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Radiation effect on late cardiopulmonary toxicity: An analysis comparing supine DIBH versus prone techniques for breast treatment

Yan, Sherry X; Maisonet, Olivier G; Perez, Carmen A; Huppert, Nelly; Hitchen, Christine J; Das, Indra J; Gerber, Naamit K
Two commonly used whole breast irradiation (WBI) techniques, deep inspiration breath hold (DIBH) and prone positioning, are compared with regard to dosimetry and estimated late cardiac morbidity and secondary lung cancer mortality using published models. Forty patients with left-sided DCIS or breast cancer who underwent lumpectomy and required adjuvant WBI were enrolled on a prospective trial comparing supine DIBH (S-DIBH) with prone free breathing (P-FB) planning. Patients underwent CT simulation in both positions; two plans were generated for each patient. Comparative dosimetry was available for 34 patients. Mean cardiac and lung doses were calculated. Risk of death from ischemic heart disease (IHD), risk of at least one acute coronary event (ACE), and lung cancer mortality were estimated from published data. Difference between S-DIBH and P-FB plans was compared using paired two-tailed t test. Estimated mean risk of death from IHD by age 80 was 0.1% (range 0.0%-0.2%) for both plans (P = 1.0). Mean risk of at least one ACE was 0.3% (range 0.1%-0.6%) for both plans (P = .6). Mean lung cancer mortality risk was 1.4% (range 0.5%-15.4%) for S-DIBH and 1.0% (range 0.4%-9.8%) for P-FB (P = .008). Excess lung cancer mortality due to radiation was 0.5% (range 0.1%-6.0%) with S-DIBH and 0.0% (range 0.0%-0.4%) with P-FB (P = .008). Both S-DIBH and P-FB provide excellent cardiac sparing. Prone positioning results in lower lung dose than S-DIBH and leads to an absolute decrease of 0.5% in excess lung cancer mortality for patients receiving WBI.
PMID: 31912595
ISSN: 1524-4741
CID: 4257322

Ipsilateral breast tumor recurrence in early stage breast cancer patients treated with breast conserving surgery and adjuvant radiation therapy: Concordance of biomarkers and tumor location from primary tumor to in-breast tumor recurrence

Purswani, Juhi M; Shaikh, Fauzia; Wu, S Peter; Kim, Jennifer Chun; Schnabel, Freya; Huppert, Nelly; Perez, Carmen A; Gerber, Naamit K
BACKGROUND:Patients with an in-breast tumor recurrence (IBTR) after breast-conserving therapy have a high risk of distant metastasis and disease-related mortality. Classifying clinical parameters that increase risk for recurrence after IBTR remains a challenge. AIM/OBJECTIVE:To describe primary and recurrent tumor characteristics in patients who experience an IBTR and understand the relationship between these characteristics and disease outcomes. METHODS:Patients with stage 0-II breast cancer treated with lumpectomy and adjuvant radiation were identified from institutional databases of patients treated from 2003-2017 at our institution. Overall survival (OS), disease-free survival, and local recurrence-free survival (LRFS) were estimated using the Kaplan Meier method. We identified patients who experienced an isolated IBTR. Concordance of hormone receptor status and location of tumor from primary to recurrence was evaluated. The effect of clinical and treatment parameters on disease outcomes was also evaluated. RESULTS:= 0.004) decreased the risk of IBTR. CONCLUSION/CONCLUSIONS:Among patients with early stage breast cancer who had breast conserving surgery treated with adjuvant RT, ER/PR status and quadrant were highly concordant from primary to IBTR. Tumor size greater than 1.5 cm and use of adjuvant endocrine therapy were significantly associated with decreased risk of IBTR.
PMCID:6935692
PMID: 31976307
ISSN: 2218-4333
CID: 4273472

No Increase in Acute or Late Toxicity in Women with Autoimmune Diseases Treated with Hypofractionated Breast Radiation [Meeting Abstract]

Purswani, J.; Oh, C.; Sandigursky, S.; Xiao, J.; Gerber, N. K.
ISI:000582521500033
ISSN: 0360-3016
CID: 4686142

Survey of Twitter and Social Media Use Among US Radiation Oncologists [Meeting Abstract]

