Top

Published in:

Open Access 01-06-2021 | Radiotherapy | Letter to the Editor

Reply to: The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice

Authors: Prof. Dr. Marc D. Piroth, David Krug, Gerd Fastner, Felix Sedlmayer, Wilfried Budach, Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

Published in: Strahlentherapie und Onkologie | Issue 6/2021

Excerpt

We thank Dr. Loap and Dr. Kirova for their thoughtful comments. In principle, we can support the comments. We agree that with ultra-hypofractionation, such as the regimens tested in the FAST and FAST-Forward trials [1, 2], caution should be exercised with regard to cardiac constraints. The recommended dose constraints [3] cannot simply be adopted for ultra-hypofractionation in the case of breast cancer radiotherapy. The FAST-Forward trial protocol recommended to keep the volume of the heart receiving 7 Gy (Gray) and 1.5 Gy to less than 5% and less than 30%, respectively. So far, only 6‑year data are available for the FAST-Forward trial with regard to cardiac toxicity. This is too early to be able to make reliable recommendations regarding cardiac side effects. …

Brunt AM, Haviland JS, Wheatley DA et al (2020) Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5‑year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 395:1613–1626. https://doi.org/10.1016/S0140-6736(20)30932-6CrossRef

Brunt AM, Haviland JS, Sydenham M et al (2020) Ten-year results of FAST: a randomized controlled trial of 5‑fraction whole-breast radiotherapy for early breast cancer. J Clin Oncol. https://doi.org/10.1200/JCO.19.02750CrossRefPubMed

Piroth MD, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Krug D, Roser A, Sedlmayer F, Souchon R, Wenz F, Sauer R (2019) Heart toxicity from breast cancer radiotherapy: current findings, assessment, and prevention. Strahlenther Onkol 195(1):1–12. https://doi.org/10.1007/s00066-018-1378-zCrossRefPubMed

Appelt AL, Vogelius IR, Bentzen SM (2013) Modern hypofractionation schedules for tangential whole breast irradiation decrease the fraction size-corrected dose to the heart. Clin Oncol 25(3):147–152. https://doi.org/10.1016/j.clon.2012.07.012CrossRef

Loap P, Fourquet A, Kirova Y (2020) The limits of the linear quadratic (LQ) model for late cardiotoxicity prediction: example of hypofractionated rotational intensity modulated radiation therapy (IMRT) for breast cancer. Int J Radiat Oncol Biol Phys 106:1106–1108CrossRef

Haviland JS, Owen JR, Dewar JA et al (2013) The UK standardisation of breast radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094. https://doi.org/10.1016/S1470-2045(13)70386-3CrossRefPubMed

Whelan TJ, Pignol J‑P, Levine MN et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520. https://doi.org/10.1056/NEJMoa0906260CrossRefPubMed

Hickey BE, Lames ML, Lehman M et al (2016) Fraction size in radiation therapy for breast conservation in early breast cancer. Cochrane Database Syst Rev 7(7):CD3860. https://doi.org/10.1002/14651858.CD003860.pub4CrossRefPubMed

Title: Reply to: The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice
Authors: Prof. Dr. Marc D. Piroth
David Krug
Gerd Fastner
Felix Sedlmayer
Wilfried Budach
Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keyword: Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 6/2021
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-021-01775-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reply to: The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice

Excerpt

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 6/2021

Long-term results of robotic radiosurgery for non brachytherapy patients with cervical cancer

Kurzzeitstrahlentherapie mit 5 × 5 Gy gefolgt von präoperativer Chemotherapie und Resektion bei Patienten mit lokal fortgeschrittenen Rektumkarzinomen führt zu einer Verbesserung des krankheitsfreien Überlebens

Lebensqualität der Patientinnen mit DCIS nach brusterhaltender Operation und adjuvanter Strahlentherapie: konventionell fraktioniert vs. hypofraktioniert, mit und ohne Boost

Dosimetric comparison of volumetric modulated arc therapy (VMAT) and high-dose-rate brachytherapy (HDR-BT) for superficial skin irradiation with significant curvature in one or more planes

Prediction of treatment response in patients with locally advanced cervical cancer using midtreatment PET/MRI during concurrent chemoradiotherapy

An easy way to determine bone mineral density and predict pelvic insufficiency fractures in patients treated with radiotherapy for cervical cancer

Kurzzeitstrahlentherapie mit 5 × 5 Gy gefolgt von präoperativer Chemotherapie und Resektion bei Patienten mit lokal fortgeschrittenen Rektumkarzinomen führt zu einer Verbesserung des krankheitsfreien Überlebens