PMID- 34043153 OWN - NLM STAT- MEDLINE DCOM- 20220111 LR - 20220111 IS - 1699-3055 (Electronic) IS - 1699-048X (Linking) VI - 23 IP - 11 DP - 2021 Nov TI - 5-year results of accelerated partial breast irradiation (APBI) with SBRT (stereotactic body radiation therapy) and exactrac adaptive gating (Novalis((R))) for very early breast cancer patients: was it all worth it? PG - 2358-2367 LID - 10.1007/s12094-021-02636-3 [doi] AB - PURPOSE: To explore the feasibility of image-guided and respiratory-gated Stereotactic Body Radiation Therapy (SBRT) for Accelerated Partial Breast Irradiation (APBI) in patients with very early breast cancer. MATERIAL AND METHODS: Selected patients with early breast carcinoma after breast-conserving surgery were enrolled in this phase II trial. A fiducial marker was percutaneously placed close to surgical bed and five external fiducials were set on the skin. A CT scan for planning was acquired at free breathing. The treatment was planned and DVH were assessed according to international recommendations. Prescription dose was 30 Gy in five consecutive fractions of 6 Gy. A 6MV monoenergetic LINAC (linear accelerator) that combines stereoscopic X-ray imaging system and ExacTrac Adaptive Gating technique was used. PTV (planning target volume) intrafraction motion was controlled and PTV was irradiated in a selected gated area of the respiratory cycle. Shifts for a correct, gated set-up were calculated and automatically applied. RESULTS: Between April 2013 and October 2015, a total of 23 patients were included. The median tumor size was 12 mm. The mean PTV volume was 114 cc. The mean ipsilateral lung V9 Gy was 2.2% and for left-sided breast cancers, the volume of the heart receiving 1.5 Gy was 11.5%. Maximum skin dose was 30.8 Gy. Acute toxicity was grade1 in all the patients and 100% experienced excellent/good breast cosmesis outcomes. With a median follow-up of 66 months (range 8-99 months) local-relapse-free-survival reaches 100%. One patient developed a second breast cancer outside the treated quadrant after 25.1 months. CONCLUSION: APBI with SBRT and ExacTrac Adaptive Gating System was feasible. The acute and late toxicities were almost null and cosmesis was excellent. We also found that the margins of 5 mm applied from CTV to PTV were sufficient to compensate for geometric uncertainties. CI - (c) 2021. Federacion de Sociedades Espanolas de Oncologia (FESEO). FAU - Ciervide, R AU - Ciervide R AUID- ORCID: 0000-0003-0130-878X AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. raquel.ciervide@gmail.com. FAU - Montero, A AU - Montero A AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. FAU - Potdevin, G AU - Potdevin G AD - Department of Radiation Oncology, Fundacion Valle del Lili, Cali, Colombia. FAU - Garcia, J AU - Garcia J AD - Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain. FAU - Aranda, M G AU - Aranda MG AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. FAU - Alvarez, B AU - Alvarez B AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. FAU - Rossi, K AU - Rossi K AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. FAU - Lopez, M AU - Lopez M AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. FAU - Hernando, O AU - Hernando O AD - Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain. FAU - Valero, J AU - Valero J AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. FAU - Sanchez, E AU - Sanchez E AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. FAU - Chen, X AU - Chen X AD - Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain. FAU - Alonso, R AU - Alonso R AD - Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain. FAU - Leton, P F AU - Leton PF AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. AD - Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain. FAU - Rubio, C AU - Rubio C AD - Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Ona, 10, 28050, Madrid, Spain. AD - Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain. LA - eng PT - Clinical Trial, Phase II PT - Journal Article DEP - 20210527 PL - Italy TA - Clin Transl Oncol JT - Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico JID - 101247119 SB - IM MH - Breast Neoplasms/diagnostic imaging/pathology/*radiotherapy/surgery MH - Carcinoma, Ductal, Breast/diagnostic imaging/pathology/*radiotherapy/surgery MH - Disease-Free Survival MH - Dose Fractionation, Radiation MH - Feasibility Studies MH - Female MH - Fiducial Markers MH - Heart/radiation effects MH - Humans MH - Lung/radiation effects MH - Mastectomy, Segmental MH - Middle Aged MH - Organ Motion MH - Organs at Risk/radiation effects MH - Postoperative Care/methods MH - Prospective Studies MH - Radiosurgery/instrumentation/*methods MH - Respiration MH - Skin/radiation effects MH - Time Factors MH - Tomography, X-Ray Computed MH - Tumor Burden OTO - NOTNLM OT - Breast cancer OT - Gating OT - Partial breast irradiation OT - SBRT EDAT- 2021/05/28 06:00 MHDA- 2022/01/12 06:00 CRDT- 2021/05/27 12:40 PHST- 2021/04/22 00:00 [received] PHST- 2021/05/05 00:00 [accepted] PHST- 2021/05/28 06:00 [pubmed] PHST- 2022/01/12 06:00 [medline] PHST- 2021/05/27 12:40 [entrez] AID - 10.1007/s12094-021-02636-3 [pii] AID - 10.1007/s12094-021-02636-3 [doi] PST - ppublish SO - Clin Transl Oncol. 2021 Nov;23(11):2358-2367. doi: 10.1007/s12094-021-02636-3. Epub 2021 May 27.