Initial radiation experience evaluating early tolerance and toxicities in patients undergoing accelerated partial breast irradiation using the Contura™ multi-lumen balloon (MLB) breast brachytherapy catheter.

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Abstract Abstract #5138 Purpose: We reviewed our institution's experience treating patients with the Contura™ Multi-Lumen Balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) to determine short-term treatment efficacy, cosmesis, toxicity and additional dosimetric capabilities of the new APBI device.
 Materials and Methods: From 05/07 to 05/08, 41 patients, from a single surgeon (PI), were treated with breast conserving therapy (BCT) received adjuvant radiation using the Contura™ catheter (34 Gy in 3.4 Gy fractions). 13/41 patients (31.7%) had stage 0 disease, 21 (51.2%) had stage I and 7 (17.1%) had stage II breast cancer.
 For each patient, the dosimetric plan was customized using the 5 high dose rate brachytherapy channels of the Contura™ catheter by selecting from 45 different dwell positions (9 per catheter).
 Results: Median, minimum skin spacing was 10 mm (range 2 to 17). The median maximum skin dose (% of prescribed dose [PD]) was 99.7 (57.1 to 124.1). Eight patients were able to be treated with a skin spacing of 5 mm or less, 2 had spacing of 2 mm. The median maximum rib dose was 102.6 % of PD (10.0 to 187.7), median percentage of the planning target volume (PTV) receiving 95% of the PD was 98.8 (79.4 to 107.4) and the median volume receiving 200% of the PD was 5.7 cc (range 1.3 to 9.9).
 The percentage of patients with excellent/good cosmetic results at 3 and 6 months was 94% (16 evaluable patients) and 89% (9 evaluable patients), respectively. One patient developed skin ulceration after receiving chemotherapy. Patient tolerance was assessed on a scale 0-10 (0=no pain, 10 = requiring narcotic analgesics). In 37/38 (97.3%) patients, pain was graded ≤ 3 at the time of catheter insertion. Four transient breast infections (11%) developed and one transient symptomatic seroma developed (3%).
 Conclusion: Adjuvant APBI using the Contura™ MLB catheter exhibited similar toxicities to standard single-lumen balloon brachytherapy with absolute improvements in dosimetric capabilities (i.e., reduced skin dose, improved PTV coverage and normal tissue avoidance). With multiple lumen planning, more conformal dosimtery was achieved as compared to single-lumen balloon treatment. This allowed the treatment of 8 patients with skin spacing of 5 mm or less, normally not achievable with single-lumen balloon treatment. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5138.