Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
La radiologia medica
Published in: La radiologia medica 7/2020

01-07-2020 | Breast Cancer | RADIOTHERAPY

Present clinical practice of breast cancer radiotherapy in Italy: a nationwide survey by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group

Authors: Fabiana Gregucci, Alessandra Fozza, Sara Falivene, Daniela Smaniotto, Anna Morra, Antonino Daidone, Raffaele Barbara, Antonella Ciabattoni, on behalf of the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group

Published in: La radiologia medica | Issue 7/2020

Login to get access

Abstract

Aims

To investigate the present attitude of the Italian Radiation Oncologists in the management of breast cancer (BC) concerning hypofractionated radiotherapy (hRT), partial-breast irradiation (PBI), re-irradiation (rRT) and radiotherapy after neoadjuvant chemotherapy (post-NAC RT).

Methods

A nationwide, 21-point questionnaire was distributed online via SurveyMonkey.

Results

Seventy-four Italian Radiotherapy Centers answered to the survey. In most cases, the responding centers treated more than 100 BC patients/year between January 2016 and December 2017. Almost half of responding centers (49%) treated patients with hRT, out of these, 95% as routine practice for early-stage BC. Dose prescriptions ranged between 39 and 45 Gy indicating a high use of moderate hRT. The chest wall and regional lymph nodes were irradiated with hRT by 13% and 15% of the responding centers, respectively. PBI was used by 60% of responders, with different techniques. Only 0.6% of participants perform rRT after BC recurrence. Finally, only 11% of the interviewed centers responded to their attitude toward post-NAC RT, which, however, was indicated in 97% of patients after breast-conserving surgery.

