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5-year results of accelerated partial breast irradiation (APBI) with SBRT (stereotactic body radiation therapy) and exactrac adaptive gating (Novalis®) for very early breast cancer patients: was it all worth it?

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Abstract

Purpose

To explore the feasibility of image-guided and respiratory-gated Stereotactic Body Radiation Therapy (SBRT) for Accelerated Partial Breast Irradiation (APBI) in patients with very early breast cancer.

Material and methods

Selected patients with early breast carcinoma after breast-conserving surgery were enrolled in this phase II trial. A fiducial marker was percutaneously placed close to surgical bed and five external fiducials were set on the skin. A CT scan for planning was acquired at free breathing. The treatment was planned and DVH were assessed according to international recommendations. Prescription dose was 30 Gy in five consecutive fractions of 6 Gy. A 6MV monoenergetic LINAC (linear accelerator) that combines stereoscopic X-ray imaging system and ExacTrac Adaptive Gating technique was used. PTV (planning target volume) intrafraction motion was controlled and PTV was irradiated in a selected gated area of the respiratory cycle. Shifts for a correct, gated set-up were calculated and automatically applied.

Results

Between April 2013 and October 2015, a total of 23 patients were included. The median tumor size was 12 mm. The mean PTV volume was 114 cc. The mean ipsilateral lung V9 Gy was 2.2% and for left-sided breast cancers, the volume of the heart receiving 1.5 Gy was 11.5%. Maximum skin dose was 30.8 Gy. Acute toxicity was grade1 in all the patients and 100% experienced excellent/good breast cosmesis outcomes. With a median follow-up of 66 months (range 8–99 months) local-relapse-free-survival reaches 100%. One patient developed a second breast cancer outside the treated quadrant after 25.1 months.

Conclusion

APBI with SBRT and ExacTrac Adaptive Gating System was feasible. The acute and late toxicities were almost null and cosmesis was excellent. We also found that the margins of 5 mm applied from CTV to PTV were sufficient to compensate for geometric uncertainties.

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References

  1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41. https://doi.org/10.1056/NEJMoa022152.

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32. https://doi.org/10.1056/NEJMoa020989.

    Article  PubMed  Google Scholar 

  3. Speers C, Pierce LJ. Postoperative radiotherapy after breast-conserving surgery for early-stage breast cancer: a review. JAMA Oncol. 2016;2:1075–82. https://doi.org/10.1001/jamaoncol.2015.5805.

    Article  PubMed  Google Scholar 

  4. Morrow BM, White J, Moughan J, Owen J, Pajack T, Sylvester J, et al. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol. 2016;19:2254–62.

    Article  Google Scholar 

  5. Voti L, Richardson LC, Reis I, Fleming LE, MacKinnon J, Coebergh JW. The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida. Breast Cancer Res Treat. 2006;95(1):89–95. https://doi.org/10.1007/s10549-005-9050-6.

    Article  PubMed  Google Scholar 

  6. Showalter SL, Grover S, Sharma S, Lin L, Czerniecki BJ. Factors influencing surgical and adjuvant therapy in stage I breast cancer : a SEER 18 database analysis. Ann Surg Oncol. 2013;20(4):1287–94. https://doi.org/10.1245/s10434-012-2693-8.

    Article  PubMed  Google Scholar 

  7. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;2045:1–9. https://doi.org/10.1016/S1470-2045(13)70386-3.

    Article  Google Scholar 

  8. Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W, Grimard L, Bowen J, Lukka H, Perera F, Fyles A, Schneider K, Gulavita S, Freeman C. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20. https://doi.org/10.1056/NEJMoa0906260.

    Article  CAS  PubMed  Google Scholar 

  9. Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, Hahn C, et al. Radiation therapy for the whole breast : Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8:145–52. https://doi.org/10.1016/j.prro.2018.01.012.

    Article  PubMed  Google Scholar 

  10. Veronesi U, Marubini E, Mariani L, Galimberti V, Luini A, Veronesi P, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol Off J Eur Soc Med Oncol. 2001;12:997–1003. https://doi.org/10.1023/a:1011136326943.

    Article  CAS  Google Scholar 

  11. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106. https://doi.org/10.1016/S0140-6736(05)67887-7.

    Article  CAS  PubMed  Google Scholar 

  12. Shah C, Vicini F, Shaitelman SF, Hepel J, Keisch M, Arthur D, et al. The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation. Brachytherapy. 2017. https://doi.org/10.1016/j.brachy.2017.09.004.

    Article  PubMed  Google Scholar 

  13. Vicini FA, Cecchini RS, White JR, Julian TB, Arthur DW, Rabinovitch RA, et al. Abstract GS4–04: Primary results of NSABP B-39/RTOG 0413 (NRG Oncology): A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer. Cancer Res. 2019. https://doi.org/10.1158/1538-7445.SABCS18-GS4-04.

