The Experts below are selected from a list of 5562 Experts worldwide ranked by ideXlab platform
Frank A Vicini - One of the best experts on this subject based on the ideXlab platform.
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Partial Breast Irradiation: Accelerated and intraoperative accelerated and intraoperative
The Breast, 2018Co-Authors: Chirag Shah, Eleanor E.r. Harris, Dennis R. Holmes, Frank A ViciniAbstract:Abstract Partial Breast Irradiation encompasses a variety of techniques including accelerated Partial Breast Irradiation (APBI) and intraoperative radiation therapy (IORT). APBI includes multicatheter brachytherapy, applicator based brachytherapy, and external-beam techniques. With the publication of five randomized trials demonstrating no difference in local recurrence with APBI compared with whole Breast Irradiation, APBI is increasingly being used and considered a standard treatment option for appropriately selected women after Breast conserving surgery. IORT, although promising in its ability to complete treatment at the time of surgery, has been shown in two randomized trials, using different techniques, to have higher rates of local recurrence compared with whole Breast Irradiation. At this time, IORT remains investigational with further studies required in light of the findings of the randomized studies to date, a lack of mature data, and an inability to provide clinicians with evidence based consensus guidelines on patient selection.
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Accelerated Partial-Breast Irradiation: Trial by Media or by Science?
International journal of radiation oncology biology physics, 2012Co-Authors: Laurie W. Cuttino, Frank A Vicini, David E. Wazer, Julia White, Rachel Rabinovitch, David A. Gewirtz, Mitchell Steven Anscher, Thomas B. Julian, Douglas W. ArthurAbstract:Accelerated Partial-Breast Irradiation: Trial by Media or by Science? Laurie W. Cuttino, M.D.,* Julia R. White, M.D.,y Rachel Rabinovitch, M.D.,z David A. Gewirtz, Ph.D.,* Mitchell S. Anscher, M.D.,* David E. Wazer, M.D.,x,k Frank A. Vicini, M.D.,{ Thomas B. Julian, M.D., and Douglas W. Arthur, M.D.* *Virginia Commonwealth University, Richmond, Virginia; yOhio State University, Columbus, Ohio; zUniversity of Colorado, Denver, Colorado; xTufts University, Boston, Massachusetts; kBrown University, Providence, Rhode Island; {Michigan Healthcare Professionals/21st Century Oncology, Royal Oak, Michigan; and Drexel University College of Medicine/ Allegheny General Hospital, Pittsburgh, Pennsylvania
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Initial clinical experience with multilumen brachytherapy catheters for accelerated Partial Breast Irradiation.
Brachytherapy, 2011Co-Authors: Chirag Shah, Douglas W. Arthur, Peter Y. Chen, Mihai Ghilezan, J.b. Wilkinson, Martin Keisch, Frank A ViciniAbstract:Abstract Purpose To review the initial experience of three institutions using multilumen catheters to deliver accelerated Partial Breast Irradiation (APBI) and evaluate dosimetric improvements. Methods and Materials Patients were eligible for this analysis if they met criteria for accelerated Partial Breast Irradiation at their respective institution and were not enrolled on the national Phase III trial. Minimum guidelines for treatment planning from the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 protocol were followed. Toxicities were coded using common toxicity criteria version 3.0 criteria. Results Sixty-two patients were analyzed as part of this study. Median skin spacing was 11 mm with a median skin dose of 86.9% (% of prescription dose [PD]). Median rib dose was 76.1% of the PD (range, 4.3–155.7%). The V90, V95, and V100 of the PD for the planning target volume evaluation was 95.4%, 95.2%, and 80.3%, respectively. Seven patients had both skin and rib spacing Conclusion The multilumen device led to improvements in target coverage and normal structure doses compared with traditionally accepted guidelines. Similar toxicities were seen compared with single-lumen devices, even in patients with skin and rib spacing
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Axillary Failure in Patients Treated with MammoSite Accelerated Partial Breast Irradiation
Annals of surgical oncology, 2011Co-Authors: Majd A. Aburabia, Peter D. Beitsch, Henry Mark Kuerer, Sharad Goyal, Bruce G. Haffty, Robert E. Roses, Richard N. Fine, Maureen Lyden, Frank A ViciniAbstract:Background The risk of axillary failure (AF) after accelerated Partial Breast Irradiation (APBI) using MammoSite brachytherapy is unknown and has been source of concern as the axillary region is not treated with this technique. We aimed to determine the rate of AF in patients treated with APBI and identify factors associated with its occurrence.
