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Cancers
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Radiation Therapy for Breast Cancer: Recent Advances and Challenges
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Radiation Therapy for Breast Cancer: Recent Advances and Challenges

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 16232

Special Issue Editor

Prof. Dr. Yazid Belkacémi

E-Mail Website
Guest Editor
1. INSERM 955 EQ07, The Mondor Institute for Biomedical Research (IMRB), University of Paris-Est Creteil (UPEC), Créteil, France
2. Department of Radiation Oncology, Henri Mondor University Hospital & Henri Mondor Breast Cancer Center, 94000 Créteil, France
Interests: modern radiotherapy; innovations; radiobiology; new drugs; combined therapy; toxicity; stereotactic radiation therapy; oligometatasis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast cancer is the most common cancer in women. In recent years, considerable progress has been made in multidisciplinary care, toward treatment personalization based on innovative diagnostic methods, using state-of-the-art biological tools.

Radiotherapy is an essential element in the treatment strategy at all stages of the disease in the adjuvant, metastatic, as well as neoadjuvant setting, integrated with tumor biology research.

In recent years, new technological developments have been applied in breast irradiation aiming at reducing the doses to organs at risk while maintaining optimal doses to the breast and lymph node bearing areas. Axillary irradiation has become an alternative to surgery in many patients with positive sentinel lymph nodes, in the context of surgical de-escalation. In selected patients, hypofractionation with increased dose per fraction and decreased irradiated volume has allowed the development of partial breast irradiation as an alternative to standard radiotherapy, resulting in reduced costs and increased quality of life. Research in the field of individual patients’ radiosensitivity will hopefully provide a better selection of irradiation schemes adapted individually to each patient.

All these advances and challenges will be addressed in our Special Issue, which will provide answers to many pending questions in the new era of breast cancer radiotherapy.

Prof. Yazid Belkacémi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast cancer
  • radiotherapy
  • innovations

Published Papers (7 papers)

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Editorial

Jump to: Research, Review

4 pages, 188 KiB  
Editorial
Advances and Challenges in Breast Cancer Management: A History Made of Evolutions and Revolutions
by Yazid Belkacemi
Cancers 2023, 15(6), 1713; https://doi.org/10.3390/cancers15061713 - 10 Mar 2023
Viewed by 975
Abstract
Jean Jaurès (1859–1914) stated that “Human history is but a ceaseless effort of invention, and perpetual evolution and creation” [...] Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancer: Recent Advances and Challenges)

