TY - JOUR AU - Lovey, K AU - Fodor, János AU - Major, Tibor AU - Szabo, E AU - Orosz, Zsolt AU - Sulyok, Z AU - Jánváry, Zsolt Levente AU - Fröhlich, Georgina AU - Kásler, Miklós AU - Polgár, Csaba TI - Fat necrosis after partial-breast irradiation with brachytherapy or electron irradiation versus standard whole-breast radiotherapy--4-year results of a randomized trial. JF - INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS J2 - INT J RADIAT ONCOL VL - 69 PY - 2007 IS - 3 SP - 724 EP - 731 PG - 8 SN - 0360-3016 DO - 10.1016/j.ijrobp.2007.03.055 UR - https://m2.mtmt.hu/api/publication/1118079 ID - 1118079 N1 - Megjegyzés-20317363 Cited By (since 1996): 1 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Polgár, Csaba AU - Fodor, János AU - Major, Tibor AU - Németh, György AU - Lovey, K AU - Orosz, Zsolt AU - Sulyok, Z AU - Takácsi-Nagy, Zoltán AU - Kásler, Miklós TI - Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma--5-year results of a randomized trial. JF - INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS J2 - INT J RADIAT ONCOL VL - 69 PY - 2007 IS - 3 SP - 694 EP - 702 PG - 9 SN - 0360-3016 DO - 10.1016/j.ijrobp.2007.04.022 UR - https://m2.mtmt.hu/api/publication/1118078 ID - 1118078 N1 - Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary Department of Human and Experimental Tumor Pathology, National Institute of Oncology, Budapest, Hungary Department of General and Thoracic Surgery, National Institute of Oncology, Budapest, Hungary Cited By :304 Export Date: 10 July 2023 CODEN: IOBPD Correspondence Address: Polgár, C.; Department of Radiotherapy, , Budapest, Hungary; email: polgar@oncol.hu Chemicals/CAS: cobalt, 7440-48-4 AB - 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. LA - English DB - MTMT ER - TY - JOUR AU - Polgár, Csaba AU - Sulyok, Z AU - Fodor, János AU - Orosz, Zsolt AU - Major, Tibor AU - Takácsi-Nagy, Zoltán AU - Mangel, László Csaba AU - Somogyi, A AU - Kásler, Miklós AU - Németh, György TI - 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. JF - JOURNAL OF SURGICAL ONCOLOGY J2 - J SURG ONCOL VL - 80 PY - 2002 IS - 3 SP - 121 EP - 128 PG - 8 SN - 0022-4790 DO - 10.1002/jso.10110 UR - https://m2.mtmt.hu/api/publication/1118050 ID - 1118050 AB - 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. LA - English DB - MTMT ER -