    Article  Google Scholar 

  14. Livi L, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, et al. Accelerated partial breast irradiation using intensity- modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51:451–63. https://doi.org/10.1016/j.ejca.2014.12.013.

    Article  PubMed  Google Scholar 

  15. Shah C, Badiyan S, Ben Wilkinson J, Vicini F, Beitsch P, Keisch M, et al. Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American Society of Breast Surgeons MammoSite(®) breast brachytherapy registry trial. Ann Surg Oncol. 2013;20:3279–85. https://doi.org/10.1245/s10434-013-3158-4.

    Article  PubMed  Google Scholar 

  16. Polgár C, Fodor J, Major T, Sulyok Z, Kásler M. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2013;108:197–202. https://doi.org/10.1016/j.radonc.2013.05.008.

    Article  Google Scholar 

  17. Strnad V, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet. 2016;387:229–38. https://doi.org/10.1016/S0140-6736(15)00471-7.

    Article  PubMed  Google Scholar 

  18. Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14:1269–77. https://doi.org/10.1016/S1470-2045(13)70497-2.

    Article  PubMed  Google Scholar 

  19. Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer ( TARGIT-A trial ): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102. https://doi.org/10.1016/S0140-6736(10)60837-9.

    Article  PubMed  Google Scholar 

  20. Coles CE, Griffin CL, Kirby AM, Titley J, Agrawal RK, Alhasso A, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet (London, England). 2017;390:1048–60. https://doi.org/10.1016/S0140-6736(17)31145-5.

    Article  Google Scholar 

  21. Rodríguez N, Sanz X, Dengra J, Foro P, Membrive I, Reig A, et al. Five-year outcomes, cosmesis, and toxicity with 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2013;87:1051–7. https://doi.org/10.1016/j.ijrobp.2013.08.046.

    Article  PubMed  Google Scholar 

  22. Livi L, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51:451–63. https://doi.org/10.1016/j.ejca.2014.12.013.

    Article  PubMed  Google Scholar 

  23. Vicini FA, Cecchini RS, White JR, Arthur DW, Julian TB, Rabinovitch RA, et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. Lancet. 2019;394:2155–64. https://doi.org/10.1016/S0140-6736(19)32514-0.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Whelan TJ, Julian JA, Berrang TS, Kim D-H, Germain I, Nichol AM, et al. External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial. Lancet (London, England). 2019;394:2165–72. https://doi.org/10.1016/S0140-6736(19)32515-2.

    Article  Google Scholar 

  25. Trombetta M, Julian TB, Kim Y, Werts ED, Parda D. The allegheny general modification of the Harvard Breast Cosmesis Scale for the retreated breast. Oncology. 2009;23:954–6.

    PubMed  Google Scholar 

  26. Obayomi-Davies O, Kole TP, Oppong B, Rudra S, Makariou EV, Campbell LD, et al. Stereotactic accelerated partial breast irradiation for early-stage breast cancer: rationale, feasibility, and early experience using the cyberknife radiosurgery delivery platform. Front Oncol. 2016;6:129. https://doi.org/10.3389/fonc.2016.00129.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ciérvide R, Formenti SC. Why is partial-breast irradiation still investigational. Am J Clin Oncol. 2012;35:290–2. https://doi.org/10.1097/COC.0b013e31820dbf41.

    Article  PubMed  Google Scholar 

  28. Kirby AM. Updated ASTRO guidelines on accelerated partial breast irradiation ( APBI ): to whom can we offer APBI outside a clinical trial ? Br Inst Radiol. 2018;91(1085):20170565.

    Article  Google Scholar 

  29. Strnad V, Major T, Polgar C, Lotter M, Guinot J-L, Gutierrez-Miguelez C, et al. ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost - GEC-ESTRO Breast Cancer Working Group practical recommendations. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2018;128:411–20. https://doi.org/10.1016/j.radonc.2018.04.009.

    Article  Google Scholar 

  30. Xiang X, Ding Z, Feng L, Li N. A meta-analysis of the efficacy and safety of accelerated partial breast irradiation versus whole-breast irradiation for early-stage breast cancer. Radiat Oncol. 2021;16:24. https://doi.org/10.1186/s13014-021-01752-2.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Matuschek C, Bölke E, Haussmann J, Mohrmann S, Nestle-Krämling C, Gerber PA, et al. The benefit of adjuvant radiotherapy after breast conserving surgery in older patients with low risk breast cancer- a meta-analysis of randomized trials. Radiat Oncol. 2017;12:60. https://doi.org/10.1186/s13014-017-0796-x.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16:266–73. https://doi.org/10.1016/S1470-2045(14)71221-5.

