Electron and high-dose-rate brachytherapy boost in the conservative treatment of stage I-II breast cancer

First results of the randomized Budapest boost trial

C. Polgár, J. Fodor, Zsolt Orosz, T. Major, Nagy Z. Takácsi, László Csaba Mangel, Z. Sulyok, A. Somogyi, M. Kásler, György Németh

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109 Citations (Scopus)

Abstract

Background and Aims: To evaluate the effect of electron and high-dose-rate brachytherapy (HDR BT) boost on local tumor control (LTC), side effects and cosmesis after breast-conserving surgery (BCS) in a prospective randomized study. Patients and Methods: 207 women with stage I-II breast cancer who underwent BCS were treated by 50 Gy irradiation to the whole breast and then randomly assigned to receive either a boost to the tumor bed (n = 104) or no further radiotherapy (n = 103). Boost treatments consisted of either 16 Gy electron irradiation (n = 52) or 12-14.25 Gy HDR BT (n = 52). Breast cancer-related events, side effects, and cosmetic results were assessed. Results: At a median follow-up of 5.3 years, the crude rate of local recurrence was 6.7% (7/104) with and 15.5% (16/103) without boost. The 5-year probability of LTC, relapse-free survival (RFS), and cancer-specific survival (CSS) was 92.7% vs 84.9% (p = 0.049), 76.6% vs 66.2% (p = 0.044), and 90.4% vs 82.1% (p = 0.053), respectively. There was no significant difference in LTC between patients treated with electron or HDR BT boost (94.2% vs 91.4%; p = 0.74). On multivariate analysis, patient age <40 years (RR: 4.53), positive margin status (RR: 4.17), and high mitotic activity index (RR: 3.60) were found to be significant risk factors for local recurrence. The incidence of grade 2-3 side effects was higher in the boost arm (17.3% vs 7.8%; p = 0.03). However, the rate of excellent/good cosmetic results was similar for the two arms (85.6% vs 91.3%; p = 0.14). Cosmesis was rated as excellent/good in 88.5% of patients treated with HDR BT and 82.7% of patients with electron boost (p = 0.29). Conclusions: Boost dose significantly improves LTC and RFS in patients treated with BCS and radiotherapy. In spite of the higher incidence of late side effects in the boost arm, boost dose is strongly recommended for patients at high risk for local recurrence. Positive or close margin status, high mitotic activity index, and young patient age should be viewed as absolute indications for tumor bed boost. LTC and cosmesis are excellent and similar to patients boosted with either HDR BT or electrons.

Original languageEnglish
Pages (from-to)615-623
Number of pages9
JournalStrahlentherapie und Onkologie
Volume178
Issue number11
DOIs
Publication statusPublished - Nov 1 2002

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Brachytherapy
Electrons
Breast Neoplasms
Segmental Mastectomy
Neoplasms
Recurrence
Mitotic Index
Cosmetics
Survival
Arm
Radiotherapy
Conservative Treatment
Incidence
Breast
Multivariate Analysis
Prospective Studies

Keywords

  • Boost irradiation
  • Brachytherapy
  • Breast cancer
  • Breast-conserving therapy
  • Electron
  • Local recurrence

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cancer Research
  • Radiological and Ultrasound Technology

