Mammographic Findings Associated with Accelerated Partial Breast Irradiation Using Single Fraction Intraoperative Radiotherapy

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.

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Accelerated Partial Breast Irradiation in Early-Stage Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.09.7436 ◽

2007 ◽

Vol 25 (8) ◽

pp. 996-1002 ◽

Cited By ~ 64

Author(s):

Mary Ella Sanders ◽

Troy Scroggins ◽

Federico L. Ampil ◽

Benjamin D. Li

Keyword(s):

Breast Cancer ◽

Time Course ◽

Treatment Time ◽

Early Stage ◽

Breast Conservation ◽

Intraoperative Radiotherapy ◽

Accelerated Partial Breast Irradiation ◽

Intracavitary Brachytherapy ◽

Partial Breast Irradiation ◽

Breast Irradiation

Whole-breast irradiation, as part of breast-conservation therapy (BCT), has well-established results, good cosmesis, and low toxicity. Results from the BCT trials suggest that the risk for ipsilateral breast cancer recurrence resides within close proximity to the original tumor site. This leads investigators to consider the role of an accelerated and more tumor bed–focused course of radiotherapy. Accelerated partial-breast irradiation (APBI) involves treating a limited volume of breast tissue, with dose of irradiation per fraction increased and the treatment time course decreased. Four currently available methods of APBI are interstitial brachytherapy, intracavitary brachytherapy, intraoperative radiotherapy, and three-dimensional conformal external-beam radiotherapy. Patient selection is critical. This review article presents some preliminary clinical observations and limitations that suggest a potential role for APBI as a more user-friendly mode for delivering radiotherapy after lumpectomy for early breast cancer.

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How Do the ASTRO Consensus Statement Guidelines for the Application of Accelerated Partial Breast Irradiation Fit Intraoperative Radiotherapy? A Retrospective Analysis of Patients Treated at the European Institute of Oncology

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2011.08.014 ◽

2012 ◽

Vol 83 (3) ◽

pp. 806-813 ◽

Cited By ~ 78

Author(s):

Maria Cristina Leonardi ◽

Patrick Maisonneuve ◽

Mauro Giuseppe Mastropasqua ◽

Anna Morra ◽

Roberta Lazzari ◽

...

Keyword(s):

Retrospective Analysis ◽

Consensus Statement ◽

Intraoperative Radiotherapy ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

European Institute

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Cost comparison of radiation treatment options after lumpectomy for breast cancer: Intraoperative radiotherapy versus alternatives.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.187 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 187-187

Author(s):

Dennis R. Holmes ◽

Juvairiya Pulicharamveettil ◽

Gary Lee Sutter ◽

Ronald J. Rivera

Keyword(s):

Breast Cancer ◽

Los Angeles ◽

Radiation Treatment ◽

Intraoperative Radiotherapy ◽

Cost Comparison ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Potential Cost ◽

Single Fraction ◽

The Cost

187 Background: Increasing constraints on health care resources call for implementation of breast cancer treatment strategies that preserve treatment efficacy while reducing healthcare cost. In this investigation, we model potential cost savings associated with the use of single-fraction intraoperative radiotherapy (IORT) compared to two commonly used alternative radiotherapy approaches. Methods: A database survey was performed of female subjects undergoing breast conserving surgery (BCS) with or without sentinel lymphadenectomy at HealthCare Partners, a major IPA in metropolitan Los Angeles, CA. Subjects were identified by cross-referencing ICD-9 codes (174.0-174.9) for invasive breast cancer, CPT codes for BCS (19120, 19125, or 19301), and CPT codes for sentinel node biopsy without ALND (38500, 38525, or 38740). Calculations were based on the 2011 U.S. Medicare Fee Schedule. Treatment costs and savings were modeled assuming that patients with node-negative disease who underwent BCS were eligible for accelerated partial breast irradiation based on American Society of Breast Surgeons Guidelines (age ≥45, IDCA, DCIS, size ≤3 cm, node and margin negative). Results: A sample of 1,478 women meeting criteria was evaluated to determine the average per-patient cost of breast radiotherapy comparing three modalities: single-fraction IORT ($4,402), 5-day multi-lumen balloon brachytherapy (MLBB) (e.g., MammoSite) ($12,021), and standard 6-week whole breast external beam radiotherapy followed by a tumor bed boost (WBRT) ($8,988). IORT was approximately 49% the cost of standard 6-week WBRT and 37% the cost of MLBB. Conclusions: When eligible breast cancer patients are offered IORT as an alternative to WBRT, the expenditures from this sample may be reduced from $13.3M to $6.5M, a savings of $6.8M. Compared to MLBB, IORT may reduce radiotherapy expenditures from $17.8M to $6.5M, a savings of $11.3M. [Table: see text]

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Intraoperative Radiotherapy as Accelerated Partial Breast Irradiation for Early Breast Cancer

Strahlentherapie und Onkologie ◽

10.1007/s00066-010-8001-2 ◽

2010 ◽

Vol 186 (12) ◽

pp. 651-657 ◽

Cited By ~ 33

Author(s):

Marie-Luise Sautter-Bihl ◽

Felix Sedlmayer ◽

Wilfried Budach ◽

Jürgen Dunst ◽

Rita Engenhart- Cabillic ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Intraoperative Radiotherapy ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation

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A phase I/II trial of intraoperative breast radiotherapy in an Asian population: 10-year results with critical evaluation

Journal of Radiation Research ◽

10.1093/jrr/rraa029 ◽

2020 ◽

Vol 61 (4) ◽

pp. 602-607

Author(s):

Mariko Kawamura ◽

Yoshiyuki Itoh ◽

Takeshi Kamomae ◽

Masataka Sawaki ◽

Toyone Kikumori ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Phase I ◽

Critical Evaluation ◽

Intraoperative Radiotherapy ◽

Phase Iii ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation

Abstract Although phase III trials have been published comparing whole breast irradiation (WBI) with accelerated partial breast irradiation (APBI) using intraoperative radiotherapy (IORT), long-term follow-up results are lacking. We report the 10-year follow-up results of a prospective phase I/II clinical trial of IORT. The inclusion criteria were as follows: (i) tumor size <2.5 cm, (ii) desire for breast-conserving surgery, (iii) age >50 years, (iv) negative margins after resection and (v) sentinel lymph node-negative disease. A single dose of IORT (19–21 Gy) was delivered to the tumor bed in the operation room just after wide local excision of the primary breast cancer using a 6–12 MeV electron beam. Local recurrence was defined as recurrence or new disease within the treated breast and was evaluated annually using mammography and ultrasonography. A total of 32 patients were eligible for evaluation. The median patient age was 65 years and the median follow-up time was 10 years. Two patients experienced local recurrence just under the nipple, out of the irradiated field, after 8 years of follow-up. Three patients had contralateral breast cancer and one patient experienced bone metastasis after 10 years of follow-up. No patient experienced in-field recurrence nor breast cancer death. Eight patients had hypertrophic scarring at the last follow-up. There were no lung or heart adverse effects. This is the first report of 10-year follow-up results of IORT as APBI. The findings suggest that breast cancer with extended intraductal components should be treated with great caution.

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