Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial
Bosma, Sophie C J; van der Leij, Femke; Vreeswijk, Sandra; Maaker, Michiel de; Wesseling, Jelle; Vijver, Marc van de; Scholten, Astrid; Rivera, Sofia; Bourgier, Celine; Auzac, Guillaume; Foukakis, Theodoros; Lekberg, Tobias; Bongard, Desiree; Loo, Claudette; Rutgers, Emiel; Bartelink, Harry; Elkhuizen, Paula H M
(2020) International Journal of Radiation Oncology Biology Physics, volume 106, issue 5, pp. 958 - 967
(Article)
Abstract
PURPOSE: In this multicenter phase 2 feasibility study, we investigated the impact of preoperative accelerated partial breast irradiation (PAPBI) on local control, breast fibrosis, and cosmetic outcome. METHODS AND MATERIALS: Women aged >60 years with an invasive, unifocal (mammography and magnetic resonance imaging), nonlobular adenocarcinoma of the breast were treated
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with PAPBI. Six weeks after radiation therapy, a wide local excision was performed. Radiation therapy consisted of 10 × 4 Gy (2010-2013) or 5 × 6 Gy (after 2013) to the tumor (gross target volume) with a 25 mm margin (20 mm from gross target volume to clinical target volume, 5 mm planning target volume). RESULTS: One hundred thirty-three patients treated between 2010 and 2016 were analyzed with a median follow-up of 5.0 years (0.9-8.8 years). Seventy-eight (59%) patients were treated with 10 × 4 Gy in 2 weeks and 55 (41%) patients with 5 × 6 Gy in 1 week. Eighteen postoperative complications (14%) occurred in 15 patients (11%). The proportion of patients with no to mild fibrosis in the treated part of the breast at 2 years and later time points was around 90%. Cosmesis improved over time in several patients: excellent to good cosmetic score as rated by the physician was 68% at 6 months and 92% at 5 years. Seventy-seven percent (6 months) to 82% (5 years) of patients were "satisfied" or "very satisfied" with their cosmetic outcome. Three recurrences were detected in the biopsy track and 1 recurrence in the ipsilateral breast. CONCLUSIONS: PAPBI is a feasible method with a low postoperative complication rate, limited fibrosis, and good to excellent cosmetic outcome. The local recurrence rate was 3% at 5 years; however, no local recurrences were observed since removal of the needle biopsy track.
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Keywords: Aged, Aged, 80 and over, Breast Neoplasms/pathology, Cosmetics, Feasibility Studies, Female, Fibrosis, Humans, Middle Aged, Neoplasm Metastasis, Preoperative Period, Radiotherapy Dosage, Survival Analysis, Treatment Outcome, Radiation, Oncology, Radiology Nuclear Medicine and imaging, Cancer Research, Research Support, Non-U.S. Gov't, Multicenter Study, Clinical Trial, Phase II, Journal Article
ISSN: 0360-3016
Publisher: Elsevier Inc.
Note: Funding Information: This study was financially supported by the Dutch Cancer Society-KWF grant NKI 2009-4389 and the Cancer Society in Stockholm. Publisher Copyright: © 2020 Elsevier Inc.
(Peer reviewed)