Technique Matters: Pearls for Excellent Breast Brachytherapy by Various Techniques Learned over 2500 Cases

Abstract

In the 1970s and 1980s, brachytherapy covering the original tumor site was a common boost technique after 5 weeks of external beam breast irradiation. In 1991, wide-volume brachytherapy was introduced as a sole method of breast irradiation as a component of breast conservation therapy. Over the subsequent 28 years, significant improvements in target volume coverage, dose homogeneity, image-guided catheter insertion techniques, and quality measures have enhanced the field of accelerated partial breast irradiation (APBI). Now, approximately 15% of early breast cancers in the U.S. are treated by APBI, and randomized trials from Europe and North America have demonstrated non-inferiority and insignificant differences in ipsilateral breast tumor recurrence rates (IBTR) in comparison to traditional whole breast irradiation (WBI). Breast cancer is unforgiving: an appropriate risk-adapted target volume must be reproducibly treated by a tumoricidal dose or IBTR will become unacceptable. IBTR without WBI ranges between 25 and 35%, while quality APBI reduces IBTR to approximately 5%. This presentation examines the details that define quality breast brachytherapy.