National Cancer Institute®
Last Modified: November 21, 2001
UI - 21245397
AU - Small W Jr; Lurie RH
TI - Current status of radiation in the treatment of breast cancer.
SO - Oncology (Huntingt) 2001 Apr;15(4):469-76; discussion 476, 479-80, 482-4 passim
AD - Clinical Radiology, Division of Radiation Oncology, Robert H. Lurie, Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA. email@example.com
Radiation therapy in combination with lumpectomy and axillary dissection has remained standard therapy for early-stage disease since the 1970s. Although there has been no definitive trial in patients with ductal carcinoma in situ, the data suggest that excision plus radiation therapy is a viable option. The local management of early-stage breast cancer includes modified radical mastectomy, with or without reconstruction, or breast-conserving therapy. Six prospective randomized trials compared mastectomy with breast-conserving therapy, and all have shown equivalent survival. Despite efforts to identify subgroups of patients with invasive disease who do not require breast irradiation, based on current data, this modality remains standard treatment after conservative surgery in all patients. Ongoing multicenter studies may clarify the role of brachytherapy, which may provide advantages in some patients after breast-conserving therapy. Axillary radiation is a viable option for patients who fail to undergo sampling of the axilla and may be a future option for patients who have a positive sentinel node but no further dissection. The ability of postmastectomy radiation to affect survival has long been controversial.
UI - 21406152
AU - Unnithan J; Macklis RM
TI - Contralateral breast cancer risk.
SO - Radiother Oncol 2001 Sep;60(3):239-46
AD - Department of Radiation Oncology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
The use of breast-conserving treatment approaches for breast cancer has now become a standard option for early stage disease. Numerous randomized studies have shown medical equivalence when mastectomy is compared to lumpectomy followed by radiotherapy for the local management of this common problem. With an increased emphasis on patient involvement in the therapeutic decision making process, it is important to identify and quantify any unforeseen risks of the conservation approach. One concern that has been raised is the question of radiation- related contralateral breast cancer after breast radiotherapy. Although most studies do not show statistically significant evidence that patients treated with breast radiotherapy are at increased risk of developing contralateral breast cancer when compared to control groups treated with mastectomy alone, there are clear data showing the amount of scattered radiation absorbed by the contralateral breast during a routine course of breast radiotherapy is considerable (several Gy) and is therefore within the range where one might be concerned about radiogenic contralateral tumors. While radiation related risks of contralateral breast cancer appear to be small enough to be statistically insignificant for the majority of patients, there may exist a smaller subset which, for genetic or environmental reasons, is at special risk for scatter related second tumors. If such a group could be predicted, it would seem appropriate to offer either special counseling or special prevention procedures aimed at mitigating this second tumor risk. The use of genetic testing, detailed analysis of breast cancer family history, and the identification of patients who acquired their first breast cancer at a very early age may all be candidate screening procedures useful in identifying such at- risk groups. Since some risk mitigation strategies are convenient and easy to utilize, it makes sense to follow the classic 'ALARA' (as low as reasonably achievable) principles and to minimize scattered radiation for these special risk groups and perhaps for all patients undergoing breast radiotherapy. This paper reviews the literature on the risk of radiation- related second contralateral breast cancers.
UI - 21406153
AU - Landau D; Adams EJ; Webb S; Ross G
TI - Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy.
SO - Radiother Oncol 2001 Sep;60(3):247-55
AD - Department of Radiotherapy, Royal Marsden Trust, Fulham Road, London SW3 6JJ, UK.
