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Robotic Stereotactic Body Radiation Therapy for the Adjuvant Treatment of Early-Stage Breast Cancer: Outcomes of a Large Single-Institution Study

Jaysing, A; Lischalk, J W; Sanchez, A; Mendez, C; May, P; Solan, A; Witten, M; Logman, Z; Haas, J A
Purpose: Advancements in breast radiation therapy offer innumerable benefits to patients and the health care system. Despite promising outcomes, clinicians remain hesitant about long-term side effects and disease control with accelerated partial breast radiation therapy (APBI). Herein, we review the long-term outcomes of patients with early-stage breast cancer treated with adjuvant stereotactic partial breast irradiation (SAPBI). Methods and Materials: This retrospective study examined outcomes of patients who received diagnoses of early-stage breast cancer treated with adjuvant robotic SAPBI. All patients were eligible for standard ABPI and underwent lumpectomy, followed by fiducial placement in preparation for SAPBI. Using fiducial and respiratory tracking to maintain a precise dose distribution throughout the course of treatment, patients received 30 Gy in 5 fractions on consecutive days. Follow-up occurred at routine intervals to evaluate disease control, toxicity, and cosmesis. Toxicity and cosmesis were characterized using the Common Terminology Criteria for Adverse Events version 5.0 and Harvard Cosmesis Scale, respectively.
Result(s): Patients (N = 50) were a median age of 68.5 years at the time of treatment. The median tumor size was 7.2 mm, 60% had an invasive cell type, and 90% were estrogen receptor positive, progesterone receptor positive, or both. Patients (n = 49) were followed for a median of 4.68 years for disease control and 1.25 years for cosmesis and toxicity. One patient experienced local recurrence, 1 patient experienced grade 3+ late toxicity, and 44 patients demonstrated excellent cosmesis.
Conclusion(s): To our knowledge, this is the largest retrospective analysis with the longest follow-up time for disease control among patients with early breast cancer treated with robotic SAPBI. With follow-up time for cosmesis and toxicity comparable to that of previous studies, results of the present cohort advance our understanding of the excellent disease control, excellent cosmesis, and limited toxicity that can be achieved by treating select patients with early-stage breast cancer with robotic SAPBI.
ISSN: 2452-1094
CID: 5510052

There is no correlation between erectile dysfunction and dose to penile bulb and neurovascular bundles following real-time low-dose-rate prostate brachytherapy

Solan, Amy N; Cesaretti, Jamie A; Stone, Nelson N; Stock, Richard G
PURPOSE: We evaluated the relationship between the onset of erectile dysfunction and dose to the penile bulb and neurovascular bundles (NVBs) after real-time ultrasound-guided prostate brachytherapy. METHODS AND MATERIALS: One hundred forty-seven patients who underwent prostate brachytherapy met the following eligibility criteria: (1) treatment with 125I brachytherapy to a prescribed dose of 160 Gy with or without hormones without supplemental external beam radiation therapy, (2) identification as potent before the time of implantation based on a score of 2 or higher on the physician-assigned Mount Sinai Erectile Function Score and a score of 16 or higher on the abbreviated International Index of Erectile Function patient assessment, and (3) minimum follow-up of 12 months. Median follow-up was 25.7 months (range, 12-47 months). RESULTS: The 3-year actuarial rate of impotence was 23% (34 of 147 patients). An additional 43% of potent patients (49 of 113 patients) were using a potency aid at last follow-up. The penile bulb volume receiving 100% of the prescription dose (V(100)) ranged from 0-0.05 cc (median, 0 cc), with a dose to the hottest 5% (D(5)) range of 12.5-97.9 Gy (median, 40.8 Gy). There was no correlation between penile bulb D(5) or V(100) and postimplantation impotency on actuarial analysis. For the combined right and left NVB structures, V(100) range was 0.3-5.1 cc (median, 1.8 cc), and V(150) range was 0-1.5 cc (median, 0.31 cc). There was no association between NVB V(100) or V(150) and postimplantation impotency on actuarial analysis. CONCLUSION: Penile bulb doses are low after real-time ultrasound-guided prostate brachytherapy. We found no correlation between dose to either the penile bulb or NVBs and the development of postimplantation impotency.
PMID: 18922652
ISSN: 1879-355X
CID: 2356742

Treatment of patients with cardiac pacemakers and implantable cardioverter-defibrillators during radiotherapy

Solan, Amy N; Solan, Merrill J; Bednarz, Greg; Goodkin, Michael B
PURPOSE: To define the practical clinical guidelines that can be implemented by busy radiation oncology departments to minimize the risk of harm to patients with implanted cardiac pacemaker (ICP) and implantable cardioverter-defibrillator (ICD) devices during radiotherapy. METHODS AND MATERIALS: A literature review was conducted to identify the mechanism of potential damage to ICPs and ICDs from exposure to electromagnetic interference and/or ionizing radiation and to assess the published evidence of such device malfunction or failure. Recommendations for patient management were obtained from three major manufacturers. Eighty-seven radiation oncology facilities across the United States and Canada were contacted to determine current practice patterns; 75 centers responded. RESULTS: The published documentation of potential life-threatening malfunction of ICP and ICD devices exposed to electromagnetic interference and ionizing radiation is considerable. However, major discrepancies exist among manufacturer recommendations and wide variations are present among radiation oncology facilities regarding patient management precautions. CONCLUSION: Precautions are necessary to minimize the risk to patients with ICP and ICD devices during radiotherapy. Practical management guidelines are presented that can be readily adopted by any busy clinical radiation oncology practice.
PMID: 15183493
ISSN: 0360-3016
CID: 2356752