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©2014 Baishideng Publishing Group Inc.
World J Clin Oncol. Aug 10, 2014; 5(3): 425-439
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.425
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.425
Table 1 Randomized phase III trials of intensity modulated radiation therapy for breast cancer
Ref. | N | FU (mo) | End-points | IMRT | Non IMRT | P value | Outcomes reported | |
IMRT | 2D RT | |||||||
Donovan et al[32], 2007 | 150 | 156 | N/A | Distribution of any change in breast appearance between the presence or absence of doses > 105% | OR, 2.6; 95%CI: 1.1-6 | 0.03 | DC, LAE, QOL | |
Photographic assessment of any change in breast appearance at 1, 2 and 5 yr | OR, 1.7; 95%CI; 1.2-2.5 | 0.008 | ||||||
Physician assessment of breast induration at 5-yr, % | ||||||||
Centre of the breast | 21 | 32 | 0.02 | |||||
Pectoral fold | 22 | 29 | 0.006 | |||||
İnframammary fold | 17 | 24 | 0.009 | |||||
Boost site | 37 | 61 | < 0.001 | |||||
Pignol et al[30], 2008 | 170 | 161 | N/A | Acute skin toxicity (Gr 3-4), % | 27.1 | 36.7 | 0.06 | DC, AAE, QOL |
Moist desquamation (all breast), % | 31.2 | 47.8 | 0.002 | |||||
Moist desquamation (inframammary crease), % | 26.5 | 43.5 | 0.001 | |||||
Pain (Gr 2-4), % | ||||||||
Barnett et al[31], 2012 | 411 | 404 | 241 | Photographic assessment of breast shrinkage at 2 yr | OR, 1.51; 95%CI: 0.83-1.58 | 0.41 | AAE, LAE, QOL | |
Acute toxicity (Gr ≥ 2) | OR, 1.00; 95%CI: 0.76-1.34 | 0.97 | ||||||
Telangiectasia | OR, 1.68; 95%CI: 1.13-2.50 | 0.009 | ||||||
Moderate or poor overall cosmesis (good baseline surgical cosmesis) | OR, 0.63; 95%CI: 0.39-1.03 | 0.061 | ||||||
Patient reported | ||||||||
Breast pain, % | 46.7 | 37.3 | 0.98 | |||||
Oversensitivity, % | 47.1 | 35 | 0.43 | |||||
Mukesh et al[33], 2013 | 228 | 237 | 601 | Photographic assessment of breast shrinkage at 5 yr | OR, 0.79; 95%CI: 0.55-1.14 | 0.21 | LAE, TRO | |
Teleangiectasia | OR, 0.58; 95%CI: 0.36-0.92 | 0.021 | ||||||
Overall cosmesis | OR, 0.68; 95%CI: 0.48-0.96 | 0.027 | ||||||
Breast edema | OR, 0.74; 95%CI: 0.48-1.15 | 0.18 | ||||||
Tumor bed induration | OR, 0.76; 95%CI: 0.54-1.06 | 0.11 | ||||||
Pigmentation | OR, 0.80; 95%CI: 0.46-1.38 | 0.42 | ||||||
5-yr overall survival, % | 91.7 | 92.5 | 0.88 | |||||
5-yr locoregional recurrence, % | 1.35 | 2.56 | 0.36 |
Table 2 American Society for Radiation Oncology and GEC-ESTRO recommendations on patient selection criteria for Accelerated Partial Breast Irradiation
ASTRO | GEC-ESTRO | ASTRO | GEC-ESTRO | ASTRO | GEC-ESTRO | |
Factor | Suitable | Low-risk | Cautionary | Intermediate-risk | Unsuitable | High-risk |
Patient factors | ||||||
Age (yr) | ≥ 60 | > 50 | 50-59 | 40-50 | < 50 | < 40 |
BRCA1/2 mutation | Not present | Not defined | Not present | Not defined | Present | Not defined |
Pathologic factors | ||||||
Tumor size (cm) | ≤ 2 | ≤ 3 | 2.1-3.0 | ≤ 3 | > 3 | > 3 |
T stage | T1 | T1-2 | T0 or T2 | T1-2 | T3-4 | T2 (> 3 cm), T3-4 |
Histology | IDC or other favorable subtypes | IDC, mucinous, tubular, medullary and colloid carcinoma | ILC allowed | ILC allowed | Any | Any |
Grade | Any | Any | Any | Any | Any | Any |
Pure DCIS | Not allowed | Not allowed | ≤ 3 cm | Allowed | > 3 cm | Any |
EIC | Not allowed | Not allowed | ≤ 3 cm | Not allowed | > 3 cm | Allowed |
Associated LCIS | Allowed | Allowed | Allowed | Allowed | Allowed | Allowed |
