K. Erven MD, PhD

Partial breast irradiation of early-stage breast cancer

SUMMARY

Whole-breast irradiation, as part of breast-conservation therapy (BCT), has been well-established the last decades. Nonetheless, most local recurrences found after BCT are within or close to the tumour bed. This led to the concept of partial breast irradiation (PBI), delivering the radiation dose to a decreased target volume, thereby lowering exposure to the organs at risk and hence potentially minimizing late adverse effects. This became increasingly important with growing survivorship of patients with early-stage breast cancer over the past decades and the consideration of late adverse effects is gaining more importance. In this review, we will present an overview of the current literature, techniques to deliver PBI and we try to establish whether there is a place for PBI in early-stage breast cancer treatment.

(BELG J MED ONCOL 2020;14(4):140–45)

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Brain metastases: The evolving role of whole-brain radiotherapy

Over the last decade the use of whole-brain radiotherapy has decreased due to therapeutic advances, as well as in systemic treatment as in radiotherapy, but also due to a growing concern about neurocognitive failure in long-term survivors.

In patients with good prognostic factors (defined by recursive partitioning analysis or disease specific-graded prognostic assessment) and with limited brain metastases (excluding histologies s.a. SCLC, germ cell tumours, lymphomas and leukaemias), there is a trend to defer WBRT and only perform localised treatment (surgery, radiosurgery, stereotactic fractionated radiotherapy) with close follow up.

WBRT is still an option in better prognostic patients with higher intracranial tumour burden. When patients have a poor performance status, best supportive care is an equally valid option.

(BELG J MED ONCOL 2018:12(3):103–109)

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Radiation pneumonitis: occurrence, prediction, prevention and treatment

Summary

Radiation pneumonitis is the most important dose-limiting toxicity in the treatment of thoracic malignancies amendable for high-dose radiotherapy such as lung or oesophageal cancer.
Several patient-specific factors (e.g. age, smoking history, pre-existing inflammatory lung disease, tumour location and performance score) as well as treatment-related factors (e.g. radiation dose and volume, chemotherapy, hormonal therapy) have been studied as potential predictors of the risk of radiation pneumonitis. The most robust parameters that correlate with radiation pneumonitis are Dose Volume Histogram-related, such as the mean lung dose, the percentage of a volume receiving a certain dose such as the V20 and more complex models. All of these show a low overall accuracy with an area under the receiver-operator curve of about 0.65, although they might be still clinically useful by virtue of their high negative predictive value.
Besides research in the underlying genetics of radiation pneumonitis, the interaction between radiotherapy and most targeted agents has not been elucidated.
At present, validated Dose Volume Histogram parameters can be used in clinical practice. Drugs administered concurrently with irradiation of the lungs should only be carried out in combinations with proven safety in prospective trials.

(BELG J MED ONCOL 2013;7(4):105–10)

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Breast cancer irradiation: optimisation of treatment techniques and evaluation of toxicity

Summary

Radiotherapy plays an important role in the treatment of breast cancer patients as it has shown to improve both local control and survival.¹ To further improve the therapeutic ratio, it is important to optimise radiotherapy dose distributions using modern radiotherapy techniques. This is particularly true when the locoregional lymph nodes are included in the target volume, as the resulting complex target volume, in close proximity of the heart and lungs, makes treatment planning more challenging.² With improving survival rates for breast cancer patients, prevention of long-term treatment-related toxicity becomes more important. Therefore, a better understanding of the occurrence of radiotherapy-induced late cardiopulmonary side-effects is needed.

(BELG J MED ONCOL 2013;7(4):123–6)

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