Single Institution Analysis of In-Breast Tumor Recurrence Risk after No Radiation Versus Accelerated Partial Breast Irradiation for Ductal Carcinoma in Situ

6040 Background: The use of accelerated partial breast irradiation using brachytherapy (APBI-b) for patients with invasive cancer is increasing but data for ductal carcinoma in situ (DCIS) cases are limited. The American Society of Radiation Oncology (ASTRO) guidelines suggest that APBI-b should be used only on a "cautionary" or "on trial" basis for women with DCIS. The purpose of this study was to examine utilization trends and correlates of APBI-b use for patients with DCIS. Methods: A total of 70,043 postlumpectomy patients from the National Cancer Database diagnosed with DCIS between 2002 and 2007 were studied. Chi-square tests and logistic regression models were used to determine trends and factors related to APBI-b use. Results: The use of APBI-b increased from 0.7% in 2002 to 10.0% in 2007 (p<0.001). Independent predictors APBI-b use were age, race, insurance status, comorbidity index, facility type, and facility location. Older patients were more likely to use APBI-b; relative to patients 30-39 years old, the OR for patients 80-89 years old was 5.9 (95% CI: 3.7-9.6). APBI-b use was higher in whites (4.9%), compared to blacks (4.4%), Hispanics (2.8%), and Asian pacific islanders (1.5%; p<0.001). Compared to noninsured, Medicare (OR=2.1, 95% CI: 1.3-3.3) and managed care patients (OR=2.0, 95% CI: 1.3-3.2) were more likely to undergo APBI-b. 2.3% of community cancer programs, 5.7% of comprehensive community programs and 4.1% of academic/research programs utilized APBI-b for treating DCIS (p<0.001). The use of APBI-b varied significantly by facility location; the West and South regions of the country were more likely to use APBI-b (OR=14, 95% CI: 10.1-19.6) than the Northeast region. 91% of the APBI-b patients fit the ASTRO "cautionary" guideline and 9% of patients fit the ASTRO "on trial" guidelines. In 2002, 4% of ABPI-b patients fit the "on trial" guidelines which increased to 8.6% in 2007 (p<0.001). Conclusions: The use of APBI-b for DCIS increased from 2002-2007. APBI-b use varies by socioeconomic and facility factors with age being the most significant factor. Future studies are needed to determine the indications for APBI-b in patients with DCIS.

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Accelerated partial-breast irradiation using strut-based brachytherapy in ductal carcinoma in situ patients: A report on 321 patients with median 25-month follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.92 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 92-92

Author(s):

John Paul Einck ◽

Steven E. Finkelstein ◽

Ben Han ◽

Robert Hong ◽

Lydia T. Komarnicky ◽

...

Keyword(s):

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Late Toxicity ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Skin Dose ◽

Breast Irradiation ◽

Median Maximum

92 Background: Limited data are available on the treatment of ductal carcinoma in situ (DCIS) with accelerated partial breast irradiation (APBI). The American Society for Radiation Oncology (ASTRO) consensus guidelines on APBI classify patients with DCIS as “cautionary”. We present the largest series of DCIS patients reported to date treated with APBI using strut-based brachytherapy. Methods: The SAVI Collaborative Research Group (SCRG) database was used to identify APBI patients with DCIS at 15 institutions treated with strut-based brachytherapy. All patients had a histologic diagnosis of DCIS and received monotherapy APBI (34 Gy in 10 fractions). Data on patient age and margin status, implant dosimetry, device size, disease status and toxicity in this population were analyzed. Results: From 2007-2011, 321 patients (322 breasts) with DCIS received APBI using strut-based brachytherapy. Patient ages ranged from 40-88 with a median age of 62. 51 patients were under 50 years of age. Detailed dosimetry data were reported on 245 patients. Long-term follow up was available on 221 breasts (median F/U = 25 months). Sixty patients have been followed for >3 years. Skin spacing was a challenge in a significant number of patients including 52 with skin spacing ≤ 5mm and 20 with skin spacing ≤ 3mm. Median maximum skin dose in those patient groups were 87% and 84% of prescription dose (PD), respectively. Overall reported dosimetry (n=245) was excellent: median percent of target volume receiving 90% PD was 96.9%, median maximum skin dose was 83.2%, V150% and V200% (volume at 150% and 200% PD) were 25.2 cc and 12.7 cc respectively. The ipsilateral recurrence rate was 2.2% (1.1% TR/MM). Late toxicity (grade ≥ 2) was low: hyperpigmentation = 0.0%, telangiectasias =1.4%, seroma = 3.2%, and fat necrosis in 1.8%. Conclusions: APBI using strut-based brachytherapy appears to be an effective treatment for patients with DCIS with acceptably low ipsilateral breast recurrence rates and low rates of late toxicity. 52 patients in our series had skin spacing 5 mm or less. APBI using brachytherapy may not have been possible for these women with other single-entry devices.

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