Effectiveness of Radiotherapy Techniques After Breast-Conserving Surgery in Patients with Early Breast Cancer
The improvement of early diagnostics of breast cancer has resulted in the increased proportion of early forms of the disease in women with newly diagnosed breast cancer. Enhancement of the existing and development of new breast conserving therapeutic techniques, as well as recurrence-free and total survival rate indices is of current concern. The obligatory radiotherapy for the remaining breast part has been shown to be the gold standard of such treatment.
The authors have analyzed the main current radiation techniques: boost to the tumor bed, radiation of regional metastasis areas. Particular attention is paid to a new technique, which is under study now — accelerated partial breast irradiation (APBI) in some patients. The advantages and disadvantages of these methods using the data of original studies have been presented.
There have been discussed the problems of clipping of a removed tumor bed using titanium wire clips, and the main criteria for selecting patients for accelerated partial breast irradiation.
- Kaprin A.D., Starinskiy V.V., Petrova G.V. Zlokachestvennye novoobrazovaniya v Rossii v 2012 g. (zabolevaemost’ i smertnost’) [Malignancies in Russia in 2012 (morbidity and death rate)]. Moscow; 2014; p. 10–12.
- Baranova M.P. Luchevaya terapiya v organosokhranyayushchem lechenii bol’nykh rakom molochnoy zhelezy I–II–III stadiy. Avtoref. dis. … kand. med. nauk [Radiotherapy in organ preservation treatment in patients with I–II–III stage breast cancer. Abstract of Dissertation for the degree of Candidate of medical science]. Moscow; 2009.
- Vysotskaya I.V., Letyagin V.P., Abashin S.Yu., Pogodina E.M. Lechenie rannikh form raka molochnoy zhelezy [Treatment of early breast cancer]. Moscow; 2000.
- Trofimova O.P., Kondrat’eva A.P. Rol’ luchevoy terapii v kompleksnom lechenii bol’nykh rakom molochnoy zhelezy. V kn.: Klinicheskaya mammologiya. Sovremennoe sostoyanie problemy [The role of radiotherapy in complex treatment of breast cancer patients. In: Clinical mammology. Current state of the problem]. Moscow: GEOTAR-Media; 2006; p. 291–314.
- Clarke M., Collins R., Darby S., Davies C., Elphinstone P., Evans E., et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005 Dec 17; 366(9503): 2087–2106, http://dx.doi.org/10.1016/S0140-6736(05)67887-7.
- Formenti S.C., Arslan A.A., Pike M.C. Re: Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011 Nov 16; 103(22): 1723, http://dx.doi.org/10.1093/jnci/djr406.
- START Trialists’ Group, Bentzen S.M., Agrawal R.K., Aird E.G., Barrett J.M., Barrett-Lee P.J., et al. The UK Standardization of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 2008 Apr; 9(4): 331–341, http://dx.doi.org/10.1016/S1470-2045(08)70077-9.
- START Trialists’ Group, Bentzen S.M., Agrawal R.K., Aird E.G., Barrett J.M., Barrett-Lee P.J., et al. The UK Standardization of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008 Mar 29; 371(9618): 1098–1107, http://dx.doi.org/10.1016/S0140-6736(08)60348-7.
- Whelan T.J., Pignol J.P., Levine M.N., Julian J.A., MacKenzie R., Parpia S., et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010; 362: 513–520, http://dx.doi.org/10.1056/NEJMoa0906260.
- Smith B.D., Bentzen S.M., Correa C.R., Hahn C.A., Hardenbergh P.H., Ibbott G.S., et al. Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Int J Radiat Oncol Biol Phys 2011 Sep 1; 81(1): 59–68, http://dx.doi.org/10.1016/j.ijrobp.2010.04.042.
- Poddubnaya I.V., Komov D.V., Kolyadina I.V. Lokal’nye retsidivy raka molochnoy zhelezy [Local recurrences of breast cancer]. Moscow: Media Medika; 2010.
- Bartelink H., Horiot J.C., Poortmans P.M., Struikmans H., Van den Bogaert W., Fourquet A., et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 2007 Aug 1; 25(22): 3259–3265, http://dx.doi.org/10.1200/JCO.2007.11.4991.
- Goldhirsch A., Wood W.C., Coates A.S., et al. Strategies for subtypes — dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Annals of Oncology 2011, http://dx.doi.org/10.1093/annonc/mdr304.
- NCCN Clinical practice guidelines in oncology. Version 3.2012. http://www.nccn.org.
- Freedman G.M., Fowble B.L., Nicolaou N., Sigurdson E.R., Torosian M.H., Boraas M.C., Hoffman J.P. Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys 2000 Mar 1; 46(4): 805–814.
- Smith B.D., Arthur D.W., Buchholz T.A., Haffty B.G., Hahn C.A., Hardenbergh P.H., et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 2009 Jul 15; 74(4): 987–1001, http://dx.doi.org/10.1016/j.ijrobp.2009.02.031.
- Polgr C., Van Limbergen E., Ptter R., Kovcs G., Polo A., Lyczek J., et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Europen de Curiethrapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010 Mar; 94(3): 264–273, http://dx.doi.org/10.1016/j.radonc.2010.01.014.
- Kirby A.M., Coles C.E., Yarnold J.R. Target volume definition for external beam partial breast radiotherapy: clinical, pathological and technical studies informing current approaches. Radiother Oncol 2010 Mar; 94(3): 255–263, http://dx.doi.org/10.1016/j.radonc.2009.12.010.
- Leonardi M.C., Maisonneuve P., Mastropasqua M.G., Morra A., Lazzari R., Sangalli C., et al. How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology. International Journal of Radiation Oncology Biology Physics 2012 Jul; 83(3): 806–813, http://dx.doi.org/10.1016/j.ijrobp.2011.08.014.
- Cox J.D., Stetz J., Pajak T.F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995 Mar 30; 31(5): 1341–1346.
- AJCC Cancer Staging Manual. Edge S.B., Byrd D.R., Compton C.C., Fritz A.G., Greene F.L., Trotti A. (eds.). New York: Springer; 2010; 649 p.