Noninvasive Image-Guided Breast Brachytherapy (NIBB)

Abstract

Noninvasive image-guided breast brachytherapy (NIBB) is a novel APBI technique and holds potential advantages over other APBI techniques. Similar to interstitial and intracavitary brachytherapy, NIBB has the advantage of delivering radiation to the tumor bed with a high degree of precision. This is accomplished by employing breast immobilization and mammographic-like image guidance for each radiation treatment. However, unlike interstitial and intracavitary brachytherapy, NIBB is completely noninvasive making this approach more acceptable to patients not willing to undergo percutaneous catheter placement. The inconvenience and discomfort of managing an indwelling catheter or catheters is eliminated, as is the risk of instrumentation-related infection. Also, oncoplastic reconstruction to enhance the cosmetic outcomes of surgery can be performed with NIBB as long as the tissues at risk are appropriated marked with surgical clips or other fiducials. Furthermore, unlike the 3D-CRT technique, NIBB does not require an additional large margin expansion. With breast immobilization and image guidance, the inaccuracies related to set-up errors and patient or breast motion are essentially eliminated. Additionally, the breast compression used for immobilization displaces nontarget breast tissue out of the irradiation field. This results in further reduction in target and irradiated volumes, thereby reducing the risk of toxicities associated with larger treatment volumes. Altogether, this makes NIBB an attractive and promising approach for the delivery of APBI [9].