Accelerated partial breast irradiation with interstitial brachytherapy as the sole modality of radiation for women with low risk early stage breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10661-10661 ◽  
Author(s):  
A. N. Budrukkar ◽  
R. Sarin ◽  
R. Jalali ◽  
R. Badwe ◽  
V. Parmar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prospective Study ◽  
Local Control ◽  
Interstitial Brachytherapy ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
High Dose ◽  
X Rays ◽  
Breast Irradiation

10661 Purpose: The aim of the study is to evaluate the safety and feasibility of radical brachytherapy for accelerated partial breast irradiation (APBI) and to study the outcome with respect to local control and survival. Materials and Methods: During May 2000 to December 2004, 115 women participated in the ongoing prospective study of APBI using interstitial brachytherapy as the sole modality of radiation for early breast cancer. Women with age > 40 years, single tumour up to 3 cm without diffuse microcalcification and clinically negative axilla were considered suitable. Brachytherapy was done either intraoperatively during the breast conserving surgery or postoperatively using 2–4 planes. Tumor bed demarcation was done with radiopaque clips placed during surgery, CT scans, ultrasonography and/or fluoroscopy. Cavity with 1cm margin was treated based on orthogonal pair of X rays to a dose of 34 Gy in 10 fractions over 1 week with twice daily fractionation using high dose rate iridium source. Results: Implant was done postoperatively in 35 patients while in remaining patients it was done intraoperatively. Implant procedure was tolerated well by all the patients. In 8 patients only 3 or 4 fractions of HDR Brachytherapy were delivered and this was followed by 45 Gy/25 # whole breast radiation therapy for following reasons: positive nodes (4), EIC positive (3) and poor implant coverage (1). At a median follow up of 23 months, the actuarial local control rate is 100%. Three year actuarial disease free survival is 93% while the overall survival is 100%. Complications included fat necrosis in 5 and wound gape in 4 patients. Cosmesis was good to excellent in 60% of the patients. Conclusion: In this ongoing prospective study, APBI using radical interstitial implant was well tolerated and appears to be safe and feasible in appropriately selected patients. Further follow up is needed for confirm the long term safety of the procedure. No significant financial relationships to disclose.

Five-day accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) in stage 0-II breast cancer: A report of 214 cases with up to 39 month follow-up.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12508-e12508
Author(s):  
Rufus J. Mark ◽  
Valerie Gorman ◽  
Michal Wolski ◽  
Steven McCullough
Keyword(s):  
Breast Cancer ◽  
Intensity Modulated Radiation Therapy ◽  
Target Volume ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Skin Reactions ◽  
Cosmetic Results ◽  
Non Invasive

e12508 Background: Randomized trials in stage 0-II breast cancer have proven that APBI given via HDR implant in 5 days is equivalent to whole breast irradiation (WBI) given in 5-6 weeks in regard to breast tumor local recurrence (LR). However, complications have been significant. Recently APBI using non-invasive IMRT given in 5 fractions has been shown in another randomized trial with 10 year follow-up to be equivalent to WBI in 6 weeks, with respect to LR. IMRT was superior in regard to acute effects, late effects, and cosmesis. In the randomized clinical trial of APBI IMRT, the Clinical Target Volume (CTV) was defined by the injection of individual fiducial markers bordering the surgical cavity. We have used the Biozorb fiducial system to localize the CTV for IMRT. We sought to confirm the APBI IMRT results with this simpler less labor intensive fiducial placement system. Methods: Between 2017 and 2021, 214 patients have undergone IMRT targeted to a Biozorb defined CTV with the walls of the surgical cavity sewn to the Biozorb device. Eligible patients were older than age 40, had tumor sizes < 3 cm, negative surgical margins, and negative sentinel node dissections. IMRT dose was 30 Gy given in 5 fractions. Dose Constraints were as follows : V-30 Gy < 105%, Ipsilateral Breast V-15 Gy < 50%, Ipsilateral Lung V-10 Gy < 20%, Contralateral Lung V-5 Gy < 10%, Heart V-3 Gy < 20%, Contralateral Breast Dmax < 2 Gy and Skin Dmax < 27 Gy. The Planning Target Volume (PTV) ranged from 27 to 355 cc with a median of 80 cc. PTV = CTV + 1-2 cm. Results: Follow-up ranged from 1-39 months with a median of 20 months. LR has been 0% (0/214). There have been no skin reactions or seromas. Infection has occurred in one patient (0.5%). Four (1.9%) patients developed pain around the Biozorb site. This resolved on a short courses of steroids in all cases. Cosmetic results as rated by the Surgeon, Radiation Oncologist, and Nurse, were rated excellent in 99.0% (212/214) of cases. Conclusions: Non-invasive APBI with IMRT given qd over 5 days targeted to Biozorb has resulted in LR, complications, and cosmetic results which compare favorably to invasive APBI given bid with HDR implant. At last follow-up, there have been no LR, skin reactions, or significant complications. Cosmesis has been excellent in 99.0% of patients.

