Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy
ABSTRACT Breast irradiation after lumpectomy is an integral component of breast-conserving therapy (BCT). As the prognosis is general good following BCT, late morbidity and cosmesis are important. The present study compares two different radiation schedules with respect to these two endpoints.
129 breast cancer patients (pT1-2 pN0-1 cM0) were irradiated between 09/1992 and 08/1994 with either a 22-day fractionation schedule (2.5 Gy to 55 Gy, 4x/week, n = 65) or with a conventional fractionation schedule (28 days, 2.0 Gy to 55 Gy, 5x/week, n = 64), both without additional boost. The equivalent dose of 2-Gy fractions (EQD2) was 55 Gy and 62 Gy, respectively. Late toxicity, assessed according to the LENT-SOMA criteria, and cosmetic outcome, graded on a 5-point scale, were evaluated after a median of 86 months (range 72-94 months) in tumor-free breast cancer patients.
LENT-SOMA grade 2/3 toxicity (2.5 Gy vs. 2.0 Gy): breast pain (18% vs. 11%; p = 0.3), fibrosis (57% vs. 16%; p < 0.001), telangiectasia (22% vs. 3%; p = 0.002), atrophy (31% vs. 3%; p < 0.001). Medication to breast pain was taken by 8% versus 9% of patients. Cosmesis was very good/good/acceptable in 75% versus 93% (2.5 Gy vs. 2.0 Gy; p = 0.006).
Late morbidity was significantly frequent and cosmesis was significantly worse after hypofractionated radiotherapy (2.5 Gy to 55 Gy). However, morbidity was not associated with major implications on daily life.
- SourceAvailable from: Angel Montero
[Show abstract] [Hide abstract]
- "Hypofractionated regimens without a compensatory decrease in total dose may lead to increased rates of arm oedema. One retrospective comparison reported a 15% incidence after hypofractionated treatment to 55e60 Gy compared with 6% after conventional fractionation to the same total dose . Similarly, rates of significant lymphoedema were low (approximately 6e8%) and were not increased with hypofractionated radiotherapy in the study of the RMH/GOC (axillary surgery performed in 59% of patients) or the Hôpital Necker trials (rate of axillary surgery not reported)  . "
ABSTRACT: The demand for breast cancer care has increased as cancer treatment innovations have proliferated. Adjuvant radiotherapy to the breast is considered to be part of the standard treatment in breast cancer. The role of radiotherapy in terms of reducing loco-regional recurrence and increased survival after conservative surgery, and also after a mastectomy in selected cases, has been previously shown in several randomized trials. Patterns of radiotherapy commonly used for breast cancer comprise a period of approximately five weeks, frequently with the addition of an additional 1–1.5 weeks of a radiation boost to the primary tumour area. In last years, there has been a renewed interest in hypofractionated and accelerated radiotherapy schedules that reduce the overall treatment time to barely three weeks, leading to an improvement in quality of life for patients and also optimizing workload of radiation oncology departments. However, despite the existing evidence supporting the use of hypofractionated treatment regimens, their widespread is still far from complete. Many questions have generated resistance among clinical oncologists for their regular use. The aim of this review is to answer those questions that may arise with the use of moderate hypofractionation in breast cancer.Breast (Edinburgh, Scotland) 08/2014; 23(4). DOI:10.1016/j.breast.2014.01.011 · 2.58 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Hintergrund:Tamoxifen (TAM) ist in der adjuvanten Therapie des Mammakarzinoms ebenso etabliert wie die Strahlentherapie; der optimale Zeitpunkt für den Beginn der Therapie mit TAM – simultan zur oder sequentiell nach Strahlentherapie – wird kontrovers diskutiert. Methodik:In dieser Arbeit wird ein Literaturüberblick gegeben. Ergebnisse:In-vitro-Daten unterstützen die Vermutung einer antagonistischen Wirkung von TAM auf den Tumor; im Tierexperiment zeigte sich eine synergistische Wirkung. Berücksichtigt man zusätzlich die Modulation der Wirkung von TAM beispielsweise durch Östrogene oder andere Wachstumsfaktorrezeptoren, erscheint die kombinierte Wirkung von TAM und Bestrahlung zu komplex, um in einem zweidimensionalen, zellulären In-vitro-System untersucht werden zu können. Aus klinischer Sicht gibt es zurzeit keinen ausreichenden Anhalt für eine reduzierte Strahlenwirkung am Tumor durch die simultane im Gegensatz zur sequentiellen Gabe von TAM. Um eine Radioprotektion sicher auszuschließen, sollten jedoch prospektive, randomisierte klinische Studien mit dieser Fragestellung durchgeführt werden. Schlussfolgerung:Die aktuelle Literatur zu Interaktionen von Strahlentherapie und TAM ist widersprüchlich, aber klinisch und damit für die Therapieentscheidung wohl nur von untergeordneter Bedeutung. Background:Tamoxifen (TAM) is well established in the adjuvant therapy of breast cancer. However, the timing of TAM therapy, concurrent or after radiotherapy, is controversial. Method:Literature is reviewed with respect to experimental and clinical data on interaction of TAM and radiation on tumor control and radiation side effects. Results:In vitro data support the concept of antagonistic effects of concurrent TAM and radiation on tumor cells, but in animal models a synergistic effect was seen. Considering the modulation of TAM effects by estrogen and growth factor receptors, two-dimensional systems may not be suitable for studying the interaction of TAM and radiation. From a clinical perspective, a tumor-protective effect of TAM therapy concurrent with radiation was not evident. However, prospective studies addressing this question adequately are not available at the time. Conclusion:Although some studies indicate an enhancement of lung and subcutaneous fibrosis after TAM therapy, the side effects are mild and at this point do not seem to warrant withholding TAM.Strahlentherapie und Onkologie 183(10):535-544. DOI:10.1007/s00066-007-1710-5 · 2.73 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: SFTF (stable fast transversal filters), an exact least squares adaptation algorithm with complexity of order 8 times the number of filter coefficients, has been applied to the solution of blind equalization cost functions with dramatic improvements in convergence speed compared to stochastic gradient (lms style) adaptation. This method requires only four times more computation than stochastic gradient methods and has the advantage of being eigenvalue spread independent. The SFTF exact least squares adaptation removes the eigenvalue spread of the channel problem and leaves us now with the speed of convergence depending only on the type of signal used and the initial ISI caused by the channel. Gray's optimum cost function for the generalized Gaussian pdf is discussed and used in the simulations. In summary, an optimal blind cost function is combined with an optimal filter adaptation method. The topic of entropy is discussed and it's relation to kurtosis and speed of convergence propertiesSignals, Systems and Computers, 1994. 1994 Conference Record of the Twenty-Eighth Asilomar Conference on; 01/1994