https://www.ucl.ac.uk/%7Ermhkjsv/papers/2006JTBiol%20Maths%20model.pdf

Mathematical modelling of radiotherapy strategies for early breast cancer.

Herskind, C., Steil, V., Kraus-Tiefenbacher, U. and Wenz, F. Radiobiological Aspects of Intraoperative Radiotherapy (IORT) with Isotropic Low-Energy X Rays for Early-Stage Breast Cancer. Radiat. Res. 163, 208–215 (2005). The purpose of this study was to model the distribution of biological effect around a miniature isotropic X-ray source incorporating spherical applicators for single-dose or hypofractionated partial-breast intraoperative radiotherapy. A modification of the linear-quadratic formalism was used to calculate the relative biological effectiveness (RBE) of 50 kV X rays as a function of dose and irradiation time for late-reacting normal tissue and tumor cells. The response was modeled as a function of distance in the tissue based on the distribution of equivalent dose and published dose–response data for pneumonitis and subcutaneous fibrosis after single-dose conventional irradiation. Furthermore, the spatial distribution of tumor cell inactivation was assessed. The RBE for late reactio...

Radiobiological Aspects of Intraoperative Radiotherapy (IORT) with Isotropic Low-Energy X Rays for Early-Stage Breast Cancer

Whole-breast irradiation, as part of breast-conservation therapy (BCT), has well-established results, good cosmesis, and low toxicity. Results from the BCT trials suggest that the risk for ipsilateral breast cancer recurrence resides within close proximity to the original tumor site. This leads investigators to consider the role of an accelerated and more tumor bed-focused course of radiotherapy. Accelerated partial-breast irradiation (APBI) involves treating a limited volume of breast tissue, with dose of irradiation per fraction increased and the treatment time course decreased. Four currently available methods of APBI are interstitial brachytherapy, intracavitary brachytherapy, intraoperative radiotherapy, and three-dimensional conformal external-beam radiotherapy. Patient selection is critical. This review article presents some preliminary clinical observations and limitations that suggest a potential role for APBI as a more user-friendly mode for delivering radiotherapy after lumpectomy for early breast cancer.

Accelerated Partial Breast Irradiation in Early-Stage Breast Cancer

At present, radiation therapy after breast-conserving surgery is generally delivered to the whole breast over a period of 5 to 6 weeks. Recently, however, rapidly emerging technological advances in radiation delivery have allowed the concept of accelerated partial breast irradiation (APBI) to quickly come to the forefront as a potential alternative to standard whole-breast irradiation after breast-conserving surgery. APBI refers to radiation therapy that is delivered over a shorter period than the standard 5 to 6 weeks (“accelerated”) and is delivered to only a portion of the breast (“partial”). Since the late 1990s, investigators at multiple institutions have been investigating the efficacy and safety of APBI. Initial results of several clinical trials of APBI have now been published. In this article, we will review the potential advantages of APBI, the biologic rationale for APBI, and the various methods of delivering APBI, each of their associated benefits and limitations, and a potential large randomized multidisciplinary trial evaluating APBI after breast conserving surgery for breast cancer.

Accelerated partial breast irradiation after conservative surgery for breast cancer.

Background and purpose
The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fur Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012.

/pdf/degro-practical-guidelines-radiotherapy-of-breast-cancer-i-3xsdxhw9ra.pdf

DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer.

Intraoperative radiotherapy given as a boost after breast-conserving surgery in breast cancer patients.

Intraoperative electron boost radiotherapy (IORT) versus postoperative external electron beam boost radiation in breast cancer patients — A sequential intervention study on local recurrence rates

312 oral RESULTS OF AN ISIORT POOLED ANALYSIS WITH LINAC-BASED IORT WITH ELECTRONS (IOERT) AS BOOST STRATEGY DURING BREAST CONSERVING THERAPY IN LIMITED STAGE BREAST CANCER

