Skip to main content

The Radiobiology of Accelerated Partial Breast Irradiation

  • Chapter
Accelerated Partial Breast Irradiation
  • 729 Accesses

This chapter focuses on the radiobiology of breast cancer and the radiobiological principles that underpin APBI. The linear quadratic (LQ) equation is the radiobiological model most commonly used to compare the effects of different dose and fractionation schedules. Within this model, there are two assumed components of radiation damage, characterized by radiosensitivity coefficients α and β. The calculated values of α/β specific to breast cancer are presented. In addition to the general radiobiology of APBI, the radiobiological principles specifically related to the most commonly used APBI techniques are discussed. Understanding these principles enables a more informed prediction of disease control and toxicity, and enables quantitative comparison between techniques and regimes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Armpilia C, Dale RG, et al. (2006) Radiobiological modelling of dose-gradient effects in low dose rate, high dose rate and pulsed brachytherapy. Phys Med Biol 51:4399–4411

    Article  PubMed  CAS  Google Scholar 

  • Arthur DW, Koo D, et al. (2003) Partial breast brachytherapy after lumpectomy: low-dose-rate and high-dose-rate experience. Int J Radiat Oncol Biol Phys 56(3):681–689

    PubMed  Google Scholar 

  • Bartelink H, Horiot JC, et al. (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881–10882 trial. J Clin Oncol 25(22):3259–3265

    Article  PubMed  Google Scholar 

  • Belletti B, Vaidya JS, et al. (2008) Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res 14(5):1324–1332

    Article  Google Scholar 

  • Bentzen SM, Saunders MI, et al. (1999) Repair halftimes estimated from observations of treatment-related morbidity after CHART or conventional radiotherapy in head and neck cancer. Radiother Oncol 53:219–226

    Article  PubMed  CAS  Google Scholar 

  • Bentzen SM, Skoczylas JZ, et al. (2000) Quantitative clinical radiobiology of early and late lung reactions. Int J Radiat Biol 76:453–462

    Article  PubMed  CAS  Google Scholar 

  • Clark M, Collins R, et al. (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106

    Google Scholar 

  • Cordes N, Park CC (2007) Beta1 integrin as a molecular therapeutic target. Int J Radiat Biol 83(11–12):753–760

    Article  PubMed  CAS  Google Scholar 

  • Curran D, Van Dongen JP, et al. (1998) Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC trial 10801. Eur J Cancer 34:307–314

    Article  PubMed  CAS  Google Scholar 

  • Dale RG. (1985) The application of the linear quadratic dose-effect equation to fractionated and protracted radiotherapy. Br J Radiol 58:515–528

    Article  PubMed  CAS  Google Scholar 

  • Dale RG. (1987) What minimum number of fractions is required with high dose rate remote after-loading? Brit J Radiol 60:300–302

    Google Scholar 

  • Dale RG, Coles IP, et al. (1997) Calculation of integrated biological response in brachytherapy. Int J Radiat Oncol Biol Phys 38(3):633–642

    PubMed  CAS  Google Scholar 

  • Dale RG, Fowler JF (2007) Radiation repair mechanisms. In: Dale RG, Jones B (eds.) Radiobiological modelling in radiation oncology. British Institute of Radiology, London

    Google Scholar 

  • Dickler A, Kirk M, et al. (2004) Treatment volume and dose optimization of MammoSite breast brachytherapy applicator. Int J Radiat Oncol Biol Phys 59(2):469–474

    PubMed  Google Scholar 

  • Dragun AE, Aguero EG, et al. (2005) Chest wall dose in MammoSite breast brachytherapy: radiobio-logic estimations of late complication risk based on dose-volume considerations. Brachy 4:259–263

    Article  Google Scholar 

  • Early Breast Cancer Trialists' Collaborative Group (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer. Lancet 355:1757–1770

    Article  Google Scholar 

  • Edmundson GK, Vicini FA, et al. (2002) Dosimetric characteristics of the MammoSite RTS, a new breast brachytherapy applicator. Int J Radiat Oncol Biol Phys 52(4):1132–1139

    PubMed  Google Scholar 

  • Faverly DR, Hendricks JH, et al. (2001) Breast carcinomas of limited extent: frequency, radio-logic-pathologic characteristics, and surgical margin requirements. Cancer 91(4):647–659

    Article  PubMed  CAS  Google Scholar 

  • Fisher B, Anderson S, et al. (2002a) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Eng J Med 347(16):1233–1241

    Article  Google Scholar 

  • Fisher B, Bryant J, et al. (2002b) Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol 20(20):4141–4149

    Article  CAS  Google Scholar 

  • Formenti SC (2005) External-beam partial-breast irradiation. Semin Radiat Oncol 15:92–99

