The purpose of this study was to determine if 40 Gy in 10 daily fractions is a tolerable dose schema for accelerated partial breast irradiation (APBI) as compared to more traditional twice-daily regimens that have produced mixed cosmetic results in trials. 

There were 106 patients enrolled in the study. Median age was 62 years. All patient received lumpectomy for in-situ or early invasive disease. A 3-D conformal RT technique was used. 

Median follow-up was 58 months. Regarding recurrence outcomes, there were in total 3 recurrences: 2 local, 1 distant. Regarding cosmesis, 15% experienced grade 2 or greater skin toxicity with only two cases of grade 3 skin toxicity. The planning target volume (PTV) and breast volume receiving 20 Gy (V20) were found to be predictors of skin toxicity. The authors suggest that limiting breast V20 to less than 45% may limit skin toxicity, as 62% of patients who developed skin complications had a breast V20 greater than 50%. 

Given these results, 40 Gy in 10 daily fractions may be an appropriate APBI regimen in patients with early stage breast cancer. PTV and V20 may also be accurate predictors of skin toxicity and may be useful constraints in guiding treatment planning. More follow-up will be needed to determine the toxicity profile and safety of this regimen in the long-term. 

Reference (PubMed Link): Braunstein LZ, Thor M, Flynn J, et al. Daily fractionation of external beam accelerated partial breast irradiation to 40 gy is well tolerated and locally effective. Int J Radiat Oncol Biol Phys 2019;104:859-866.

Key Institution: Memorial Sloan Kettering Cancer Center
Keywords: Accelerated Partial Breast Irradiation, APBI, Skin Toxicity, Breast Cancer 

This randomized study was conducted in 537 patients from 22 surgical practices, randomly assigned online to the iCanDecide interactive and tailored Web site (intervention) or the iCanDecide static Web site (control). The aim was to determine the effect of iCanDecide, an interactive and tailored breast cancer treatment decision tool, on the rate of high-quality patient decisions—both informed and values concordant—regarding locoregional breast cancer treatment and on patient appraisal of decision making. The tailored and interactive iCanDecide Web site, which focused on knowledge building and values clarification, positively affected high-quality decisions largely by improving knowledge compared with static online information.

Harnessing available technology to improve oncology outcomes is a largely untapped avenue for clinical research and/or commercial enterprise. Decision making tools such as iCanDecide will become increasingly common in the next decade in a nationwide and global effort to bring quality control to diverse clinical settings. Experiences such as this study will serve to advance this aspect of oncology care. 

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Journal & Date: JCO, 2018
Key Institution: Multicenter
Keywords: Clinical decision making, breast cancer, oncologic surgery, technology, patient decision making, patient centered care