Surgical perspectives from a prospective, nonrandomized, multicenter study of breast conserving surgery and adjuvant electronic brachytherapy for the treatment of breast cancer

William C Dooley,Art G Lerner,Ozer Algan,Susan K Boolbol,Elizabeth Tito,Betsy Ballard,Darius Francescatti,J David Beatty,Kambiz Dowlatshahi

doi:10.1186/1477-7819-9-30

Abstract

BackgroundAccelerated partial breast irradiation (APBI) may be used to deliver radiation to the tumor bed post-lumpectomy in eligible patients with breast cancer. Patient and tumor characteristics as well as the lumpectomy technique can influence patient eligibility for APBI. This report describes a lumpectomy procedure and examines patient, tumor, and surgical characteristics from a prospective, multicenter study of electronic brachytherapy.MethodsThe study enrolled 65 patients of age 45-84 years with ductal carcinoma or ductal carcinoma in situ, and 44 patients, who met the inclusion and exclusion criteria, were treated with APBI using the Axxent® electronic brachytherapy system following lumpectomy. The prescription dose was 34 Gy in 10 fractions over 5 days.ResultsThe lumpectomy technique as described herein varied by site and patient characteristics. The balloon applicator was implanted by the surgeon (91%) or a radiation oncologist (9%) during or up to 61 days post-lumpectomy (mean 22 days). A lateral approach was most commonly used (59%) for insertion of the applicator followed by an incision site approach in 27% of cases, a medial approach in 5%, and an inferior approach in 7%. A trocar was used during applicator insertion in 27% of cases. Local anesthetic, sedation, both or neither were administered in 45%, 2%, 41% and 11% of cases, respectively, during applicator placement. The prescription dose was delivered in 42 of 44 treated patients.ConclusionsEarly stage breast cancer can be treated with breast conserving surgery and APBI using electronic brachytherapy. Treatment was well tolerated, and these early outcomes were similar to the early outcomes with iridium-based balloon brachytherapy.

Highlights

Accelerated partial breast irradiation (APBI) may be used to deliver radiation to the tumor bed postlumpectomy in eligible patients with breast cancer
The use of a single balloon catheter for APBI has demonstrated good control rates, cosmesis and safety at up to 5 years followup [15,16,17] The majority of APBI techniques require the use of an 192Iridium source, which in turn requires a heavily-shielded radiation vault and a high dose rate (HDR) afterloader unit
The initial publication of this study focused on treatment outcomes and characteristics of treated patients and tumors omitting critical surgical aspects of the study [20]

Summary

Introduction

Accelerated partial breast irradiation (APBI) may be used to deliver radiation to the tumor bed postlumpectomy in eligible patients with breast cancer. The use of a single balloon catheter for APBI has demonstrated good control rates, cosmesis and safety at up to 5 years followup [15,16,17] The majority of APBI techniques require the use of an 192Iridium source, which in turn requires a heavily-shielded radiation vault and a high dose rate (HDR) afterloader unit. These facilities are not present in many geographical areas of the United States due to the large capital expenditure [18]. The electronic source mimics an 192Iridium source and provides an equivalent or higher dose rate with a steeper fall off of dose over distance [20]

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Discussion

Conclusion