Balloon breast brachytherapy – Review of current data

Abstract

Recently, several publications have reported on the development and implementation of accelerated partial breast irradiation (APBI) (1–4). This relatively new treatment philosophy could significantly affect the care provided to many breast cancer patients. Increasing convenience without altering the outcome could increase the number of eligible patients who choose breast conservation over mastectomy. Additionally, new literature has raised questions about the need for adjuvant radiotherapy in older patients with small tumors (5, 6). Until such time as more mature data from these studies are available APBI or standard whole breast irradiation should be offered to these patients. The ongoing NSABP B-39/RTOG 0431 trial compares conventional adjuvant radiotherapy with APBI. Now may be a good time to evaluate the treatment techniques that we are going to use on the patients enrolled in this trial. The trial allows radiation oncologists to pick one of the three APBI techniques – multicatheter brachytherapy, balloonbased brachytherapy, or conformal three-dimensional external beam therapy – if the patient is randomized to the APBI arm. Given that current techniques of breast conservation using conventional adjuvant radiotherapy result in excellent local control rates and cosmesis, it is imperative that APBI be at least as good if not better than conventional therapy in most respects. The previous issue of this journal featured an article by Dickler et al. (7) that reviewed balloon-based breast brachytherapy. The message of this article is that balloontype breast brachytherapy is a safe and efficacious technique for APBI. However, long-term data on balloon breast brachytherapy are not available. One needs to realize that even a small decrease in the quality of long-term outcomes with balloon brachytherapy compared to those with multicatheter brachytherapy would have a significant detrimental impact on the use of APBI. Because of its relative simplicity balloon brachytherapy has the potential of being used rapidly and widely. It is important, therefore, that we carefully assess the indications, dosimetry, and