Sentinel-Node-Driven Personalized Radiation Techniques Ranging from Partial Breast Irradiation to Regional Nodal Radiation after Breast-Conserving Surgery

Kazuhiko Sato, Yoshio Mizuno, Hiromi Fuchikami, Masahiro Kato, Takahiro Shimo, Jun Kubota, Naoko Takeda, Yuko Inoue, Hiroshi Seto, Tomohiko Okawa

Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Tokyo, Japan.
Department of Radiation Oncology, Tokyo- West Tokushukai Hospital, Tokyo, Japan.
Health Evaluation Center, Utsunomiya Memorial Hospital, Tochigi, Japan.
Inoue Ladies Clinic, Tokyo, Japan.
Seto Hospital, Saitama, Japan.

DOI: 10.4236/jct.2013.47A008                

Abstract

Background: Breast-conserving surgery (BCS) followed by whole breast irradiation (WBI) has become the standard of care for treating patients with early-stage breast cancer. Recently, various radiation techniques followed by BCS have been reported. We have been investigating “personalized radiotherapy after BCS” ranging from accelerated partial breast irradiation (APBI) to WBI with regional nodal irradiation (RNI) based on the axillary node status. In this study, we compared different cohorts that received personalized radiotherapy. Method: Of 317 consecutive patients who underwent BCS followed by radiotherapy since November 2007, 187 who received APBI and 122 who received WBI were analyzed. Results: The local-only recurrence rate was 1.1% in the APBI group and 3.3% in the WBI group, and the regional-only recurrence rate was 1.1% for APBI and 0.8% for WBI. Conclusions: The clinical efficacy of APBI for local control after BCS was comparable to that of WBI ± RNI. Although this study was based on a small number of patients with a short follow-up period, the feasibility of breast-conserving therapy using multicatheter brachytherapy to achieve acceptable clinical outcomes was demonstrated.

Keywords

Breast Cancer; Personalized Radiotherapy; Sentinel Node; Partial Breast Irradiation; Regional Nodal Radition

