Go To Main TNBC Website


  New Posts New Posts RSS Feed - Partial vs Whole Breast Irradiation
  FAQ FAQ  Forum Search   Events   Register Register  Login Login

Partial vs Whole Breast Irradiation

 Post Reply Post Reply
Author
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Topic: Partial vs Whole Breast Irradiation
    Posted: Nov 29 2012 at 6:58pm
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Nov 29 2012 at 7:00pm

Worse Cosmesis, Toxicity with Partial- vs. Whole-Breast Irradiation

By: NEIL OSTERWEIL, Skin & Allergy News Digital Network

BOSTON – Cosmetic results were significantly worse after 3 years for women who had accelerated partial-breast irradiation than for women treated with whole-breast irradiation in a randomized clinical trial, investigators found.

Nearly a third (32%) of women who underwent accelerated partial breast irradiation (APBI) with a 3-D conformal technique had cosmetic results rated as fair or poor by a nurse, compared with 19% of women who had undergone whole-breast irradiation (WBI), Dr. Timothy J. Whelan reported at the annual meeting of the American Society for Radiation Oncology.

APBI was also associated with more grade 1 and 2 toxicities than WBI, but there were few grade 3 toxicities with either technique and no grade 4 toxicities, said Dr. Whelan, a radiation oncologist at the Juravinski Cancer Centre in Hamilton, Ont.

"This increase in toxicity may have resulted from limited conformality of the 3-D conformal approach, the short time between the fractions – radiation with APBI was given twice a day with 6 hours between the fractions, which may not have been adequate – and maybe due to the asymmetric nature of partial breast irradiation itself, given that it’s only given to part of the breast," he said at a press briefing.

Trading Convenience for Toxicity?

APBI – in which a large dose per fraction of external beam radiation is given only to the surgical cavity with an additional safety margin – allows radiation therapy to be delivered in 1 week or less, making it an attractive alternative to multifraction therapy that can stretch over many weeks.

But it is still not clear whether APBI trades poorer outcomes for convenience, Dr. Whelan said. He and colleagues in Canada, Australia, and New Zealand conducted the RAPID trial (Randomized Trial of Accelerated Partial-Breast Irradiation Using 3-D Conformal External Beam Radiation Therapy) to find out. The study compared the efficacy and safety of the two modalities in women over 40 years of age with invasive or noninvasive breast cancers smaller than 3 cm.

Investigators enrolled 2,135 patients and randomized them to receive either WBI (1,065 patients) at 50 Gy in 25 fractions or 42.5 Gy in 16 fractions given once daily with or without boost irradiation or 3-D conformal APBI at 38.5 Gy in 10 fractions twice daily (1,070 patients). Cosmetic results were rated by a trained nurse on a global assessment using the European Organisation for Research and Treatment of Cancer (EORTC) Cosmetic Rating System for Breast Cancer, and for toxicity using the National Cancer Institute Common Terminology Criteria for Adverse Events 3.0. Radiologists blinded to treatment type also rated results on digital photographs.

Immediately after radiation, cosmetic results were similar between the groups, with nurse-assessed appearance rated as fair or poor in 17% of women who had WBI, and 19% who had APBI (= .35). However, an interim toxicity analysis among 850 evaluable patients, showed that at 3 years (2.3 years median follow-up) 13% more of the patients who had undergone APBI had fair or poor cosmesis.

The Jury Is Out

Dr. Whelan noted that the between-group differences were about the same at 5 years, but did not provide data.

"The evidence for partial-breast irradiation is still not very clear. We don’t have very robust evidence about its efficacy, and we just now have recent evidence about its potential toxicities, he said.

Dr. Bruce Haffty, chair of radiation oncology at the Cancer Institute of New Jersey in New Brunswick, commented that "the results from the RAPID trial shed further light on the use of accelerated partial-breast irradiation, and emphasize the need to further investigate these fractionation schemes and sort out whether in fact the toxicity from partial-breast irradiation may be slightly worse than with whole-breast irradiation."

Dr. Haffty moderated a briefing where the data were presented, but was not involved in the RAPID trial.

