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Abramson Cancer CenterNCI CANCERLIT® Search: Radiotherapy for Breast Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
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. w-small@northwestern.edu
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.
2
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.
3
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.
4
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.
5
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
6
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
7
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
8
UI - 21323974
AU - Koc M; Capoglu I; Unuvar N
TI -
Does the tamoxifen increase thyroid dysfunction after loco-regional
irradiation of breast cancer?
SO - Radiother Oncol 2001 Jun;59(3):361-2
9
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.
anatting@mcw.edu
10
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.
11
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. lyasui@niu.edu
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.
12
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. aapro@cdg.ch
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.
13
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.
14
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
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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