BACKGROUND AND PURPOSE: Adjuvant breast radiotherapy (RT) is now part of the routine care of patients with early breast cancer. However, analysis of the Early Breast Cancer Trialists' Collaborative suggests that patients with the lowest risk of dying of breast cancer are at significant risk of cardiac mortality due to longer relapse-free survival. Patients with a significant amount of heart in the high-dose volume have been shown to be at risk of fatal cardiac events. This study was designed to assess whether conformal planning or intensity-modulated radiotherapy (IMRT) techniques allow reduced cardiac irradiation whilst maintaining full target coverage. MATERIAL AND METHODS: Ten patients with early breast cancer were available for computed tomography (CT) planning. Each had at least 1 cm maximum heart depth within the posterior border of conventional tangents. For each patient, plans were generated and compared using dose volume histograms for planning target volume (PTV) and organs at risk. The plans included conventional tangents with and without shielding. The shielding was designed to either completely spare the heart or to shield as much heart as possible without compromising PTV coverage. IMRT plans were also prepared using two- and four-field tangential and six-field arc-like beam arrangements. RESULTS: PTV homogeneity was better for the tangential IMRT techniques. For all patients, cardiac irradiation was reduced by the addition of partial cardiac shielding to conventional tangents, without compromise of PTV coverage. The two- and four-field IMRT techniques also reduced heart doses. The average percentage volume of heart receiving >60% of the prescription dose was 4.4% (range 1.0-7.1%) for conventional tangents, 1.5% (0.2-3.9%) for partial shielding, 2.3% (0.5-4.6%) for the two-field IMRT technique and 2.2% (0.4-5.6%) for the four-field IMRT technique. For patients with larger maximum heart depths the four-field IMRT plan achieved greater heart sparing than the partial shielding, although irradiation of the contralateral breast was increased. Full cardiac shielding resulted in the most complete heart sparing but with compromise of the PTV coverage; the mean volume receiving less than 95% of the prescription dose was 4% (range 1.5-8.7%). CONCLUSION: All patients undergoing adjuvant tangential breast RT in whom the heart is seen to be in the high-dose volume should be considered for the addition of cardiac-sparing lead blocks. Three-dimensional CT planning and alternative beam arrangements with IMRT optimization enables more complete cardiac sparing without compromise of PTV coverage in certain patients.
UI - 21406154
AU - Lievens Y; Poortmans P; Van den Bogaert W
TI - A glance on quality assurance in EORTC study 22922 evaluating techniques for internal mammary and medial supraclavicular lymph node chain irradiation in breast cancer.
SO - Radiother Oncol 2001 Sep;60(3):257-65
AD - Radiotherapy Department, University Hospital, Herestraat 49, 3000 Leuven, Belgium.
PURPOSE: To evaluate the irradiation techniques used for the irradiation of the internal mammary and medial supraclavicular lymph node chain (IM-MS) in the EORTC 22922 study, which evaluates its impact on survival in stage I-III breast cancer patients with axillary node invasion and/or central or medial location of the primary tumour. MATERIALS AND METHODS: The analysis was performed based on the dummy run data of the Quality Assurance Programme of the study. A standard irradiation technique was proposed within the study protocol, and the use of other treatment 12 different countries had participated in the study; 32 of these had already fulfilled the dummy run procedure. No centres had to be excluded from the study. Seventy-eight percent of the centres are using the standard irradiation technique, 64% of these with minor variations. Twenty-two percent of the centres developed an alternative irradiation technique. The remarks to the centres using the standard set-up were most often related to the junction problem and the possible under- or overdosage in the target volumes. The remarks to the centres with alternative techniques most often concerned the possible enhanced dose to the lungs and the heart. CONCLUSION: In a multi-centre trial an easy irradiation technique applicable in a large number of centres should be provided. A quality assurance programme allows early detection of possible problems with treatment planning and delivery. The analysis of the dummy run data showed that if the recommendations of the Quality Assurance Committee are applied, both standard and alternative IM-MS irradiation techniques produce acceptable dose distributions.
UI - 20575037
AU - Cutuli B; Quentin P; Rodier JF; Barakat P; Grob JC
TI - Severe hypothyroidism after chemotherapy and locoregional irradiation for breast cancer.
SO - Radiother Oncol 2000 Oct;57(1):103-5
UI - 21425290
AU - Megali Y; Mikhina ZP; Gorlachev GE; Gutnik RA; Ivanov VN; Pirogova NA
TI - A clinico-dosimetric characteristic of radiotherapy in patients with early stages of breast cancer.
SO - Saudi Med J 2000 Apr;21(4):400-1
UI - 21277429
AU - Hector C; Webb S; Evans PM
TI - A simulation of the effects of set-up error and changes in breast volume on conventional and intensity-modulated treatments in breast radiotherapy.
