Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer
| Autor: | S. Stevenson, Xuejun Gu, Rachel Wooldridge, Howard E. Morgan, Sally Goudreau, Yuanyuan Zhang, Chuxiong Ding, Barbara Haley, Ann Spangler, Roshni Rao, Ryan Jones, Dan Garwood, Robert Timmerman, Sarah Neufeld, Kevin Albuquerque, Jason Staley, Aeisha Rivers, Bo Zhao, Asal Rahimi, Marilyn Leitch, Dong W. Kim, Chul Ahn, Stephen J. Seiler, Prasanna G. Alluri |
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| Rok vydání: | 2020 |
| Předmět: |
Cancer Research
medicine.medical_specialty Esthetics medicine.medical_treatment Breast Neoplasms 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Breast cancer McNemar's test Cyberknife medicine Humans Radiology Nuclear Medicine and imaging Stage (cooking) Aged Neoplasm Staging Radiation business.industry Lumpectomy Partial Breast Irradiation Cosmesis Middle Aged medicine.disease Treatment Outcome Oncology 030220 oncology & carcinogenesis Cohort Female Radiology Dose Fractionation Radiation business |
| Zdroj: | International journal of radiation oncology, biology, physics. 110(3) |
| ISSN: | 1879-355X |
| Popis: | Our purpose was to evaluate cosmetic changes after 5-fraction adjuvant stereotactic partial breast irradiation (S-PBI).Seventy-five women with in situ or invasive breast cancer stage 0, I, or II, with tumor size ≤3 cm, were enrolled after lumpectomy in a phase 1 dose escalation trial of S-PBI into cohorts receiving 30, 32.5, 35, 37.5, or 40 Gy in 5 fractions. Before S-PBI, 3 to 4 gold fiducial markers were placed in the lumpectomy cavity for tracking with the Synchrony respiratory tracking system. S-PBI was delivered with a CyberKnife robotic radiosurgery system. Patients and physicians evaluated global cosmesis using the Harvard Breast Cosmesis Scale. Eight independent panelists evaluated digital photography for global cosmesis and 10 subdomains at baseline and follow-up. McNemar tests were used to evaluate change in cosmesis, graded as excellent/good or fair/poor, from baseline to year 3. Wilcoxon signed rank tests were used to evaluate change in subdomains. Cohen's kappa (κ) statistic was used to estimate interobserver agreement (IOA) between raters, and Fleiss' κ was used to estimate IOA between panelists.Median cosmetic follow-up was 5, 5, 5, 4, and 3 years for the 30, 32.5, 35, 37.5, and 40 Gy cohorts. Most patients reported excellent/good cosmesis at both baseline (86.3%) and year 3 (89.8%). No dose cohort had significantly worsened cosmesis by year 3 on McNemar analysis. No cosmetic subdomain had significant worsening by year 3. IOA was fair for patient-physician (κ = 0.300, P.001), patient-panel (κ = 0.295, P.001), physician-panel (κ = 0.256, P.001), and individual panelists (Fleiss κ = 0.327, P.001).Dose escalation of S-PBI from 30 to 40 Gy in 5 fractions for early stage breast cancer was not associated with a detectable change in cosmesis by year 3. S-PBI is a promising modality for treatment of early stage breast cancer. |
| Databáze: | OpenAIRE |
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