Hypofractionated whole breast irradiation after IORT treatment: evaluation of acute toxicity and cosmesis

Abstract

Introduction

Hypofractionated whole breast irradiation (HWBI) is the current standard of treatment after breast conservative surgery (BCS). Intraoperative radiotherapy (IORT) must be associated to WBI in patients showing high-risk factors of local recurrence in the definitive pathology report. The aim of this trial was to evaluate, for the first time, the acute toxicity and cosmesis of HWBI after photon-IORT.

Materials and methods

Twenty-six luminal breast cancer patients treated by BCS and IORT(20 Gy) were included between February and December 2019, in this prospective trial, of adjuvant HWBI (40.5 Gy/2.67 Gy/15 fractions). Acute toxicity (CTCAEv5.0) and cosmesis (Harvard scale), were assessed 3 months after treatment.

Results

All patients completed their treatment without interruptions. All cases were evaluable 3 months after treatment showing no toxicity ≥ G3 and excellent/good cosmesis assessment in 88% of the patients.

Conclusion

HWBI seems to have similar acute toxicity and cosmesis results than conventionally fractionated WBI in combination to photon-IORT after BCS.

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References

  1. 1.

    Early Breast Cancer Trialists Collaborative Group (EBCTCG). Effects of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomized trials. Lancet. 2011;378:1707–16.

    Article  Google Scholar 

  2. 2.

    Fowler JF. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol. 1989;62(740):679–94.

    CAS  Article  Google Scholar 

  3. 3.

    Haviland JS, Bentzen SM, Bliss JM, Yarnold JR, START Trial Management Group. Prolongation of overall treatment time as a cause of treatment failure in early breast cancer: an analysis of the UK START (standardization of breast radiotherapy) trials of radiotherapy fractionation. Radiother Oncol. 2016;121:420–3.

    Article  Google Scholar 

  4. 4.

    Fowble B, Solin LJ, Schultz DJ, et al. Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys. 1990;19:833–42.

    CAS  Article  Google Scholar 

  5. 5.

    Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.

    Article  Google Scholar 

  6. 6.

    Vaidya JS, Baum M, Tobias JS, et al. Long- term results of TARGeted intraoperative radioTherapy (Targit) boost during breast-conserving surgery. Int J Radiat Oncol Biol Phys. 2011;81(4):1091–7.

    Article  Google Scholar 

  7. 7.

    Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56.

    Article  Google Scholar 

  8. 8.

    Blank E, Kraus-Tiefenbacher U, Welzel G, et al. Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays. Ann Surg Oncol. 2010;17(3):352–8.

    Article  Google Scholar 

  9. 9.

    Radiation Therapy Oncology Group (RTOG) https://www.rtog.org/CoreLab/ContouringAtlases.aspx

  10. 10.

    Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 2017. https://ctep.cancer.gov/docs/CTCAE_v5_Quick_Reference_5x7

  11. 11.

    Harris JR, Levene MB, Svensson G, et al. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5(2):257–61.

    CAS  Article  Google Scholar 

  12. 12.

    Postoperative radiotherapy for breast cancer: UK consensus statement. Royal College of Radiologist, 2016. https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfco2016_breast-consensus-guidelines.pdf

  13. 13.

    Smith BD, Bellon J, Blitzblau R, et al. Radiation therapy for the whole breast: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Prac Radiat Oncol. 2018;3:145–52.

    Article  Google Scholar 

  14. 14.

    Pez M, Keller A, Welzel G, et al. Long-term outcome after intraoperative radiotherapy as a boost in breast cancer. Strahlenther Onkol. 2019. https://doi.org/10.1007/s00066-019-01525-7.

    Article  PubMed  Google Scholar 

  15. 15.

    Fastner G, Reitsamer R, Murawa D, et al. Hypofractionated WBI plus IOERT-boost in early stage breast cancer (HIOB): updated results of a prospective trial [Abstract]. Radiother Oncol. 2015;115(1):S233–S234234.

    Article  Google Scholar 

  16. 16.

    Joseph DJ, Bydder S, Jackson LR, et al. Prospective trial of intraoperative radiation treatment for breast cancer. Anz J Surg. 2004;74:1043–8.

    Article  Google Scholar 

  17. 17.

    Kraus-Tiefenbacher U, Bauer L, Kehrer T, et al. Intraoperative radiotherapy (IORT) as a boost in patients with early stage breast cancer—acute toxicity. Onkologie. 2006;29(3):77–82.

    PubMed  Google Scholar 

  18. 18.

    Lee JJ, Choi J, Gwen S, et al. In vivo dosimetry and acute toxicity in breast cancer patient undergoing intraoperative radiotherapy as boost. Radiot Oncol J. 2017;35(2):121–8.

    Article  Google Scholar 

  19. 19.

    Anh SG, Bae SJ, Lee HW, et al. A phase II study investigating the acute toxicity of targeted intraoperative radiotherapy as tumor-bed boost plus whole breast irradiation after breast-conserving surgery in Korean patients. Breast Cancer Res Treat. 2018;174(1):157–63.

    Google Scholar 

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Funding

Breast Cancer Grant 2019-0001 Hospital Universitario San Roque/Universidad Fernando Pessoa Canarias.

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Correspondence to P. C. Lara.

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The authors declare that they have no conflict of interest.

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All human studies have been approved by the appropriate committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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All persons gave their informed consent prior to their inclusion in the study and details that might disclose the identity of the subjects under study were omitted.

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Burgos-Burgos, J., Vega, V., Macias-Verde, D. et al. Hypofractionated whole breast irradiation after IORT treatment: evaluation of acute toxicity and cosmesis. Clin Transl Oncol 23, 179–182 (2021). https://doi.org/10.1007/s12094-020-02400-z

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Keywords

  • Breast cancer
  • Boost
  • IORT
  • Hypofractionated radiotherapy