SO - Phys Med Biol 2001 May;46(5):1451-71
AD - Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, Surrey, UK.
The effect of interfractional patient movement on dosimetry has been investigated for breast radiotherapy. Errors in patient set-up and changes in breast volume were simulated individually to determine how each contributes to the total dosimetric error. Two treatment techniques were investigated: a conventional treatment and an intensity-modulated treatment delivered using compensators. Six patients were investigated and anterior-posterior (AP) and superior-inferior (SI) displacements were simulated by displacing the isocentre in both directions by 2, 5 and 10 mm. A model of the breast was developed from the six patients to simulate changes in breast volume. In this model, the breast was described as a set of semi-ellipses. The volume of the breast was changed by varying the magnitude of the semi-major and semi-minor axes. Anisotropic changes in breast volume were also investigated. The dosimetric error was evaluated for each dose plan by calculating the volume outside the 95-105% dose range resulting from the simulations. A number of parameters describing the size and shape of the breast were also investigated to determine whether a susceptibility of outline sets to interfractional patient movement could be predicted. A parameter describing the increase in the breast volume outside the 95-105% dose range was calculated for AP a
UI - 21427146
AU - Nattinger AB; Kneusel RT; Hoffmann RG; Gilligan MA
TI - Relationship of distance from a radiotherapy facility and initial breast cancer treatment.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1344-6
AD - Department of Medicine, Medical College of Wisconsin, Milwaukee, USA. firstname.lastname@example.org
UI - 21461559
AU - Sadler IJ; Jacobsen PB
TI - Progress in understanding fatigue associated with breast cancer treatment.
SO - Cancer Invest 2001;19(7):723-31
AD - Department of Psychology, University of South Florida, Tampa, USA.
Fatigue is one of the most common and distressing symptoms reported by cancer patients. This article reviews research that has examined the extent to which breast cancer patients experience fatigue during and following completion of chemotherapy and radiotherapy. The article also addresses methodological issues in the study of fatigue as well as the current status of efforts to prevent or relieve fatigue associated with breast cancer treatment.
UI - 21460700
AU - Yasui LS; Hughes A; Desombre ER
TI - Cytotoxicity of 125I-oestrogen decay in non-oestrogen receptor-expressing human breast cancer cells, MDA-231 and oestrogen receptor-expressing MCF-7 cells.
SO - Int J Radiat Biol 2001 Sep;77(9):955-62
AD - Northern Illinois University, Department of Biological Sciences, DeKalb, IL 60115, USA. email@example.com
PURPOSE: To compare the cytotoxicity of 125I-oestrogen (E-17alpha[125I]iodovinyl-11betamethoxyoestradiol or 125IVME2) decay accumulation in human breast adenocarcinoma cells that do not express oestrogen receptor (ER) (MDA-231 cells) with human breast adenocarcinoma cells that do express ER (MCF-7 cells). MATERIALS AND METHODS: MDA-231 cells were labelled with 125IVME2 or [125I]iododeoxyuridine (125IdU), frozen for decay accumulation, thawed and then plated for colony formation. gamma-irradiation survival was also determined. A whole-cell 3H-oestrogen-binding assay and a specific-binding assay were used to detect ER. RESULTS: No MDA-231 cell killing by accumulated 125IVME2 decays (up to 440 dpc) was observed but ER-positive MCF-7 cells were killed by 125IVME2 (D(o)=28 dpc). MDA-231 cells were not significantly more radioresistant to gamma-rays (D(o)=1.7Gy for MDA-231 cells; 1 Gy for MCF-7 cells) or to 125IdU decays (D(o)= 44dpc for MDA-231 cells; 30 dpc for MCF-7 cells). No ER were detected in MDA-231 cells. CONCLUSIONS: ER-negative cells, MDA-231, are not killed by 125IVME2 decay accumulation. It is speculated that without ER (required to translocate the 125IVME2 to its nuclear target), formation of the 125IVME2-ER-DNA oestrogen-response element (ERE) complex and subsequent specific irradiation of the DNA at the ERE cannot occur. These results support the hypothesis that the nuclear genome is a critical target for radiation-induced cell death.