    Article  PubMed  Google Scholar 

  • Formenti SC, Truong MT, et al. (2004) Prone accelerated partial breast irradiation after breast conserving surgery: preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 60(2):493–504

    PubMed  Google Scholar 

  • Fowler JF (1999) Is repair of DNA strand break damage from ionizing radiation second-order rather than fi rst-order? A simpler explanation of apparently multiexponential repair. Radiat Res 152(2):124–136

    Article  PubMed  CAS  Google Scholar 

  • Gagliardi G, Bjohle J, et al. (2000) Radiation pneumonitis after breast cancer irradiation: analysis of the complication probability using the relative seriality model. Int J Radiat Oncol Biol Phys 46(2):373–381

    Article  PubMed  CAS  Google Scholar 

  • Harrington K, Jankowska P, et al. (2007) Molecular biology for the radiation oncologist: the 5Rs of radiobiology meet the hallmarks of cancer. Clin Oncol 19(8):561–571

    Article  CAS  Google Scholar 

  • Herskind C, Steil V, et al. (2005) Radiobiological aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X-rays for early-stage breast cancer. Radiat Res 163:208–215

    Article  PubMed  CAS  Google Scholar 

  • Hiatt JR, Evans SB, et al. (2006) Dose-modelling study to compare external beam techniques from protocol NSABP B-39/RTOG 0413 for patients with highly unfavorable cardiac anatomy. Int J Radiat Oncol Biol Phys 65(5):1368–1374

    PubMed  Google Scholar 

  • Holland R, Veling SH, et al. (1985) Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5):979–990

    Article  PubMed  CAS  Google Scholar 

  • Hui SK, Das RK, et al. (2004) Helical tomotherapy as a means of delivering accelerated partial breast irradiation. Technol Cancer Res Treatment 3(6):639–646

    Google Scholar 

  • ICRU (1985) Dose and volume specifi cations for reporting intracavitary therapy in gynecology (Report 38). International Commission on Radiation Units and Measurements, Bethesda, MD

    Google Scholar 

  • ICRU (1993) Prescribing, recording and reporting photon beam therapy (Report 50). International Commission on Radiation Units and Measurements, Bethesda, MD

    Google Scholar 

  • Joiner MC, van der Kogel AJ (1997) The linear quadratic approach to fractionation and calculation of isoeffect relationships. In: Steel GG (ed) Basic clinical radiobiology. Arnold, London, pp 106–122

    Google Scholar 

  • Khan AJ, Kirk MC, et al. (2006) A dosimetric comparison of three-dimensional conformal, intensity-modulated radiation therapy and MammoSite partial-breast irradiation. Brachy 5:183–188

    Article  Google Scholar 

  • Kozak KR, Smith BL, et al. (2006) Accelerated partial-breast irradiation using proton beams: initial clinical experience. Int J Radiat Oncol Biol Phys 66(3):691–698

    PubMed  Google Scholar 

  • Krüse JJ, Zurcher C, et al. (2001) Structural changes in the auricles of the rat heart after local ionising irradiation. Radiother Oncol 58:303–311

    Article  PubMed  Google Scholar 

  • Landis DM, Luo W, et al. (2007) Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys 67(5):1299–1308

    PubMed  Google Scholar 

  • Lawneda BD, Taghian AG, et al. (2003) Dose-volume analysis of radiotherapy for T1N0 invasive breast cancer treated by local excision and partial breast irradiation by low-dose-rate interstitial implant. Int J Radiat Oncol Biol Phys 56(3):671–680

    Google Scholar 

  • Manning MA, Zwicker RD, et al. (2001) Biologic treatment planning for high-dose-rate brachyther-apy. Int J Radiat Oncol Biol Phys 49(3):839–845

    PubMed  CAS  Google Scholar 

  • Marks LB (2002) Dosimetric predictors of radiation-induced lung injury. Int J Radiat Oncol Biol Phys 54(2):313–316

    Article  PubMed  Google Scholar 

  • Mikeljevic JS, Haward R, et al. (2004) Trends in post-operative radiotherapy delay and the effect on survival in breast cancer patients treated with conservation surgery. Br J Cancer 90:1343–1348

    Article  PubMed  Google Scholar 

  • Millar WT, Canney PA (1993) Derivation and application of equations describing the effects of fractionated protracted irradiation, based on multiple and incomplete repair processes. Part 1L: derivation of equations. Int J Radiobiol 64:275–291

    Article  CAS  Google Scholar 

  • Niemierko A (2007) Reporting and analyzing dose distributions: a concept of equivalent uniform dose. Med Phys 24(1):103–110

