Abstract
BackgroundTo investigate the efficacy and safety of accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) multicatheter interstitial brachytherapy for early-stage breast cancer.MethodsBetween 2002 and 2006, 48 prospectively selected patients with early-stage breast cancer received APBI using multicatheter brachytherapy following breast-conserving surgery. Their median age was 52 years (range 36-78). A median of 34 Gy (range 30-34) in 10 fractions given twice daily within 5 days was delivered to the tumor bed plus a 1-2 cm margin. Most (92%) patients received adjuvant systemic treatments. The median follow-up was 53 months (range 36-95). Actuarial local control rate was estimated from surgery using Kaplan-Meier method.ResultsLocal recurrence occurred in two patients. Both were true recurrence/marginal miss and developed in patients with close (< 0.2 cm) surgical margin after 33 and 40 months. The 5-year actuarial local recurrence rate was 4.6%. No regional or distant relapse and death has occurred to date. Late Grade 1 or 2 late skin and subcutaneous toxicity was seen in 11 (22.9%) and 26 (54.2%) patients, respectively. The volumes receiving 100% and 150% of the prescribed dose were significantly higher in the patients with late subcutaneous toxicity (p = 0.018 and 0.034, respectively). Cosmesis was excellent to good in 89.6%.ConclusionsAPBI using HDR multicatheter brachytherapy yielded local control, toxicity, and cosmesis comparable to those of conventional whole breast irradiation for select early-stage breast cancer. Patients with close resection margins may be ineligible for APBI.
Highlights
To investigate the efficacy and safety of accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) multicatheter interstitial brachytherapy for early-stage breast cancer
The 5-6 weeks of conventional whole breast irradiation (WBI) are problematic for elderly patients, working women, and those who live a great distance from a radiotherapy facility [1]
WBI-induced cardiovascular mortality, which counteracted an increase in overall survival by adding WBI after breast-conserving surgery (BCS), may be reduced using APBI by avoiding radiation exposure to coronary vessels [7]
Summary
To investigate the efficacy and safety of accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) multicatheter interstitial brachytherapy for early-stage breast cancer. Controversies and logistical problems exist that are associated with integrating this prolonged course of WBI and systemic chemotherapy [2]. These make a barrier to the acceptance of breast conservation by patients or their physicians, and some patients do not receive WBI after BCS [3]. The rationale underlying the accelerated partial breast irradiation (APBI) is that in-breast failure for select lowrisk patients occurs mostly in the immediate area of the tumor bed [4]. WBI-induced cardiovascular mortality, which counteracted an increase in overall survival by adding WBI after BCS, may be reduced using APBI by avoiding radiation exposure to coronary vessels [7]
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