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2. 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

Author

Barbara Strang, Michelle Bishop, Radhika Yelamanchili, Maria Vlachaki, Jon-Paul Voroney, Keith Tankel, Tanya Berrang, Wayne Koll, Jonathan Wan, Tarek Hijal, André Fortin, Francois Germain, David Nguyen, Vikash Patel, D. Voduc, Michael Lock, Janice Giesbrecht, Ivo A. Olivotto, Anupam Chaudhuri, Aisling Barry, Sophie Lavertu, D.I. Hodson, Chakiath Jose, Elaine Sze-Sze Wai, Paul-Émile Raymond, Bashir Bashir, Dorianne Elizabeth Rheaume, Farah Naz, Alan Nichol, David W. Petrik, Hosam (Sam) Kader, Pierre Chabot, Marjory Jolicoeur, Kalyani Vijayraghavan, Vamsee Torri, Caroline Chung, Woodrow A. Wells, Theresa Trotter, Susan Tyler, Boon Chua, Eric Vigneault, Martin Samosh, Hedley Krawitz, Susan Chafe, Philip Hughes, Isabelle Roy, Holly Campbell, Ken I. Mills, Sonia Nguyen, John Radwan, Som D. Mukherjee, Jim A. Julian, Lucie Blondeau, Jonathan Sussman, Khalil Sultanem, Christina Kim, Marie-Andrée Fortin, Nathalie Lessard, Isabelle Vallieres, Darin Gopaul, Fleur Huang, Mira Keyes, Jacqueline Lam, Celine Lemaire, Beverly Helen Lester, Kurian Joseph, Aminudin Rahman Mohd Mydin, Karen Chu, Maged Nashed, Carson Leong, Susan Gudelis, Michael Levesque, Wilson H. Miller, H. Abu-Zahra, Isabelle Germain, Brian Dingle, David Want, Mark Levine, Andre-Guy Martin, Robert E. Dinniwell, Ethel MacIntosh, Kathy Han, Mary K. Dwyer, Sudha Purchuri, Jennifer Goulart, Mohamed Akra, Hugh L. Prichard, Ken Schneider, Sarwat Shehata, S. Eshwar Kumar, Juanita Mary Crook, J. Bowen, Sally Smith, Benjamin Goldenberg, Michael Yassa, Michael Sia, Thierry Muanza, Harold I. Reiter, Peter Lim, Yongjin Wang, Bassam Abdul Karim, Medhat Zikry Abd-El-Malek, Wayne Beckham, Khalid Hirmiz, David D'Souza, Ruth Angell, Joanne Meng, Pierre Rousseau, Maha Almahmudi, Jose Ayllon, Paris-Ann Ingledew, Bernd Esche, Zsolt Gabos, Ramesh Arunachalam, Steven David, Olga Vujovic, Marc David, Lee Manchul, Chen Liu, William McMillan, Neil Kopek, Lorraine Walsh, Joycelin Canavan, Arthur Cheung, Claire Philips, JD (Jidong) Lian, Joelle Helou, Christine Elder, Caroline Holloway, Ian S. Dayes, Sawyna Provencher, Robert Olson, Christina Aquino Parsons, Medhat El-Mallah, Wladyslawa Cwajna, Francisco Perera, Gillian Campbell, Senti Senthelal, Christine Anne Koch, Paul Ahlgren, Peter S. Craighead, Nancy Grant, Julianna Caon, Brian Yaremko, Jasper Yuen, Fawaad Iqbal, Elizabeth Yan, Timothy J. Whelan, Suki Gill, Adrian Langleben, Richie Sinha, Chu Shu Gu, Pauline T. Truong, Wilfred Levin, Negin Shahid, Christopher Ford, Elizabeth Saettler, Pierre Del Vecchio, Thomas McGowan, David Wasserman, Do Hoon Kim, James Pinilla, Scott Morgan, Luis-Victor Diaz de Bedoya, Krystine Lupe, Roger Huang, Luleul Khan, Annie Carbonneau, Vimoj Nair, Behzad (Sayed) Banihashemi, Melanie Reed, Marisa Finlay, Steven Latosinsky, Charles Hayter, Peter Vavassis, Frances Lai-Wah Wong, Ramana Rachakonda, Levon Igidbashian, Andrew Cooke, Marie Larochelle, Susan Brooks, B. Findlay, Anne Dagnault, Sachi Voruganti, Olivier Ballivy, Jean-Marc Bourque, Rachel VanderMeer, Edward Yu, M.D. Mohiuddin, Jawaid Younus, Tracy Sexton, Rachel Bujold, Yiu-Keung (James) Lau, Catherine Lochrin, Glenn Jones, Paul Blood, Sofya Kobeleva, Glenys Round, Niluja Thiruthaneeswaran, Scott Tyldesley, Susan Balkwill, Michael J. McLean, J.A. (Jack) MacKinnon, Islam Gharib Mohamed, Catalin Mihalioiu, Bronwyn King, Sundeep Shahi, Philip C. Chan, Melanie Gaudreault, Samy El-Sayed, Dominique Lee, Diane Marie Severin, Tatiana Conrad, John Amanie, Christine Lambert, Linda Lee, Winkle Kwan, Annie Ebacher, Youssef M. Youssef, Paul Genest, Chang Shu Wang, Fei-Fei Liu, Jean-Pierre Guay, B.C. John Cho, Pamela Catton, Thayavalappil Hemanth, Tien Phan, Peter H. Dixon, Peter Cross, Roslyn Drummond, Abdenour Nabid, Joel Broomfield, Abraham Alexander, Theodore A. Vandenberg, Giuseppe Sasso, Barbara Krause, Marianne Krahn, Jimmy Mui, Nancy Read, Jane Wilson, Francois Patenaude, Cathy Menkarios, Nadeem Pervez, Donna Stern, Solveig Grenfell, Robert Nordal, Anthony Fyles, Valerie Panet-Raymond, David Melnychuk, James G. Wright, Vasanth Basrur, Toni Vu, Richard Dalfen, Maria Pearse, Valérie Théberge, Jonathan Tsao, Adam Andronowski, Hannah Mills Carolan, Chelleraj Benjamin, Lawrence Panasci, Robert Rutledge, Tracie Gleisner, Randall Bissett, Maureen C. Nolan, Lorna Weir, Siraj Husain, Laval Grimard, Jean-Michel Caudrelier, Francis Methot, and Kylea Potvin