Research

Jump to: Editorial, Review

10 pages, 3195 KiB  
Article
Linac-Based Ultrahypofractionated Partial Breast Irradiation (APBI) in Low-Risk Breast Cancer: First Results of a Monoinstitutional Observational Analysis
by Roland Merten, Mirko Fischer, Gennadii Kopytsia, Jörn Wichmann, Tim Lange, Anne Caroline Knöchelmann, Jan-Niklas Becker, Rüdiger Klapdor, Jan Hinrichs and Michael Bremer
Cancers 2023, 15(4), 1138; https://doi.org/10.3390/cancers15041138 - 10 Feb 2023
Cited by 2 | Viewed by 1424
Abstract
Purpose: For adjuvant radiotherapy of low-risk breast cancer after breast-conserving surgery, there have been many trials of hypofractionation and partial breast irradiation (PBI) over the years, with proven mild long-term toxicity. The aim of this study was to introduce a short-course dose-adapted concept, [...] Read more.
Purpose: For adjuvant radiotherapy of low-risk breast cancer after breast-conserving surgery, there have been many trials of hypofractionation and partial breast irradiation (PBI) over the years, with proven mild long-term toxicity. The aim of this study was to introduce a short-course dose-adapted concept, proven in whole breast irradiation (WBI) for use in accelerated partial breast irradiation (APBI), while monitoring dosimetric data and toxicity. Methods: From April 2020 to March 2022, 61 patients with low-risk breast cancer or ductal carcinoma in situ (DCIS) were treated at a single institution with percutaneous APBI of 26 Gy in five fractions every other day after breast-conserving surgery. Dosimetric data for target volume and organs at risk were determined retrospectively. Acute toxicity was evaluated. Results: The target volume of radiotherapy comprised an average of 19% of the ipsilateral mamma. The burden on the heart and lungs was very low. The mean cardiac dose during irradiation of the left breast was only 0.6 Gy. Two out of three patients remained without any acute side effects. Conclusions: Linac-based APBI is an attractive treatment option for patients with low-risk breast cancer in whom neither WBI nor complete omission of radiotherapy appears to be an adequate alternative. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancer: Recent Advances and Challenges)
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17 pages, 920 KiB  
Article
Safety and Feasibility of Radiation Therapy Combined with CDK 4/6 Inhibitors in the Management of Advanced Breast Cancer
by Marcin Kubeczko, Dorota Gabryś, Marzena Gawkowska, Anna Polakiewicz-Gilowska, Alexander J. Cortez, Aleksandra Krzywon, Grzegorz Woźniak, Tomasz Latusek, Aleksandra Leśniak, Katarzyna Świderska, Marta Mianowska-Malec, Barbara Łanoszka, Konstanty Chomik, Mateusz Gajek, Anna Michalik, Elżbieta Nowicka, Rafał Tarnawski, Tomasz Rutkowski and Michał Jarząb
Cancers 2023, 15(3), 690; https://doi.org/10.3390/cancers15030690 - 22 Jan 2023
Cited by 5 | Viewed by 3423
Abstract
The addition of CDK4/6 inhibitors to endocrine therapy in advanced hormone receptor-positive HER2-negative breast cancer has led to practice-changing improvements in overall survival. However, data concerning the safety of CDK4/6i combination with radiotherapy (RT) are conflicting. A retrospective evaluation of 288 advanced breast [...] Read more.
The addition of CDK4/6 inhibitors to endocrine therapy in advanced hormone receptor-positive HER2-negative breast cancer has led to practice-changing improvements in overall survival. However, data concerning the safety of CDK4/6i combination with radiotherapy (RT) are conflicting. A retrospective evaluation of 288 advanced breast cancer patients (pts) treated with CDK4/6i was performed, and 100 pts also received RT. Forty-six pts received 63 RT courses concurrently and fifty-four sequentially before CDK4/6i initiation (76 RT courses). Neutropenia was common (79%) and more frequent during and after concurrent RT than sequential RT (86% vs. 76%); however, CDK4/6i dose reduction rates were similar. In patients treated with CDK4/6i alone, the dose reduction rate was 42% (79 pts) versus 38% with combined therapy, and 5% discontinued treatment due to toxicity in the combined group. The risk of CDK4/6i dose reduction was correlated with neutropenia grade, RT performed within the first two CDK4/6i cycles, and more than one concurrent RT; a tendency was observed in concurrent bone irradiation. However, on multivariate regression analysis, only ECOG 1 performance status and severe neutropenia at the beginning of the second cycle were found to be associated with a higher risk of CDK4/6i dose reduction. This largest single-center experience published to date confirmed the acceptable safety profile of the CDK4/6i and RT combination without a significantly increased toxicity compared with CDK4/6i alone. However, one might delay RT for the first two CDK4/6i cycles, when myelotoxic AE are most common. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancer: Recent Advances and Challenges)
