Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: prospective randomized study.
APBI
Adjuvant radiotherapy
Early breast cancer
External beam radiotherapy
Surgical bed
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
03 Feb 2024
03 Feb 2024
Historique:
received:
28
11
2023
accepted:
29
01
2024
medline:
4
2
2024
pubmed:
4
2
2024
entrez:
3
2
2024
Statut:
epublish
Résumé
Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. Early breast cancer patients after partial mastectomy were equally randomized into two arms- external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21-45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. NCT06007118.
Sections du résumé
BACKGROUND
BACKGROUND
Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects.
METHODS
METHODS
Early breast cancer patients after partial mastectomy were equally randomized into two arms- external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation.
RESULTS
RESULTS
The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21-45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy.
CONCLUSION
CONCLUSIONS
External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice.
TRIAL REGISTRATION
BACKGROUND
NCT06007118.
Identifiants
pubmed: 38310249
doi: 10.1186/s13014-024-02412-x
pii: 10.1186/s13014-024-02412-x
doi:
Banques de données
ClinicalTrials.gov
['NCT06007118']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
17Subventions
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI 00209805
Organisme : Ministerstvo Školství, Mládeže a Tělovýchovy
ID : LM2023049
Organisme : Ministerstvo Školství, Mládeže a Tělovýchovy
ID : CZ.02.1.01/0.0/0.0/16_013/0001674
Informations de copyright
© 2024. The Author(s).
Références
Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16.
pubmed: 22019144
doi: 10.1016/S0140-6736(11)61629-2
Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al. The UK standardisation of breast radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14:1086–94.
pubmed: 24055415
doi: 10.1016/S1470-2045(13)70386-3
Whelan TJ, Pignol J-P, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.
pubmed: 20147717
doi: 10.1056/NEJMoa0906260
Greenup RA, Camp MS, Taghian AG, Buckley J, Coopey SB, Gadd M, et al. Cost comparison of radiation treatment options after lumpectomy for breast cancer. Ann Surg Oncol. 2012;19:3275–81.
pubmed: 22851048
doi: 10.1245/s10434-012-2546-5
Strnad V, Polgár C, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, et al. Accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy compared with whole-breast irradiation with boost for early breast cancer: 10-year results of a GEC-ESTRO randomised, phase 3, non-inferiority trial. Lancet Oncol. 2023;24:262–72.
pubmed: 36738756
doi: 10.1016/S1470-2045(23)00018-9
Coles CE, Griffin CL, Kirby AM, Titley J, Agrawal RK, Alhasso A, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet. 2017;390:1048–60.
pubmed: 28779963
pmcid: 5594247
doi: 10.1016/S0140-6736(17)31145-5
Whelan TJ, Julian JA, Berrang TS, Kim DH, Germain I, Nichol AM, et al. External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial. Lancet. 2019;394:2165–72.
pubmed: 31813635
doi: 10.1016/S0140-6736(19)32515-2
Vicini FA, Cecchini RS, White JR, Arthur DW, Julian TB, Rabinovitch RA, et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. Lancet. 2019;394:2155–64.
pubmed: 31813636
pmcid: 7199428
doi: 10.1016/S0140-6736(19)32514-0
Haussmann J, Budach W, Corradini S, Krug D, Jazmati D, Tamaskovics B et al. Comparison of adverse events in partial- or whole breast radiotherapy: investigation of cosmesis, toxicities and quality of life in a meta-analysis of randomized trials. Radiat Oncol. 2023;18.
Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based Consensus Statement. Pract Radiat Oncol. 2017;7:73–9.
pubmed: 27866865
doi: 10.1016/j.prro.2016.09.007
Strnad V, Major T, Polgar C, Lotter M, Guinot JL, Gutierrez-Miguelez C, et al. ESTRO-ACROP guideline: interstitial multi-catheter breast brachytherapy as accelerated partial breast irradiation alone or as boost - GEC-ESTRO breast Cancer Working Group practical recommendations. Radiother Oncol. 2018;128:411–20.
pubmed: 29691075
doi: 10.1016/j.radonc.2018.04.009
Strnad V, Krug D, Sedlmayer F, Piroth MD, Budach W, Baumann R, et al. DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol. 2020;196:749–63.
pubmed: 32350554
pmcid: 7449998
doi: 10.1007/s00066-020-01613-z
Hepel JT, Tokita M, MacAusland SG, Evans SB, Hiatt JR, Price LL, et al. Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2009;75:1290–6.