    Article  PubMed  Google Scholar 

  33. Kunkler IH, Williams LJ, Jack WJL, et al. PRIME 2 Trial Investigators. PRIME 2 randomized trial (Postoperative Radiotherapy in Minimum-Risk Elderly): wide local excision and adjuvant hormonal therapy +/- whole breast irradiation in women ≥65 years with early invasive breast cancer: 10 year results. Presented at: 2020 San Antonio Breast Cancer Symposium; December 8-12, 2020; Virtual. Abstract GS2-03.

  34. Giannakeas V, Sopik V, Narod SA. Association of a diagnosis of ductal carcinoma in situ with death from breast cancer. JAMA Netw Open. 2020;3:e2017124. https://doi.org/10.1001/jamanetworkopen.2020.17124.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Polgár C, Fodor J, Major T, Sulyok Z, Kásler M. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol. 2013;108:197–202. https://doi.org/10.1016/j.radonc.2013.05.008.

    Article  PubMed  Google Scholar 

  36. Vicini F, Winter K, Wong J. Initial efficacy results of RTOG conformal radiation therapy (3D-CRT ) confined to the region of the lumpectomy cavity for stage I/II breast carcinoma. Breast Dis. 2011;22:191–3. https://doi.org/10.1016/j.breastdis.2011.03.001.

    Article  Google Scholar 

  37. Meattini I, Marrazzo L, Saieva C, Desideri I, Scotti V, Simontacchi G. original reports abstract accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer : long-term results of the randomized phase III APBI-IMRT-Florence trial. J Clin Oncol. 2020. https://doi.org/10.1200/JCO.20.00650.

    Article  PubMed  Google Scholar 

  38. Meduri B, Baldissera A, Galeandro M, Donini E, Tolento G, Giacobazzi P. OC-0568 Accelerated PBI VS standard radiotherapy (IRMA trial): interim cosmetic and toxicity results. Radiother Oncol. 2017. https://doi.org/10.1016/S0167-8140(17)31008-3.

    Article  Google Scholar 

  39. Whelan T, Julian J, Levine M, Berrang T, Kim D-H, Gu CS, et al. Abstract GS4–03: RAPID: a randomized trial of accelerated partial breast irradiation using 3-dimensional conformal radiotherapy (3D-CRT). Cancer Res. 2019. https://doi.org/10.1158/1538-7445.SABCS18-GS4-03.

    Article  Google Scholar 

  40. Rodríguez N, Sanz X, Dengra J, Foro P, Membrive I, Reig A, Quera J, Fernández-Velilla E, Pera Ó, Lio J, Lozano JAM. Five-year outcomes, cosmesis, and toxicity with 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2013;87(5):1051–7. https://doi.org/10.1016/j.ijrobp.2013.08.046.

    Article  PubMed  Google Scholar 

  41. Shah C, Vicini F, Shaitelman SF, Hepel J, Keisch M, Arthur D, et al. The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation. Brachytherapy. 2018;17:154–70. https://doi.org/10.1016/j.brachy.2017.09.004.

    Article  PubMed  Google Scholar 

  42. Hernando-requejo O, Sánchez E, Fernández P, Zucca D, Pérez JM, García-aranda M, et al. Institutional experience on the treatment of lung and liver lesions with stereotactic body radiotherapy and Novalis Exactrac Adaptive Gating technique. J Radiosurgery SBRT. 2012;1:231–6.

    Google Scholar 

  43. Chen-Zhao X, Hernando O, López M, Sánchez E, Montero A, García-Aranda M, Ciérvide R, Valero J, Alonso R, Cárdenas-Rebollo JM, Vicente E, QuijanoY Cubillo A, Álvarez R, Prados S, Plaza C, García J, Zucca D, Fernández-Letón P, Rubio C. A prospective observational study of the clinical and pathologicalimpact of stereotactic body radiotherapy (SBRT) as a neoadjuvant strategy of chemoradiation in pancreatic cancer. Clin Transl Oncol. 2020;22(9):1499–505. https://doi.org/10.1007/s12094-020-02287-w.

    Article  CAS  PubMed  Google Scholar 

  44. Cox B, Horst K, Thorndyke B, Loo B, Maxim P, Dirbas F. Respiratory gating during Accelerated Partial Breast Irradiation (APBI) permits reduced planning tumorvolumes and improved normal tissue dose distributions. Int J Radiat Oncol Biol Phys. 2005;. https://doi.org/10.1016/j.ijrobp.2005.07.424.

    Article  PubMed  Google Scholar 

  45. Vermeulen S, Cotrutz C, Morris A, Meier R, Buchanan C, Dawson P, et al. Accelerated partial breast irradiation : using the CyberKnife as the radiation delivery platform in the treatment of early breast cancer. Front Oncol. 2011;1:1–8. https://doi.org/10.3389/fonc.2011.00043.

