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Journal of Radiation Oncology

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Open Access 01-03-2019 | Breast Cancer | Original Research

Ductal carcinoma in situ (DCIS) breast cancer treated with 3-week accelerated hypofractionated whole-breast radiation therapy and concomitant boost

Authors: Eva Berlin, Susan K. Boolbol, Sarah P. Cate, Carol White, Manjeet Chadha

Published in: Journal of Radiation Oncology | Issue 1/2019

Abstract

Introduction

In patients with ductal carcinoma in situ (DCIS), the clinical outcomes with hypofractionated (HF) whole-breast radiation (WBRT), as well as the role of lumpectomy boost, continue to be evaluated. In this paper, we report our experience on DCIS patients treated with HF WBRT with concomitant boost (CB).

Methods

Early-stage (DCIS, stages I and II) breast cancer patients were treated on an IRB-approved prospective single-arm study with HF WBRT and CB. This study includes only the DCIS subset of patients prescribed a dose of 40.5 Gy × 2.7 Gy per fraction to WB with CB of 4.5 Gy × 0.3G y per fraction over 15 fractions. A total of 107 breasts in 104 patients met the study criteria.

Results

All patients underwent lumpectomy with negative margins. Median age was 59 years. DCIS nuclear grade distribution was 9.3% grade 1, 50.5% grade 2, and 37.4% grade 3. Majority (86%) were ER positive. 41.1% received endocrine therapy. With median follow-up of 74 months (range, 12–158), 5-year actuarial overall survival was 97.2%. At the time of this report, no patient has experienced local relapse. The CTCAE grades 1 and 2 acute skin toxicity was 66.4% and 3.7%, respectively. No patients experienced grade 3 or higher skin toxicity, breast pain, and fatigue.

Conclusion

The HF schedule with CB in DCIS patients is well tolerated and associated with excellent clinical outcomes. This schedule affords the benefit of delivering higher dose to the lumpectomy site without protracting overall treatment time.

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241. https://doi.org/10.1056/NEJMoa022152 CrossRef

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232. https://doi.org/10.1056/NEJMoa020989 CrossRef

Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W, Grimard L, Bowen J, Lukka H, Perera F, Fyles A, Schneider K, Gulavita S, Freeman C (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520. https://doi.org/10.1056/NEJMoa0906260 CrossRefPubMed

Haviland JS, Yarnold JR, Bentzen SM (2010) Hypofractionated radiotherapy for breast cancer. N Engl J Med 362:1843–1844. https://doi.org/10.1056/NEJMc1002798 CrossRefPubMed

Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, Haviland J, Bentzen SM, Yarnold JR (2006) Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol 7:467–471. https://doi.org/10.1016/S1470-2045(06)70699-4 CrossRef

Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM et al (2008) The UK standardisation of breast radiotherapy (START) trial a of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341. https://doi.org/10.1016/s1470-2045(08)70077-9 CrossRefPubMed

Agrawal RK, Aird EGA, Barrett JM, Barrett-Lee PJ, Bentzen SM, Bliss JM et al (2008) The UK standardisation of breast radiotherapy (START) trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371:1098–1107. https://doi.org/10.1016/S0140-6736(08)60348-7 CrossRefPubMed

Guenzi M, Giannelli F, Bosetti D, Blandino G, Milanese ML, Pupillo F, Corvò R, Fozza A (2013) Two different hypofractionated breast radiotherapy schedules for 113 patients with ductal carcinoma in situ: preliminary results. Anticancer Res 33:3503–3507PubMed

Ciervide R, Dhage S, Guth A, Shapiro RL, Axelrod DM, Roses DF, Formenti SC (2012) Five year outcome of 145 patients with ductal carcinoma in situ (DCIS) after accelerated breast radiotherapy. Int J Radiat Oncol Biol Phys 83:e159–e164. https://doi.org/10.1016/j.ijrobp.2011.11.025 CrossRefPubMed

10.

Cante D, Franco P, Sciacero P, Girelli G, Marra AM, Pasquino M, Russo G, Casanova Borca V, Mondini G, Paino O, Numico G, Tofani S, la Porta MR, Ricardi U (2014) Hypofractionation and concomitant boost to deliver adjuvant whole-breast radiation in ductal carcinoma in situ (DCIS): a subgroup analysis of a prospective case series. Med Oncol 31:838. https://doi.org/10.1007/s12032-014-0838-2 CrossRefPubMed

11.

Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, Schinagl D, Oei B, Rodenhuis C, Horiot JC, Struikmans H, van Limbergen E, Kirova Y, Elkhuizen P, Bongartz R, Miralbell R, Morgan D, Dubois JB, Remouchamps V, Mirimanoff RO, Collette S, Collette L, European Organisation for Research and Treatment of Cancer Radiation Oncology and Breast Cancer Groups (2015) Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 16:47–56. https://doi.org/10.1016/S1470-2045(14)71156-8 CrossRefPubMed

12.

Moran MS, Zhao Y, Ma S, Kirova Y, Fourquet A, Chen P, Hoffman K, Hunt K, Wong J, Halasz LM, Freedman G, Prosnitz R Jr, Yassa M, Nguyen DHA, Hijal T, Haffty BG, Wai ES, Truong PT (2017) Association of radiotherapy boost for ductal carcinoma in situ with local control after whole-breast radiotherapy. JAMA Oncol 3:1060–1068. https://doi.org/10.1001/jamaoncol.2016.6948 CrossRefPubMedPubMedCentral

13.

Chadha M, Woode R, Sillanpaa J, Lucido D, Boolbol SK, Kirstein L, Osborne MP, Feldman S, Harrison LB (2013) Early-stage breast cancer treated with 3-week accelerated whole-breast radiation therapy and concomitant boost. Int J Radiat Oncol Biol Phys 86:40–44. https://doi.org/10.1016/j.ijrobp.2012.11.010 CrossRefPubMed

14.

Bekelman JE, Sylwestrzak G, Barron J, Liu J, Epstein AJ, Freedman G, Malin J, Emanuel EJ (2014) Uptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008–2013. JAMA 312:2542–2550. https://doi.org/10.1001/jama.2014.16616 CrossRefPubMedPubMedCentral

15.

Greenup RA, Camp MS, Taghian AG, Buckley J, Coopey SB, Gadd M, Hughes K, Specht M, Smith BL (2012) Cost comparison of radiation treatment options after lumpectomy for breast cancer. Ann Surg Oncol 19:3275–3281. https://doi.org/10.1245/s10434-012-2546-5 CrossRefPubMed

16.

Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, Hahn C, Halberg F, Hoffman K, Horst K, Moran J, Patton C, Perlmutter J, Warren L, Whelan T, Wright JL, Jagsi R (2018) Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol 8:145–152. https://doi.org/10.1016/j.prro.2018.01.012 CrossRef

17.

Stokes WA, Amini A, Jackson MW, Plimpton SR, Kounalakis N, Kabos P, Rabinovitch RA, Rusthoven CG, Fisher CM (2018) Patterns of fractionation and boost usage in adjuvant external beam radiotherapy for ductal carcinoma in situ in the United States. Clin Breast Cancer 18:220–228. https://doi.org/10.1016/j.clbc.2017.06.009 CrossRefPubMed

18.

Jagsi R, Falchook AD, Hendrix LH, Curry H, Chen RC (2014) Adoption of hypofractionated radiation therapy for breast cancer after publication of randomized trials. Int J Radiat Oncol 90:1001–1009. https://doi.org/10.1016/j.ijrobp.2014.09.032 CrossRef

19.

Azria D, Cowen D, Bourgier C, de la Lande B, Gourgou-Bourgade S, Douadi Gaci Z, Leblanc-Onfroy M, Latorzeff I, Pradier O, Maingon P, Lecouillard I, Bontemps P, Ellis S, Levy C, Benyoucef A, Racadot S, Laharie-Mineur H, Lagarde P, Marchal C, Lemanski C (2011) Phase III randomized French multicentric study to evaluate the impact of a localized 16-Gy boost after conservative surgery and a 50-Gy whole-breast irradiation in breast ductal carcinoma in situ (the BONBIS trial). J Clin Oncol 29:TPS131–TPS131. https://doi.org/10.1200/jco.2011.29.15_suppl.tps131 CrossRef

20.

TROG 07.01: Radiation doses and fractionation schedules in non-low risk ductal carcinoma in situ (DCIS) of the breast (DCIS). ClinicalTrialsGov n.d. https://clinicaltrials.gov/ct2/show/NCT00470236. Accessed 29 Dec 2017

Title: Ductal carcinoma in situ (DCIS) breast cancer treated with 3-week accelerated hypofractionated whole-breast radiation therapy and concomitant boost
Authors: Eva Berlin
Susan K. Boolbol
Sarah P. Cate
Carol White
Manjeet Chadha
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Keywords: Breast Cancer
Breast Cancer
Published in: Journal of Radiation Oncology / Issue 1/2019
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-019-00373-3

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