Patients with bilateral breast ductal carcinoma in situ treated with accelerated partial breast irradiation—initial experience

Abstract

This study was conducted to report the initial experience of treating patients with synchronous bilateral breast ductal carcinomas in situ (DCIS) treated with accelerated partial breast irradiation (APBI). Between August 2008 and September 2012, five patients with bilateral DCIS were treated with Contura Multi-Lumen high-dose rate (HDR) brachytherapy to 34 Gy in ten fractions twice daily. The dose was prescribed to 1 cm from the applicator surface. We report on the tumor characteristics and dosimetric data as well as clinical outcomes and toxicities according to RTOG 9517 and RTOG 9804. Median follow-up was 35 months (range 8–37 months). The median age was 61 years (range 61–75). All patients had bilateral DCIS. Contralateral DCIS was detected with preoperative magnetic resonance imaging (MRI) performed before lumpectomy. Median tumor size was 4.8 mm on the right and 10 mm on the left. Two patients had grade 1, one patient had grade 2, and two patients had no acute skin toxicity, respectively. At last follow-up, grade 1 late skin toxicity was reported in two patients, and the remaining patients did not have any residual skin reaction. Cosmesis was described as minimal or no difference in the size, shape, or texture of both breasts. There was no loco-regional recurrence. Our initial experience of using APBI to treat bilateral DCIS is safe and effective and associated with excellent cosmetic outcome in this small population of patients. Long-term results in a larger population are needed.