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Title: Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience

Abstract

Purpose: To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center. Methods and Materials: A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications. Results: With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered 'excellent', 33% 'good', and <1.5% 'fair/poor'. For physician-reported cosmesis, boost doses {>=}16 Gy, breast size >900 cc, or boost volumes >34 cc were significantly associated with a 'fair/poor' cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with 'fair/poor' physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported 'excellent', 'good',more » and 'fair/poor' cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with 'fair/poor' outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose {>=}16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy. Conclusions: Whole-breast IMRT is associated with very low rates of local recurrence at 5 years, 83%-98% 'good/excellent' cosmetic outcomes, and minimal chronic toxicity, including late fibrosis.« less

Authors:
 [1];  [1];  [2]; ; ;  [1]; ;  [3];  [4]
  1. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
  2. Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA (United States)
  3. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
  4. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)
Publication Date:
OSTI Identifier:
22149619
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 4; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; EDEMA; ERYTHEMA; FIBROSIS; MAMMARY GLANDS; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY; TOXICITY; WOMEN

Citation Formats

Keller, Lanea M.M., E-mail: Lanea.Keller@fccc.edu, Sopka, Dennis M., Li Tianyu, Klayton, Tracy, Li Jinsheng, Anderson, Penny R., Bleicher, Richard J., Sigurdson, Elin R., and Freedman, Gary M. Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.069.
Keller, Lanea M.M., E-mail: Lanea.Keller@fccc.edu, Sopka, Dennis M., Li Tianyu, Klayton, Tracy, Li Jinsheng, Anderson, Penny R., Bleicher, Richard J., Sigurdson, Elin R., & Freedman, Gary M. Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience. United States. doi:10.1016/J.IJROBP.2012.01.069.
Keller, Lanea M.M., E-mail: Lanea.Keller@fccc.edu, Sopka, Dennis M., Li Tianyu, Klayton, Tracy, Li Jinsheng, Anderson, Penny R., Bleicher, Richard J., Sigurdson, Elin R., and Freedman, Gary M. Thu . "Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience". United States. doi:10.1016/J.IJROBP.2012.01.069.
@article{osti_22149619,
title = {Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience},
author = {Keller, Lanea M.M., E-mail: Lanea.Keller@fccc.edu and Sopka, Dennis M. and Li Tianyu and Klayton, Tracy and Li Jinsheng and Anderson, Penny R. and Bleicher, Richard J. and Sigurdson, Elin R. and Freedman, Gary M.},
abstractNote = {Purpose: To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center. Methods and Materials: A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications. Results: With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered 'excellent', 33% 'good', and <1.5% 'fair/poor'. For physician-reported cosmesis, boost doses {>=}16 Gy, breast size >900 cc, or boost volumes >34 cc were significantly associated with a 'fair/poor' cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with 'fair/poor' physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported 'excellent', 'good', and 'fair/poor' cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with 'fair/poor' outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose {>=}16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy. Conclusions: Whole-breast IMRT is associated with very low rates of local recurrence at 5 years, 83%-98% 'good/excellent' cosmetic outcomes, and minimal chronic toxicity, including late fibrosis.},
doi = {10.1016/J.IJROBP.2012.01.069},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}