Outcomes by breast cancer subtype in patients treated with accelerated partial breast irradiation.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 83-83
Author(s):  
J. B. Wilkinson ◽  
C. Shah ◽  
M. Amin ◽  
S. F. Shaitelman ◽  
L. Nadeau ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Subtype ◽  
Disease Free Survival ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Receptor Subtypes ◽  
Breast Irradiation ◽  
Cancer Subtype ◽  
Her 2

83 Background: To determine clinical outcomes for patients treated with accelerated partial breast irradiation (APBI) based on breast cancer subtype. Methods: We evaluated 516 consecutive patients who received APBI with a minimum follow-up of 6 months. Methods of APBI delivery included interstitial brachytherapy (n=221), balloon-based brachytherapy (n=201), and 3D-CRT (n=106). Women were assigned a breast cancer subtype (BCST) based on results of testing for estrogen (ER), progesterone (PR), and human epidermal growth factor (HER2/neu) receptors. Those without test results for all three receptors were excluded. 278 patients were eligible and submitted for analysis. Receptor subtypes were approximated as follows: ER+, PR+/–, and HER-2 negative [luminal A (LA), 164 pts.]; ER+, PR+/–, and HER-2 positive [luminal B (LB), 81 pts.]; ER/PR–, HER-2+ [HER-2 (H2), 5 pts.], and ER/PR/HER-2 negative [basal (B), 28 pts.]. An analysis was then performed to estimate IBTR, RNF, DM, DFS, CSS, and OS. Results: Mean age was 66 years, median follow-up was 4.9 yrs. Basal and H2 subtype patients had higher histologic grades (Gr. 3 = 75% vs. 10% LA/LB, p<0.001), larger tumors (13.0mm vs. 10.7mm LA/LB, p=0.05), and were more likely to receive chemotherapy (68% vs. 15% LA/LB, p<0.001). Basal subtype patients were also more likely to be African American (18% vs. 4% LA/LB, p=0.002). Margin and nodal status were similar between all BCSTs. At five years, IBTR rates were 2.9%, 3.2%, 0%, and 4.8% for LA, LB, H2, and B subtypes, respectively (p=0.75). The IBTR within the B subtype group was due to a single elsewhere failure, the rate of which was not statistically different than that for the LA subtype (2.9%, p=0.30). DM was only seen in LA (2.5%) and LB (1.4%) (p=0.87). Disease-free survival (95-100%), CSS (97%-100%), and OS (80-100%) (Table) were also not statistically different (p=0.98, 0.85, 0.24, respectively) between BCST categories. Conclusions: Five-year local control rates after treatment with APBI are excellent for luminal, HER2, and triple-negative phenotypes of early-stage breast cancer. Further study of BCST is important and may be useful when counseling patients on adjuvant treatment options following breast-conserving surgery.

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