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Current Oncology
Volume 26
Issue 3
10.3747/co.26.4479
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Stereotactic Image-Guided Neoadjuvant Ablative Single-Dose Radiation, then Lumpectomy, for Early Breast Cancer: The Signal Prospective Single-Arm Trial of Single-Dose Radiation Therapy

by
K. Guidolin
1,
B. Yaremko
2,3,
K. Lynn
4,
S. Gaede
5,
A. Kornecki
2,6,
G. Muscedere
2,6,
I. BenNachum
2,6,
O. Shmuilovich
2,6,
M. Mouawad
2,
E. Yu
1,2,
T. Sexton
,
N. Gelman
6,
V. Moiseenko
7,
M. Brackstone
2,8,* and
M. Lock
1,2
1
Department of Surgery, University of Toronto, Toronto, ON, Canada
2
Division of Radiation Oncology, Department of Oncology, London Regional Cancer Program, London, ON, Canada
3
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
4
London Tumour Biobank, St. Joseph’s Health Care, London, ON, Canada
5
Medical Physics, London Regional Cancer Program, London, ON, Canada
6
Department of Medical Imaging, St. Joseph’s Health Care, London, ON, Canada
7
Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California, San Diego, CA, USA
8
Division of Surgical Oncology, Department of Surgery, London Health Sciences Centre, London, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2019, 26(3), 334-340; https://doi.org/10.3747/co.26.4479
Submission received: 11 March 2019 / Revised: 10 April 2019 / Accepted: 3 May 2019 / Published: 1 June 2019

Abstract

Background and Purpose: Adjuvant whole-breast irradiation after breast-conserving surgery, typically delivered over several weeks, is the traditional standard of care for low-risk breast cancer. More recently, hypofractionated, partial-breast irradiation has increasingly become established. Neoadjuvant single-fraction radiotherapy (RT) is an uncommon approach wherein the unresected lesion is irradiated preoperatively in a single fraction. We developed the SIGNAL (Stereotactic Image-Guided Neoadjuvant Ablative Radiation Then Lumpectomy) trial, a prospective single-arm trial to test our hypothesis that, for low-risk carcinoma of the breast, the preoperative single-fraction approach would be feasible and safe. Methods: Patients presenting with early-stage (T < 3 cm), estrogen-positive, clinically node-negative invasive carcinoma of the breast with tumours at least 2 cm away from skin and chest wall were enrolled. All patients received prone breast magnetic resonance imaging (MRI) and prone computed tomography simulation. Treatable patients received a single 21 Gy fraction of external-beam rt (as volumetric-modulated arc therapy) to the primary lesion in the breast, followed by definitive surgery 1 week later. The primary endpoints at 3 weeks, 6 months, and 1 year were toxicity and cosmesis (that is, safety) and feasibility (defined as the proportion of mri-appropriate patients receiving RT). Results: Of 52 patients accrued, 27 were successfully treated. The initial dosimetric constraints resulted in a feasibility failure, because only 57% of eligible patients were successfully treated. Revised dosimetric constraints were developed, after which 100% of patients meeting mri criteria were treated according to protocol. At 3 weeks, 6 months, and 1 year after the operation, toxicity, patient- and physician-rated cosmesis, and quality of life were not significantly different from baseline. Conclusions: The SIGNAL trial presents a feasible method of implementing single-dose preoperative rt in early-stage breast cancer. This pilot study did not identify any significant toxicity and demonstrated excellent cosmetic and quality-of-life outcomes. Future randomized multi-arm studies are required to corroborate these findings.
Keywords: radiation oncology; stereotactic body radiotherapy; sbrt radiation oncology; stereotactic body radiotherapy; sbrt

Share and Cite

MDPI and ACS Style

Guidolin, K.; Yaremko, B.; Lynn, K.; Gaede, S.; Kornecki, A.; Muscedere, G.; BenNachum, I.; Shmuilovich, O.; Mouawad, M.; Yu, E.; et al. Stereotactic Image-Guided Neoadjuvant Ablative Single-Dose Radiation, then Lumpectomy, for Early Breast Cancer: The Signal Prospective Single-Arm Trial of Single-Dose Radiation Therapy. Curr. Oncol. 2019, 26, 334-340. https://doi.org/10.3747/co.26.4479

AMA Style

Guidolin K, Yaremko B, Lynn K, Gaede S, Kornecki A, Muscedere G, BenNachum I, Shmuilovich O, Mouawad M, Yu E, et al. Stereotactic Image-Guided Neoadjuvant Ablative Single-Dose Radiation, then Lumpectomy, for Early Breast Cancer: The Signal Prospective Single-Arm Trial of Single-Dose Radiation Therapy. Current Oncology. 2019; 26(3):334-340. https://doi.org/10.3747/co.26.4479

Chicago/Turabian Style

Guidolin, K., B. Yaremko, K. Lynn, S. Gaede, A. Kornecki, G. Muscedere, I. BenNachum, O. Shmuilovich, M. Mouawad, E. Yu, and et al. 2019. "Stereotactic Image-Guided Neoadjuvant Ablative Single-Dose Radiation, then Lumpectomy, for Early Breast Cancer: The Signal Prospective Single-Arm Trial of Single-Dose Radiation Therapy" Current Oncology 26, no. 3: 334-340. https://doi.org/10.3747/co.26.4479

APA Style

Guidolin, K., Yaremko, B., Lynn, K., Gaede, S., Kornecki, A., Muscedere, G., BenNachum, I., Shmuilovich, O., Mouawad, M., Yu, E., Sexton, T., Gelman, N., Moiseenko, V., Brackstone, M., & Lock, M. (2019). Stereotactic Image-Guided Neoadjuvant Ablative Single-Dose Radiation, then Lumpectomy, for Early Breast Cancer: The Signal Prospective Single-Arm Trial of Single-Dose Radiation Therapy. Current Oncology, 26(3), 334-340. https://doi.org/10.3747/co.26.4479

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