Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial

Sophie C J Bosma; Femke van der Leij; Sandra Vreeswijk; Michiel de Maaker; Jelle Wesseling; Marc van de Vijver; Astrid Scholten; Sofia Rivera; Celine Bourgier; Guillaume Auzac; Theodoros Foukakis; Tobias Lekberg; Desiree Bongard; Claudette Loo; Emiel Rutgers; Harry Bartelink; Paula H M Elkhuizen

doi:10.1016/j.ijrobp.2019.12.037

Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial

Sophie C J Bosma, Femke van der Leij, Sandra Vreeswijk, Michiel de Maaker, Jelle Wesseling, Marc van de Vijver, Astrid Scholten, Sofia Rivera, Celine Bourgier, Guillaume Auzac, Theodoros Foukakis, Tobias Lekberg, Desiree Bongard, Claudette Loo, Emiel Rutgers, Harry Bartelink, Paula H M Elkhuizen

Research output: Contribution to journal › Article › Academic › peer-review

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 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.

Original language	English
Pages (from-to)	958-967
Number of pages	10
Journal	International Journal of Radiation Oncology Biology Physics
Volume	106
Issue number	5
DOIs	https://doi.org/10.1016/j.ijrobp.2019.12.037
Publication status	Published - 1 Apr 2020

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

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10.1016/j.ijrobp.2019.12.037

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Bosma, S. C. J., van der Leij, F., Vreeswijk, S., Maaker, M. D., Wesseling, J., Vijver, M. V. D., Scholten, A., Rivera, S., Bourgier, C., Auzac, G., Foukakis, T., Lekberg, T., Bongard, D., Loo, C., Rutgers, E., Bartelink, H., & Elkhuizen, P. H. M. (2020). Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial. International Journal of Radiation Oncology Biology Physics, 106(5), 958-967. https://doi.org/10.1016/j.ijrobp.2019.12.037

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title = "Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial",

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 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.",

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",

author = "Bosma, {Sophie C J} and {van der Leij}, Femke and Sandra Vreeswijk and Maaker, {Michiel de} and Jelle Wesseling and Vijver, {Marc van de} and Astrid Scholten and Sofia Rivera and Celine Bourgier and Guillaume Auzac and Theodoros Foukakis and Tobias Lekberg and Desiree Bongard and Claudette Loo and Emiel Rutgers and Harry Bartelink and Elkhuizen, {Paula H M}",

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: {\textcopyright} 2020 Elsevier Inc.",

year = "2020",

month = apr,

day = "1",

doi = "10.1016/j.ijrobp.2019.12.037",

language = "English",

volume = "106",

pages = "958--967",

journal = "International Journal of Radiation Oncology Biology Physics",

issn = "0360-3016",

publisher = "Elsevier",

number = "5",

}

Bosma, SCJ, van der Leij, F, Vreeswijk, S, Maaker, MD, Wesseling, J, Vijver, MVD, Scholten, A, Rivera, S, Bourgier, C, Auzac, G, Foukakis, T, Lekberg, T, Bongard, D, Loo, C, Rutgers, E, Bartelink, H & Elkhuizen, PHM 2020, 'Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial', International Journal of Radiation Oncology Biology Physics, vol. 106, no. 5, pp. 958-967. https://doi.org/10.1016/j.ijrobp.2019.12.037

TY - JOUR

T1 - Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial

AU - Bosma, Sophie C J

AU - van der Leij, Femke

AU - Vreeswijk, Sandra

AU - Maaker, Michiel de

AU - Wesseling, Jelle

AU - Vijver, Marc van de

AU - Scholten, Astrid

AU - Rivera, Sofia

AU - Bourgier, Celine

AU - Auzac, Guillaume

AU - Foukakis, Theodoros

AU - Lekberg, Tobias

AU - Bongard, Desiree

AU - Loo, Claudette

AU - Rutgers, Emiel

AU - Bartelink, Harry

AU - Elkhuizen, Paula H M

PY - 2020/4/1

Y1 - 2020/4/1

N2 - 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 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.

AB - 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 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.

KW - Aged

KW - Aged, 80 and over

KW - Breast Neoplasms/pathology

KW - Cosmetics

KW - Feasibility Studies

KW - Female

KW - Fibrosis

KW - Humans

KW - Middle Aged

KW - Neoplasm Metastasis

KW - Preoperative Period

KW - Radiotherapy Dosage

KW - Survival Analysis

KW - Treatment Outcome

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U2 - 10.1016/j.ijrobp.2019.12.037

DO - 10.1016/j.ijrobp.2019.12.037

M3 - Article

C2 - 31987957

SN - 0360-3016

VL - 106

SP - 958

EP - 967

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

IS - 5

ER -

Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial

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