort="Desai, K R" uniqKey="Desai K" first="K R" last="Desai">K R Desai</name></author><author><name sortKey="Wong, J Y" sort="Wong, J Y" uniqKey="Wong J" first="J Y" last="Wong">J Y Wong</name></author><author><name sortKey="Luk, K H" sort="Luk, K H" uniqKey="Luk K" first="K H" last="Luk">K H Luk</name></author></analytic><series><title level="j">International journal of radiation oncology, biology, physics</title><idno type="ISSN">0360-3016</idno><imprint><date when="1989" type="published">1989</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Breast Neoplasms (pathology)</term><term>Breast Neoplasms (radiotherapy)</term><term>Combined Modality Therapy</term><term>Doxorubicin (adverse effects)</term><term>Esophagitis (etiology)</term><term>Female</term><term>Humans</term><term>Lymphatic Metastasis</term><term>Mastectomy</term><term>Middle Aged</term><term>Neoplasm Recurrence, Local (radiotherapy)</term><term>Neoplasm Staging</term><term>Palliative Care</term><term>Radiodermatitis (epidemiology)</term><term>Radiotherapy (adverse effects)</term><term>Radiotherapy Dosage</term><term>Retrospective Studies</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Doxorubicin</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Radiotherapy</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Radiodermatitis</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Esophagitis</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Breast Neoplasms</term><term>Neoplasm Recurrence, Local</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Combined Modality Therapy</term><term>Female</term><term>Humans</term><term>Lymphatic Metastasis</term><term>Mastectomy</term><term>Middle Aged</term><term>Neoplasm Staging</term><term>Palliative Care</term><term>Radiotherapy Dosage</term><term>Retrospective Studies</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A combination of photon and electron radiation therapy (RT) fields was devised to treat patients with initial or recurrent breast cancer presentations which extensively involved the chest wall (CW) and/or the axilla. The ipsilateral supraclavicular, infraclavicular, axillary, and lateral CW regions are treated in continuity by anterior and posterior opposed photon beam "reverse hockey stick" fields. The internal mammary and medial chest wall regions are treated by an anterior electron beam field which is tightly junctioned to the photon beam fields. Electron beam energy and thickness of applied bolus are selected so that the electron beam 80% depth isodose curve matches the anterior pleural surface and/or deepest extent of tumor. The goal of treatment is to deliver 4400-5000 cGy to regions at risk of microscopic tumor with local boosts to 6000-7500 cGy to sites of gross disease. Between January 1977, and June 1985, this technique was selectively used in 46 patients, 31 patients with loco-regional tumor recurrence and 15 post-mastectomy patients who initially presented with locally advanced disease. A minimum tumor dose of 4400 cGy was delivered in all except five patients. A diffuse moist skin reaction developed in 31 of the 44 (70%) patients who received at least 3800 cGy. This healed in less than 1 month in all except seven. Frequency of CW diffuse moist skin reaction within the electron beam field was related to the daily applied RT dose. Diffuse moist skin reactions were also noted to be more frequent among patients who had received prior or concurrent Adriamycin. Significant complications included symptomatic arm lymphedema in seven; CW ulcer in two; and acute radiation pneumonitis; steroid-withdrawal radiation pneumonitis, pleuritis, and marked thrombocytopenia in one patient each. With a follow-up of 36-100 months, there was no evidence of loco-regional tumor relapse in 55% of patients treated for recurrent disease and in 73% treated following mastectomy for locally advanced presentations. In summary, we find the reverse hockey stick technique to be a simple, highly reproducible and effective RT approach for postmastectomy breast cancer patients with extensive initial presentation or recurrent disease.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">2473051</PMID><DateCreated><Year>1989</Year><Month>08</Month><Day>11</Day></DateCreated><DateCompleted><Year>1989</Year><Month>08</Month><Day>11</Day></DateCompleted><DateRevised><Year>2013</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0360-3016</ISSN><JournalIssue CitedMedium="Print"><Volume>17</Volume><Issue>1</Issue><PubDate><Year>1989</Year><Month>Jul</Month></PubDate></JournalIssue><Title>International journal of radiation oncology, biology, physics</Title><ISOAbbreviation>Int. J. Radiat. Oncol. Biol. Phys.</ISOAbbreviation></Journal><ArticleTitle>The reverse hockey stick technique: postmastectomy radiation therapy for breast cancer patients with locally advanced tumor presentation or extensive loco-regional recurrence.