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Accelerated Partial Breast Irradiation - Accelerated Partial Breast Irradiation
Journal of surgical oncology, 2011Co-Authors: Peter D. Beitsch, Simona F. Shaitelman, Frank A ViciniAbstract:Accelerated Partial Breast Irradiation has become an important component of the management of early-stage Breast cancer. While local control following APBI continues to be excellent with acceptable rates of acute and late toxicities, further refinement of patient selection guidelines and completion of the ongoing Phase III trials remain priorities for this growing segment of radiation oncology.
Henry Mark Kuerer - One of the best experts on this subject based on the ideXlab platform.
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Accelerated Partial Breast Irradiation for Early Breast Cancer
NEJM Journal Watch, 2015Co-Authors: Henry Mark KuererAbstract:Accelerated Partial Breast Irradiation (APBI) can be delivered for Breast cancer by several means and can reduce the length of treatments from a
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Adverse Cosmesis with Accelerated Partial-Breast Irradiation
NEJM Journal Watch, 2013Co-Authors: Henry Mark KuererAbstract:Accelerated Partial-Breast Irradiation (APBI) delivers a much shorter course of radiotherapy than whole-Breast Irradiation (WBI; ≤1 week and 3–6 weeks,
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Axillary Failure in Patients Treated with MammoSite Accelerated Partial Breast Irradiation
Annals of surgical oncology, 2011Co-Authors: Majd A. Aburabia, Peter D. Beitsch, Henry Mark Kuerer, Sharad Goyal, Bruce G. Haffty, Robert E. Roses, Richard N. Fine, Maureen Lyden, Frank A ViciniAbstract:Background The risk of axillary failure (AF) after accelerated Partial Breast Irradiation (APBI) using MammoSite brachytherapy is unknown and has been source of concern as the axillary region is not treated with this technique. We aimed to determine the rate of AF in patients treated with APBI and identify factors associated with its occurrence.
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Integrating Partial Breast Irradiation into Surgical Practice and Clinical Trials
The Surgical clinics of North America, 2007Co-Authors: Regina M. Fearmonti, Frank A Vicini, Timothy M. Pawlik, Henry Mark KuererAbstract:The use of accelerated Partial Breast Irradiation (APBI) in place of whole-Breast Irradiation (WBI) for Breast-conservation therapy (BCT) is an area of intensive clinical investigation. This article describes evolving methods of APBI in comparison to WBI and in the setting of ongoing clinical trials.
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Accelerated Partial Breast Irradiation as an alternative to whole Breast Irradiation in Breast-conserving therapy for early-stage Breast cancer.
Women's health (London England), 2005Co-Authors: Timothy M. Pawlik, Henry Mark KuererAbstract:Breast-conserving therapy has been established as a standard treatment for women with early-stage Breast cancer. Whole Breast Irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole Breastwhole Breast Irradiation after Breast-conserving surgery has become controversial, with some investigators advocating accelerated Partial Breast Irradiation as an alternative. Accelerated Partial Breast Irradiation is delivered over a shorter period and only to a portion of the Breast. This review will examine the emerging role of accelerated Partial Breast Irradiation in the treatment of early-stage Breast cancer and review the biologic rationale for, techniques of, and limitations of Partial Breast Irradiation following Breast-conserving surgery.
G. Casazza - One of the best experts on this subject based on the ideXlab platform.
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Partial Breast Irradiation or whole Breast radiotherapy for early Breast cancer: A meta-analysis of randomized controlled trials
Journal of Clinical Oncology, 2009Co-Authors: A. Valachis, D. Mauri, N. P. Polyzos, D. Mavroudis, V. Georgoulias, G. CasazzaAbstract:CRA532 Background: The purpose of the study was to compare treatment outcomes in patients with Breast cancer treated with Partial Breast Irradiation and of those treated with whole Breast radiation therapy. Methods: We conducted a systematic review and meta-analysis of published. Randomized clinical trials comparing Partial Breast Irradiation versus whole Breast radiation therapy. Primary outcome was overall survival and secondary outcomes were locoregional, distant and supraclavicular recurrences. Results: A search of the literature identified 3 trials with pooled total of 1,140 patients. We found no statistically significant difference between Partial and whole Breast radiation arms associated with death (OR 0.912, 95% CI 0.674–1.234, p = 0.550), distant metastasis (OR 0.740, 95% CI, 0.506–1.082, p = 0.120), or supraclavicular recurrences (pooled OR 1.415, 95% CI 0.278–7.202, p = 0.560). However, Partial Breast Irradiation was statistically significantly associated with an increased risk of both local (pooled OR 2.150, 95% CI, 1.396–3.312; p = 0.001) and regional disease recurrences (pooled OR 3.430, 95% CI, 2.058–5.715; p < 0.0001) compared with whole Breast radiation. Conclusions: Partial Breast Irradiation does not jeopardize survival and may be used as an alternative to whole Breast radiation. Nevertheless, the issue of locoregional recurrence needs to be further addressed. No significant financial relationships to disclose.
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Partial Breast Irradiation or whole Breast radiotherapy for early Breast cancer: A meta-analysis of randomized controlled trials
Journal of Clinical Oncology, 2009Co-Authors: A. Valachis, D. Mauri, N. P. Polyzos, D. Mavroudis, V. Georgoulias, G. CasazzaAbstract:CRA532 Background: The purpose of the study was to compare treatment outcomes in patients with Breast cancer treated with Partial Breast Irradiation and of those treated with whole Breast radiation therapy. Methods: We conducted a systematic review and meta-analysis of published. Randomized clinical trials comparing Partial Breast Irradiation versus whole Breast radiation therapy. Primary outcome was overall survival and secondary outcomes were locoregional, distant and supraclavicular recurrences. Results: A search of the literature identified 3 trials with pooled total of 1,140 patients. We found no statistically significant difference between Partial and whole Breast radiation arms associated with death (OR 0.912, 95% CI 0.674–1.234, p = 0.550), distant metastasis (OR 0.740, 95% CI, 0.506–1.082, p = 0.120), or supraclavicular recurrences (pooled OR 1.415, 95% CI 0.278–7.202, p = 0.560). However, Partial Breast Irradiation was statistically significantly associated with an increased risk of both local (...
David E. Wazer - One of the best experts on this subject based on the ideXlab platform.
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Update on Partial Breast Irradiation
Clinical breast cancer, 2020Co-Authors: Jaroslaw T Hepel, David E. WazerAbstract:For early-stage Breast cancer, Partial Breast Irradiation (PBI) allows for reduction in the irradiated volume of normal tissues by confining the radiation target to the area surrounding the lumpectomy cavity after Breast-conserving surgery. This approach has been supported by phase 2 data. However, widespread adoption of PBI has awaited the results of randomized controlled trials. This review discusses the results of randomized controlled trials comparing whole Breast Irradiation to PBI, including the recently published National Surgical Adjuvant Breast and Bowel Project (NSABP) B39/Radiotherapy Oncology Group (RTOG) 0413, and the Canadian RAPID trials. PBI techniques, dose/fractionation schedules, and patient selection are also reviewed.
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Accelerated Partial-Breast Irradiation: Trial by Media or by Science?
International journal of radiation oncology biology physics, 2012Co-Authors: Laurie W. Cuttino, Frank A Vicini, David E. Wazer, Julia White, Rachel Rabinovitch, David A. Gewirtz, Mitchell Steven Anscher, Thomas B. Julian, Douglas W. ArthurAbstract:Accelerated Partial-Breast Irradiation: Trial by Media or by Science? Laurie W. Cuttino, M.D.,* Julia R. White, M.D.,y Rachel Rabinovitch, M.D.,z David A. Gewirtz, Ph.D.,* Mitchell S. Anscher, M.D.,* David E. Wazer, M.D.,x,k Frank A. Vicini, M.D.,{ Thomas B. Julian, M.D., and Douglas W. Arthur, M.D.* *Virginia Commonwealth University, Richmond, Virginia; yOhio State University, Columbus, Ohio; zUniversity of Colorado, Denver, Colorado; xTufts University, Boston, Massachusetts; kBrown University, Providence, Rhode Island; {Michigan Healthcare Professionals/21st Century Oncology, Royal Oak, Michigan; and Drexel University College of Medicine/ Allegheny General Hospital, Pittsburgh, Pennsylvania
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A comparison of brachytherapy techniques for Partial Breast Irradiation.
Brachytherapy, 2011Co-Authors: Jaroslaw T Hepel, David E. WazerAbstract:Accelerated Partial Breast Irradiation has emerged as an important treatment option for select patients with early-stage Breast cancer. Numerous techniques for the delivery of accelerated Partial Breast Irradiation have been developed involving both external beam and brachytherapy techniques. Brachytherapy techniques in general have the advantage of directly targeting the tumor bed and are not hampered by the requirement for large planning target volume margins needed with external beam techniques to account for uncertainties in targeting a very mobile organ, easily affected by patient and respiratory motion. We review established brachytherapy techniques and new emerging approaches. Technical considerations, available clinical data, advantages and shortcomings of each technique are reviewed.
