scholarly journals Accelerated Partial Breast Irradiation in the Elderly:8-year Oncological Outcome and Prognostic Factors

2020 ◽  
Author(s):  
Shakeel Sumodhee ◽  
Marc PUJALTE-MARTIN ◽  
Jocelyn Gal ◽  
Daniel Lam Cham Kee ◽  
Mathieu Gautier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Late Toxicity ◽  
The Elderly ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Breast Irradiation ◽  
Free Survival

Abstract Introduction: To evaluate long term clinical outcome and prognostic factors after accelerated partial breast irradiation (APBI) in the elderly using high-dose-rate interstitial multi-catheter brachytherapy (HIBT).Material and methods: Between 2005 and 2018, 109 patients underwent APBI using HIBT (34 Gy/10f/5d or 32 Gy/8f/4d). Based on a prospective database, outcomes were retrospectively analyzed (local relapse-free survival (LRFS), metastatic-free survival (MFS), specific survival (SS) and overall survival (OS). Prognostic factors were investigated. Late toxicity and cosmetic evaluation were reported.Results: With a median follow-up of 97 months [7–159], median age was 81.7 years [58-89]. According to the GEC-ESTRO APBI classification, 72.5%, 11.9% and 15.6% were classified as low, intermediate and high-risk respectively. The histological type was mainly invasive ductal carcinoma (87.1%). The median tumor size was 10 mm [range 1-35]. Eight-year LRFS, SS and OS were 96.7% [95% CI [0.923; 1]), 96.7% [95% CI [0.924; 1] and 72%[95% CI [0.616; 0.837] respectively. In univariate analysis, APBI classification was not cosidered as prognostic factor, whilemolecular classification was prognostic factor for OS (p<0.0001), SS (p=0.007) and MFS (p=0.009) but not for LR (p=0.586). No Grade ³3 late toxicity was observed while 61 patients (88.4%) and 8 patients (11.6%) presented grade 1 and 2 toxicities respectively. Cosmetic outcome was excellent/good for 96.4%.Conclusion: Long-term follow-up confirms that HIBT is safe and effective for elderly early breast cancer. Our results suggest that selected elderly women presenting with high-risk breast cancer could be also considered for APBI.

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

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.

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.

scholarly journals Five-year oncological outcome after a single fraction of accelerated partial breast irradiation in the elderly

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Rémy Kinj ◽  
Marie-Eve Chand ◽  
Jocelyn Gal ◽  
Mathieu Gautier ◽  
Daniel Lam Cham Kee ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Late Toxicity ◽  
The Elderly ◽  
Local Relapse ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
High Dose ◽  
Axillary Lymph ◽  
Breast Irradiation ◽  
Single Fraction

Abstract Background To update the clinical outcome of an elderly women cohort with early breast cancer who underwent accelerated partial breast irradiation (APBI) based on a post-operative single fraction of multicatheter interstitial high dose–rate brachytherapy (MIB). Material and methods A single institution retrospective cohort study was performed focusing on elderly patients (≥ 65 years old) presenting a low-risk breast carcinoma treated by lumpectomy plus axillary evaluation followed by MIB APBI. A single fraction of 16 Gy was prescribed on the 100% isodose. Clinical outcome at 5 years was reported based on local relapse free survival (LRFS), specific survival (SS) and overall survival (OS). Late toxicity was evaluated. Cosmetic results were evaluated clinically by the physician. Results Between January 2012 and August 2015, 48 women (51 lesions) were treated. Median age was 77.7 years (range: 65–92) with a median tumor size of 12 mm (range: 3–32). Five patients (pts) presented an axillary lymph node involvement (4 Nmic, 1 N1). Invasive ductal carcinoma was the most frequent histology type (86.3%). With a median follow–up of 64 months (range: 56–71), no local relapse occurred while 1 pt. developed an axillary relapse (2.1%). No Grade 3 or higher late toxicity was observed while 16 late toxicities occurred (G1: 14 events [87.5%) mainly G1 breast fibrosis). The rate of excellent cosmetic outcome was 76.4%. Conclusion We confirmed the safety of the process and remained encouraging clinical outcome of a post-operative single fraction of MIB ABPI in the elderly. This approach leads to consider a very APBI as an attractive alternative to intra-operative radiation therapy while all the patients will be good candidates for APBI in regards to the post-operative pathological report.

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.

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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