Skip to main content
Top
Published in: Radiation Oncology 1/2017

Open Access 01-12-2017 | Research

Seven fractions to deliver partial breast irradiation: the toxicity is Low

Authors: Marco Trovo, Michele Avanzo, Lorenzo Vinante, Carlo Furlan, Francesco Fiorica, Tiziana Perin, Loredana Militello, Simon Spazzapan, Massimiliano Berretta, Rajesh Jena, Joseph Stancanello, Erica Piccoli, Mario Mileto, Elvia Micheli, Mario Roncadin, Samuele Massarut

Published in: Radiation Oncology | Issue 1/2017

Login to get access

Abstract

Purpose

To assess toxicity and clinical outcome, in breast cancer patients treated with external beam partial breast irradiation (PBI) consisting of 35 Gy in 7 daily fractions (5 Gy/fraction).

Materials and Methods

Patients affected by early-stage breast cancer were enrolled in this phase II trial. Patients had to be 60 years old or over and treated with breast conservative surgery for early stage invasive carcinoma.

Results

Seventy-three patients were analyzed. Median follow-up was 40 months. The proposed schedule was well tolerated. No Grade 3 toxicity was documented. Late toxicity was assessable for all the treated patients. Two patients (2.7%) developed Grade 2 pain 6 months after PBI. Four patients (5%) developed asymptomatic fat necrosis. Grade 2 fibrosis was observed in 5 patients (6.7%). No correlation was found between early and late toxicity and the type of adjuvant systemic therapy (no therapy vs. hormonal therapy vs. chemotherapy). No statistical correlation between dosimetric parameters and toxicity was found. Patients who developed Grade 2 radiation fibrosis had not higher radiation volumes to the untreated normal breast than those without fibrosis. Cosmesis was judged good/excellent in the majority of the cases (93%). One patient relapsed locally, and one developed distant metastases, corresponding to a 5-year local control and distant metastases-free survival of 98% and 96.7%, respectively.