Cite this

@article{1f6d0f6679b542aeba374d13b343f555,
title = "Electron and high-dose-rate brachytherapy boost in the conservative treatment of stage I-II breast cancer: First results of the randomized Budapest boost trial",
abstract = "Background and Aims: To evaluate the effect of electron and high-dose-rate brachytherapy (HDR BT) boost on local tumor control (LTC), side effects and cosmesis after breast-conserving surgery (BCS) in a prospective randomized study. Patients and Methods: 207 women with stage I-II breast cancer who underwent BCS were treated by 50 Gy irradiation to the whole breast and then randomly assigned to receive either a boost to the tumor bed (n = 104) or no further radiotherapy (n = 103). Boost treatments consisted of either 16 Gy electron irradiation (n = 52) or 12-14.25 Gy HDR BT (n = 52). Breast cancer-related events, side effects, and cosmetic results were assessed. Results: At a median follow-up of 5.3 years, the crude rate of local recurrence was 6.7{\%} (7/104) with and 15.5{\%} (16/103) without boost. The 5-year probability of LTC, relapse-free survival (RFS), and cancer-specific survival (CSS) was 92.7{\%} vs 84.9{\%} (p = 0.049), 76.6{\%} vs 66.2{\%} (p = 0.044), and 90.4{\%} vs 82.1{\%} (p = 0.053), respectively. There was no significant difference in LTC between patients treated with electron or HDR BT boost (94.2{\%} vs 91.4{\%}; p = 0.74). On multivariate analysis, patient age <40 years (RR: 4.53), positive margin status (RR: 4.17), and high mitotic activity index (RR: 3.60) were found to be significant risk factors for local recurrence. The incidence of grade 2-3 side effects was higher in the boost arm (17.3{\%} vs 7.8{\%}; p = 0.03). However, the rate of excellent/good cosmetic results was similar for the two arms (85.6{\%} vs 91.3{\%}; p = 0.14). Cosmesis was rated as excellent/good in 88.5{\%} of patients treated with HDR BT and 82.7{\%} of patients with electron boost (p = 0.29). Conclusions: Boost dose significantly improves LTC and RFS in patients treated with BCS and radiotherapy. In spite of the higher incidence of late side effects in the boost arm, boost dose is strongly recommended for patients at high risk for local recurrence. Positive or close margin status, high mitotic activity index, and young patient age should be viewed as absolute indications for tumor bed boost. LTC and cosmesis are excellent and similar to patients boosted with either HDR BT or electrons.",
keywords = "Boost irradiation, Brachytherapy, Breast cancer, Breast-conserving therapy, Electron, Local recurrence",
author = "C. Polg{\'a}r and J. Fodor and Zsolt Orosz and T. Major and Tak{\'a}csi, {Nagy Z.} and {Csaba Mangel}, L{\'a}szl{\'o} and Z. Sulyok and A. Somogyi and M. K{\'a}sler and Gy{\"o}rgy N{\'e}meth",
year = "2002",
month = "11",
day = "1",
doi = "10.1007/s00066-002-1053-1",
language = "English",
volume = "178",
pages = "615--623",
journal = "Strahlentherapie und Onkologie",
issn = "0179-7158",
publisher = "Urban und Vogel",
number = "11",

}

TY - JOUR

T1 - Electron and high-dose-rate brachytherapy boost in the conservative treatment of stage I-II breast cancer

T2 - First results of the randomized Budapest boost trial

AU - Polgár, C.

AU - Fodor, J.

AU - Orosz, Zsolt

AU - Major, T.

AU - Takácsi, Nagy Z.

AU - Csaba Mangel, László

AU - Sulyok, Z.

AU - Somogyi, A.

AU - Kásler, M.