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Breast surgery, Brachytherapy, Partial Breast Irradiation, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Radiation therapy, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Whole Breast Irradiation, medicine, Breast-conserving surgery, 030212 general & internal medicine, Radiology, business, Survival rate
Abstract

Summary Background Whole breast irradiation delivered once per day over 3–5 weeks after breast conserving surgery reduces local recurrence with good cosmetic results. Accelerated partial breast irradiation (APBI) delivered over 1 week to the tumour bed was developed to provide a more convenient treatment. In this trial, we investigated if external beam APBI was non-inferior to whole breast irradiation. Methods We did this multicentre, randomised, non-inferiority trial in 33 cancer centres in Canada, Australia and New Zealand. Women aged 40 years or older with ductal carcinoma in situ or node-negative breast cancer treated by breast conserving surgery were randomly assigned (1:1) to receive either external beam APBI (38·5 Gy in ten fractions delivered twice per day over 5–8 days) or whole breast irradiation (42·5 Gy in 16 fractions once per day over 21 days, or 50 Gy in 25 fractions once per day over 35 days). Patients and clinicans were not masked to treatment assignment. The primary outcome was ipsilateral breast tumour recurrence (IBTR), analysed by intention to treat. The trial was designed on the basis of an expected 5 year IBTR rate of 1·5% in the whole breast irradiation group with 85% power to exclude a 1·5% increase in the APBI group; non-inferiority was shown if the upper limit of the two-sided 90% CI for the IBTR hazard ratio (HR) was less than 2·02. This trial is registered with ClinicalTrials.gov , NCT00282035 . Findings Between Feb 7, 2006, and July 15, 2011, we enrolled 2135 women. 1070 were randomly assigned to receive APBI and 1065 were assigned to receive whole breast irradiation. Six patients in the APBI group withdrew before treatment, four more did not receive radiotherapy, and 16 patients received whole breast irradiation. In the whole breast irradiation group, 16 patients withdrew, and two more did not receive radiotherapy. In the APBI group, a further 14 patients were lost to follow-up and nine patients withdrew during the follow-up period. In the whole breast irradiation group, 20 patients were lost to follow-up and 35 withdrew during follow-up. Median follow-up was 8·6 years (IQR 7·3–9·9). The 8-year cumulative rates of IBTR were 3·0% (95% CI 1·9–4·0) in the APBI group and 2·8% (1·8–3·9) in the whole breast irradiation group. The HR for APBI versus whole breast radiation was 1·27 (90% CI 0·84–1·91). Acute radiation toxicity (grade ≥2, within 3 months of radiotherapy start) occurred less frequently in patients treated with APBI (300 [28%] of 1070 patients) than whole breast irradiation (484 [45%] of 1065 patients, p Interpretation External beam APBI was non-inferior to whole breast irradiation in preventing IBTR. Although less acute toxicity was observed, the regimen used was associated with an increase in moderate late toxicity and adverse cosmesis, which might be related to the twice per day treatment. Other approaches, such as treatment once per day, might not adversely affect cosmesis and should be studied. Funding Canadian Institutes for Health Research and Canadian Breast Cancer Research Alliance.