Conclusions

This survey shows a fairly good use of hRT and a moderate practice of PBI in Italy. Some practices like hRT to the chest wall and regional lymph nodes as well as rRT need further verification. Likewise, the management of post-NAC RT is very heterogeneous. Future national clinical collaborative studies are advocated in order to investigate these controversial topics about breast cancer radiotherapy.
Literature
1.
Darby S, McGale P, Correa C et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716PubMedCrossRef
2.
McGale P, Taylor C, Correa C et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135PubMedCrossRef
3.
4.
Curigliano G, Burstein HJ, Winer EP et al (2017) De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer. Ann Oncol 28(8):1700–1712PubMedPubMedCentralCrossRef
5.
Valle LF, Agarwal S, Bickel KE et al (2017) Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials. Breast Cancer Res Treat 162(3):409–417PubMedCrossRef
6.
Bloomfield DJ, on behalf of the Core Group facilitated by The Royal College of Radiologists (2017) Development of postoperative radiotherapy for breast cancer: UK consensus statements—a model of patient, clinical and commissioner engagement? Clin Oncol 29(10):639–641CrossRef
7.
Smith BD, Bellon JR, Blitzblau R et al (2018) Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol 8(3):145–152PubMedCrossRef
8.
Sedlmayer F, Sautter-Bihl M-L, Budach W et al (2013) DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 189:825–833PubMedPubMedCentralCrossRef
9.
10.
Marta GN, Hijal T, de Andrade Carvalho H (2017) Reirradiation for locally recurrent breast cancer. Breast 33:159–165PubMedCrossRef
11.
Janssen S, Rades D, Meyer A et al (2018) Local recurrence of breast cancer: conventionally fractionated partial external beam re-irradiation with curative intention. Strahlenther Onkol 194:806–814PubMedCrossRef
12.
Guix B, Lejárcegui JA, Tello JI et al (2010) Exeresis and brachytherapy as salvage treatment for local recurrence after conservative treatment for breast cancer: results of a ten year pilot study. Int J Radiat Oncol Biol Phys 78:804–810PubMedCrossRef
13.
Hannoun-Levi JM, Resch A, Gal J et al (2013) Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO Breast CancerWorking Group. Radiother Oncol 108:226–231PubMedCrossRef
14.
Kauer-Dorner D, Pötter R, Resch A et al (2012) Partial breast irradiation for locally recurrent breast cancer within a second breast conserving treatment: alternative to mastectomy? Results from a prospective trial. Radiother Oncol 102:96–101PubMedCrossRef
15.
Trombetta M, Julian TB, Werts DE et al (2009) Long-term cosmesis after lumpectomy and brachytherapy in the management of carcinoma of the previously irradiated breast. Am J Clin Oncol 32:314–3188PubMedCrossRef
16.
Deutsch M (2002) Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Int J Radiat Oncol Biol Phys 53:687–691PubMedCrossRef
17.
Kraus-Tiefenbacher U, Bauer L, Scheda A et al (2007) Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer 7:178–189PubMedPubMedCentralCrossRef
18.
Blandino G, Guenzi M, Belgioia L et al (2017) Adjuvant intraoperative radiotherapy for selected breast cancers in previously irradiated women: evidence for excellent feasibility and favorable outcomes. Rep Pract Oncol Radiother 22:277–283PubMedPubMedCentralCrossRef
19.
Chin C, Jadeja P, Taback B et al (2017) Evaluation of partial breast reirradiation with intraoperative radiotherapy after prior thoracic radiation: a single-institution report of outcomes and toxicity. Front Oncol 7:175–183PubMedPubMedCentralCrossRef
20.
Mamounas EP (2015) Impact of neoadjuvant chemotherapy on locoregional surgical treatment of breast cancer. Ann Surg Oncol 22:1425–1433PubMedCrossRef
21.
McGuire SE et al (2007) Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys 68:1004–1009PubMedPubMedCentralCrossRef
22.
Bernier J (2015) Post-mastectomy radiotherapy after neodjuvant chemotherapy in breast cancer patients: a review. Crit Rev Oncol/Hematol 93:180–189CrossRef
23.
Nagar H et al (2015) Disease-free survival according to the use of postmastectomy radiation therapy after neoadjuvant chemotherapy. Clin Breast Cancer 15:128–134PubMedCrossRef
24.
Huang EH et al (2004) Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol 22:4691–4699PubMedCrossRef
25.
26.
Jagsi R, Pierce L (2009) Postmastectomy radiation therapy for patients with locally advanced breast cancer. Semin Radiat Oncol 19:236–243PubMedCrossRef
27.
Fowble BL et al (2012) Role of postmastectomy radiation after neoadjuvant chemotherapy in stage II-III breast cancer. Int J Radiat Oncol Biol Phys 83:494–503PubMedCrossRef
28.
Shim SJ et al (2014) The role of postmastectomy radiation therapy after neoadjuvant chemotherapy in clinical stage II-III breast cancer patients with pn0: a multicenter, retrospective study (krog 12–05). Int J Radiat Oncol Biol Phys 88:65–72PubMedCrossRef
29.
Boughey JC, McCall LM, Ballman KV et al (2014) Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg 260:608–614PubMedCrossRef
30.
Truin W, Vugts G, Roumen RM et al (2016) Differences in response and surgical management with neoadjuvant chemotherapy in invasive lobular versus ductal breast cancer. Ann Surg Oncol 23:51–57PubMedCrossRef
