@article{MTMT:1118079,
	title = {Fat necrosis after partial-breast irradiation with brachytherapy or electron irradiation versus standard whole-breast radiotherapy--4-year results of a randomized trial.},
	url = {https://m2.mtmt.hu/api/publication/1118079},
	author = {Lovey, K and Fodor, János and Major, Tibor and Szabo, E and Orosz, Zsolt and Sulyok, Z and Jánváry, Zsolt Levente and Fröhlich, Georgina and Kásler, Miklós and Polgár, Csaba},
	doi = {10.1016/j.ijrobp.2007.03.055},
	journal-iso = {INT J RADIAT ONCOL},
	journal = {INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS},
	volume = {69},
	unique-id = {1118079},
	issn = {0360-3016},
	abstract = {PURPOSE: To examine the incidence and clinical relevance of fat necrosis after
		accelerated partial-breast irradiation (PBI) using interstitial high-dose-rate
		brachytherapy (HDR-BT) in comparison with partial-breast electron irradiation
		(ELE) and whole-breast irradiation (WBI). METHODS AND MATERIALS: Between 1998 and
		2004, 258 early-stage breast cancer patients were randomized to receive 50 Gy WBI
		(n = 130) or PBI (n = 128). The latter consisted of either 7 x 5.2 Gy HDR-BT (n =
		88) or 50 Gy ELE (n = 40). The incidence of fat necrosis, its impact on cosmetic 
		outcome, accompanying radiologic features, and clinical symptoms were evaluated. 
		RESULTS: The 4-year actuarial rate of fat necrosis was 31.1% for all patients,
		and 31.9%, 36.5%, and 17.7% after WBI, HDR-BT and ELE, respectively
		(p(WBI/HDR-BT) = 0.26; p(WBI/ELE) = 0.11; p(ELE/HDR-BT) = 0.025). The respective 
		rate of asymptomatic fat necrosis was 20.2%, 25.3%, and 10% of patients. The
		incidence of symptomatic fat necrosis was not significantly different after WBI
		(8.5%), HDR-BT (11.4%), and ELE (7.5%). Symptomatic fat necrosis was
		significantly associated with a worse cosmetic outcome, whereas asymptomatic fat 
		necrosis was not. Fat necrosis was detectable with mammography and/or ultrasound 
		in each case. Additional imaging examinations were required in 21% of cases and
		aspiration cytology in 42%. CONCLUSIONS: Asymptomatic fat necrosis is a common
		adverse event of breast-conserving therapy, having no significant clinical
		relevance in the majority of the cases. The incidence of both symptomatic and
		asymptomatic fat necrosis is similar after conventional WBI and accelerated
		partial-breast HDR-BT.},
	keywords = {Follow-Up Studies; Aged; Adult; Female; Middle Aged; Humans; Aged, 80 and over; Incidence; Radiotherapy Dosage; Breast Neoplasms/*radiotherapy; Fat Necrosis/*epidemiology/etiology/radiography; Electrons/adverse effects/therapeutic use; Breast/*pathology/radiation effects; Brachytherapy/adverse effects/methods},
	year = {2007},
	eissn = {1879-355X},
	pages = {724-731},
	orcid-numbers = {Major, Tibor/0000-0002-4672-6910; Jánváry, Zsolt Levente/0000-0002-4583-4901; Fröhlich, Georgina/0000-0001-6428-6536; Kásler, Miklós/0000-0002-7235-8787; Polgár, Csaba/0000-0001-7245-0762}
}

@article{MTMT:1118078,
	title = {Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma--5-year results of a randomized trial.},
	url = {https://m2.mtmt.hu/api/publication/1118078},
	author = {Polgár, Csaba and Fodor, János and Major, Tibor and Németh, György and Lovey, K and Orosz, Zsolt and Sulyok, Z and Takácsi-Nagy, Zoltán and Kásler, Miklós},
	doi = {10.1016/j.ijrobp.2007.04.022},
	journal-iso = {INT J RADIAT ONCOL},
	journal = {INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS},
	volume = {69},
	unique-id = {1118078},
	issn = {0360-3016},
	abstract = {PURPOSE: To report the 5-year results of a randomized study comparing the
		survival and cosmetic results of breast-conserving treatment with partial breast 
		irradiation (PBI) or conventional whole breast irradiation (WBI). METHODS AND
		MATERIALS: Between 1998 and 2004, 258 selected patients with T1 N0-1mi, Grade
		1-2, nonlobular breast cancer without presence of extensive intraductal component
		and resected with negative margins were randomized after breast-conserving
		surgery to receive 50 Gy/25 fractions WBI (n = 130) or PBI (n = 128). The latter 
		consisted of either 7 x 5.2 Gy high-dose-rate (HDR) multicatheter brachytherapy
		(BT; n = 88) or 50 Gy/25 fractions electron beam (EB) irradiation (n = 40).
		RESULTS: At a median follow-up of 66 months, the 5-year actuarial rate of local
		recurrence was 4.7% and 3.4% in the PBI and WBI arms, respectively (p = 0.50).
