Accelerated partial breast irradiation is safe and effective using intensity-modulated radiation therapy in selected early-stage breast cancer

Alan A. Lewin, Robert Derhagopian, Kunal Saigal, Joseph Panoff, Andre Abitbol, D. Jay Wieczorek, Vivek Mishra, Isildinha Reis, Annapoorna Ferrell, Lourdes Moreno, Cristiane Takita

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Abstract

Purpose: To report the feasibility, toxicity, cosmesis, and efficacy of using intensity-modulated radiation therapy (IMRT) with respiratory gating to deliver accelerated partial breast irradiation (APBI) in selected Stage I/II breast cancer after breast-conserving surgery. Methods and Materials: Eligible patients with node-negative Stage I/II breast cancer were prospectively enrolled in an institutional review board approved protocol to receive APBI using IMRT after breast-conserving surgery. The target volume was treated at 3.8 Gy/fraction twice daily for 5 days, to a total dose of 38 Gy. Results: Thirty-six patients were enrolled for a median follow-up time of 44.8 months. The median tumor size was 0.98 cm (range, 0.08-3 cm). The median clinical target volume (CTV) treated was 71.4 cc (range, 19-231 cc), with the mean dose to the CTV being 38.96 Gy. Acute toxicities included Grade 1 erythema in 44% of patients and Grade 2 in 6%, Grade 1 hyperpigmentation in 31% of patients and Grade 2 in 3%, and Grade 1 breast/chest wall tenderness in 14% of patients. No Grade 3/4 acute toxicities were observed. Grade 1 and 2 late toxicities as edema, fibrosis, and residual hyperpigmentation occurred in 14% and 11% of patients, respectively; Grade 3 telangiectasis was observed in 3% of patients. The overall cosmetic outcome was considered "excellent" or "good" by 94% of patients and 97% when rated by the physician, respectively. The local control rate was 97%; 1 patient died of a non-cancer-related cause. Conclusions: APBI can be safely and effectively administered using IMRT. In retrospective analysis, IMRT enabled the achievement of normal tissue dose constraints as outlined by Radiation Therapy Oncology Group 04-13/NSABP B-13 while providing excellent conformality for the CTV. Local control and cosmesis have remained excellent at current follow-up, with acceptable rates of acute/late toxicities. Our data suggest that cosmesis is dependent on target volume size. Further prospective multi-institutional trials should be performed to evaluate IMRT to deliver APBI.

Original languageEnglish
Pages (from-to)2104-2110
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number5
DOIs
StatePublished - Apr 1 2012

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breast
radiation therapy
Breast
Radiotherapy
cancer
grade
Breast Neoplasms
irradiation
toxicity
Hyperpigmentation
Segmental Mastectomy
surgery
dosage
edema
Telangiectasis
fibrosis
Radiation Oncology
physicians
chest
Research Ethics Committees

Keywords

  • Accelerated partial breast irradiation
  • Intensity-modulated radiation therapy
  • Partial breast irradiation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Accelerated partial breast irradiation is safe and effective using intensity-modulated radiation therapy in selected early-stage breast cancer. / Lewin, Alan A.; Derhagopian, Robert; Saigal, Kunal; Panoff, Joseph; Abitbol, Andre; Wieczorek, D. Jay; Mishra, Vivek; Reis, Isildinha; Ferrell, Annapoorna; Moreno, Lourdes; Takita, Cristiane.

In: International Journal of Radiation Oncology Biology Physics, Vol. 82, No. 5, 01.04.2012, p. 2104-2110.

Research output: Contribution to journalArticle

Lewin, Alan A. ; Derhagopian, Robert ; Saigal, Kunal ; Panoff, Joseph ; Abitbol, Andre ; Wieczorek, D. Jay ; Mishra, Vivek ; Reis, Isildinha ; Ferrell, Annapoorna ; Moreno, Lourdes ; Takita, Cristiane. / Accelerated partial breast irradiation is safe and effective using intensity-modulated radiation therapy in selected early-stage breast cancer. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 82, No. 5. pp. 2104-2110.
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AU - Wieczorek, D. Jay

AU - Mishra, Vivek

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