Tumor bed-to-skin distance using accelerated partial-breast irradiation with the strut-adjusted volume implant device

Breast conservation therapy (BCT), consisting of local excision of the breast tumor to achieve negative margins followed by whole breast irradiation, is standard treatment for early-stage breast cancer. The conventional radiotherapy course treats the entire breast, typically followed by a boost to the tumor bed over six to seven weeks. While the efficacy and cosmetic outcomes of conventionally fractionated whole breast radiation are well-established, two strategies are being investigated to address the lengthy treatment time associated with adjuvant radiotherapy for early-stage breast cancer. Accelerated partial breast irradiation (APBI) involves treatment to the tumor bed plus a small margin, allowing completion of therapy in five days or less. A variety of techniques, each with unique advantages and disadvantages, is currently under investigation for delivering APBI. Hypofractionated whole breast radiation (hWBRT) involves treating the entire breast with larger daily doses of radiation over three to four weeks. This article reviews the principles behind APBI and hWBRT, the indications for each technique, and relevant data supporting their use.

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Estimating long-term efficacy of multi-catheter brachytherapy in Japanese breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e12009 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e12009-e12009

Author(s):

Kazuhiko Sato ◽

Yoshio Mizuno ◽

Takahiro Shimo ◽

Masahiro Kato

Keyword(s):

Breast Cancer ◽

Bilateral Breast Cancer ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

Tumor Bed ◽

Term Efficacy ◽

Number Of Patients

e12009 Background: The efficacy of an accelerated partial breast irradiation (APBI) has been investigated as an alternative method to whole breast irradiation (WBI) in breast-conserving treatment (BCT). We have previously reported that multi-catheter brachytherapy as APBI using intra-operative open-cavity implant (IOCI) technique is feasible for Japanese patients. Since the follow-up period of this technique was relatively short, a long-term efficacy has been evaluated using an individualized-case-control (ICC) analysis. Methods: 179 consequent patients with 183 lesions were treated with BCT using IOCI from October 2008 to January 2013. Patients with bilateral breast cancer were included in the database twice. After the confirmation of the free margin and negative sentinel-nodes for metastases using frozen section analysis, applicators were inserted. APBI was started the same day of the operation, delivering 32 Gy in 8 fractions. We performed an ICC analysis to estimate the number of patients with an ipsilateral breast recurrence (ILBR). The 10-year risk of ILBR for each patient if treated by BCT with WBI was calculated with web-based decision-making tool (IBTR!) and it was adjusted by the actual follow-up period using EBCTCG overview’s data. Results: 123 patients with pN0 and longer than 1 year follow-up were enrolled in this analysis. Their mean age was 54.9 years. Most tumors (94.3%) were 2 cm or less in diameter. The median follow-up period was 3.0 years (1.0-4.3 years). All toxicities related to radiation therapy were mild. When BCT was performed with and without WBI, we estimated that there should be 1.2-2.4 and 4.9-9.1 ILBR in this group, respectively. Although one ILBR was observed, there was no tumor-bed recurrence in this treatment group. Conclusions: There was only one ILBR (no tumor-bed recurrence), which was within an estimated range of local recurrences. Multi-catheter brachytherapy using this technique is expected to offer the same rates of long-term local control than WBI using ICC analysis.

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The Role of Brachytherapy in the Treatment of Breast Cancer

Breast Care ◽

10.1159/000489638 ◽

2018 ◽

Vol 13 (3) ◽

pp. 157-161 ◽

Cited By ~ 2

Author(s):

Daniela Kauer-Dorner ◽

Daniel Berger

Keyword(s):

Breast Cancer ◽

Treatment Options ◽

Breast Conservation ◽

Recurrence Risk ◽

Breast Conserving Surgery ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Tumor Bed

Radiotherapy plays an important part in the management of breast cancer. Especially after breast-conserving surgery, external whole breast irradiation, occasionally with an additional local boost, is an integral part of breast conservation. Besides external radiation techniques, brachytherapy (BT) has long been among the treatment options, especially with regard to local boost application. With the emerging implementation of accelerated partial breast irradiation (APBI), BT in general and interstitial multi-catheter BT in particular, are gaining an increasing role in the management of a selected group of early breast cancer patients. APBI is an approach to reduce the irradiated area to the former tumor bed rather than treating the whole breast tissue in patients with a low baseline local recurrence risk. After a variety of phase I-III clinical studies, it is clearly evident that APBI will play a role in the treatment of this selected patient group. In this review, we focus on the clinical development and different available techniques of breast BT and provide a preview of prospects for its use.

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