    Article  Google Scholar 

  • Orecchia R, Veronesi U (2005) Intraoperative electrons. Semin Radiat Oncol 15:76–83

    Article  PubMed  Google Scholar 

  • Orton C (2001) High dose rate brachytherapy may be radiobiologically superior to low dose rate due to slow repair of late responding normal tissue cells. Int J Radiat Oncol Biol Phys 49(1):183–189

    PubMed  CAS  Google Scholar 

  • Overgaard M, Bentzen SM, et al. (1987) The value of the NSD formula in equation of acute and late radiation complications in normal tissue following 2 and 5 fractions per week in breast cancer patients treated with postmastectomy irradiation. Radiother Oncol 9:1–11

    Article  PubMed  CAS  Google Scholar 

  • Owen JR, Ashton A, et al. (2006) Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomized trial. Lancet Oncol 7:467–471

    Article  PubMed  Google Scholar 

  • Polgar C, Major T, et al. (2004) High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: seven year results of a comparative study. Int J Radiat Oncol Biol Phys 60:1173–1181

    PubMed  Google Scholar 

  • Pop LA, van den Broek JF, et al. (1996) Constraints in the use of repair half times and mathematical modelling for the clinical application of HDR and PDR treatment schedules as an alternative for LDR brachytherapy. Radiother Oncol 38(2):153–162

    Article  PubMed  CAS  Google Scholar 

  • Ribero GG, Magee B, et al. (1993) The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol 5(5):278–283

    Article  Google Scholar 

  • Rosenstein BS, Lymberis SC, et al. (2004) Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol Biol Phys 60(5):1393–1404

    PubMed  Google Scholar 

  • Schiller DE, Le LW, et al. (2008) Factors associated with negative margins of lumpectomy specimen: potential use in selecting patients for intraoperative radiotherapy. Ann Surg Oncol 15(3):833–842

    Article  PubMed  CAS  Google Scholar 

  • Schultz-Hector S (1992) Radiation-induced heart disease: review of experimental data on dose response and pathogenesis. Int J Radiat Biol 61:149–160

    Article  PubMed  CAS  Google Scholar 

  • Steel G (2002) Basic clinical radiobiology. Arnold, London

    Google Scholar 

  • Taghian AG, Kozak KR, et al. (2006) Initial dosimetric experience using simple three-dimensional conformal external-beam accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 64(4):1092–1099

    PubMed  Google Scholar 

  • Taylor CW, McGale P, et al. (2006) Cardiac risks of breast-cancer radiotherapy: a contemporary view. Clin Oncol 18:236–246

    Article  CAS  Google Scholar 

  • Taylor CW, Nisbet A, et al. (2007) Cardiac exposures in breast cancer radiotherapy: 1950s-1990s. Int J Radiat Oncol Biol Phys 69(5):1484–1495

    PubMed  Google Scholar 

  • The START Trialists' Group (2008a) The UK Standardisation of Breast Radiotherapy (START) trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341

    Article  Google Scholar 

  • The START Trialists' Group (2008b) The UK Standardisation of Breast Radiotherapy (START) trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371:1098–1107

    Article  Google Scholar 

  • Tutt A, Yarnold J (2006) Radiobiology of breast cancer. Clin Oncol 18:166–178

    Article  CAS  Google Scholar 

  • Veronesi U, Luini A, et al. (1993) Radiotherapy after breast-preserving surgery in women with localised cancer of the breast. N Engl J Med 328:1587–1591

    Article  PubMed  CAS  Google Scholar 

  • Veronesi U, Cascinelli N, et al. (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Eng J Med 347(16):1227–1232

    Article  Google Scholar 

  • Wazer DE, Kaufman S, et al. (2006) Accelerated partial breast irradiation: an analysis of variables associated with late toxicity and long-term cosmetic outcome after high-dose-rate interstitial brachytherapy. Int J Radiat Oncol Biol Phys 64(2):489–495

    PubMed  Google Scholar 

  • Wyatt RM, Beddoe AH, et al. (2003) The effects of delays in radiotherapy treatment on tumour control. Phys Med Biol 48:139–155

    Article  PubMed  CAS  Google Scholar 

  • Yarnold J (2002) Breast. In: Price P, Sikora K (eds) Treatment of cancer. Arnold, London

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alexandra Stewart .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Stewart, A., Dale, R. (2009). The Radiobiology of Accelerated Partial Breast Irradiation. In: Wazer, D.E., Arthur, D.W., Vicini, F.A. (eds) Accelerated Partial Breast Irradiation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88006-6_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-88006-6_4

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-88005-9

  • Online ISBN: 978-3-540-88006-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics