Hypofractionated whole breast irradiation for patients with large breasts: A randomized trial comparing prone and supine positions

Background and purpose

Comparison of acute toxicity of whole-breast irradiation (WBI) in prone and supine positions.

Materials and methods

This non-blinded, randomized, prospective, mono-centric trial was undertaken between December 29, 2010, and December 12, 2012. One hundred patients with large breasts were randomized between supine multi beam (MB) and prone tangential field (TF) intensity modulated radiotherapy (IMRT). Dose–volume parameters were assessed for the breast, heart, left anterior descending coronary artery (LAD), ipsilateral lung and contralateral breast. The primary endpoint was acute moist skin desquamation. Secondary endpoints were dermatitis, edema, pruritus and pain.

Results

Prone treatment resulted in: improved dose coverage (p < 0.001); better homogeneity (p < 0.001); less volumes of over-dosage (p = 0.001); reduced acute skin desquamation (p < 0.001); a 3-fold decrease of moist desquamation p = 0.04 (chi-square), p = 0.07 (Fisher’s exact test)); lower incidence of dermatitis (p < 0.001), edema (p = 0.005), pruritus (p = 0.06) and pain (p = 0.06); 2- to 4-fold reduction of grades 2–3 toxicity; lower ipsilateral lung (p < 0.001) and mean LAD (p = 0.007) dose; lower, though statistically non-significant heart and maximum LAD.

Conclusions

This study provides level I evidence for replacing the supine standard treatment by prone IMRT for whole-breast irradiation in patients with large breasts. A confirmatory trial in a multi-institutional setting is warranted.     

Late normal tissue effects in the arm and shoulder following lymphatic radiotherapy: Results from the UK START (Standardisation of Breast Radiotherapy) trials

Background and purpose

Adjuvant lymphatic radiotherapy (LNRT) is recommended for selected axillary node positive women with early breast cancer. We investigated whether hypofractionated LNRT is safe combined with similarly-hypofractionated breast/chest wall radiotherapy (RT).

c-erbB-2 and c-erbA-1 (ear-1) Gene Amplification and c-erbB-2 Protein Expression in Japanese Breast Cancers: Their Relationship to the Histology and Other Disease Parameters

We studied c- erb B-2 and c- erb A-1 ( ear -1) gene amplification, and c- erb B-2 protein expression in 123 primary Japanese breast cancers. c- erb B-2 amplification was found in 19 of the 123 tumors (15%), and c- erb A-1 was coamplified in 7 of the 19. The presence or absence of c- erb B-2 amplification correlated with the grade of cellular atypism ( P = 0.008), or that of mitotic index ( P = 0.002), but not with the histologic types. The tumor size ( P = 0.04) and the lymph node status ( P = 0.06) were associated, but the patients' age, the TNM stage, or the presence or absence of estrogen or progesterone receptors was not associated, with c- erb B-2 amplification. There were no differences in the histologic type, cellular atypism, mitotic index, and other disease parameters between tumors with c- erb B-2 amplification only and those with coamplification of c- erb B-2 and c- erb A-1. Paraffin sections from all 19 tumors with c- erb B-2 amplification, and those from only one of 104 tumors without the amplification were positively stained with polyclonal anti-c- erb B-2 protein antibody. Since the correlation between the amplification and the protein expression was excellent, such immunohistochemical studies may be substituted for the time-consuming DNA studies using Southern blotting.     

乳腺癌保乳术后俯卧位与仰卧位放疗危及器官剂量比较的Meta分析

目的 探讨乳腺癌保乳术后采用俯卧位与仰卧位放疗危及器官的剂量差异,为临床实践提供证据。方法 制定严格的纳入和排除标准,全面检索PubMed、FMJS、CHKD和万方全文数据库。纳入乳腺癌保乳术后俯卧位与仰卧位危及器官剂量对比的相关研究。统计学处理采用Cochrane协作网提供的RevMan5.2统计软件计算标准化均差及其95%可信区间。结果 共检索到267篇文献,经评价后最终16个研究442例乳腺癌患者符合本系统评价的纳入标准。Meta分析结果显示：乳腺癌保乳术后患者采用俯卧位放疗患侧肺（SMD=-4.36,95%CI：-5.41~-3.31,P<0.001）和心脏（SMD=-0.24,95%CI：-0.4~-0.09,P<0.05）受照剂量明显低于仰卧位;对侧乳腺受照剂量在两种体位间差异无统计学意义（SMD=0.19,95%CI：-0.02~0.40,P>0.05）。结论 与仰卧位相比,乳腺癌保乳术后俯卧位放疗可明显降低心脏和患侧肺的受照剂量。     

Women Who Are Young,Non‐White,and with Lower Socioeconomic Status Report Higher Financial Toxicity up to 1 Year After Breast Cancer Surgery: A Mixed‐Effects Regression Analysis

PurposeWe examined self‐reported financial toxicity and out‐of‐pocket expenses among adult women with breast cancer.MethodsPatients spoke English, Spanish, or Mandarin Chinese, were aged 18+ years, had stage I–IIIA breast cancer, and were eligible for breast‐conserving and mastectomy surgery. Participants completed surveys about out‐of‐pocket costs and financial toxicity at 1 week, 12 weeks, and 1 year postsurgery.ResultsThree hundred ninety‐five of 448 eligible patients (88.2%) from the parent trial completed surveys. Excluding those reporting zero costs, crude mean ± SD out‐of‐pocket costs were $1,512 ± $2,074 at 1 week, $2,609 ± $6,369 at 12 weeks, and $3,308 ± $5,000 at 1 year postsurgery. Controlling for surgery, cancer stage, and demographics with surgeon and clinic as random effects, higher out‐of‐pocket costs were associated with higher financial toxicity 1 week and 12 weeks postsurgery (p < .001). Lower socioeconomic status (SES) was associated with lower out‐of‐pocket costs at each time point (p = .002–.013). One week postsurgery, participants with lower SES reported financial toxicity scores 1.02 points higher than participants with higher SES (95% confidence interval [CI], 0.08–1.95). Black and non‐White/non‐Black participants reported financial toxicity scores 1.91 (95% CI, 0.46–3.37) and 2.55 (95% CI, 1.11–3.99) points higher than White participants. Older (65+ years) participants reported financial toxicity scores 2.58 points lower than younger (<65 years) participants (95% CI, −3.41, −1.74). Younger participants reported significantly higher financial toxicity at each time point.DiscussionYounger age, non‐White race, and lower SES were associated with higher financial toxicity regardless of costs. Out‐of‐pocket costs increased over time and were positively associated with financial toxicity. Future work should reduce the impact of cancer care costs among vulnerable groups.Implications for PracticeThis study was one of the first to examine out‐of‐pocket costs and financial toxicity up to 1 year after breast cancer surgery. Younger age, Black race, race other than Black or White, and lower socioeconomic status were associated with higher financial toxicity. Findings highlight the importance of addressing patients’ financial toxicity in several ways, particularly for groups vulnerable to its effects.