The RAPID trial is supported by the Canadian Institutes of Health Research and Canadian Breast Cancer Research Alliance. Dr. Whelan has received honoraria from AstraZeneca and Novartis. Dr. Haffty reported no relevant disclosures.

http://www.skinandallergynews.com/ttnewslist/ttnewssingleview/worse-cosmesis-toxicity-with-partial-vs-whole-breast-irradiation/f29b57c5f9fe0b62fefde73fab4809b9.html

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Apr 18 2013 at 2:36pm
Note that the treatment guidelines for APBI were for women with Estrogen Positive BC, not TNBC.

Accelerated Partial-Breast Irradiation: The Current State of Our Knowledge

By Simona F. Shaitelman, MD, EdM1, Leonard H. Kim, MS, AMusD2 | April 15, 2013
1Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, 2Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey: Robert Wood Johnson Medical School & Cancer Institute of New Jersey, New Brunswick, New Jersey
http://www.cancernetwork.com/breast-cancer/content/article/10165/2137303?

Quoted Excerpts from the above link:

Guidelines for Treatment

Beginning in 2007, four separate oncologic societies have published guidelines to assist physicians in selecting patients for APBI offered off protocol (Table 1). ASTRO organized a task force that published the most detailed set of guidelines regarding suitability to receive APBI off protocol. This group recommended that women be classified as “suitable” for APBI treatment if they are age 60 or older and have invasive ductal carcinoma (or other favorable histology) ≤ 2 cm; estrogen receptor–positive; unicentric and unifocal; lymph node–negative; with negative margins (≥ 2 mm); and with no extensive intraductal component (EIC), lymphovascular space invasion (LVSI), or neoadjuvant therapy.[53] The Groupe Européen de Curiethérapie and European Society for Therapeutic Radiology and Oncology (GEC-ESTRO), the American Society of Breast Surgeons, and the American Brachytherapy Society have all published their own sets of guidelines.[54-56] These four sets of guidelines were based on older published studies and the inclusion criteria used therein, coupled with the judgment of experienced breast radiation oncologists.


APBI: The Future

At least four randomized trials comparing WBI and APBI have been presented thus far, in at least partial form (Table 2); the results regarding toxicity and efficacy have been mixed. In the future, we anticipate the publication of results from at least eight randomized controlled trials comparing WBI and APBI (Table 3). These trials are being conducted in North America and Europe and in total will include over 16,000 women. The largest of these, the NSABP B-39/RTOG 0413 trial, is being conducted in the United States, with trial closure anticipated shortly.[59] This trial will include 4,300 women with early-stage breast cancer randomly assigned to receive either WBI (with or without a tumor bed boost) or APBI. In this study, APBI can be delivered via MIB, single-entry brachytherapy catheter, or 3-dimensional conformal external beam radiation. While the trials now open vary in terms of patient inclusion criteria and how APBI is delivered, we expect that they will provide definitive information on the equivalency of APBI to WBI. However, given the differences in the mode of APBI delivery in these studies, the findings of one may not be applicable to the technique used in another, in terms of either tumor control or toxicity.

Meanwhile, investigators are attempting to answer such questions as whether MRI can be used to better define patients who can be treated with APBI, whether brachytherapy-based APBI can be delivered with fewer total fractions, whether APBI can be delivered preoperatively, and whether pathologic and surgical margin findings can be used for patient-specific target definition in APBI.[60-66]

Conclusion

Given its greater convenience and perceived better associated quality of life, APBI is becoming an increasingly popular alternative to conventional WBI among women with early-stage breast cancer who desire breast conservation. Published data on APBI are limited largely to findings from prospectively collected phase II trials, which have shown high rates of local control in appropriately selected patients. Several sets of guidelines have been published outlining which patients should be considered reasonable candidates for treatment with APBI. We anticipate in the near future the publication of results from a number of randomized controlled trials including over 16,000 women, which should better characterize the efficacy and safety of APBI in comparison to WBI.