AU - Németh, György

PY - 2002/11/1

Y1 - 2002/11/1

N2 - Background and Aims: To evaluate the effect of electron and high-dose-rate brachytherapy (HDR BT) boost on local tumor control (LTC), side effects and cosmesis after breast-conserving surgery (BCS) in a prospective randomized study. Patients and Methods: 207 women with stage I-II breast cancer who underwent BCS were treated by 50 Gy irradiation to the whole breast and then randomly assigned to receive either a boost to the tumor bed (n = 104) or no further radiotherapy (n = 103). Boost treatments consisted of either 16 Gy electron irradiation (n = 52) or 12-14.25 Gy HDR BT (n = 52). Breast cancer-related events, side effects, and cosmetic results were assessed. Results: At a median follow-up of 5.3 years, the crude rate of local recurrence was 6.7% (7/104) with and 15.5% (16/103) without boost. The 5-year probability of LTC, relapse-free survival (RFS), and cancer-specific survival (CSS) was 92.7% vs 84.9% (p = 0.049), 76.6% vs 66.2% (p = 0.044), and 90.4% vs 82.1% (p = 0.053), respectively. There was no significant difference in LTC between patients treated with electron or HDR BT boost (94.2% vs 91.4%; p = 0.74). On multivariate analysis, patient age <40 years (RR: 4.53), positive margin status (RR: 4.17), and high mitotic activity index (RR: 3.60) were found to be significant risk factors for local recurrence. The incidence of grade 2-3 side effects was higher in the boost arm (17.3% vs 7.8%; p = 0.03). However, the rate of excellent/good cosmetic results was similar for the two arms (85.6% vs 91.3%; p = 0.14). Cosmesis was rated as excellent/good in 88.5% of patients treated with HDR BT and 82.7% of patients with electron boost (p = 0.29). Conclusions: Boost dose significantly improves LTC and RFS in patients treated with BCS and radiotherapy. In spite of the higher incidence of late side effects in the boost arm, boost dose is strongly recommended for patients at high risk for local recurrence. Positive or close margin status, high mitotic activity index, and young patient age should be viewed as absolute indications for tumor bed boost. LTC and cosmesis are excellent and similar to patients boosted with either HDR BT or electrons.

AB - Background and Aims: To evaluate the effect of electron and high-dose-rate brachytherapy (HDR BT) boost on local tumor control (LTC), side effects and cosmesis after breast-conserving surgery (BCS) in a prospective randomized study. Patients and Methods: 207 women with stage I-II breast cancer who underwent BCS were treated by 50 Gy irradiation to the whole breast and then randomly assigned to receive either a boost to the tumor bed (n = 104) or no further radiotherapy (n = 103). Boost treatments consisted of either 16 Gy electron irradiation (n = 52) or 12-14.25 Gy HDR BT (n = 52). Breast cancer-related events, side effects, and cosmetic results were assessed. Results: At a median follow-up of 5.3 years, the crude rate of local recurrence was 6.7% (7/104) with and 15.5% (16/103) without boost. The 5-year probability of LTC, relapse-free survival (RFS), and cancer-specific survival (CSS) was 92.7% vs 84.9% (p = 0.049), 76.6% vs 66.2% (p = 0.044), and 90.4% vs 82.1% (p = 0.053), respectively. There was no significant difference in LTC between patients treated with electron or HDR BT boost (94.2% vs 91.4%; p = 0.74). On multivariate analysis, patient age <40 years (RR: 4.53), positive margin status (RR: 4.17), and high mitotic activity index (RR: 3.60) were found to be significant risk factors for local recurrence. The incidence of grade 2-3 side effects was higher in the boost arm (17.3% vs 7.8%; p = 0.03). However, the rate of excellent/good cosmetic results was similar for the two arms (85.6% vs 91.3%; p = 0.14). Cosmesis was rated as excellent/good in 88.5% of patients treated with HDR BT and 82.7% of patients with electron boost (p = 0.29). Conclusions: Boost dose significantly improves LTC and RFS in patients treated with BCS and radiotherapy. In spite of the higher incidence of late side effects in the boost arm, boost dose is strongly recommended for patients at high risk for local recurrence. Positive or close margin status, high mitotic activity index, and young patient age should be viewed as absolute indications for tumor bed boost. LTC and cosmesis are excellent and similar to patients boosted with either HDR BT or electrons.

KW - Boost irradiation

KW - Brachytherapy

KW - Breast cancer

KW - Breast-conserving therapy

KW - Electron

KW - Local recurrence

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U2 - 10.1007/s00066-002-1053-1

DO - 10.1007/s00066-002-1053-1

M3 - Article

VL - 178

SP - 615

EP - 623

JO - Strahlentherapie und Onkologie

JF - Strahlentherapie und Onkologie

SN - 0179-7158

IS - 11

ER -