Accelerated partial breast irradiation
Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study

https://doi.org/10.1016/j.radonc.2010.01.019Get rights and content

Abstract

Background and purpose

To report the 12-year updated results of accelerated partial-breast irradiation (APBI) using multicatheter interstitial high-dose-rate (HDR) brachytherapy (BT).

Patients and methods

Forty-five prospectively selected patients with T1N0-N1mi, nonlobular breast cancer without the presence of an extensive intraductal component and with negative surgical margins were treated with APBI after breast-conserving surgery (BCS) using interstitial HDR BT. A total dose of 30.3 Gy (n = 8) and 36.4 Gy (n = 37) in seven fractions within 4 days was delivered to the tumour bed plus a 1–2 cm margin. The median follow-up time was 133 months for surviving patients. Local and regional control, disease-free (DFS), cancer-specific (CSS), and overall survival (OS), as well as late side effects, and cosmetic results were assessed.

Results

Four (8.9%) ipsilateral breast tumour recurrences were observed, for a 5-, 10-, and 12-year actuarial rate of 4.4%, 9.3%, and 9.3%, respectively. A total of two regional nodal failures were observed for a 12-year actuarial rate of 4.4%. The 12-year DFS, CSS, and OS was 75.3%, 91.1%, and 88.9%, respectively. Grade 3 fibrosis was observed in one patient (2.2%). No patient developed grade 3 teleangiectasia. Fat necrosis requiring surgical intervention occurred in one woman (2.2%). Cosmetic results were rated excellent or good in 35 patients (77.8%).

Conclusions

Twelve-year results with APBI using HDR multicatheter interstitial implants continue to demonstrate excellent long-term local tumour control, survival, and cosmetic results with a low-rate of late side effects.

Section snippets

Eligibility criteria, patient and tumour characteristics

The study population consisted of 45 consecutive patients with invasive, early-stage breast cancer who were prospectively treated at the Hungarian National Institute of Oncology (HNIO) between 1996 and 1998 with APBI using multicatheter interstitial high-dose-rate (HDR) brachytherapy (BT) after BCS. During surgery, the boundaries of the excision cavity were marked with titanium clips. The excision cavities were not closed by the surgeons. However, seroma fluids were punctured in the

Treatment outcome

Overall, four patients (8.9%) developed ipsilateral breast failure and all LR occurred as a first event. All LRs were classified as elsewhere breast failures. Characteristics of patients developing LR are detailed in Table 2. The crude rates of first events are summarized in Table 3. The 5-, 10-, and 12-year actuarial rate of LR was 4.4% (95% CI, 0–10.6%), 9.3% (95% CI, 0.6–18.0%), and 9.3% (95% CI, 0.6–18.0%), respectively (Fig. 1). A total of two regional nodal failures were observed for a

Discussion

Following the general acceptance of breast-conserving therapy including elective WBI, several centres have pioneered APBI, limiting radiotherapy to the immediate vicinity of the primary tumour site [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39]. The majority of these trials using strict patient selection criteria and appropriate treatment technique were

Conclusions

Twelve-year results with APBI using HDR multicatheter interstitial implants continue to demonstrate excellent long-term local tumour control, survival, and cosmetic results with a low-rate of late side effects comparable to those achieved with conventional WBI in selected low-risk patients. However, long-term data from ongoing prospective randomized trials are needed to establish the equivalence of this treatment approach compared with standard WBI.

References (39)

  • J.D. Cox et al.

    Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)

    Int J Radiat Oncol Biol Phys

    (1995)
  • K. Lövey et al.

    Fat necrosis after partial-breast irradiation with brachytherapy or electron irradiation versus standard whole-breast radiotherapy – 4-year results of a randomized trial

    Int J Radiat Oncol Biol Phys

    (2007)
  • C. Aristei et al.

    Computed tomography for excision cavity localization and 3D-treatment planning in partial breast irradiation with high-dose-rate interstitial brachytherapy

    Radiother Oncol

    (2009)
  • D.W. Arthur et al.

    A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 95–17

    Int J Radiat Oncol Biol Phys

    (2008)
  • Y. Belkacémi et al.

    Partial breast irradiation as sole therapy for low risk breast carcinoma: early toxicity, cosmesis and quality of life results of a MammoSite brachytherapy phase II study

    Radiother Oncol

    (2009)
  • P.R. Benitez et al.

    Five-year results: the initial clinical trial of Mammosite balloon brachytherapy for partial breast irradiation in early-stage breast cancer

    Am J Surg

    (2007)
  • T.A. King et al.

    Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for Tis, 1, 2 breast cancer

    Am J Surg

    (2000)
  • T. Major et al.

    Dosimetric experience with accelerated partial breast irradiation using image-guided interstitial brachytherapy

    Radiother Oncol

    (2009)
  • M. Mannino et al.

    Accelerated partial breast irradiation trials: diversity in rationale and design

    Radiother Oncol

    (2009)
  • Cited by (0)

    View full text