Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy.

Caroline Genebes,Adel Courdi,Ines Raoust,Jean-Michel Hannoun-Levi,Isabelle Peyrottes,Jean-Marc Ferrero,Marie-Eve Chand,Jocelyn Gal,Mathieu Gautier,Tarik Ihrai

doi:10.1186/1748-717x-9-115

Abstract

ObjectiveTo evaluate clinical outcome after accelerated partial breast irradiation (APBI) in the elderly after high-dose-rate interstitial multi-catheter brachytherapy (HIBT).Methods and materialsBetween 2005 and 2013, 70 patients underwent APBI using HIBT. Catheter implant was performed intra or post-operatively (referred patients) after lumpectomy and axillary sentinel lymph node dissection. Once the pathological results confirmed the indication of APBI, planification CT-scan was performed to deliver 34 Gy/10f/5d or 32 Gy/8f/4d. Dose-volume adaptation was manually achieved (graphical optimization). Dosimetric results and clinical outcome were retrospectively analyzed. Physician cosmetic evaluation was reported.ResultsWith a median follow-up of 60.9 months [4.6 – 90.1], median age was 80.7 years [62 – 93.1]. Regarding APBI ASTRO criteria, 61.4%, 18.6% and 20% were classified as suitable, cautionary and non-suitable respectively. Axillary sentinel lymph node dissection was performed in 94.3%; 8 pts (11.5%) presented an axillary involvement. A median dose of 34 Gy [32 – 35] in 8 to 10 fractions was delivered. Median CTV was 75.2 cc [16.9 – 210], median D90 EQD2 was 43.3 Gy [35 – 72.6] and median DHI was 0.54 [0.19 – 0.74]. One patient experienced ipsilateral recurrence (5-year local free recurrence rate: 97.6%. Five-year specific and overall survival rates were 97.9% and 93.2% respectively. Thirty-four patients (48%) presented 47 late complications classified grade 1 (80.8%) and grade 2 (19.2%) with no grade ≥ 3. Cosmetic results were considered excellent/good for 67 pts (95.7%).ConclusionAPBI using HIBT and respecting strict rules of implantation and planification, represents a smart alternative between no post-operative irradiation and whole breast irradiation delivered over 6 consecutive weeks.

Highlights

With the increase in life expectancy, the incidence of breast cancer is growing in the elderly population
APBI using high-dose-rate interstitial multi-catheter brachytherapy (HIBT) and respecting strict rules of implantation and planification, represents a smart alternative between no post-operative irradiation and whole breast irradiation delivered over 6 consecutive weeks
We investigated the results of a high-doserate (HDR) interstitial multicatheter brachytherapy (HIBT) as APBI in the elderly, in terms of clinical outcome

Summary

Introduction

With the increase in life expectancy, the incidence of breast cancer is growing in the elderly population. Whole breast irradiation (WBI), improving locoregional control and overall survival, remains the standard of care after breast conserving surgery, whatever the age of the patient [1,2,3]. A total treatment time of 6–7 weeks has been shown to affect the observance [4] of WBI in the elderly patient. During the last decade, accelerated and partial breast irradiation (APBI) techniques have emerged, as an alternative to whole breast irradiation (WBI) for patients with early breast cancer and low risk of local recurrence [5,6,7]. The volume of breast tissue irradiated is smaller and the course of treatment is shortened, which is interesting in the elderly [8]. Concerns remain about the risk of local recurrence requiring classically a salvage mastectomy

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Results

Discussion

Conclusion