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Title: Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

Abstract

Purpose: To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) with active-breathing control (ABC). Methods and Materials: Women older than 40 with breast cancer stages 0-I who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep inspiration breath-hold. Patients received 38.5 Gy in 3.85-Gy fractions given twice daily over 5 consecutive days. The planning target volume was defined as the lumpectomy cavity with a 1.5-cm margin. Cosmesis was scored on a 4-category scale by the treating physician. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). We report the cosmetic and toxicity results at a median follow-up of 5 years. Results: A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women at a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at the time of last assessment was 43.3% excellent, 30% good,more » 20% fair, and 6.7% poor. Fibrosis according to CTCAE at last assessment was 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions: In this prospective trial with 5-year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique.« less

Authors:
 [1];  [2]; ;  [1];  [3]; ;  [1];  [1]
  1. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)
  2. Department of Radiation Oncology, The Sheba Medical Center, Ramat Gan (Israel)
  3. Biostatistics Unit, University of Michigan, Ann Arbor, Michigan (United States)
Publication Date:
OSTI Identifier:
22416551
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 89; Journal Issue: 1; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CLINICAL TRIALS; FIBROSIS; MAMMARY GLANDS; NEOPLASMS; PATIENTS; PLANNING; RADIOTHERAPY; RESPIRATION; REVIEWS; SURGERY; TOXICITY; WOMEN

Citation Formats

Liss, Adam L., Ben-David, Merav A., Jagsi, Reshma, Hayman, James A., Griffith, Kent A., Moran, Jean M., Marsh, Robin B., and Pierce, Lori J., E-mail: ljpierce@umich.edu. Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.01.005.
Liss, Adam L., Ben-David, Merav A., Jagsi, Reshma, Hayman, James A., Griffith, Kent A., Moran, Jean M., Marsh, Robin B., & Pierce, Lori J., E-mail: ljpierce@umich.edu. Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial. United States. doi:10.1016/J.IJROBP.2014.01.005.
Liss, Adam L., Ben-David, Merav A., Jagsi, Reshma, Hayman, James A., Griffith, Kent A., Moran, Jean M., Marsh, Robin B., and Pierce, Lori J., E-mail: ljpierce@umich.edu. Thu . "Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial". United States. doi:10.1016/J.IJROBP.2014.01.005.
@article{osti_22416551,
title = {Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial},
author = {Liss, Adam L. and Ben-David, Merav A. and Jagsi, Reshma and Hayman, James A. and Griffith, Kent A. and Moran, Jean M. and Marsh, Robin B. and Pierce, Lori J., E-mail: ljpierce@umich.edu},
abstractNote = {Purpose: To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) with active-breathing control (ABC). Methods and Materials: Women older than 40 with breast cancer stages 0-I who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep inspiration breath-hold. Patients received 38.5 Gy in 3.85-Gy fractions given twice daily over 5 consecutive days. The planning target volume was defined as the lumpectomy cavity with a 1.5-cm margin. Cosmesis was scored on a 4-category scale by the treating physician. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). We report the cosmetic and toxicity results at a median follow-up of 5 years. Results: A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women at a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at the time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to CTCAE at last assessment was 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions: In this prospective trial with 5-year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique.},
doi = {10.1016/J.IJROBP.2014.01.005},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 89,
place = {United States},
year = {Thu May 01 00:00:00 EDT 2014},
month = {Thu May 01 00:00:00 EDT 2014}
}