UI - 21415897
AU - Aapro MS
TI - Adjuvant therapy of primary breast cancer: a review of key findings from
SO - Oncologist 2001;6(4):376-85
AD - Clinique de Genolier, Switzerland. firstname.lastname@example.org
Breast cancer research has developed at a rapid pace over the last decades. Recent discoveries promise to provide individualized treatment options, increased long-term survival for women with breast cancer, and the possibility of moving toward curative intent in the treatment of advanced breast cancer. Age, race, tumor size, histological tumor type, axillary nodal status, standardized pathological grade, and hormone-receptor status are accepted as established prognostic and/or predictive factors for selection of systemic adjuvant treatment of breast cancer. The role of other promising new factors, such as p53 mutations, HER-2 status, plasminogen activator system, histological evidence of vascular invasion, and quantitative parameters of angiogenesis will be determined in ongoing prospective studies. Currently, 5 years' treatment with adjuvant tamoxifen in women with hormone-positive receptor status, is regarded as the optimal duration of treatment. Long-term follow-up on the randomized trials will determine the added benefit of treatment beyond 5 years. Ovarian ablation has shown a reduction in recurrence and death, and the exact role and extent of adjuvant chemotherapy in premenopausal women with hormone-responsive tumors is under discussion. Combination hormonal and chemo-hormonal therapies are also being evaluated. There are no convincing data on the survival impact of tamoxifen as a preventative therapy for breast cancer: longer-term follow-up is required, and the planned meta-analyses in 2005 should help shed light on this issue. Statistically significant benefits have been observed with adjuvant chemotherapy (particularly with anthracycline-containing regimens in premenopausal women) versus no adjuvant chemotherapy. The optimal length of adjuvant anthracycline/cyclophosphamide (AC) regimens needs further evaluation as do randomized comparisons of AC to cyclophosphamide/ doxorubicin/5-fluorouracil (5-FU) and cyclophosphamide/epirubicin/5-FU. Although taxanes promise to provide an additive benefit to adjuvant chemotherapy regimens, the Cancer and Leukemia Group B 9344 and the National Surgical Adjuvant Breast and Bowel Project B-28 studies evaluating paclitaxel in the adjuvant setting have not yet demonstrated statistically significant benefits on disease-free survival and overall survival. In the year 2000, all adjuvant therapy studies conducted by the Co-operative Groups in both node-negative and node-positive disease involve a taxane. High-dose chemotherapy evaluations are still ongoing. The numerous prospective adjuvant therapy trials (hormonal; selective estrogen-receptor modulators; aromatase inhibitors; chemotherapy, involving anthracyclines/taxanes/platinum/trastuzumab; biological factors; elderly women (>70 years); high-risk patients; radiotherapy in 1-3 positive lymph nodes), and neoadjuvant studies might further define the chances to enhance cure rates in the treatment of primary breast cancer.
UI - 21444205
AU - Jamal N; Das KR
TI - Measurement of dose to the contralateral breast during radiation therapy for breast cancer: reduction by the use of superflab.
SO - Australas Phys Eng Sci Med 2001 Jun;24(2):102-5
AD - Malaysian Institute for Nuclear Technology Research, Kajang.
The effect of radiation in regard to breast carcinogenesis is well studied and analysed from data from atomic bomb survivors, patients treated for acute mastitis and tuberculosis patients monitored by fluoroscopy. Therefore the radiation received by the untreated breast during breast irradiation of the other breast, is of concern to clinicians. Using thermoluminescence dosimeters, we have measured the dose received by contraleteral breast of six patients during radiation therapy. Most of the dose received will be from the collimator scatter and leakage. We investigated the effect of an absorber, superflab, in reducing the skin dose to contralateral breast. With the overlaying of a cm superflab on the breast, the skin (surface) dose could be reduced by 40-75% of its original value. This is an effective and practical method of reducing significantly the dose to contralateral breast during breast conservation therapy. Superflab can be made conveniently at low cost.
UI - 81141724
AU - Levitt SH; Potish RA
TI - The role of radiation therapy in the treatment of breast cancer: the use and abuse of clinical trials, statistics and unproven hypotheses.
SO - Int J Radiat Oncol Biol Phys 1980 Jul;6(7):791-8
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