Published
2019
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3. 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

Author

Whelan, Timothy J, primary, Julian, Jim A, additional, Berrang, Tanya S, additional, Kim, Do-Hoon, additional, Germain, Isabelle, additional, Nichol, Alan M, additional, Akra, Mohamed, additional, Lavertu, Sophie, additional, Germain, Francois, additional, Fyles, Anthony, additional, Trotter, Theresa, additional, Perera, Francisco E, additional, Balkwill, Susan, additional, Chafe, Susan, additional, McGowan, Thomas, additional, Muanza, Thierry, additional, Beckham, Wayne A, additional, Chua, Boon H, additional, Gu, Chu Shu, additional, Levine, Mark N, additional, Olivotto, Ivo A, additional, Leong, Carson, additional, Lester, Beverly Helen, additional, Kwan, Winkle Bingchung, additional, Abd-El-Malek, Medhat Zikry, additional, Cheung, Arthur, additional, Almahmudi, Maha, additional, Broomfield, Joel, additional, Sia, Michael, additional, Reed, Melanie Jean, additional, Wilson, Jane, additional, Mohamed, Islam Gharib, additional, Holloway, Caroline, additional, Mills, Kenneth, additional, Petrik, David W., additional, Crook, Juanita Mary, additional, Wong, Frances Lai-Wah, additional, Mills Carolan, Hannah, additional, Voduc, David, additional, Ingledew, Paris-Ann, additional, Nguyen, Sonia, additional, Keyes, Mira, additional, Weir, Lorna M., additional, Tyldesley, Scott, additional, Lim, Peter, additional, Aquino Parsons, Christina, additional, Olson, Robert, additional, Blood, Paul, additional, Wai, Elaine Sze-Sze, additional, Truong, Pauline, additional, Kader, Hosam (Sam), additional, Alexander, Abraham, additional, Mohd Mydin, Aminudin Rahman, additional, Smith, Sally, additional, Vlachaki, Maria, additional, Panet-Raymond, Valerie, additional, Lupe, Krystine, additional, Goulart, Jennifer, additional, Nguyen, David, additional, Chu, Karen, additional, Canavan, Joycelin, additional, Caon, Julianna, additional, Tyler, Susan, additional, Shahid, Negin, additional, Lam, Jacqueline, additional, Amanie, John, additional, Severin, Diane Marie, additional, Abdul Karim, Bassam, additional, Tankel, Keith, additional, Pervez, Nadeem, additional, Joseph, Kurian, additional, Gabos, Zsolt, additional, Krause, Barbara, additional, Huang, Fleur, additional, Phan, Tien, additional, Craighead, Peter, additional, Yan, Elizabeth, additional, MacKinnon, J.A. (Jack), additional, Nordal, Robert, additional, Husain, Siraj, additional, Voroney, Jon-Paul, additional, Sinha, Richie, additional, Pinilla, James, additional, Cooke, Andrew, additional, Vijayraghavan, Kalyani, additional, Latosinsky, Steven, additional, Saettler, Elizabeth, additional, Lau, Yiu-Keung (James), additional, Krahn, Marianne, additional, MacIntosh, Ethel, additional, Nashed, Maged, additional, Bashir, Bashir, additional, Torri, Vamsee, additional, Goldenberg, Benjamin, additional, Kim, Christina, additional, Basrur, Vasanth, additional, Rachakonda, Ramana, additional, Gopaul, Darin, additional, Shahi, Sundeep, additional, Kobeleva, Sofya, additional, Dayes, Ian, additional, Hodson, David, additional, Strang, Barbara, additional, Voruganti, Sachi, additional, McMillan, William, additional, Reiter, Harold, additional, Wright, Jim, additional, Sussman, Jonathan, additional, Mukherjee, Som, additional, Gudelis, Susan, additional, D'Souza, David, additional, Lock, Michael, additional, Read, Nancy, additional, Vujovic, Olga, additional, Yaremko, Brian, additional, Yu, Edward, additional, Vandenberg, Theodore, additional, Younus, Jawaid, additional, Potvin, Kylea, additional, Sexton, Tracy, additional, Dingle, Brian, additional, Findlay, Brian, additional, Giesbrecht, Janice, additional, Hughes, Philip, additional, Samosh, Martin, additional, Levesque, Michael, additional, Yelamanchili, Radhika, additional, Lee, Linda, additional, VanderMeer, Rachel, additional, Wasserman, David, additional, Bowen, Julie, additional, Want, David, additional, Bissett, Randall, additional, Andronowski, Adam, additional, Shehata, Sarwat, additional, Prichard, Hugh