pubmed: 19395195
doi: 10.1016/j.ijrobp.2009.01.009
Jagsi R, Ben-David MA, Moran JM, Marsh RB, Griffith KA, Hayman JA, et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:71–8.
pubmed: 19409733
pmcid: 4414125
doi: 10.1016/j.ijrobp.2009.01.041
Olivotto IA, Whelan TJ, Parpia S, Kim DH, Berrang T, Truong PT, et al. Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. 2013;31:4038–45.
pubmed: 23835717
doi: 10.1200/JCO.2013.50.5511
Purdie TG, Bissonnette JP, Franks K, Bezjak A, Payne D, Sie F, et al. Cone-beam computed tomography for on-line image guidance of lung stereotactic radiotherapy: localization, verification, and intrafraction tumor position. Int J Radiat Oncol Biol Phys. 2007;68:243–52.
pubmed: 17331671
doi: 10.1016/j.ijrobp.2006.12.022
Bergom C, Currey A, Desai N, Tai A, Strauss JB. Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation. Front Oncol. 2018;8 APR.
Latty D, Stuart KE, Wang W, Ahern V. Review of deep inspiration breath-hold techniques for the treatment of breast cancer. J Med Radiat Sci. 2015;62:74–81.
pubmed: 26229670
pmcid: 4364809
doi: 10.1002/jmrs.96
Otto K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys. 2008;35:310–7.
pubmed: 18293586
doi: 10.1118/1.2818738
Yan Y, Yadav P, Bassetti M, Du K, Saenz D, Harari P, et al. Dosimetric differences in flattened and flattening filter-free beam treatment plans. J Med Phys. 2016;41:92–9.
pubmed: 27217620
pmcid: 4871009
doi: 10.4103/0971-6203.181636
Schmidhalter D, Fix MK, Wyss M, Schaer N, Munro P, Scheib S et al. Evaluation of a new six degrees of freedom couch for radiation therapy. Med Phys. 2013;40.
Haviland JS, Hopwood P, Mills J, Sydenham M, Bliss JM, Yarnold JR. Do patient-reported outcome measures agree with clinical and photographic assessments of normal tissue effects after breast Radiotherapy? The experience of the standardisation of breast radiotherapy (START) trials in early breast Cancer. Clin Oncol (R Coll Radiol). 2016;28:345–53.
pubmed: 26868286
doi: 10.1016/j.clon.2016.01.011
Ong CL, Verbakel WFAR, Cuijpers JP, Slotman BJ, Lagerwaard FJ, Senan S. Stereotactic radiotherapy for peripheral lung tumors: a comparison of volumetric modulated arc therapy with 3 other delivery techniques. Radiother Oncol. 2010;97:437–42.
pubmed: 21074878
doi: 10.1016/j.radonc.2010.09.027
Livi L, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51:451–63.
pubmed: 25605582
doi: 10.1016/j.ejca.2014.12.013
Piroth MD, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R et al. Heart toxicity from breast cancer radiotherapy: current findings, assessment, and prevention. Strahlenther Onkol. 2019;195.
Lee BM, Chang AS, Kim SY et al. Risk of radiation pneumonitis following individualized modern radiotherapy with IMRT, a breath-holding technique, and prone positioning for breast cancer. Abstract selected for 2018 Best of ASTRO (November 30-December 1, 2018) from ASTRO’s 60th Annual Meeting (October 21–24, 2018).
Obayomi-Davies O, Kole TP, Oppong B, Rudra S, Makariou EV, Campbell LD et al. Stereotactic Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Rationale, Feasibility, and Early Experience Using the CyberKnife Radiosurgery Delivery Platform. Front Oncol. 2016;6 MAY:23.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.
pubmed: 8433390
doi: 10.1093/jnci/85.5.365
Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol. 1996;14:2756–68.
pubmed: 8874337
doi: 10.1200/JCO.1996.14.10.2756
Bjelic-Radisic V, Cardoso F, Cameron D, Brain E, Kuljanic K, da Costa RA, et al. An international update of the EORTC questionnaire for assessing quality of life in breast cancer patients: EORTC QLQ-BR45. Ann Oncol. 2020;31:283–8.
pubmed: 31959345
doi: 10.1016/j.annonc.2019.10.027
Haloua MH, Marianna N, Krekel A, Johannes G, Jacobs A, Zonderhuis B et al. Cosmetic Outcome Assessment following breast-conserving therapy: a comparison between BCCT.core Software and Panel evaluation. Int J Breast Cancer. 2014;2014.