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	B. Fisher, S. Anderson, J. Bryant, et al., “Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer,” The New England Journal of Medicine, Vol. 347, No. 16, 2002, pp. 1233-1241. doi:10.1056/NEJMoa022152
[2]	U. Veronesi, N. Cascinelli, L. Mariani, et al., “TwentyYear Follow-Up of a Randomized Study Comparing Breast-Conserving Surgerywith Radical Mastectomy for Early Breast Cancer,” The New England Journal of Medicine, Vol. 347, No. 16, 2002, pp. 1227-1232. doi:10.1056/NEJMoa020989
[3]	M. Clarke, R. Collins, S. Darby, et al., “Effects of Radiotherapy and of Differences in the Extent of Surgery for Early Breast Cancer on Local Recurrence and 15-Year Survival: An Overview of the Randomised Trials,” Lancet, Vol. 366, No. 9503, 2005, pp. 2087-2106.
[4]	Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), S. Darby, P. McGale, C. Correa, et al., “Effect of Radiotherapy after Breast-Conserving Surgery on 10-Year Recurrence and 15-Year Breast Cancer Death: Meta-Analysis of Individual Patient Data for 10,801 Women in 17 Randomised Trials,” Lancet, Vol. 378, No. 9804, 2011, pp. 1707-1716. doi:10.1016/S0140-6736(11)61629-2
[5]	D. C. Farrow, W. C. Hunt and J. M. Samet, “Geographic Variation in the Treatment of Localized Breast Cancer,” The New England Journal of Medicine, Vol. 326, No. 17, 1992, pp. 1097-1101. doi:10.1056/NEJM199204233261701
[6]	D. A. Lazovich, E. White, D. B. Thomas, et al., “Underutilization of Breast-Conserving Surgery and Radiation Therapy among Women with Stage I or II Breast Cancer,” The Journal of the American Medical Association, Vol. 266, No. 24, 1991, pp. 3433-3438. doi:10.1001/jama.1991. 03470240055032
[7]	B. A. Mann, J. M. Samet, W. C. Hunt, et al., “Changing Treatment of Breast Cancer in New Mexico from 1969 through 1985,” The Journal of the American Medical Association, Vol. 259, No. 23, 1988, pp. 3413-3417. doi:10.1001/jama.1988.03720230023024
[8]	R. Ballard-Barbash, A. L. Potosky, L. C. Harlan, et al., “Factors Associated with Surgical and Radiation Therapy for Early Stage Breast Cancer in Older Women,” Journal of the National Cancer Institute, Vol. 88, No. 23, 1996, pp. 716-726. doi:10.1093/jnci/88.11.716
[9]	W. F. Athas, M. Adams-Cameron, W. C. Hunt, et al., “Travel Distance to Radiation Therapy and Receipt of Radiotherapy Following Breast-Conserving Surgery,” Journal of the National Cancer Institute, Vol. 92, No. 3, 2000, pp. 269-271. doi:10.1093/jnci/92.3.269
[10]	A. T. Schroen, D. R. Brenin, M. D. Kelly, et al., “Impact of Patient Distance to Radiation Therapy on Mastectomy Use in Early-Stage Breast Cancer Patients,” Journal of Clinical Oncology, Vol. 23, No. 28, 2005, pp. 7074-7080. doi:10.1200/JCO.2005.06.032
[11]	B. Fisher, J. Bryant, J. J. Dignam, et al., “Tamoxifen, Radiation Therapy, or Both for Prevention of Ipsilateral Breast Tumor Recurrence after Lumpectomy in Women with Invasive Breast Cancers of One Centimeter or Less,” Journal of Clinical Oncology, Vol. 20, No. 20, 2002, pp. 4141-4149. doi:10.1200/JCO.2002.11.101
[12]	A. W. Fyles, D. R. McCready, L. A. Manchul, et al., “Tamoxifen with or without Breast Irradiation in Women 50 Years of Age or Older with Early Breast Cancer,” The New England Journal of Medicine, Vol. 351, No. 10, 2004, pp. 963-970. doi:10.1056/NEJMoa040595
[13]	K. S. Hughes, L. A. Schnaper, D. Berry, et al., “Lumpectomy plus Tamoxifen with or without Irradiation in Women 70 Years of Age or Older with Early Breast Cancer,” The New England Journal of Medicine, Vol. 351, No. 10, 2004, pp. 971-977.
[14]	B. Fisher and S. Anderson, “Conservative Surgery for the Management of Invasive and Noninvasive Carcinoma of the Breast: NSABP Trials, National Surgical Adjuvant Breast and Bowel Project,” World Journal of Surgery, Vol. 18, No. 1, 1994, pp. 63-69. doi:10.1007/BF00348193
[15]	K. Holli, R. Saaristo, J. Isola, et al., “Lumpectomy with or without Postoperative Radiotherapy for Breast Cancer with Favourable Prognostic Features: Results of a Randomized Study,” British Journal of Cancer, Vol. 84, No. 2, 2001, pp. 164-169. doi:10.1054/bjoc.2000.1571
[16]	G. Liljegren, L. Holmberg, H.-O. Adami, et al., “Sector Resection with or without Postoperative Radiotherapy for Stage I Breast Cancer: Five-Year Results of a Randomized Trial,” Journal of the National Cancer Institute, Vol. 86, No. 9, 1994, pp. 717-722. doi:10.1093/jnci/86.9.717
[17]	R. M. Clark, P. B. McCulloch, M. N. Levine, et al., “Randomized Clinical Trial to Assess the Effectiveness of Breast Irradiation Following Lumpectomy and Axillary Dissection for Node-Negative Breast Cancer,” Journal of the National Cancer Institute, Vol. 84, No. 9, 1992, pp. 683-689. doi:10.1093/jnci/84.9.683
