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Brachytherapy: An emblematic example of extreme hypofractionated regimen |
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| Affiliation: | 1. Department of radiation oncology, Antoine Lacassagne Cancer Centre, university of Côte d’Azur, Nice, France;2. Medical physique unite, Antoine Lacassagne Cancer Centre, university of Côte d’Azur, Nice, France;1. Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy;2. Medical Physics, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy;3. Department of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, Pavia, Italy;4. General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;1. Department of Radiation Oncology, Centre Antoine-Lacassagne, University Côte d’Azur, 33, avenue de Valombrose, 06189 Nice, France;2. Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, Nice, France;3. Department of Endocrinology, Centre Hospitalier Universitaire de Nice, Nice, France;4. Department of Biostatistics, Centre Antoine-Lacassagne, Nice, France;5. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King''s College, London, UK;6. UCL Institute of Ophthalmology, University College London, London, UK;7. Department of Internal Medicine, CHU de La Réunion, 97400 Saint Denis, France;1. Département de radiothérapie, Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, CS 30 519, 54511 Vand?uvre-lès-Nancy, France;2. Département de biostatistiques, Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54511 Vand?uvre-lès-Nancy, France;3. Département de radiothérapie, centre Henri-Becquerel, 76000 Rouen, France |
| Abstract: | In order to provide more convenient irradiation regimens for patient comfort, radiation facility organization and health expenses, new hypofractionated protocols have been evaluated. Moderately (dose/fraction: 2.3 to 3 Gy), then ultra (dose/fraction: 5.2 to 6.1 Gy) hypofractionated irradiations were first validated. The current question is: is it possible to go forward using extreme hypofractionated regimens (EHR) based on 1 to 3 fractions. Different irradiation techniques are under investigation. However, brachytherapy remains the smartest way to deliver a high dose in a small volume. We report prospective and retrospective study results which evaluated EHR for breast and prostate brachytherapy. While oncological outcome and toxicity profile appear extremely encouraging for low-risk breast cancer after a 1 to 4 fractions (6.25 to 20 Gy/fraction), the use of a single fraction of 19 to 23 Gy appears debatable for prostate cancer. Brachytherapy represents an emblematic example of EHR but longer follow-up and more mature results are awaited in order to specify the right indications and refine the EQD2 calculation method including new biological and technical factors. |
| Keywords: | Radiation therapy Extreme hypofractionated regimen Breast cancer Prostate cancer Brachytherapy Radiothérapie Hypofractionnement extrème Cancer du sein Cancer de la prostate Curiethérapie ADT"} {"#name":"keyword" "$":{"id":"kw0035"} "$$":[{"#name":"text" "_":"Androgen deprivation therapy APBI"} {"#name":"keyword" "$":{"id":"kw0045"} "$$":[{"#name":"text" "_":"Accelerated and partial breast irradiation BCR"} {"#name":"keyword" "$":{"id":"kw0055"} "$$":[{"#name":"text" "_":"Biochemical control rate EQD2"} {"#name":"keyword" "$":{"id":"kw0065"} "$$":[{"#name":"text" "$$":[{"#name":"__text__" "_":"Equivalent dose at 2"} {"#name":"hsp" "$":{"sp":"0 25"}} {"#name":"__text__" "_":"Gy per fraction EBRT"} {"#name":"keyword" "$":{"id":"kw0075"} "$$":[{"#name":"text" "_":"External beam radiation therapy EHF"} {"#name":"keyword" "$":{"id":"kw0085"} "$$":[{"#name":"text" "_":"Extreme hypofractionated regimen GI"} {"#name":"keyword" "$":{"id":"kw0095"} "$$":[{"#name":"text" "_":"Gastro-intestinal GU"} {"#name":"keyword" "$":{"id":"kw0105"} "$$":[{"#name":"text" "_":"Genito-urinary HDR"} {"#name":"keyword" "$":{"id":"kw0115"} "$$":[{"#name":"text" "_":"High dose-rate IORT"} {"#name":"keyword" "$":{"id":"kw0125"} "$$":[{"#name":"text" "_":"Intraoperative radiation therapy LQ"} {"#name":"keyword" "$":{"id":"kw0135"} "$$":[{"#name":"text" "_":"Linear-quadratic MFU"} {"#name":"keyword" "$":{"id":"kw0145"} "$$":[{"#name":"text" "_":"Median follow-up MIB"} {"#name":"keyword" "$":{"id":"kw0155"} "$$":[{"#name":"text" "_":"Multicatheter interstitial OAR"} {"#name":"keyword" "$":{"id":"kw0165"} "$$":[{"#name":"text" "_":"Organs at risk OTT"} {"#name":"keyword" "$":{"id":"kw0175"} "$$":[{"#name":"text" "_":"Overall treatment time uAPBI"} {"#name":"keyword" "$":{"id":"kw0185"} "$$":[{"#name":"text" "_":"Ultra APBI WBI"} {"#name":"keyword" "$":{"id":"kw0195"} "$$":[{"#name":"text" "_":"Whole breast irradiation |
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