- Email: [email protected]
2015
S218
I. J. Radiation Oncology
● Biology ● Physics
Volume 66, Number 3, Supplement, 2006
Conclusions: Early results suggest that PBI, as delivered in this pilot study, concurrent with ddAC appears feasible and safe. Trial enrolment continues and longer follow-up is required. (Funded by The Breast Cancer Research Foundation). Author Disclosure: R. Zellars, None; D. Frassica, None; V. Stearns, None; J. Fetting, None; D. Armstrong, None; L. Myers, None; T. Tsangaris, None; L. Jacobs, None; J. Lange, None; A. Wolff, None.
2015
Breast Cancer in the Elderly: Whole Breast Hypofractionated Radiotherapy
M. Racsa-Alamgir, A. Doshi, M. Alonso-Basanta, C. Magnolfi-Bozzi, B. Rosenstein, S. Formenti NYU Department of Radiation Oncology, NY, NY Background: The optimal management of elderly patients with early stage breast cancer is currently unclear as the conventional six week regimen is often challenging to implement since the common co-morbidities in this population make it difficult to adhere to thirty daily visits for treatment. Alternatives include the use of hypofractionated regimens in which fewer treatments are delivered over a shorter period of time or alternatively, omitting radiation therapy altogether. Limited data has been published regarding the use of hypofractionated regimens for breast cancer. We are reporting the preliminary results of twenty-six patients treated with the hypo-fractionated protocol initially described by Baillet et al (Int J Radiat Oncol Biol Phys. 1990 Nov;19(5):1131–3). Materials/Methods: Beginning July 2000, patients who refused conventional radiation therapy and were not eligible to participate in an in-house protocol for partial breast radiation therapy were offered the whole breast, hypofractionated radiation therapy protocol. The protocol, originally described by Baillet et al, consists of tangential fields to the entire breast to be delivered at 5Gy per fraction on days 1 and 3 and 6.5 Gy per fraction on days 15 and 17, over the course of 17 days, for a total dose of 23 Gy. Data was collected on each patient through an extensive chart review. Primary end points were acute toxicity, local or regional recurrence and late toxicity including cosmetic result. Results: Twenty-six patients were treated on the above protocol, with a median follow-up of 26 months (range 3– 62 months). The median age of patients was 80 years (range 53– 89 years). Patients included in the study were Stage I with the exception of one patient with Stage II breast cancer, according to the AJCC guidelines. Acute toxicity was modest, limited primarily to erythema grade 1 in 23% and grade 2 in 4%. At follow-up, patients reported their evaluation of the cosmetic result rating as fair in 4%, good in 31% and excellent in 54%. There has been no local or regional recurrence to date. Conclusions: Assuming an alpha/beta ratio of 4 Gy for breast cancer, the biologically effective dose for tumor control for the hypofractionated protocol is 57 Gy4 compared to 82 Gy4 for standard treatment (25 fractions x 1.8 Gy per fraction plus a 7 fractions x 2 Gy per fraction boost). While the regimen has a relatively low biologically effective dose for tumor control, with the risk of resulting in an increased rate of recurrence, the protocol is easy to deliver and is associated with minimal toxicity. A longer follow up is required to assess if it may be a reasonable option for the subset of elderly patients, who might not otherwise receive adjuvant radiation therapy. Author Disclosure: M. Racsa-Alamgir, None; A. Doshi, None; M. Alonso-Basanta, None; C. Magnolfi-Bozzi, None; B. Rosenstein, None; S. Formenti, None.