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14 pages, 2088 KiB  
Article
Skin Surface Dose for Whole Breast Radiotherapy Using Personalized Breast Holder: Comparison with Various Radiotherapy Techniques and Clinical Experiences
by Chiu-Ping Chen, Chi-Yeh Lin, Chia-Chun Kuo, Tung-Ho Chen, Shao-Chen Lin, Kuo-Hsiung Tseng, Hao-Wen Cheng, Hsing-Lung Chao, Sang-Hue Yen, Ruo-Yu Lin, Chen-Ju Feng, Long-Sheng Lu, Jeng-Fong Chiou and Shih-Ming Hsu
Cancers 2022, 14(13), 3205; https://doi.org/10.3390/cancers14133205 - 30 Jun 2022
Cited by 4 | Viewed by 2361
Abstract
Purpose: Breast immobilization with personalized breast holder (PERSBRA) is a promising approach for normal organ protection during whole breast radiotherapy. The aim of this study is to evaluate the skin surface dose for breast radiotherapy with PERSBRA using different radiotherapy techniques. Materials and [...] Read more.
Purpose: Breast immobilization with personalized breast holder (PERSBRA) is a promising approach for normal organ protection during whole breast radiotherapy. The aim of this study is to evaluate the skin surface dose for breast radiotherapy with PERSBRA using different radiotherapy techniques. Materials and methods: We designed PERSBRA with three different mesh sizes (large, fine and solid) and applied them on an anthropomorphic(Rando) phantom. Treatment planning was generated using hybrid, intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques to deliver a prescribed dose of 5000 cGy in 25 fractions accordingly. Dose measurement with EBT3 film and TLD were taken on Rando phantom without PERSBRA, large mesh, fine mesh and solid PERSBRA for (a) tumor doses, (b) surface doses for medial field and lateral field irradiation undergoing hybrid, IMRT, VMAT techniques. Results: The tumor dose deviation was less than five percent between the measured doses of the EBT3 film and the TLD among the different techniques. The application of a PERSBRA was associated with a higher dose of the skin surface. A large mesh size of PERSBRA was associated with a lower surface dose. The findings were consistent among hybrid, IMRT, or VMAT techniques. Conclusions: Breast immobilization with PERSBRA can reduce heart toxicity but leads to a build-up of skin surface doses, which can be improved with a larger mesh design for common radiotherapy techniques. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancer: Recent Advances and Challenges)
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10 pages, 738 KiB  
Article
Pertuzumab and Trastuzumab Combination with Concomitant Locoregional Radiotherapy for the Treatment of Breast Cancers with HER2 Receptor Overexpression
by Amélie Aboudaram, Pierre Loap, Delphine Loirat, Syrine Ben Dhia, Kim Cao, Alain Fourquet and Youlia Kirova
Cancers 2021, 13(19), 4790; https://doi.org/10.3390/cancers13194790 - 24 Sep 2021
Cited by 12 | Viewed by 2199
Abstract
Background: The combination of pertuzumab and trastuzumab dual HER2 blockade with concomitant curative dose locoregional breast radiotherapy in patients with metastatic breast cancer is an important part of treatment strategy. Methods: This was a retrospective study conducted at the Institut Curie on all [...] Read more.
Background: The combination of pertuzumab and trastuzumab dual HER2 blockade with concomitant curative dose locoregional breast radiotherapy in patients with metastatic breast cancer is an important part of treatment strategy. Methods: This was a retrospective study conducted at the Institut Curie on all patients treated concomitantly with pertuzumab/trastuzumab and locoregional breast radiotherapy. Toxicity was evaluated according to the NCICTCAEv4.0. Overall survival, progression-free survival and locoregional recurrence-free survival were evaluated in metastatic patients who were initially well controlled by chemotherapy, for whom local treatment was decided by the multidisciplinary team. Results: Fifty-five patients treated between October 2013 and December 2019 were included, with a median follow-up of 4.1 years. The median age was 53 years (range: 28–81). All patients received curative dose radiotherapy (RT) concomitantly with pertuzumab and trastuzumab (Pertu/Trastu). The median radiation dose was 50 Gy. Safety evaluation did not reveal any significant adverse effects, with 3 cases of grade 3 radiodermatitis (5.4%), but no significant gastrointestinal or cardiac toxicity. The mean difference in LVEF before any chemotherapy and after radiotherapy was −2.43% (p < 0.01). Conclusions: This study demonstrates that the combination of locoregional breast RT with dual HER2 blockade by Pertu/Trastu was very well tolerated, suggesting that RT can be safely administered to patients with HER2-positive breast cancer. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancer: Recent Advances and Challenges)
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Review