Knoll, M. A.; Albert, A. A.; Taussky, D.; Kahn, J.; Yechieli, R.; Gerber, N. K.; Katz, M. S.; Jagsi, R.
ISI:000582521501442
ISSN: 0360-3016
CID: 4686252

Current Social Media Use Among Radiation Oncology Trainees [Meeting Abstract]

Albert, A. A.; Kahn, J.; Knoll, M. A.; Lirette, S. T.; Yechieli, R.; Gerber, N. K.; Jagsi, R.; Katz, M. S.
ISI:000582521501471
ISSN: 0360-3016
CID: 4686272

Overutilization of Bilateral Mastectomies and Underutilization in Endocrine Therapy in Ductal Carcinoma in Situ in Young Women: Any Benefit to Survival? [Meeting Abstract]

Byun, D. J.; Wu, P.; Nagar, H.; Gerber, N. K.
ISI:000582521500085
ISSN: 0360-3016
CID: 4686182

Five-Fraction Prone Accelerated Partial Breast Irradiation: Long-Term Oncologic and Cosmetic Outcomes [Meeting Abstract]

Shah, B. A.; Xiao, J.; Oh, C.; Taneja, S.; Barbee, D.; Maisonet, O. G.; Perez, C. A.; Huppert, N. E.; Gerber, N. K.
ISI:000582521500034
ISSN: 0360-3016
CID: 4686152

Whole breast irradiation with high tangents in the prone position

Shaikh, Fauzia; Tam, Moses; Taneja, Sameer; Huppert, Nelly; McCarthy, Allison; Hitchen, Christine; Maisonet, Olivier; Perez, Carmen; Barbee, David; Gerber, Naamit Kurshan
ISI:000562705500001
ISSN: 1948-7894
CID: 4898682

The implications of genetic testing on radiotherapy decisions: a guide for radiation oncologists

Bergom, Carmen; West, Catharine M; Higginson, Daniel S; Abazeed, Mohamed E; Arun, Banu; Bentzen, Soren M; Bernstein, Jonine L; Evans, Jaden D; Gerber, Naamit K; Kerns, Sarah L; Keen, Judy; Litton, Jennifer K; Reiner, Anne S; Riaz, Nadeem; Rosenstein, Barry S; Sawakuchi, Gabriel O; Shaitelman, Simona F; Powell, Simon N; Woodward, Wendy A
PURPOSE AND METHODS/OBJECTIVE:The advent of affordable and rapid next-generation DNA sequencing technology, along with the US Supreme Court ruling invalidating gene patents, has led to a deluge of germline and tumor genetic variant tests that are being rapidly incorporated into clinical cancer decision making. A major concern for clinicians is whether the presence of germline mutations may increase the risk of radiation toxicity or secondary malignancies. Since minimal clinical data exist to inform decisions at this time, the American Society for Radiation Oncology (ASTRO) convened a group of radiation science experts and clinicians to summarize potential issues, review relevant data, and provide guidance for adult patients and their care teams regarding the impact, if any, that genetic testing should have on radiation therapy recommendations. RESULTS AND CONCLUSIONS/CONCLUSIONS:During the ASTRO Workshop, several main points emerged, which are discussed in this manuscript: 1) Variants of uncertain significance should be considered non-deleterious until functional genomic data emerges to demonstrate otherwise; 2) Possession of germline alterations in a single copy of a gene critical for radiation damage responses does not necessarily equate to increased risk of radiation-induced toxicity; 3) Deleterious ATM mutations may modestly increase second cancer risk after radiotherapy, thus follow-up for these patients after indicated radiotherapy should include second cancer screening; 4) Conveying to patients the difference between relative and absolute risk is critical to decision making; and 5) More work is needed to assess the impact of tumor somatic alterations on the probability of response to radiotherapy and the potential for individualization of radiation doses. Data on radiosensitivity related to specific genetic mutations is also briefly discussed.
PMID: 31381960
ISSN: 1879-355x
CID: 4034232

Reirradiation Required [Letter]

Gerber, Naamit K
PMID: 31540592
ISSN: 1879-355x
CID: 4098162