[18]	C. Polgár, Z. Sulyok, J. Fodor, et al., “Sole Brachytherapy of the Tumor Bed after Conservative Surgery for T1 Breast Cancer: Five-Year Results of a Phase I-II Study and Initial Fndings of a Randomized Phase III Trial,” Journal of Surgical Oncology, Vol. 80, No. 3, 2002, pp. 121-128.
[19]	C. Polgár, T. Major, J. Fodor, et al., “High-Dose-Rate Brachytherapy Alone versus Whole Breast Radiotherapy with or without Tumor Bed Boost after Breast-Conserving Surgery: Seven-Year Results of a Comparative Study,” International Journal of Radiation Oncology * Biology Physics, Vol. 60, No. 4, 2004, pp. 1173-1181.
[20]	U. Veronesi, R. Orecchia, A. Luini, et al., “Intraoperative Radiotherapy during Breast Conserving Surgery: A Study on 1822 Cases Treated with Electrons,” Breast Cancer Research and Treatment, Vol. 124, No. 1, 2010, pp. 141-151.
[21]	J. S. Vaidya, D. J. Joseph, J. S. Tobias, et al., “Targeted Intraoperative Radiotherapy versus Whole Breast Radiotherapy for Breast Cancer (TARGIT-A Trial): An International, Prospective, Randomised, Non-Inferiority Phase 3 Trial,” Lancet, Vol. 376, No. 9735, 2010, pp. 91-102.
[22]	C. Polgár, J. Fodor, T. Major, et al., “Breast-Conserving Treatment with Partial or Whole-Breast Irradiation for Low-Risk Invasive Breast Carcinoma-5-Year Results of a Randomized Trial,” International Journal of Radiation Oncology Biology Physics, Vol. 69, No. 3, 2007, pp. 694-702.
[23]	T. J. Whelan, I. Olivotto, I. Ackerman, et al., “NCICCTG MA.20: An Intergroup Trial of Regional Nodal Irradiation in Early Breast Cancer,” Journal of Clinical Oncology, Vol. 29, No. 18, 2011. http://meetinglibrary.asco.org/content/79126-102
[24]	A. E. Giuliano, K. K. Hunt, K. V. Ballman, et al., “Axillary Dissection vs No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis. A Randomized Clinical Trial,” The Journal of the American Medical Association, Vol. 305, No. 6, 2011, pp. 569-575. doi:10.1001/jama.2011.90
[25]	E. J. Rutgers, M. Donker, M. E. Straver, et al., “Radiotherapy or Surgery of the Axilla after a Positive Sentinel Node in Breast Cancer Patients: Final Analysis of the EORTC AMAROS Trial (10981/22023),” Journal of Clinical Oncology, Vol. 31, No. 15, 2013. http://meetinglibrary.asco.org/content/109779-132
[26]	K. Sato, Y. Mizuno, M. Kato, et al., “Intraoperative OpenCavity Implant for Accelerated Partial Breast Irradiation using High-Dose Rate Multicatheter Brachytherapy in Japanese Breast Cancer Patients: A Single-Institution Registry Study,” Journal of Cancer Therapy, Vol. 3, No. 5A, 2012, pp. 822-830.
[27]	K. Sato, Y. Mizuno, H. Fuchikami, et al., “Individualized Case-Control Study of Accelerated Partial Breast Irradiation by Multicatheter Intertstitial Brachytherapy in Japanese Patients with Breast Cancer,” Cancer and Clinical Oncology, Vol. 2, No. 1, 2013, pp. 127-135. doi:10.5539/cco.v2n1p127
[28]	K. Sato, K. Tamaki, H. Tsuda, et al., “Utility of Axillary Ultrasound Examination to Select Breast Cancer Patients Suited for Optimal Sentinel Node Biopsy,” The American Journal of Surgery, Vol. 187, No. 6, 2004, pp. 679-683. doi:10.1016/j.amjsurg.2003.10.012
[29]	K. Sato, H. Takayanagi, Y. Mizuno, et al., “Open-Cavity Implant for Accelerated Partial Breast Irradiation (APBI) Using HDR Multicatheter Brachytherapy,” Rinsho Geka, Vol. 66, No. 13, 2011, pp. 1669-1672. http://www.bitway.ne.jp/ejournal/club/1407103881-e.html
[30]	K. Saika and T. Sobue, “Epidemiology of Breast Cancer in Japan and the US,” Japan Medical Association Journal, Vol. 52, No. 1, 2009, pp. 39-44. http://www.med.or.jp/ english/journal/pdf/2009_01/039_044.pdf
[31]	H. Sonoo and S. Noguchi, “Results of Questionnaire Survey on Breast Cancer Surgery in Japan 2004-2006,” Breast Cancer, Vol. 15, No. 1, 2008, pp. 3-4. doi:10.1007/s12282-007-0017-9
[32]	Y. Park, T. Kitahara, R. Takagi, et al., “Current Status of Therapy for Breast Cancer Worldwide and in Japan,” World Journal of Clinical Oncology, Vol. 2, No. 2, 2011, pp. 125-134. doi:10.5306/wjco.v2.i2.125
[33]	E. S. Hwang, D. Y. Lichtensztajn, S. L. Gomez, et al., “Survival after Lumpectomy and Mastectomy for Early Stage Invasive Breast Cancer: The Effect of Age and Hormone Receptor Status,” Cancer, Vol. 119, No. 7, 2013, pp. 1402-1411. doi:10.1002/cncr.27795
[34]	M. Mitsumori, M. Hiraoka, H. Inaji, et al., “Impact of Radiation Therapy on Breast-Conserving Therapy for Breast Cancer in Japanese Women: A Retrospective Analyses of Multi-Institutional Experience. Kansai Breast Cancer Radiation Therapy Study Group,” Oncology Reports, Vol. 21, No. 6, 2009, pp. 1461-1466.