Objective: Ultrasonography has become an integral component of the evaluation of palpable and nonpalpable lesions of the female breast. We assessed the usefulness of high-frequency ultrasonography and three-dimensional ultrasonography for evaluating the benign or malignant status of sonographically reproducible lesions of the breast in patients undergoing biopsy procedures. Methods: We reviewed 300 patients who underwent clinical, sonographic and invasive evaluation of a sonographically reproducible breast lesion over a 15-month period. A total of 164 cases were evaluated with three-dimensional ultrasonography (Kretz Voluson 530 D MT 10-13.5 MHz). The two-dimensional and three-dimensional ultrasound findings were compared with the results of needle biopsy (16-gauge needle with a free-hand technique) or open biopsy. Results: High-frequency ultrasonography (ATL 3000, 12.5 MHz) had an overall sensitivity of 96% and a specificity of 70%. For nonpalpable lesions, three-dimensional ultrasonography increased the specificity from 65% to 72%. Needle biopsy had a sensitivity of 96% and a specificity of 99% with a mean of 1.66 biopsies per lesion. Conclusions: Three-dimensional ultrasonography of the breast provides additional morphologic criteria for differentiating benign from malignant breast lesions, particularly in small and nonpalpable breast lesions. Needle biopsy under ultrasound guidance is a reliable technique to evaluate the histology of focal breast lesions. Three-dimensional ultrasonography permits more precise placement and localization of the biopsy needle.

Der Stellenwert der Hochfrequenz- und 3D-Sonographie innerhalb der konventionellen und invasiven Mammadiagnostik

Fragestellung: Erhohte Lokalrezidivraten bei nach neoadjuvanter Chemotherapie brusterhaltend operiertem Mammakarzinom sind Gegenstand des wissenschaftlichen Diskurses. In der vorliegenden Studie wurden die In-Brust-Rezidivraten nach neoadjuvanter Anbehandlung, intraoperativem Tumorbett-Boost mit Elektronen (IOERT) und nachfolgender Ganzbrustbestrahlung (WBRT) evaluiert. Methode: Im Zeitraum Janner 2002 bis Dezember 2007 wurden 84 Patientinnen im klinischen Stadium II oder III identifiziert, die vor der brusterhaltenden Operation mit axillarer Dissektion eine neoadjuvante Chemotherapie mit 3–6 Zyklen eines Anthrazyklin/Taxane haltigen Schemas erhalten hatten. Intraoperativ wurde ein Single-shot Boost des Tumorbetts mit Elektronen in der Hohe von 10Gy im Dosismaximum vorgenommen, gefolgt von einer Ganzbrustbestrahlung in konventioneller Fraktionierung mit 51–57Gy. Die Zeitspanne zwischen IOERT und WBRT betrug im Mittel 7,5 (3,7–23,6) Wochen, da keine adjuvante Chemotherapie mehr folgte. Ergebnisse: Bei 18/84 (21%) Patientinnen wurde eine komplette pathologische Remission erzielt. Das resezierte Volumen des Mammaparenchyms betrug im Mittel 250ml. Nach einem medianen FUP von 49 Monaten (7,6–100) wurde ein In-Brust-Rezidiv (In-Quadrant) detektiert. Zwei Patientinnen entwickelten ein regionares axillares Rezidiv, weitere neun Patientinnen Fernmetastasen, von denen sieben an der Tumorerkrankung verstorben waren. Bei drei Patientinnen trat ein kontralaterales Mammakarzinom auf. 69 Patientinnen (83%) sind tumorfrei. Es wurde somit ein metastasenfreies Uberleben (MFS), krankheitsfreies Uberleben (DFS) sowie ein Gesamtuberleben von 86,3%, 82,6% und 94,4% erzielt. Die gesamte In-Brustkontrollrate lag bei 93%. Schlussfolgerung: Im mittelfristigen Follow-Up fuhrt die Integration der IOERT auch nach neoadjuvanter Chemotherapie zu exzellenten In-Brust-Tumorkontrollraten, in Analogie zu den Ergebnissen bei primar operativem Vorgehen.

IOERT und Ganzbrustbestrahlung nach neoadjuvanter Chemotherapie beim brusterhaltend operierten Mammakarzinom: Eine retrospektive Analyse

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