Multicentricity | Unicentric | Unicentric | Unicentric | Unicentric | Multicentric | Multicentric |
Multifocality | Clinically unifocal ≤ 2 cm | Unifocal | Clinically unifocal 2.1-3 cm | Multifocal (limited within 2 cm of the index lesion) | Clinically multifocal, > 3 cm | Multifocal (> 2 cm from the index lesion) |
LVSI | No | Not allowed | Limited/focal | Not allowed | Extensive | Allowed |
ER status | Positive | Any | Negative | Any | Any | Any |
Surgical margins | ≥ 2 mm | ≥ 2 mm | < 2 mm | < 2 mm | Positive | Positive |
Nodal factors | ||||||
N stage | pN0 (i-, i+) | pN0 | pN0 (i-, i+) | pN1mi, pN1a | ≥ pN1 | pNx, ≥ pN2a |
Nodal surgery | SN biopsy or ALND | None performed | ||||
Neoadjuvant therapy | Not allowed | Not allowed | Not allowed | Not allowed | If used | If used |
Table 3 Prospective randomized phase III trials of Accelerated Partial Breast Irradiation
Institution/trial | Number of patients | Inclusion criteria | Control arm | Experimental arm |
National Institute of Oncology, Budapest, Hungary[80] | 258 | Wide local excision, > 40 yr, Tm ≤ 20 mm, Invasive ductal carcinoma (non-lobular), Node negative, Margin negative | WBRT (50 Gy in 25 fx) | (1) MIB (36.4 Gy in 7 fx) (2)Electrons (50 Gy in 25 fx) |
European Institute of Oncology ELIOT[63,82] | 1305 | Quadrantectomy, ≥ 48 yr, Tm ≤ 2.5 cm, Invasive carcinoma, Node negative | WBRT (50 Gy in 25 fx) ± 10 Gy boost | IORT (21 Gy in 1 fx, electrons up to 9 MeV) |
TARGIT-A[69,81] | 3451 | Lumpectomy, ≥ 45 yr, Invasive ductal carcinoma (non-lobular), Node negative | WBRT 40–56 Gy ± 10–16 Gy boost | IORT (20 Gy in 1 fx, low-energy X-rays) |
Table 4 Prospective randomized phase III trials of whole breast radiotherapy vs conventional fractionation radiotherapy
Institution/trial | N | MedianF/U | Eligibility criteria | Treatment arms | Primary endpoint | Secondary endpoint |
Royal Marsden Hospital/Sutton and Gloucestershire Oncology Centre[90,91] | 1410 | 5 yr1 | Invasive breast cancer, T1-3N0-1M0, < 75 yr, BCS (complete macroscopic resection),Level II/III AD | 50 Gy in 25 fx 39 Gy in 13 fx 42.9 Gy in 13 fx | Late changes in breast appearance | Palpable breast induration Ipsilateral tumor recurrence |
UK START A[92,94] | 2236 | 9.3 yr | Invasive breast cancer, T1-3aN0-1M0, > 18 yr, Clear tm margins (≥ 1 mm), No immediate surgical reconstruction, Available for follow-up | 50 Gy in 25 fx 41.6 Gy in 13 fx 39 Gy in 13 fx | Loco-regional tumor recurrence | Late normal tissue effects QOL |
UK START B[93,94] | 2215 | 9.9 yr | Invasive breast cancer, T1-3aN0-1M0,> 18 yr, Clear tm margins (≥ 1 mm), No immediate surgical reconstruction, Available for follow-up | 50 Gy in 25 fx 40 Gy in 15 fx | Loco-regional tumor recurrence | Late normal tissue effects QOL |
Ontario Clinical Oncology Group[95] | 1234 | 12 yr | Invasive breast cancer, BCS + Level I/II AD,Tm ≤ 5 cm, Negative axillary nodes, Maximum width of breast tissue ≤ 25 cm, No multicentric disease | 50 Gy in 25 fx 42.5 Gy in 16 fx | Local recurrence | Regional and distant recurrence Second cancers Breast cosmesis Late toxic effects of radiation |
- Citation: Ozyigit G, Gultekin M. Current role of modern radiotherapy techniques in the management of breast cancer. World J Clin Oncol 2014; 5(3): 425-439
- URL: https://www.wjgnet.com/2218-4333/full/v5/i3/425.htm
- DOI: https://dx.doi.org/10.5306/wjco.v5.i3.425