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Point: Brachytherapy for accelerated Partial Breast Irradiation.
Brachytherapy, 2009Co-Authors: David E. WazerAbstract:A number of studies in recent years have detailed the rationale for and the various technical considerations of Partial Breast Irradiation, which is defined as radiation of the site of excision and adjacent Breast tissue only. Partial Breast Irradiation can be delivered with brachytherapy or external modalities. Accelerated Partial Breast Irradiation (APBI) is defined as radiotherapy that uses fractions higher than 1.8e2.0 Gy per day over a period of less than 5e6 weeks and, in North America, is most commonly delivered via three techniques: (1) interstitial brachytherapy; (2) intracavity brachytherapy through the use of a variety of balloon or ‘‘cagelike’’ catheter products; and (3) three-dimensionally planned conformal external beam techniques or ‘‘3D-CRT’’ (intraoperative techniques for APBI will not be included in this discussion). Several techniques that can be classified as ‘‘conformal external beam’’ have been described (1e4), but the most widely used 3D-CRT technique was initially developed by investigators at the William Beaumont Hospital and was subsequently adopted for use as one of the allowed treatment modalities for patients randomized to APBI in the NSABP B-39/RTOG 0143 Phase III trial (subsequently abbreviated in this text as the NSABP/RTOG protocol). It is a straightforward and readily reproducible technique that uses four to five tangentially positioned noncoplanar beams and, as such, has been incorporated in the treatment repertoire of hundreds of treatment centers nationwide irrespective of clinical trial participation. Therefore, this discussion will focus primarily on contrasting brachytherapy to the specific 3D-CRT technique for APBI as detailed in the NSABP/RTOG protocol though its general points and conclusions are likely applicable to any conformal external beam technique.
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Accelerated Partial Breast Irradiation: an updated report from the American Brachytherapy Society
Brachytherapy, 2003Co-Authors: Douglas W. Arthur, Robert R. Kuske, Frank A Vicini, David E. Wazer, Subir NagAbstract:Logistical barriers of time and travel created by the conventional six-week course of radiotherapy prevent many women from pursuing Breast conservation treatment. For the past 12 years, Accelerated Partial Breast Irradiation (APBI) has been investigated as a potential alternative treatment approach in women with early stage Breast cancer. The ability to complete treatment in five days has the potential to provide additional women with the option of Breast conservation. The validity of this APBI is supported in the study of in-Breast recurrence patterns, pathologic data and the clinical treatment experience. The review of the recent data on contemporary APBI reveals that patient selection criteria and brachytherapy quality assurance are clearly critical components and necessary to assure a successful treatment outcome. This updated report from the American Brachytherapy Society on Accelerated Partial Breast Irradiation reviews the appropriate background data supporting this treatment approach with conclusions regarding patient selection criteria and treatment delivery.
Abram Recht - One of the best experts on this subject based on the ideXlab platform.
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Update on accelerated Partial-Breast Irradiation
Current oncology reports, 2006Co-Authors: Alphonse G. Taghian, Abram RechtAbstract:Progress in radiotherapy technology, particularly the advent of CT-guided simulation and three-dimensional conformal planning, has given the radiation oncologist the ability to precisely treat part of the Breast, instead of the whole Breast, using either brachytherapy or external-beam techniques. Treating such a limited area may allow the course of treatment for patients with early-stage Breast cancer to be drastically shortened and could reduce toxicity to other organs. This article summarizes the rationale for accelerated Partial-Breast Irradiation (APBI), techniques for performing it, and outcome to date of studies of APBI.
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Lessons of studies of Breast-conserving therapy with and without whole-Breast Irradiation for patient selection for Partial-Breast Irradiation
Seminars in radiation oncology, 2005Co-Authors: Abram RechtAbstract:Partial-Breast Irradiation is a promising approach for treating patients with early-stage invasive Breast cancer. There are still few studies of Partial-Breast Irradiation that address critical issues, such as criteria for patient selection. However, an enormous body of experience has been accumulated regarding the results in patients treated with "conventional" Breast-conserving therapy using whole-Breast Irradiation and for patients treated with conservative surgery without radiotherapy of any kind. This article will therefore review portions of this existing experience that may aid the development of Partial-Breast Irradiation and give perspective on the overall role that Partial-Breast Irradiation may ultimately play in our therapeutic armamentarium.