2016
Potential Risks of Radiation-Induced Breast Cancer With Different Accelerated Partial Breast Irradiation Techniques
S. A. Russo, C. S. Wuu, Y. Xu, C. D. Elliston, D. J. Brenner Columbia University Medical Center, Department of Radiation Oncology, New York, NY Purpose/Objective(s): There is increasing current interest in treating early stage breast cancer with accelerated partial breast irradiation (APBI). One of the major rationales of APBI is to minimize the long-term risk of a radiation-induced secondary cancer. The purpose of this study was to determine if different external beam APBI techniques can minimize the potential risk of radiation-induced contralateral and ipsilateral breast cancers. Materials/Methods: An anthropomorphic whole-body phantom, with MOSFET dosimetric detectors for point dose measurements within both breasts was used to validate the radiation dose distribution delivered by 5 different external beam APBI techniques. APBI techniques compared included: 1.) a tangential technique (T) using a 30 degree enhanced dynamic wedged pair; 2.) a dynamic multi-leaf collimator forward planning intensity modulated radiation therapy (IMRT) technique (FDMLC); 3.) a multi-segment static (field in field) forward planning IMRT technique (FF); 4.) a 3-dimensional conformal radiation therapy technique (3D-CRT) using 4 non-coplanar fields as outlined in the RTOG 0413 protocol; and 5.) a dynamic multi-leaf collimator inverse planning IMRT technique (IDMLC) using the same 4 non-coplanar fields as the 3D conformal technique. Results: The Table shows preliminary estimates of the estimated lifetime attributable radiation-induced breast camcer risk due to radiation exposure to the contralateral breast only, at ages 40, 50, 60 and 70 with the 5 different APBI techniques each delivering 10 fractions of 3.85Gy/fraction. 3D-CRT APBI gave the lowest lifetime risk of contralateral breast cancer development. 3D-CRT and IDMLC APBI techniques showed lower doses of radiation to breast tissue outside the ipsilateral breast planning target volume than with the other APBI techniques. Estimated lifetime attributable breast cancer risk due to low dose radiation (non-therapuetic) exposure to the ipsilateral breast tissue will also be reported using measurements in a realistic breast phantom for supine position, based on CT breast images used for RTOG credentialing. Conclusions: Different APBI techniques result in quite different doses to the contralateral breast, and thus quite different risks of radiation- induced contralateral breast cancer. The 3D-CRT technique gives the lowest dose and therefore lowest risk, to the contralateral breast, compared to other APBI techniques described. As expected, estimated lifetime radiation-induced breast cancer risks decreases sharply with increasing age of exposure. (This research was supported by a grant from the Breast Cancer Alliance, Inc.)
I. J. Radiation Oncology
● Biology ● Physics
Volume 66, Number 3, Supplement, 2006
Conclusions: Early results suggest that PBI, as delivered in this pilot study, concurrent with ddAC appears feasible and safe. Trial enrolment continues and longer follow-up is required. (Funded by The Breast Cancer Research Foundation). Author Disclosure: R. Zellars, None; D. Frassica, None; V. Stearns, None; J. Fetting, None; D. Armstrong, None; L. Myers, None; T. Tsangaris, None; L. Jacobs, None; J. Lange, None; A. Wolff, None.
2015
Breast Cancer in the Elderly: Whole Breast Hypofractionated Radiotherapy
M. Racsa-Alamgir, A. Doshi, M. Alonso-Basanta, C. Magnolfi-Bozzi, B. Rosenstein, S. Formenti NYU Department of Radiation Oncology, NY, NY Background: The optimal management of elderly patients with early stage breast cancer is currently unclear as the conventional six week regimen is often challenging to implement since the common co-morbidities in this population make it difficult to adhere to thirty daily visits for treatment. Alternatives include the use of hypofractionated regimens in which fewer treatments are delivered over a shorter period of time or alternatively, omitting radiation therapy altogether. Limited data has been published regarding the use of hypofractionated regimens for breast cancer. We are reporting the preliminary results of twenty-six patients treated with the hypo-fractionated protocol initially described by Baillet et al (Int J Radiat Oncol Biol Phys. 1990 Nov;19(5):1131–3). Materials/Methods: Beginning July 2000, patients who refused conventional radiation therapy and were not eligible to participate in an in-house protocol for partial breast radiation therapy were offered the whole breast, hypofractionated radiation therapy protocol. The protocol, originally described by Baillet