Conclusions

35 Gy in 7 daily fractions is an effective and well-tolerated regimen to deliver PBI.
Literature
1.
go back to reference Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American society for radiation oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.CrossRefPubMed Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American society for radiation oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.CrossRefPubMed
2.
go back to reference Vicini FA, Chen P, Wallace RN, et al. Interim cosmetic results and toxicity using 3D conformal external beam radiotherapy to deliver accelerated partial breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2007;69:1124–30.CrossRefPubMed Vicini FA, Chen P, Wallace RN, et al. Interim cosmetic results and toxicity using 3D conformal external beam radiotherapy to deliver accelerated partial breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2007;69:1124–30.CrossRefPubMed
3.
go back to reference Vicini F, Winter K, Wong J, et al. Initial efficacy results of RTOG 0319: three-dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/II breast carcinoma. Int J Radiat Oncol Biol Phys. 2010;77:1120–27.CrossRefPubMed Vicini F, Winter K, Wong J, et al. Initial efficacy results of RTOG 0319: three-dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/II breast carcinoma. Int J Radiat Oncol Biol Phys. 2010;77:1120–27.CrossRefPubMed
4.
go back to reference Jagsi R, Ben-David MA, Moran JM, et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:71–8.CrossRefPubMedPubMedCentral Jagsi R, Ben-David MA, Moran JM, et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:71–8.CrossRefPubMedPubMedCentral
5.
go back to reference Hepel JT, Tokita M, MacAusland SG, et al. Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2009;75:1290–96.CrossRefPubMed Hepel JT, Tokita M, MacAusland SG, et al. Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2009;75:1290–96.CrossRefPubMed
6.
go back to reference Trovo M, Roncadin M, Polesel J, et al. Toxicity and cosmesis following partial breast irradiation consisting of 40 Gy in 10 daily fractions. Breast. 2013;22:744–47.CrossRefPubMed Trovo M, Roncadin M, Polesel J, et al. Toxicity and cosmesis following partial breast irradiation consisting of 40 Gy in 10 daily fractions. Breast. 2013;22:744–47.CrossRefPubMed
7.
go back to reference Avanzo M, Stancanello J, Trovo M, et al. Complication probability model for subcutaneous fibrosis based on published data of partial and whole breast irradiation. Phys Med. 2012;28:296–306.CrossRefPubMed Avanzo M, Stancanello J, Trovo M, et al. Complication probability model for subcutaneous fibrosis based on published data of partial and whole breast irradiation. Phys Med. 2012;28:296–306.CrossRefPubMed
8.
go back to reference Avanzo M, Trovo M, Stancanello J, et al. Hypofractionation of partial breast irradiation using radiobiological models. Phys Med. 2015;31:1022–28.CrossRefPubMed Avanzo M, Trovo M, Stancanello J, et al. Hypofractionation of partial breast irradiation using radiobiological models. Phys Med. 2015;31:1022–28.CrossRefPubMed
9.
go back to reference Trovo M, Polesel J, Biasutti C, et al. Fiducial markers for image-guided partial breast irradiation. Radiol Med. 2013;118:1212–19.CrossRefPubMed Trovo M, Polesel J, Biasutti C, et al. Fiducial markers for image-guided partial breast irradiation. Radiol Med. 2013;118:1212–19.CrossRefPubMed
10.
go back to reference Trovo M, Sartor G, Chiovati P, et al. Forward intensity modulated radiation therapy for partial breast irradiation confers high dose homogeneity and conformation to the target volume. Int J Radiat Oncol Biol Phys. 2010;78:S747.CrossRef Trovo M, Sartor G, Chiovati P, et al. Forward intensity modulated radiation therapy for partial breast irradiation confers high dose homogeneity and conformation to the target volume. Int J Radiat Oncol Biol Phys. 2010;78:S747.CrossRef
11.
go back to reference Hoops DJ, Kaziska D, Chapin P, et al. Patient preferences and physician practice patterns regarding breast radiotherapy. Int J Radiat Oncol Biol Phys. 2012;82:674–81.CrossRef Hoops DJ, Kaziska D, Chapin P, et al. Patient preferences and physician practice patterns regarding breast radiotherapy. Int J Radiat Oncol Biol Phys. 2012;82:674–81.CrossRef
12.
go back to reference Barendsen GW. Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Biol Phys. 1982;8:1981–87.CrossRefPubMed Barendsen GW. Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Biol Phys. 1982;8:1981–87.CrossRefPubMed
13.
go back to reference Steel G, Deacon J, Duchesne GM, et al. The dose-rate effect in human tumour cells. Radiother Oncol. 1987;9:299–310.CrossRefPubMed Steel G, Deacon J, Duchesne GM, et al. The dose-rate effect in human tumour cells. Radiother Oncol. 1987;9:299–310.CrossRefPubMed
14.
go back to reference Formenti SC, Truong MT, Godberg JD, et al. Prone accelerated partial breast irradiation after breast-conserving surgery: preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys. 2004;60:493–504.CrossRefPubMed Formenti SC, Truong MT, Godberg JD, et al. Prone accelerated partial breast irradiation after breast-conserving surgery: preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys. 2004;60:493–504.CrossRefPubMed
15.
go back to reference Livi L, Meattini I, Marrazzo L, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51:451–63.CrossRefPubMed Livi L, Meattini I, Marrazzo L, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51:451–63.CrossRefPubMed
Metadata
Title
Seven fractions to deliver partial breast irradiation: the toxicity is Low
Authors
Marco Trovo
Michele Avanzo
Lorenzo Vinante
Carlo Furlan
Francesco Fiorica
Tiziana Perin
Loredana Militello
Simon Spazzapan
Massimiliano Berretta
Rajesh Jena
Joseph Stancanello
Erica Piccoli
Mario Mileto
Elvia Micheli
Mario Roncadin
Samuele Massarut
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2017
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-017-0825-9

Other articles of this Issue 1/2017

Radiation Oncology 1/2017 Go to the issue