Fractionation trends in breast cancer and implications in partial breast irradiation

Abstract

Purpose/objectives

The aim of this study is to analyze the national trends in breast radiotherapy fractionation over the past decade.

Methods/materials

The National Cancer Database was queried for women with pTis-pT3pN0, cM0 breast carcinoma (ductal or lobular) treated with breast conserving surgery and radiotherapy (RT) from 1998 to 2012. Patients were grouped by number of radiotherapy fractions into four groups: conventional fractionation (ConvFx, 25–33 fractions), hypofractionation (HypoFx, 15–24 fractions), accelerated partial breast RT (APBI, 10 fractions), and intraoperative RT (IORT, 1 fraction on the day of surgery). Patients with alternative schedules were excluded. Trends were analyzed graphically, and univariable and multivariable (MVA) analyses were performed to investigate factors associated with the receipt of APBI or IORT.

Results

A total of 371,145 patients met inclusion criteria. Trends analysis demonstrates a clear increase in APBI from 1998 to 2008, at which point hypofractionation became increasingly popular and APBI stabilized. Among APBI patients (n = 5787), the predominant RT modality was HDR brachytherapy (71%). On MVA, several factors were associated with APBI over other fractionations (all p < 0.001): later year of diagnosis, older age, ductal histology, smaller tumors, estrogen receptor positivity, lower grade, and increased patient distance from treating facility (OR 2.16 if over 100 mi). Similar factors were associated with the receipt of IORT, including patients living a further distance from the hospital (OR 8.18 if over 100 mi).

Conclusions

While APBI utilization increased sharply from 2000 to 2008, the use of APBI has stabilized since 2008 with a concomitant increase in use of hypofractionation. The causes of these trends are unknown but should be the focus of future research.

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Improved infield response rates and overall survival in patients with metastatic melanoma receiving higher biological equivalent doses of radiation with ipilimumab

Abstract

Objective

There is a growing body of evidence that combining radiotherapy with ipilimumab might improve the survival and response rates in patients with metastatic melanoma. However, the patient and treatment variables that predict for improved outcomes have not been well defined.

Methods

We conducted a retrospective analysis of 69 patients treated with ipilimumab and radiotherapy for metastatic melanoma at a single institution from May 2011 to June 2015. Demographic, clinical, and treatment factors were recorded, and end points of interest included infield and global complete response (CR) after the completion of radiation and ipilimumab based on the RECIST criteria (v1.1), and overall survival (OS). A bivariate and multivariate analysis was then performed to assess the relationship between outcomes and patient variables.

Results

In the multivariate analysis, infield CR was significantly associated with completing a full course of ipilimumab, a higher BED, and a smaller size of metastatic area treated. Global CR was significantly associated with increased age and giving radiotherapy to all areas of disease. OS was significantly associated with completing a full course of ipilimumab and a higher BED. Interestingly, after a multivariate analysis, higher BED was associated with an improved infield CR (p = 0.0281) and was not associated with an improved global CR (p = 0.5284) but was marginally associated with improved OS (p = 0.0545).

Conclusion

Our findings suggest that the rate of a global CR is independent of the dose of radiation given, but the rate of infield CR and OS might improve with higher doses.

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Breast and pleuropulmonary metastasis of multirecurrent scalp dermatofibrosarcoma protuberans: a case report

Dermatofibrosarcoma protuberans is a rare tumor, representing about 0.1% of skin malignant tumors. It is characterized by local aggressiveness with significant potential for recurrence. Although metastasis is ...

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Cerebral infarction in cervical plexus block

Carotid endarterectomy (CEA) is indicated for the treatment of caroid artery disease [1,2], in which the artery becomes narrow. We have sometimes performed a cervical plexus block (CPB) to achieve the better postoperative analgesia [3]. Cerebral infraction occurred during the procedure of the CPB in this time. Such the case has not been reported until now. In case, a 73-year-old female, with a history of diabetes, underwent a right CEA due to atherosclerosis at the right carotid bifurcation. After a general anesthesia (propofol, fentanyl and rocuronium), we performed a prescan of the CPB.

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Preoperative risk stratification of critically ill patients

Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure.

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Peering over the Chasm: Diffusion of Prostate Radiotherapy Hypofractionation

Publication date: Available online 8 April 2017
Source:Practical Radiation Oncology
Author(s): Mark K Buyyounouski




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"p53 Polymorphism at Codon 72 and Breast Cancer" - Letter.

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"p53 Polymorphism at Codon 72 and Breast Cancer" - Letter.

J Cancer Prev. 2017 Mar;22(1):55

Authors: Afzaljavan F, Pasdar A

PMID: 28382287 [PubMed - in process]

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