Paige L. Dorn

The effect of treatment time in locally advanced cervical cancer in the era of concurrent chemoradiotherapy.

This study sought to determine if treatment time impacts pelvic failure (PF), distant failure (DF), or disease‐specific mortality (DSM) in patients undergoing concurrent chemoradiotherapy (CCRT).

A Prospective Study of the Utility of Magnetic Resonance Imaging in Determining Candidacy for Partial Breast Irradiation

PURPOSE Retrospective data have demonstrated that breast magnetic resonance imaging (MRI) may change a patients eligibility for partial breast irradiation (PBI) by identifying multicentric, multifocal, or contralateral disease. The objective of the current study was to prospectively determine the frequency with which MRI identifies occult disease and to establish clinical factors associated with a higher likelihood of MRI prompting changes in PBI eligibility. METHODS AND MATERIALS At The University of Chicago, women with breast cancer uniformly undergo MRI in addition to mammography and ultrasonography. From June 2009 through May 2011, all patients were screened prospectively in a multidisciplinary conference for PBI eligibility based on standard imaging, and the impact of MRI on PBI eligibility according to National Surgical Adjuvant Breast and Bowel Project protocol B-39/Radiation Therapy Oncology Group protocol 0413 entry criteria was recorded. Univariable analysis was performed using clinical characteristics in both the prospective cohort and in a separate cohort of retrospectively identified patients. Pooled analysis was used to derive a scoring index predictive of the risk that MRI would identify additional disease. RESULTS A total of 521 patients were screened for PBI eligibility, and 124 (23.8%) patients were deemed eligible for PBI based on standard imaging. MRI findings changed PBI eligibility in 12.9% of patients. In the pooled univariable analysis, tumor size ≥ 2 cm on mammography or ultrasonography (P=.02), age <50 years (P=.01), invasive lobular histology (P=.01), and HER-2/neu amplification (P=.01) were associated with a higher likelihood of MRI changing PBI eligibility. A predictive score was generated by summing the number of significant risk factors. Patients with a score of 0, 1, 2, and 3 had changes to eligibility based on MRI findings in 2.8%, 13.2%, 38.1%, and 100%, respectively (P<.0001). CONCLUSIONS MRI identified additional disease in a significant number of patients eligible for PBI, based on standard imaging. Clinical characteristics may be useful in directing implementation of MRI in the staging of PBI candidates.

Hypofractionated radiotherapy does not increase acute toxicity in large-breasted women: results from a prospectively collected series.

Background and Purpose:To compare the acute toxicity of hypofractionated whole breast radiotherapy (HypoRT) to conventionally fractionated radiotherapy (ConvRT) in large-breasted women with early stage disease. Materials and Methods:Women with breast volume>1500 cm3, body mass index>30 kg/m2, or separation>25 cm treated with HypoRT or ConvRT from 2005 through 2010 were identified from a prospective database and included in the analysis. Acute toxicity was scored for each treated breast. Results:Ninety-two patients were treated to 96 breasts. The median body mass index was 33 kg/m2 and median breast volume was 1932 cm3 for the ConvRT group compared with 32.4 kg/m2 and 1825 cm3 for the HypoRT group. Maximum acute skin toxicity consisted of focal moist desquamation in 26% and 11% of the ConvRT and HypoRT patients, respectively (P=0.002). Breast volume was the only patient factor significantly associated with moist desquamation on multivariable analysis (P=0.01). Among those with a breast volume >2500 cm3, focal moist desquamation occurred in 40.7% (11/27) compared with 11.1% (7/63) in patients with breast volume <2500 cm3 (P=0.002). Conclusions:Among obese and large-breasted women, there was no increase in acute skin toxicity with the use of HypoRT. HypoRT should be considered in obese and large-breasted women when advanced planning techniques are used.