et al, consists of tangential fields to the entire breast to be delivered at 5Gy per fraction on days 1 and 3 and 6.5 Gy per fraction on days 15 and 17, over the course of 17 days, for a total dose of 23 Gy. Data was collected on each patient through an extensive chart review. Primary end points were acute toxicity, local or regional recurrence and late toxicity including cosmetic result. Results: Twenty-six patients were treated on the above protocol, with a median follow-up of 26 months (range 3– 62 months). The median age of patients was 80 years (range 53– 89 years). Patients included in the study were Stage I with the exception of one patient with Stage II breast cancer, according to the AJCC guidelines. Acute toxicity was modest, limited primarily to erythema grade 1 in 23% and grade 2 in 4%. At follow-up, patients reported their evaluation of the cosmetic result rating as fair in 4%, good in 31% and excellent in 54%. There has been no local or regional recurrence to date. Conclusions: Assuming an alpha/beta ratio of 4 Gy for breast cancer, the biologically effective dose for tumor control for the hypofractionated protocol is 57 Gy4 compared to 82 Gy4 for standard treatment (25 fractions x 1.8 Gy per fraction plus a 7 fractions x 2 Gy per fraction boost). While the regimen has a relatively low biologically effective dose for tumor control, with the risk of resulting in an increased rate of recurrence, the protocol is easy to deliver and is associated with minimal toxicity. A longer follow up is required to assess if it may be a reasonable option for the subset of elderly patients, who might not otherwise receive adjuvant radiation therapy. Author Disclosure: M. Racsa-Alamgir, None; A. Doshi, None; M. Alonso-Basanta, None; C. Magnolfi-Bozzi, None; B. Rosenstein, None; S. Formenti, None.
2016
Potential Risks of Radiation-Induced Breast Cancer With Different Accelerated Partial Breast Irradiation Techniques
S. A. Russo, C. S. Wuu, Y. Xu, C. D. Elliston, D. J. Brenner Columbia University Medical Center, Department of Radiation Oncology, New York, NY Purpose/Objective(s): There is increasing current interest in treating early stage breast cancer with accelerated partial breast irradiation (APBI). One of the major rationales of APBI is to minimize the long-term risk of a radiation-induced secondary cancer. The purpose of this study was to determine if different external beam APBI techniques can minimize the potential risk of radiation-induced contralateral and ipsilateral breast cancers. Materials/Methods: An anthropomorphic whole-body phantom, with MOSFET dosimetric detectors for point dose measurements within both breasts was used to validate the radiation dose distribution delivered by 5 different external beam APBI techniques. APBI techniques compared included: 1.) a tangential technique (T) using a 30 degree enhanced dynamic wedged pair; 2.) a dynamic multi-leaf collimator forward planning intensity modulated radiation therapy (IMRT) technique (FDMLC); 3.) a multi-segment static (field in field) forward planning IMRT technique (FF); 4.) a 3-dimensional conformal radiation therapy technique (3D-CRT) using 4 non-coplanar fields as outlined in the RTOG 0413 protocol; and 5.) a dynamic multi-leaf collimator inverse planning IMRT technique (IDMLC) using the same 4 non-coplanar fields as the 3D conformal technique. Results: The Table shows preliminary estimates of the estimated lifetime attributable radiation-induced breast camcer risk due to radiation exposure to the contralateral breast only, at ages 40, 50, 60 and 70 with the 5 different APBI techniques each delivering 10 fractions of 3.85Gy/fraction. 3D-CRT APBI gave the lowest lifetime risk of contralateral breast cancer development. 3D-CRT and IDMLC APBI techniques showed lower doses of radiation to breast tissue outside the ipsilateral breast planning target volume than with the other APBI techniques. Estimated lifetime attributable breast cancer risk due to low dose radiation (non-therapuetic) exposure to the ipsilateral breast tissue will also be reported using measurements in a realistic breast phantom for supine position, based on CT breast images used for RTOG credentialing. Conclusions: Different APBI techniques result in quite different doses to the contralateral breast, and thus quite different risks of radiation- induced contralateral breast cancer. The 3D-CRT technique gives the lowest dose and therefore lowest risk, to the contralateral breast, compared to other APBI techniques described. As expected, estimated lifetime radiation-induced breast cancer risks decreases sharply with increasing age of exposure. (This research was supported by a grant from the Breast Cancer Alliance, Inc.)