		There was no significant difference in the 5-year probability of overall survival
		(94.6% vs. 91.8%), cancer-specific survival (98.3% vs. 96.0%), and disease-free
		survival (88.3% vs. 90.3%). The rate of excellent to good cosmetic result was
		77.6% in the PBI group (81.2% after HDR BT; 70.0% after EB) and 62.9% in the
		control group (52.2% after telecobalt; 65.6% after 6-9-MV photons; p(WBI/PBI) =
		0.009). CONCLUSIONS: Partial breast irradiation using interstitial HDR implants
		or EB to deliver radiation to the tumor bed alone for a selected group of
		early-stage breast cancer patients produces 5-year results similar to those
		achieved with conventional WBI. Significantly better cosmetic outcome can be
		achieved with carefully designed HDR multicatheter implants compared with the
		outcome after WBI.},
	keywords = {Follow-Up Studies; Aged; Adult; Female; Middle Aged; Humans; Neoplasm Staging; Aged, 80 and over; Treatment Outcome; Chemotherapy, Adjuvant; Radiotherapy Dosage; Disease-Free Survival; Salvage Therapy; Combined Modality Therapy/methods; *Mastectomy, Segmental; Breast Neoplasms/mortality/pathology/*radiotherapy/*surgery; Brachytherapy/methods},
	year = {2007},
	eissn = {1879-355X},
	pages = {694-702},
	orcid-numbers = {Polgár, Csaba/0000-0001-7245-0762; Major, Tibor/0000-0002-4672-6910; Takácsi-Nagy, Zoltán/0000-0002-3261-0271; Kásler, Miklós/0000-0002-7235-8787}
}

@article{MTMT:1118050,
	title = {Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: five-year results of a phase I-II study and initial findings of a randomized phase III trial.},
	url = {https://m2.mtmt.hu/api/publication/1118050},
	author = {Polgár, Csaba and Sulyok, Z and Fodor, János and Orosz, Zsolt and Major, Tibor and Takácsi-Nagy, Zoltán and Mangel, László Csaba and Somogyi, A and Kásler, Miklós and Németh, György},
	doi = {10.1002/jso.10110},
	journal-iso = {J SURG ONCOL},
	journal = {JOURNAL OF SURGICAL ONCOLOGY},
	volume = {80},
	unique-id = {1118050},
	issn = {0022-4790},
	abstract = {BACKGROUND AND OBJECTIVES: The objectives of this study were to test the
		feasibility of sole interstitial high-dose-rate brachytherapy (HDR-BT) after
		breast-conserving surgery (BCS) for T1 breast cancer in a phase I-II study, and
		to present the initial findings of a phase III trial comparing the efficacy of
		tumor bed radiotherapy (TBRT) alone with conventional whole breast radiotherapy
		(WBRT). METHODS: Forty-five prospectively selected patients with T1 breast cancer
		undergoing BCS were enrolled into a phase I-II study of TBRT alone, using
		interstitial HDR implants. HDR-BT of 7 x 4.33 Gy (n = 8) and 7 x 5.2 Gy (n = 37) 
		was delivered to the tumor bed. Based on the results of this phase I-II study, a 
		further 126 patients were randomized to receive 50 Gy WBRT (n = 63) or TBRT alone
		(n = 63); the latter consisted of either 7 x 5.2 Gy HDR-BT (n = 46) or 50-Gy
		wide-field electron irradiation (n = 17). Breast cancer related events and side
		effects were assessed. RESULTS: In the phase I-II study, at a median follow-up of
		57 months, 2 (4.4%) local, 3 (6.7%) axillary, and 3 (6.7%) distant failures were 
		observed. Two patients (4.4%) died of breast cancer. The 5-year probability of
		cancer-specific, relapse-free and local recurrence-free survival was 90.0%,
		85.9%, and 95.6%, respectively. The cosmetic results were judged to be excellent 
		in 44 of 45 patients (97.8%). Severe (higher than grade 2) skin sequelae or
		fibrosis was not found. Symptomatic fat necrosis occurred in one patient (2.2%). 
		In the phase III study, at a median follow-up of 30 months, the locoregional
		tumor control was 100% in both arms. The 3-year probability of cancer-specific
		and relapse-free survival was 98.1% and 98.4% in the WBRT group and 100% and
		94.4% in the TBRT group, respectively (P = NS). There was no significant
		difference between the two treatment arms regarding the incidence of radiation
		side effects. CONCLUSIONS: Five-year results of our phase I-II study prove that
		sole HDR-BT of the tumor bed with careful patient selection and adequate quality 
		assurance is a feasible alternative to WBRT. However, long-term results of phase 
		III trials are required to determine the equivalence of TBRT alone, compared with
		WBRT in the management of selected patients with early breast cancer.},
	keywords = {Aged; Adult; Female; Middle Aged; Humans; Feasibility Studies; Survival Rate; Dose-Response Relationship, Radiation; Radiotherapy Dosage; Lymph Node Excision; *Mastectomy, Segmental; Breast Neoplasms/mortality/*radiotherapy/surgery; *Brachytherapy/mortality},
	year = {2002},
	eissn = {1096-9098},
	pages = {121-128},
	orcid-numbers = {Polgár, Csaba/0000-0001-7245-0762; Major, Tibor/0000-0002-4672-6910; Takácsi-Nagy, Zoltán/0000-0002-3261-0271; Kásler, Miklós/0000-0002-7235-8787}
}