Jump to: Editorial, Research

15 pages, 1655 KiB  
Review
Non-Surgical Definitive Treatment for Operable Breast Cancer: Current Status and Future Prospects
by Yuta Shibamoto and Seiya Takano
Cancers 2023, 15(6), 1864; https://doi.org/10.3390/cancers15061864 - 20 Mar 2023
Cited by 2 | Viewed by 2237
Abstract
This article reviews the results of various non-surgical curative treatments for operable breast cancer. Radiotherapy is considered the most important among such treatments, but conventional radiotherapy alone and concurrent chemoradiotherapy do not achieve high cure rates. As a radiosensitization strategy, intratumoral injection of [...] Read more.
This article reviews the results of various non-surgical curative treatments for operable breast cancer. Radiotherapy is considered the most important among such treatments, but conventional radiotherapy alone and concurrent chemoradiotherapy do not achieve high cure rates. As a radiosensitization strategy, intratumoral injection of hydrogen peroxide before radiation has been investigated, and high local control rates (75–97%) were reported. The authors treated 45 patients with whole-breast radiotherapy, followed by stereotactic or intensity-modulated radiotherapy boost, with or without a radiosensitization strategy employing either hydrogen peroxide injection or hyperthermia plus oral tegafur-gimeracil-oteracil potassium. Stages were 0–I in 23 patients, II in 19, and III in 3. Clinical and cosmetic outcomes were good, with 5-year overall, progression-free, and local recurrence-free survival rates of 97, 86, and 88%, respectively. Trials of carbon ion radiotherapy are ongoing, with promising interim results. Radiofrequency ablation, focused ultrasound, and other image-guided ablation treatments yielded complete ablation rates of 20–100% (mostly ≥70%), but long-term cure rates remain unclear. In these treatments, combination with radiotherapy seems necessary to treat the extensive intraductal components. Non-surgical treatment of breast cancer is evolving steadily, with radiotherapy playing a major role. In the future, proton therapy with the ultra-high-dose-rate FLASH mode is expected to further improve outcomes. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancer: Recent Advances and Challenges)
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13 pages, 1136 KiB  
Review
Improving Patients’ Life Quality after Radiotherapy Treatment by Predicting Late Toxicities
by Ariane Lapierre, Laura Bourillon, Marion Larroque, Tiphany Gouveia, Céline Bourgier, Mahmut Ozsahin, André Pèlegrin, David Azria and Muriel Brengues
Cancers 2022, 14(9), 2097; https://doi.org/10.3390/cancers14092097 - 22 Apr 2022
Cited by 5 | Viewed by 2211
Abstract
Personalized treatment and precision medicine have become the new standard of care in oncology and radiotherapy. Because treatment outcomes have considerably improved over the last few years, permanent side-effects are becoming an increasingly significant issue for cancer survivors. Five to ten percent of [...] Read more.
Personalized treatment and precision medicine have become the new standard of care in oncology and radiotherapy. Because treatment outcomes have considerably improved over the last few years, permanent side-effects are becoming an increasingly significant issue for cancer survivors. Five to ten percent of patients will develop severe late toxicity after radiotherapy. Identifying these patients before treatment start would allow for treatment adaptation to minimize definitive side effects that could impair their long-term quality of life. Over the last decades, several tests and biomarkers have been developed to identify these patients. However, out of these, only the Radiation-Induced Lymphocyte Apoptosis (RILA) assay has been prospectively validated in multi-center cohorts. This test, based on a simple blood draught, has been shown to be correlated with late radiation-induced toxicity in breast, prostate, cervical and head and neck cancer. It could therefore greatly improve decision making in precision radiation oncology. This literature review summarizes the development and bases of this assay, as well as its clinical results and compares its results to the other available assays. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancer: Recent Advances and Challenges)
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