</ArticleTitle><Pagination><MedlinePgn>191-7</MedlinePgn></Pagination><Abstract><AbstractText>A combination of photon and electron radiation therapy (RT) fields was devised to treat patients with initial or recurrent breast cancer presentations which extensively involved the chest wall (CW) and/or the axilla. The ipsilateral supraclavicular, infraclavicular, axillary, and lateral CW regions are treated in continuity by anterior and posterior opposed photon beam "reverse hockey stick" fields. The internal mammary and medial chest wall regions are treated by an anterior electron beam field which is tightly junctioned to the photon beam fields. Electron beam energy and thickness of applied bolus are selected so that the electron beam 80% depth isodose curve matches the anterior pleural surface and/or deepest extent of tumor. The goal of treatment is to deliver 4400-5000 cGy to regions at risk of microscopic tumor with local boosts to 6000-7500 cGy to sites of gross disease. Between January 1977, and June 1985, this technique was selectively used in 46 patients, 31 patients with loco-regional tumor recurrence and 15 post-mastectomy patients who initially presented with locally advanced disease. A minimum tumor dose of 4400 cGy was delivered in all except five patients. A diffuse moist skin reaction developed in 31 of the 44 (70%) patients who received at least 3800 cGy. This healed in less than 1 month in all except seven. Frequency of CW diffuse moist skin reaction within the electron beam field was related to the daily applied RT dose. Diffuse moist skin reactions were also noted to be more frequent among patients who had received prior or concurrent Adriamycin. Significant complications included symptomatic arm lymphedema in seven; CW ulcer in two; and acute radiation pneumonitis; steroid-withdrawal radiation pneumonitis, pleuritis, and marked thrombocytopenia in one patient each. With a follow-up of 36-100 months, there was no evidence of loco-regional tumor relapse in 55% of patients treated for recurrent disease and in 73% treated following mastectomy for locally advanced presentations. In summary, we find the reverse hockey stick technique to be a simple, highly reproducible and effective RT approach for postmastectomy breast cancer patients with extensive initial presentation or recurrent disease.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Pezner</LastName><ForeName>R D</ForeName><Initials>RD</Initials><AffiliationInfo><Affiliation>Division of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lipsett</LastName><ForeName>J A</ForeName><Initials>JA</Initials></Author><Author ValidYN="Y"><LastName>Forell</LastName><ForeName>B</ForeName><Initials>B</Initials></Author><Author ValidYN="Y"><LastName>Vora</LastName><ForeName>N L</ForeName><Initials>NL</Initials></Author><Author ValidYN="Y"><LastName>Desai</LastName><ForeName>K R</ForeName><Initials>KR</Initials></Author><Author ValidYN="Y"><LastName>Wong</LastName><ForeName>J Y</ForeName><Initials>JY</Initials></Author><Author ValidYN="Y"><LastName>Luk</LastName><ForeName>K H</ForeName><Initials>KH</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>CA33572</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013487">Research Support, U.S. Gov't, P.H.S.</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Int J Radiat Oncol Biol Phys</MedlineTA><NlmUniqueID>7603616</NlmUniqueID><ISSNLinking>0360-3016</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>80168379AG</RegistryNumber><NameOfSubstance UI="D004317">Doxorubicin</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001943" MajorTopicYN="N">Breast Neoplasms</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000532" MajorTopicYN="Y">radiotherapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003131" MajorTopicYN="N">Combined Modality Therapy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004317" MajorTopicYN="N">Doxorubicin</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004941" MajorTopicYN="N">Esophagitis</DescriptorName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008207" MajorTopicYN="N">Lymphatic Metastasis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008408" MajorTopicYN="Y">Mastectomy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009364" MajorTopicYN="N">Neoplasm Recurrence, Local</DescriptorName><QualifierName UI="Q000532" MajorTopicYN="Y">radiotherapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009367" MajorTopicYN="N">Neoplasm Staging</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010166" MajorTopicYN="N">Palliative Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011855" MajorTopicYN="N">Radiodermatitis</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011878" MajorTopicYN="N">Radiotherapy</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011879" MajorTopicYN="N">Radiotherapy Dosage</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>1989</Year><Month>7</Month><Day>1</Day></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>1989</Year><Month>7</Month><Day>1</Day><Hour>0</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>1989</Year><Month>7</Month><Day>1</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">2473051</ArticleId><ArticleId IdType="pii">0360-3016(89)90388-X</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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