L., additional, Koll, Wayne, additional, Chan, Philip C., additional, Mui, Jimmy, additional, Youssef, Youssef M., additional, Campbell, Holly, additional, El-Mallah, Medhat, additional, Iqbal, Fawaad, additional, Banihashemi, Behzad (Sayed), additional, Dixon, Peter, additional, Grimard, Laval, additional, Lochrin, Catherine, additional, Meng, Joanne, additional, Cross, Peter, additional, El-Sayed, Samy, additional, Esche, Bernd, additional, Genest, Paul, additional, Caudrelier, Jean-Michel, additional, Morgan, Scott, additional, Bourque, Jean-Marc, additional, Nair, Vimoj, additional, Senthelal, Senti, additional, Jones, Glenn, additional, Tsao, Jonathan, additional, Radwan, John, additional, Hayter, Charles, additional, Finlay, Marisa, additional, Lian, JD (Jidong), additional, Wang, Yongjin, additional, Yuen, Jasper, additional, Khan, Luleul, additional, Cho, B.C. John, additional, Koch, Christine Anne, additional, Liu, Fei-Fei, additional, Manchul, Lee Ann, additional, McLean, Michael, additional, Catton, Pamela, additional, Dinniwell, Robert E., additional, Wells, Woodrow A., additional, Levin, Wilfred, additional, Walsh, Lorraine, additional, Chung, Caroline, additional, Han, Kathy, additional, Conrad, Tatiana, additional, Helou, Joelle, additional, Barry, Aisling, additional, Schneider, Ken, additional, Hirmiz, Khalid, additional, Abu-Zahra, Hakam T., additional, Roy, Isabelle, additional, Ayllon, Jose, additional, Del Vecchio, Pierre, additional, Fortin, Marie-Andrée, additional, Guay, Jean-Pierre, additional, Methot, Francis, additional, Rousseau, Pierre, additional, Jolicoeur, Marjory, additional, Vu, Toni, additional, Igidbashian, Levon, additional, Dagnault, Anne, additional, Diaz de Bedoya, Luis-Victor, additional, Wang, Chang Shu, additional, Fortin, Andre, additional, Vigneault, Eric, additional, Vallieres, Isabelle, additional, Raymond, Paul-Emile, additional, Martin, Andre-Guy, additional, Blondeau, Lucie, additional, Larochelle, Marie, additional, Lessard, Nathalie, additional, Gaudreault, Melanie, additional, Théberge, Valerie, additional, Nabid, Abdenour, additional, Ballivy, Olivier, additional, Bujold, Rachel, additional, Ebacher, Annie, additional, Provencher, Sawyna, additional, Chabot, Pierre, additional, Lemaire, Celine, additional, Vavassis, Peter, additional, Menkarios, Cathy, additional, Yassa, Michael, additional, Sultanem, Khalil, additional, Panasci, Lawrence, additional, Melnychuk, David, additional, Patenaude, Francois, additional, Miller, Wilson, additional, Mihalioiu, Catalin, additional, Ahlgren, Paul, additional, Dalfen, Richard, additional, Langleben, Adrian, additional, Stern, Donna, additional, Wan, Jonathan, additional, Lambert, Christine, additional, David, Marc, additional, Kopek, Neil, additional, Carbonneau, Annie, additional, Hijal, Tarek, additional, Grant, Nancy, additional, Naz, Farah, additional, Mohiuddin, M.D., additional, Kumar, S. Eshwar, additional, Rutledge, Robert, additional, Rheaume, Dorianne Elizabeth, additional, Nolan, Maureen C., additional, Cwajna, Wladyslawa, additional, Gill, Suki, additional, Gleisner, Tracie, additional, Grenfell, Solveig, additional, Bishop, Michelle, additional, Thiruthaneeswaran, Niluja, additional, Liu, Chen, additional, Philips, Claire, additional, Drummond, Roslyn, additional, King, Bronwyn, additional, David, Steven P., additional, Dwyer, Mary K., additional, Campbell, Gillian, additional, Brooks, Susan, additional, Arunachalam, Ramesh, additional, Sasso, Giuseppe, additional, Benjamin, Chelleraj, additional, Jose, Chakiath, additional, Elder, Christine, additional, Krawitz, Hedley, additional, Lee, Dominique, additional, Huang, Roger, additional, Purchuri, Sudha, additional, Pearse, Maria, additional, Hemanth, Thayavalappil, additional, Angell, Ruth, additional, Patel, Vikash, additional, Round, Glenys, additional, Chaudhuri, Anupam, additional, and Ford, Christopher, additional

