Issues
Late effects of combined modality treatment with adjuvant neutron therapy for locally advanced breast cancer
«Radiation and Risk», 2018, vol. 27, No. 1, pp.107-114
DOI: 10.21870/0131-3878-2018-27-1-107-114
Authors
Velikaya V.V. – Researcher, C. Sc., Med. Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, Tomsk. Contacts: 5 Kooperativnyi per., Tomsk, Russia, 634009. Tel.: 8 (3822) 28-26-86 (3119); e-mail:
This email address is being protected from spambots. You need JavaScript enabled to view it.
.
Startseva Zh.A. – Head of Dep., D. Sc., Med., Prof. Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, Tomsk.
Lisin V.A. – Main. Res., D. Sc., Med., Prof. Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, Tomsk.
Simonov K.A. – Researcher, C. Sc., Med. Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, Tomsk.
Goldberg V.E. – Head of Dep., D. Sc., Med., Prof. Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, Tomsk.
*
Abstract
Late effects of combined-modality treatment with adjuvant neutron therapy for reducing risk of local and regional recurrences in patients with locally advanced breast cancer are considered in the article. Treatment of breast cancer with photon beam therapy that uses low linear energy transfer (low LET) radiation can cause development of recalcitrant radioresistant recurrences. In such a case the use of neutrons, the type of high LET radiation, are more effective for treatment of some radiorestant tumors due to radiobiological properties of neutrons. Multimodal treatment (T2-4N0-3M0) that combined neo-adjuvant and adjuvant chemotherapies, radical mastectomy and postoperative external beam radiation therapy (EBRT) was delivered to 128 breast cancer patients. Patients under study (n=68) received adjuvant neutron therapy and those in the control group (n=60) received electron therapy. Late effects of the combined modality treatment were estimated by 8-year disease-free and overall survivals in the two groups of patients. Disease-free survival was significantly higher in patients received adjuvant neutron therapy delivered to the anterior chest wall as compared with the survival in the group received electron therapy: 94.3±4.2% and 81.4±5.9%, (p=0.055) respectively. The overall survival was reliably higher in the study group – 76.6±7.6%, as compared with the survival in the control group – 47.6±9.1%, (p=0.426). Neutron therapy was well tolerated, and I-II grade local radiation-induced skin reactions were the most common. The presented results allow making conclusion that adjuvant neutron therapy following radical mastectomy is evidence-based, effective and safe treatment for locally advanced breast cancer T2-4N0-3M0. Delivery of the systemic chemotherapy to the patients prolongs their overall survival and improve quality of life.
Key words
Locally advanced breast cancer, multimodal treatment, radical mastectomy, prognostic factors, radiation therapy, neutron therapy, local recurrence, radiation-induced reactions, pulmonary fibrosis, survival.
References
1. Demidov S.M., Petkau V.V., Lan S.A. Results of treatment of patients with locally advanced breast cancer. Ural'skiy meditsinskiy zhurnal – Ural Medical Journal, 2008, no. 11 (51), pp. 98-102. (In Russian).
2. Malignant neoplasms in Russia in 2015 (morbidity and mortality). Eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow, 2017. 250 p. (In Russian).
3. Overgaard M., Kvistgaard M.E., Thomsen M.S. Postoperative radiotherapy treatment of early breast cancer. Ugeskr. Laeger., 2007, vol. 169, no. 36, pp. 2993-2996.
4. Semiglazov V.F., Semiglazov V.V. Adjuvant chemoradiotherapy for breast cancer. Prakticheskaya oncologiya – Practical Oncology, 2008, vol. 9, no. 1, pp. 9-15. (In Russian).
5. Startseva Zh.A., Simonov K.A., Slonimskaya E.M. Differentiated approach to the use of adjuvant radiation therapy for patients with operable breast cancer. Radiatsiya i Risk – Radiation and Risk, 2014, vol. 23, no. 2, pp. 102-111. (In Russian).
6. Kharchenko V.R., Khmelevsky Ye.V., Chkhikvadze V.D., Bozhenko V.K., Panshin G.A. Features and causative factors of post-mastectomy risk of locally-advanced breast cancer relapse. Voprosy oncologii – The Oncology Issues, 2009, vol. 55, no. 4, pp. 436-442. (In Russian).
7. Startseva Zh.A., Simonov K.A., Slonimskaya E.M. Selection of the optimal volume of irradiation in breast cancer patients in accordance with significant predictors. Voprosy oncologii – The Oncology Issues, 2015, no. 5, pp. 778-781. (In Russian).
8. Mardynsky Yu.S., Gulidov L.A., Aminov G.G., Ragulin Yu.A., Sysoev A.S. Mixed (photon-neutron) therapy in complex treatment for locally advanced breast cancer. Voprossy oncologii – The Oncology Issues, 2014, vol. 60, no. 4, pp. 490-493. (In Russian).
9. Gribova O.V., Musabaeva L.I., Choynzonov E.L., Lisin V.A., Novikov V.A. Neutron therapy for salivary and thyroid gland cancer. AIP Conf. Proc., 2016, vol. 1760, no. 1, p. 020021.
10. Gribova O.V., Musabaeva L.I., Choĭnzonov E.L., Mukhamedov M.R. The clinical course of thyroid cancer following its combined treatment with the use of fast-neutron therapy in the patients at the high risk of relapses. Vestnik otorinolaringologii – Bulletin of Otorhinolaryngology, 2012, no. 5, pp. 91-92. (In Russian).
11. Velikaya V.V., Musabaeva L.I., Lisin V.A., Startseva Zh.A. 6,3 MeV fast neutrons in the treatment of patients with locally advanced and locally recurrent breast cancer. AIP Conf. Proc., 2016, vol. 1760, no. 1, p. 020069.
12. Startseva Zh.A. Long-term results of complex treatment of patients with locally advanced breast cancer with the use of fast neutrons of 6.3 MeV. Aktual'nye problemy gumanitarnykh i obshchestvennykh nauk – Actual Problems of Humanities and Natural Sciences, 2015, no. 3-2, pp. 223-226. (In Russian).
13. Velikaya V.V., Musabaeva L.I., Startseva Zh.A., Lisin V.A. Fast neutrons of 6.3 MeV in complex treatment of patients with breast cancer local recurrences. Voprosy onkologii – The Oncology Issues, 2015, vol. 61, no. 4, pp. 583-585. (In Russian).
14. Velikaya V.V., Gribova O.V., Musabaeva L.I., Startseva Zh.A., Simonov K.A., Aleinik A.N., Lisin V.A. Ozone therapy for radiation reactions and skin lesions after neutron therapy in patients with malignant tumors. Voprosy onkologii – The Oncology Issues, 2015, vol. 61, no. 4, pp. 571-574. (In Russian).
15. Kucherova T.Ya., Velikaya V.V., Gribova O.V., Startseva Zh.A., Choinzonov E.L., Tuzikov S.A., Vusik M.V., Doroshenko A.V. Physical therapy methods in the treatment and rehabilitation of cancer patients. AIP Conf. Proc., 2016, vol. 1760, no. 1, p. 020038.