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
MarCat View Drop Down
Newbie
Newbie
Avatar

Joined: Aug 09 2013
Location: Org Co - Calif
Status: Offline
Points: 20
Post Options Post Options   Thanks (0) Thanks(0)   Quote MarCat Quote  Post ReplyReply Direct Link To This Post Posted: Aug 10 2013 at 6:02pm
Hi Donna - I was wondering which I would do.  My RO suggested partial would be good for me, but that was before I told him I am TNBC.  So, I am not sure he would change his mind.  I have just started AC-T regimen so have a little time before deciding.  But, I also felt that with whole breast I would not be cutting any corners, so was leaning towards that.   After all this I would be afraid about not treating the whole breast and just partial.    
1.8 cm, IDC TNBC DX 6/13 age 57, Left Breast, Stage 1, Grade 2 (6/9), KI-67 low, BRCA -, 0 Lymph Nodes (MRI), Neoadj DD AC 4 cycles started 6/29/13, then DD Taxol 4 cycles
Back to Top
MarCat View Drop Down
Newbie
Newbie
Avatar

Joined: Aug 09 2013
Location: Org Co - Calif
Status: Offline
Points: 20
Post Options Post Options   Thanks (0) Thanks(0)   Quote MarCat Quote  Post ReplyReply Direct Link To This Post Posted: Aug 11 2013 at 1:17pm
Has anyone done IORT  or know if it is better than partial or whole breast radiation ??
1.8 cm, IDC TNBC DX 6/13 age 57, Left Breast, Stage 1, Grade 2 (6/9), KI-67 low, BRCA -, 0 Lymph Nodes (MRI), Neoadj DD AC 4 cycles started 6/29/13, then DD Taxol 4 cycles
Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 11 2013 at 1:20pm
What is IORT?  I had IMRT radiation.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
MarCat View Drop Down
Newbie
Newbie
Avatar

Joined: Aug 09 2013
Location: Org Co - Calif
Status: Offline
Points: 20
Post Options Post Options   Thanks (0) Thanks(0)   Quote MarCat Quote  Post ReplyReply Direct Link To This Post Posted: Aug 11 2013 at 1:23pm
IORT is when they give you high dose of radiation at the site of your tumor right after they remove the tumor (during surgery). 
1.8 cm, IDC TNBC DX 6/13 age 57, Left Breast, Stage 1, Grade 2 (6/9), KI-67 low, BRCA -, 0 Lymph Nodes (MRI), Neoadj DD AC 4 cycles started 6/29/13, then DD Taxol 4 cycles
Back to Top
MarCat View Drop Down
Newbie
Newbie
Avatar

Joined: Aug 09 2013
Location: Org Co - Calif
Status: Offline
Points: 20
Post Options Post Options   Thanks (0) Thanks(0)   Quote MarCat Quote  Post ReplyReply Direct Link To This Post Posted: Aug 11 2013 at 1:28pm
Is IMRT considered partial or whole radiation?  Or is it considered another type radiation treatment?
1.8 cm, IDC TNBC DX 6/13 age 57, Left Breast, Stage 1, Grade 2 (6/9), KI-67 low, BRCA -, 0 Lymph Nodes (MRI), Neoadj DD AC 4 cycles started 6/29/13, then DD Taxol 4 cycles
Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 11 2013 at 4:25pm
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
MarCat View Drop Down
Newbie
Newbie
Avatar

Joined: Aug 09 2013
Location: Org Co - Calif
Status: Offline
Points: 20
Post Options Post Options   Thanks (0) Thanks(0)   Quote MarCat Quote  Post ReplyReply Direct Link To This Post Posted: Aug 13 2013 at 9:37pm
Donna - Is the IMRT a trial type radiation or is something already approved?  Many have not heard of it hear in Calif.  My doctor does it but says not usually for breast cancer.  Plus, they say is not approved by many insurances cause is expensive procedure when the other methods work.
1.8 cm, IDC TNBC DX 6/13 age 57, Left Breast, Stage 1, Grade 2 (6/9), KI-67 low, BRCA -, 0 Lymph Nodes (MRI), Neoadj DD AC 4 cycles started 6/29/13, then DD Taxol 4 cycles
Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 13 2013 at 11:03pm
MarCat,

IMRT has been around for a while, but maybe only in the larger cancer centers?  I had radiation in 2011 and in my city, there were 3 IMRT machines at the time.  Siteman Cancer Center/Washington Univ had 2 of those machines.  http://www.siteman.wustl.edu/ContentPage.aspx?id=1098

It was recommended for me since I already had breast reconstruction and it was difficult to get the correct angles of the IM node through the implants.  I had no problem with my insurance company covering it.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Sep 10 2013 at 12:15pm
APBI Outcomes Similar to Whole-Breast RT

Action Points

  • This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • APBI for breast cancer matched long-term disease control and survival with whole-breast irradiation.
  • Note that significant predictors of ipsilateral breast cancer recurrence in univariate analysis with APBI were age and negative versus close surgical margins.

