Re-irradiation: New Frontiers
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Due attention is paid to the exciting developments in the fields of proton irradiation and frameless image-guided ablative radiotherapy.
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The book documents fully how refined combined modality approaches and significant technical advances in radiation treatment planning and delivery have facilitated the re-irradiation of previously exposed volumes, allowing both palliative and curative approaches to be pursued at various disease sites. Professionals involved in radiation treatment planning and multimodal oncology treatment will find it to be an invaluable aid in understanding the benefits and limitations of re-irradiation and in designing prospective trials.
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Target Volume Definition in Radiation Oncology. Decision Tools for Radiation Oncology. Radiation Oncology Free Preview. Provides a comprehensive overview on current re-irradiation strategies Discusses re-irradiation methods, technical aspects, the role of combined therapy, and normal tissue tolerance Documents recent important developments and clinical results Assists professionals in understanding the benefits and limitations of re-irradiation and in designing prospective trials see more benefits.
Buy eBook. Buy Hardcover. Buy Softcover. FAQ Policy. About this book This book, now in its second edition, provides a comprehensive overview of current re-irradiation strategies, with detailed discussion of re-irradiation methods, technical aspects, the role of combined therapy with anticancer drugs and hyperthermia, and normal tissue tolerance. Show all. Acute toxicity consisted mainly of mild induration of the tumor bed, and there were no instances of grade 3 or 4 toxicity.
Interestingly, in comparison to our study, a larger median size applicator was used to treat the lumpectomy cavity median 4. While both of our cohorts are small, the difference in our reported experiences highlights the importance of applicator selection. Larger applicator selection may help to optimize apposition of the applicator against surrounding breast tissue and improve dose homogeneity at the tissue—applicator interface.
There are a number of single-institution studies that have reported on the toxicity and outcomes of PBrI. Deutsch et al. To date, however, there is no clear optimal delivery technique or dose fractionation. Four patients underwent subsequent mastectomy, two for a subsequent IBTR, one for a non-healing wound and another patient who underwent bilateral mastectomy after discovery of contralateral disease They describe grade 1 late toxicity greater than 1 year from treatment in Comparable to the 3-year toxicity data from RTOG , we observed a significant number of grade 2 and 3 toxicities in the late setting.
The major limitations of this study include the retrospective nature of our data with limited follow-up to observe further delayed toxicities and recurrences. Given the small sample population of our study, it is difficult to draw conclusions regarding the differences in toxicity between our PBrI experience and previously published studies.
Finally, we did not report on patient satisfaction and quality of life in our study. The pursuit of breast-conservation was driven mainly by patient preference, and ultimately the low-grade toxicities we observed with breast conservation may be outweighed by the success of breast preservation. Breast-conserving surgery with IORT is a feasible salvage option for patients desiring breast conservation after prior thoracic radiation; however, continued follow-up of these patients is warranted given the incidence of delayed treatment toxicity.
Further studies are needed to determine optimal treatment strategy, dose, and dose fractionation for PBrI. Each of the listed authors contributed to the completion of this submission. Both CC and PJ worked on data collection and drafting of the final manuscript.
Re-Irradiation: New Frontiers by Carsten Nieder, Johannes Langendijk | Waterstones
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Effect of radiotherapy after breast-conserving surgery on year recurrence and year breast cancer death: meta-analysis of individual patient data for 10, women in 17 randomised trials.
Lancet — 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 — Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer. Breast Cancer Res Treat — Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery.
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Br J Surg —7. Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol —8. Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in patients.
Cancer — Is breast conservation after local recurrence feasible? Eur J Cancer —4. Breast Cancer — The prognostic significance of late local recurrence after breast-conserving therapy. Ipsilateral breast tumor recurrence after breast conservation therapy: outcomes of salvage mastectomy vs.
Prognosis after mastectomy versus repeat lumpectomy in patients with ipsilateral breast cancer recurrence: a propensity score analysis.
Eur J Surg Oncol — Repeat breast-conserving surgery for in-breast local breast carcinoma recurrence: the potential role of partial breast irradiation. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Accelerated partial breast irradiation: 5-year results of the German-Austrian multicenter phase II trial using interstitial multicatheter brachytherapy alone after breast-conserving surgery.
Intraoperative radiotherapy versus external radiotherapy for early breast cancer ELIOT : a randomised controlled equivalence trial. Lancet Oncol — Multicentricity of breast cancer: whole-organ analysis and clinical implications. Br J Cancer —4.
Deutsch M. Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Radiother Oncol — Locally recurrent breast cancer: pulse dose rate brachytherapy for repeat irradiation following lumpectomy — a second chance to preserve the breast. Radiology —8.