R Core Team. _R: A Language and Environment for Statistical Computing_. R Foundation for Statistical Computing, Vienna, Austria. 2023. https://www.r-project.org/ . Accessed 15 Feb 2023.
Franceschini D, Loi M, Chiola I, Arculeo S, Marzo M, Fernandes B et al. Preliminary results of a Randomized Study on Postmenopausal Women with early stage breast Cancer: adjuvant hypofractionated whole breast irradiation Versus Accelerated partial breast irradiation (HYPAB Trial). Clin Breast Cancer. 2021;21.
Meattini I, Saieva C, Miccinesi G, Desideri I, Francolini G, Scotti V, et al. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: Health-related quality of life final analysis from the Florence phase 3 trial. Eur J Cancer. 2017;76:17–26.
pubmed: 28262584
doi: 10.1016/j.ejca.2017.01.023
Meattini I, Marrazzo L, Saieva C, Desideri I, Scotti V, Simontacchi G, et al. Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast Cancer: long-term results of the Randomized Phase III APBI-IMRT-Florence Trial. J Clin Oncol. 2020;38:4175–83.
pubmed: 32840419
doi: 10.1200/JCO.20.00650
Colciago RR, La Rocca E, Giandini C, Rejas Mateo A, Bedini N, Capri G, et al. One-week external beam partial breast irradiation: survival and toxicity outcomes. J Cancer Res Clin Oncol. 2023;149:10965–74.
pubmed: 37329461
doi: 10.1007/s00432-023-04973-y
Marrazzo L, Meattini I, Simontacchi G, Livi L, Pallotta S. Updates on the APBI-IMRT-Florence Trial (NCT02104895) technique: from the Intensity Modulated Radiation Therapy Trial to the Volumetric Modulated Arc Therapy Clinical Practice. 2023. https://doi.org/10.1016/j.prro.2022.05.010 .
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet. 2011;378:1707–16.
doi: 10.1016/S0140-6736(11)61629-2
Bartelink H, Horiot J-C, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–87.
pubmed: 11794170
doi: 10.1056/NEJMoa010874
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.
pubmed: 12393820
doi: 10.1056/NEJMoa022152
Veronesi U, Marubini E, Mariani L, Galimberti V, Luini A, Veronesi P, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001;12:997–1003.
pubmed: 11521809
doi: 10.1023/A:1011136326943
Meattini I, Saieva C, Marrazzo L, Di Brina L, Pallotta S, Mangoni M, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy technique compared to whole breast irradiation for patients aged 70 years or older: subgroup analysis from a randomized phase 3 trial. Breast Cancer Res Treat. 2015;153:539–47.
pubmed: 26350524
doi: 10.1007/s10549-015-3565-2
Schäfer R, Strnad V, Polgár C, Uter W, Hildebrandt G, Ott OJ, et al. Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial. Lancet Oncol. 2018;19:834–44.
pubmed: 29695348
doi: 10.1016/S1470-2045(18)30195-5
Polgár C, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, et al. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18:259–68.
pubmed: 28094198
doi: 10.1016/S1470-2045(17)30011-6
Ott OJ, Strnad V, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, et al. GEC-ESTRO multicenter phase 3-trial: accelerated partial breast irradiation with interstitial multicatheter brachytherapy versus external beam whole breast irradiation: early toxicity and patient compliance. Radiother Oncol. 2016;120:119–23.
pubmed: 27422584
doi: 10.1016/j.radonc.2016.06.019
Rodríguez N, Sanz X, Dengra J, Foro P, Membrive I, Reig A, et al. Five-year outcomes, cosmesis, and toxicity with 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2013;87:1051–7.
pubmed: 24161420
doi: 10.1016/j.ijrobp.2013.08.046
Meduri B, Baldissera A, Galeandro M, Donini E, Tolento G, Giacobazzi P, et al. OC-0568: Accelerated PBI VS standard radiotherapy (IRMA trial): interim cosmetic and toxicity results. Radiother Oncol. 2017;123:303.
doi: 10.1016/S0167-8140(17)31008-3
Meattini I, Becherini C, Boersma L, Kaidar-Person O, Marta GN, Montero A, et al. European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer. Lancet Oncol. 2022;23:e21–31.
pubmed: 34973228
doi: 10.1016/S1470-2045(21)00539-8
Shaitelman SF, Anderson BM, Arthur DW, Bazan JG, Bellon JR, Bradfield L, et al. Partial breast irradiation for patients with early-stage invasive breast Cancer or Ductal Carcinoma in situ: an ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2023. https://doi.org/10.1016/J.PRRO.2023.11.001 .