SAN FRANCISCO -- Accelerated partial breast irradiation (APBI) matched long-term disease control and survival with whole-breast irradiation (WBI), according to 10-year follow-up data from a matched-pair analysis.

Rates of local and regional recurrence were identical at 10 years. Distant metastasis occurred less often with WBI (3% versus 6%), whereas contralateral recurrence was more frequent with WBI (9% versus 3%), reported Jessica Wobb, MD, of Beaumont Cancer Institute in Royal Oak, Mich., at the Breast Cancer Symposium.

Disease-free survival, disease-specific survival, and overall survival did not differ significantly between groups, but were consistently higher in WBI-treated patients, Wobb added.

"These data represent one of the only ABPI series with prolonged follow-up and show similar outcomes in a matched group of patients undergoing WBI or APBI," Wobb concluded in a poster presentation.

The findings could represent a case of too little, too late, according to invited discussant David E. Wazer, MD, of Tufts Medical Center in Boston. He reviewed data from the National Cancer Data Base, showing a downturn in the use of brachytherapy after breast-conserving surgery since 2008 and no substantive increase in the use of other forms of APBI going back almost 10 years.

"Why is this happening?" Wazer asked. "I think it is because of toxicity concerns [with APBI], the emergence of alternative short-course hypofractionated whole-breast regimens, and the rise of single-fraction intraoperative radiotherapy."

The emergence of breast-conserving surgery for early-stage breast cancer has been accompanied by the introduction of APBI as an alternative to WBI. As compared with WBI, APBI protocols historically have required less time to complete, offering potentially attractive quality-of-life considerations for patients and providers.

Whether the advantages of APBI came at a cost of cancer outcomes has remained a topic of discussion. Few studies have accumulated long-term data to compare outcomes with APBI and WBI.

Wobb and colleagues presented data from long-term follow-up of 3,009 patients treated with breast conservation at Beaumont from 1980 to 2012. The study population comprised 2,528 women who underwent WBI after surgery and 481 who received catheter- or balloon-based APBI. A matched-pair analysis was performed, including age, cancer stage, and estrogen-receptor (ER) status.

The analysis included 548 of the 3,009 patients. Follow-up averaged 8 years overall but was slightly longer in the WBI group (8.1 versus 7.8 years, P<0.001). Mean tumor size did not differ significantly but was smaller in the APBI group (11.4 versus 13.0 mm). T-stage, ER status, and final surgical margins did not differ significantly between groups. Nodal involvement was more common in the WBI group (14% versus 9%, P=0.07).

Use of adjuvant hormonal therapy was significantly more common in the WBI group (68% versus 54%, P=0.001).

Comparison of 10-year clinical outcomes with APBI versus WBI produced the following results, none of which achieved statistical significance:

  • Local failure: 4% versus 4%
  • Contralateral failure: 3% versus 9%
  • Regional recurrence: 1% versus 1%
  • Disease-free survival: 91% versus 93%
  • Cause-specific survival: 93% versus 94%
  • Overall survival: 75% versus 82%
  • Excellent cosmesis: 95% versus 94%

In a univariate analysis, significant predictors of ipsilateral breast cancer recurrence with APBI were age (P=0.05) and negative versus close surgical margins (P=0.01). Significant predictors of ipsilateral recurrence with WBI were negative versus close margins (P=0.02) and negative versus positive margins (P<0.001).

Tumor size, stage, nodal status, ER status, hormonal therapy, and chemotherapy did not predict the risk of ipsilateral recurrence with either type of adjuvant radiation therapy.

In reviewing the findings, Wazer questioned whether the two patient groups were truly well matched, noting disparities in tumor size and frequency of hormonal therapy. He also cited a recent report of a small but significantly higher risk of subsequent mastectomy (4% versus 2%) in patients treated with brachytherapy versus WBI.

"There might be a lot of issues with how the [mastectomy] study was done, but nonetheless it has raised sufficient questions for a number of investigators," Wazer said.

http://www.medpagetoday.com/MeetingCoverage/MBCS/41448


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 12845
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 08 2016 at 8:11am
Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer



DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Back to Top
 Post Reply Post Reply
  Share Topic   

Forum Jump Forum Permissions View Drop Down

Forum Software by Web Wiz Forums® version 11.05
Copyright ©2001-2016 Web Wiz Ltd.