    Article  Google Scholar 

  46. Rahimi A, Thomas K, Spangler A, Rao R, Leitch M, Wooldridge R, et al. Preliminary results of a phase 1 dose-escalation trial for early-stage breast cancer using 5-fraction stereotactic body radiation therapy for partial-breast irradiation. Radiat Oncol Biol. 2017. https://doi.org/10.1016/j.ijrobp.2017.01.020.

    Article  Google Scholar 

  47. Lozza L, Fariselli L, Sandri M, Rampa M, Pinzi V, De SMC, et al. Partial breast irradiation with CyberKnife after breast conserving surgery : a pilot study in early breast cancer. Radiat Oncol. 2018;13:1–11.

    Article  Google Scholar 

  48. Lee WH, Chang JS, Kim MJ, Park VY, Yoon JH, Kim SY, et al. First experience in Korea of stereotactic partial breast irradiation for low-risk early-stage breast cancer. Front Oncol. 2020;10:1–8. https://doi.org/10.3389/fonc.2020.00672.

    Article  Google Scholar 

  49. Mészáros N, Smanykó V, Major T, Stelczer G, Jánváry L, Kovács E. Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife Technical Considerations and Early Experiences of a Phase II Clinical Study. Pathol Oncol Res, 2020, 26:2307–13.

  50. Bentzen SJR. Reports of unexpected late side effects of accelerated partial breast irradiation–radiobiological considerations. Int J Radiat Oncol Biol Phys. 2011;77:969–73. https://doi.org/10.1016/j.ijrobp.2010.01.059.Reports.

    Article  Google Scholar 

  51. Formenti S, Hsu H, Fenton-Kerimian M, Roses D, Guth A, Jozsef G, Goldberg J, DeWyngaert K. Prone accelerated partial breast irradiation after breast-conserving surgery: five-year results of 100 patients. Int J Radiat Oncol Biol Phys. 2013;84:606–11. https://doi.org/10.1016/j.ijrobp.2012.01.039.PRONE.

    Article  Google Scholar 

  52. Landis DM, Luo W, Song J, Bellon JR, Punglia RS, Wong JS, et al. Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys. 2007;67:1299–308. https://doi.org/10.1016/j.ijrobp.2006.11.026.

    Article  PubMed  Google Scholar 

  53. Dzhugashvili M, Pichenot C, Dunant A, Balleyguier C, Delaloge S, Mathieu M-C, et al. Surgical clips assist in the visualization of the lumpectomy cavity in three-dimensional conformal accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:1320–4. https://doi.org/10.1016/j.ijrobp.2009.04.089.

    Article  PubMed  Google Scholar 

  54. Kim LH, Goyal S, Haffty BG, Taunk NK, Yue NJ. Using respiratory motion to guide planning target volume margins for external beam partial breast irradiation. Int J Radiat Oncol Biol Phys. 2012;82:1303–6. https://doi.org/10.1016/j.ijrobp.2011.11.048.

    Article  PubMed  Google Scholar 

  55. Keall PJ, Balter JM, Emery RS, Forster KM, Jiang SB, Kapatoes JM, et al. The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys. 2006;33(10):3874–900. https://doi.org/10.1118/1.2349696.

    Article  PubMed  Google Scholar 

  56. Hannoun-Levi JM, Mazeron JJ, Marsiglia H, Gerard JP. Partial breast irradiation: revolution or evolution? Cancer Treat Rev. 2004;30:599–607. https://doi.org/10.1016/j.ctrv.2004.06.009.

    Article  CAS  PubMed  Google Scholar 

  57. Coles CE, Yarnold JR. Accelerated partial breast irradiation: the new standard? Lancet. 2016;387:201–2. https://doi.org/10.1016/S0140-6736(15)00518-8.

    Article  CAS  PubMed  Google Scholar 

  58. Murray Brunt A, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395:1613–26. https://doi.org/10.1016/S0140-6736(20)30932-6.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. R. Ciérvide and Á. Montero have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain

    R. Ciérvide, Á. Montero, M. G. Aranda, B. Álvarez, K. Rossi, M. López, J. Valero, E. Sánchez, P. F. Letón & C. Rubio

  2. Department of Radiation Oncology, U.H. Puerta del Sur. HM Hospitales, Madrid, Spain

    J. García, O. Hernando, X. Chen, R. Alonso, P. F. Letón & C. Rubio

  3. Department of Radiation Oncology, Fundación Valle del Lili, Cali, Colombia

    G. Potdevin

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Ciérvide, R., Montero, Á., Potdevin, G. et al. 5-year results of accelerated partial breast irradiation (APBI) with SBRT (stereotactic body radiation therapy) and exactrac adaptive gating (Novalis®) for very early breast cancer patients: was it all worth it?. Clin Transl Oncol 23, 2358–2367 (2021). https://doi.org/10.1007/s12094-021-02636-3

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