doi: 10.1016/J.PRRO.2023.11.001
pubmed: 37984712
Bonin K, McGuffin M, Presutti R, Harth T, Mesci A, Feldman-Stewart D, et al. Breast Cancer patients’ preferences for Adjuvant Radiotherapy Post Lumpectomy: whole breast irradiation vs. partial breast irradiation-single institutional study. J Cancer Educ. 2018;33:37–43.
pubmed: 26976434
doi: 10.1007/s13187-016-1016-3
Hoopes DJ, Kaziska D, Chapin P, Weed D, Smith BD, Hale ER, et al. Patient preferences and physician practice patterns regarding breast radiotherapy. Int J Radiat Oncol Biol Phys. 2012;82:674–81.
pubmed: 21277106
doi: 10.1016/j.ijrobp.2010.11.077
Qi XS, White J, Li XA. Is α/β for breast cancer really low? Radiother Oncol. 2011;100:282–8.
pubmed: 21367477
doi: 10.1016/j.radonc.2011.01.010
Bentzen SM, Yarnold JR. Reports of unexpected late side-effects of accelerated partial breast irradiation– radiobiological considerations. Int J Radiat Oncol Biol Phys. 2010;77:969.
pubmed: 20610037
pmcid: 2905781
doi: 10.1016/j.ijrobp.2010.01.059
Thomsen MS, Alsner J, Nielsen HM, Jakobsen EH, Nielsen MH, Møller M, et al. Volume matters: breast induration is associated with irradiated breast volume in the Danish breast Cancer Group phase III randomized partial breast irradiation trial. Radiother Oncol. 2022;177:231–5.
pubmed: 36265685
doi: 10.1016/j.radonc.2022.09.024
Coles CE, Aristei C, Bliss J, Boersma L, Brunt AM, Chatterjee S, et al. International guidelines on Radiation Therapy for breast Cancer during the COVID-19 pandemic. Clin Oncol. 2020;32:279–81.
doi: 10.1016/j.clon.2020.03.006
Murray Brunt A, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395:1613–26.
pubmed: 32580883
pmcid: 7262592
doi: 10.1016/S0140-6736(20)30932-6
Vicini F, Broughman J, Halima A, Mayo Z, Obi E, Al-Hilli Z et al. Delivery of Adjuvant Radiation in 5 days or less after lumpectomy for breast Cancer: a systematic review. https://doi.org/10.1016/j.ijrobp.2021.11.026 .
Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, Hahn C et al. Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. 2018. https://doi.org/10.1016/j.prro.2018.01.012 .
Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16:47–56.
pubmed: 25500422
doi: 10.1016/S1470-2045(14)71156-8
Matuschek C, Bölke E, Haussmann J, Mohrmann S, Nestle-Krämling C, Gerber PA et al. The benefit of adjuvant radiotherapy after breast conserving surgery in older patients with low risk breast cancer- a meta-analysis of randomized trials. Radiat Oncol. 2017;12.
Chesney TR, Yin JX, Rajaee N, Tricco AC, Fyles AW, Acuna SA, et al. Tamoxifen with radiotherapy compared with tamoxifen alone in elderly women with early-stage breast cancer treated with breast conserving surgery: a systematic review and meta-analysis. Radiother Oncol. 2017;123:1–9.
pubmed: 28391871
doi: 10.1016/j.radonc.2017.02.019
Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in early breast Cancer. N Engl J Med. 2023;388:585–94.
pubmed: 36791159
doi: 10.1056/NEJMoa2207586
Crivellari D, Spazzapan S, Puglisi F, Fratino L, Scalone S, Veronesi A. Hormone therapy in elderly breast cancer patients with comorbidities. Crit Rev Oncol Hematol. 2010;73:92–8.
pubmed: 19349190
doi: 10.1016/j.critrevonc.2009.02.003
Meattini I, Poortmans PMP, Marrazzo L, Desideri I, Brain E, Hamaker M, et al. Exclusive endocrine therapy or partial breast irradiation for women aged ≥ 70 years with luminal A-like early stage breast cancer (NCT04134598 - EUROPA): Proof of concept of a randomized controlled trial comparing health related quality of life by patient reported outcome measures. J Geriatr Oncol. 2021;12:182–9.
pubmed: 32739355
doi: 10.1016/j.jgo.2020.07.013