Published
2019
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36. NEW USE FOR THE BOTH RESPIRATOR

Author

R.R. Macintosh

Subjects
business.product_category, business.industry, Medicine, General Medicine, Medical emergency, Respirator, business, medicine.disease
Published
1940
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39. HYPERALGESIA IN PREMATURE INFANTS

Author

Neil Macintosh, Maria Fitzgerald, and Catherine Millard

Subjects
Pediatrics, medicine.medical_specialty, Text mining, business.industry, Hyperalgesia, medicine, General Medicine, medicine.symptom, business, Bioinformatics
Published
1988
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41. A SIMPLE METHOD OF BLOOD TRANSFUSION

Author

R.R. Macintosh

Subjects
Blood transfusion, business.industry, Simple (abstract algebra), medicine.medical_treatment, Anesthesia, Medicine, General Medicine, business, Autotransfusion, Whole blood
Published
1927
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44. COMMON SENSE IN ANÆSTHETICS

Author

Robert R. Macintosh and WilliamW. Mushin

Subjects
business.industry, media_common.quotation_subject, Medicine, Common sense, General Medicine, business, Epistemology, media_common
Published
1943
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48. SPINAL ANqSTHESIA FOR CqSAREAN SECTION

Author

Robert R. Macintosh and WilliamW. Mushin

Subjects
business.industry, medicine.medical_treatment, Anesthesia, Medicine, Spinal anesthesia, Caesarean section, General Medicine, business
Published
1944
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50. TRAINING IN ANÆSTHETICS

Author

R.R. Macintosh

Subjects
medicine.medical_specialty, business.industry, Training (meteorology), Physical therapy, Medicine, General Medicine, business
Published
1940
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