31.
Mamounas EP, Anderson SJ, Dignam JJ et al (2012) Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol 30:3960–3966PubMedPubMedCentralCrossRef
32.
33.
Monten C, Lievens Y (2018) Adjuvant breast radiotherapy: how to trade-off cost and effectiveness? Radiother Oncol 126:132–138PubMedCrossRef
34.
Khan AJ, Rafique R, Zafar W et al (2017) Nation-scale adoption of shorter breast radiotherapy schedules can increase survival in resource constrained economies: results from a Markov chain analysis. Int J Radiat Oncol Biol Phys 97(2):287–295PubMedCrossRef
35.
Van Dam PA, Tomatis M, Marotti L et al (2015) The effect of EUSOMA certification on quality of breast cancer care. Eur J Surg Oncol 41(10):1423–1429PubMedCrossRef
36.
Yarnold J (2018) Changes in radiotherapy fractionation-breast cancer. Br J Radiol 19:2017–2028
37.
38.
Cante D, Franco P, Sciacero P et al (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(2):838–847PubMedCrossRef
39.
Guenzi M, Giannelli F, Bosetti D et al (2013) Two different hypofractionated breast radiotherapy schedules for 113 patients with ductal carcinoma in situ: preliminary results. Anticancer Res 33(8):3503–3507PubMed
40.
Guenzi M, Blandino G, Vidili MG et al (2015) Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity. Radiat Oncol 10:177–189PubMedPubMedCentralCrossRef
41.
Orecchia R, Rojas DP, Cattani F et al (2018) Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation. Med Oncol 35(3):39PubMedCrossRef
42.
Haviland JS, Mannino M, Griffin C et al (2018) Late normal tissue effects in the arm and shoulder following lymphatic radiotherapy: results from the UK START (Standardisation of Breast Radiotherapy) trials. Radiother Oncol 126(1):155–162PubMedPubMedCentralCrossRef
43.
Khan AJ, Poppe MM, Goyal S et al (2017) Hypofractionated postmastectomy radiation therapy is safe and effective: first results from a prospective phase II trial. J Clin Oncol 35(18):2037–2043PubMedPubMedCentralCrossRef
44.
Veronesi U et al (2013) Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 14:1269–1277PubMedCrossRef
45.
Vaidya JS et al (2014) Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 383:603–613PubMedCrossRef
46.
Strnad V et al (2016) 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 387:229–238PubMedCrossRef
47.
Coles CE et al (2017) Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet 390:1048–1060PubMedPubMedCentralCrossRef
48.
Panet-Raymond V et al (2011) True recurrence versus new primary: an analysis of ipsilateral breast tumor recurrences after breast-conserving therapy. Int J Radiat Oncol Biol Phys 81:409–417PubMedCrossRef
49.
Doyle T, Schultz DJ, Peters C, Harris E, Solin LJ (2011) Long-term results of local recurrence after breast conservation treatment for invasive breast cancer. Int J Radiat Oncol Biol Phys 51:74–80CrossRef
50.
Mamounas EP, Anderson SJ, Dignam JJ et al (2012) Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. JCO 30:3960–3966CrossRef
51.
Bonnefoi H, Litière S, Piccart M et al (2014) Pathological complete response after neoadjuvant chemotherapy is an independent predictive factor irrespective of simplified breast cancer intrinsic subtypes: a landmark and two-step approach analyses from the EORTC 10994/BIG 1-00 phase III trial. Ann Oncol 25:1128–1136PubMedPubMedCentralCrossRef
52.
Mamounas EP, White JR, Bandos H et al (2014) NSABP B-51/RTOG 1304: randomized phase III clinical trial evaluating the role of postmastectomy chest wall and regional nodal XRT (CWRNRT) and post-lumpectomy RNRT in patients with documented positive axillary (Ax) nodes before neoadjuvant chemotherapy (NC) who convert to pathologically negative Ax nodes after NC. JCO 32(15 supp):tps1141CrossRef
Metadata
Title
Present clinical practice of breast cancer radiotherapy in Italy: a nationwide survey by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group
Authors
Fabiana Gregucci
Alessandra Fozza
Sara Falivene
Daniela Smaniotto
Anna Morra
Antonino Daidone
Raffaele Barbara
Antonella Ciabattoni
on behalf of the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group
Publication date
01-07-2020
Publisher
Springer Milan
Published in
La radiologia medica / Issue 7/2020
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI
https://doi.org/10.1007/s11547-020-01147-5

Other articles of this Issue 7/2020

La radiologia medica 7/2020 Go to the issue

HEAD, NECK AND DENTAL RADIOLOGY

Differentiation between nasopharyngeal carcinoma and lymphoma at the primary site using whole-tumor histogram analysis of apparent diffusion coefficient maps

Short Communication

Radiological management of COVID-19: structure your diagnostic path to guarantee a safe path

ABDOMINAL RADIOLOGY

Efficacy of non-rigid registration technique for misregistration in 3D-CTA fusion imaging

ABDOMINAL RADIOLOGY

Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma

Editorial

Direct MR arthrography of the shoulder: current practice in the UK

CHEST RADIOLOGY

Exploring technical issues in personalized medicine: NSCLC survival prediction by quantitative image analysis—usefulness of density correction of volumetric CT data