Breast-conserving Radiation Research Articles

The Prognostic Value of MDM2, MDM4 (MDMX), and p53 in Early Stage Breast Cancer Treated with Breast Conserving Surgery and Radiotherapy

The Prognostic Value of MDM2, MDM4 (MDMX), and p53 in Early Stage Breast Cancer Treated with Breast Conserving Surgery and Radiotherapy

Interstitial High Dose Rate (HDR) Brachytherapy for Ductal Carcinoma In Situ of the Breast: Median 6 Year Results of 68 Cases Using Multi-Catheter Technique

External Beam Radiation Therapy (EBRT) has been the standard of care for breast conservation radiation therapy, in both Invasive Ductal Carcinoma (IDC) and Ductal Carcinoma In Situ (DCIS). Recent data indicates that Interstitial Implant and High Dose Rate (HDR) radiation afterloading compares favorably to EBRT in selected cases of IDC. There is little data regarding HDR in DCIS. Current ASTRO and American Brachytherapy Society Guidelines consider DCIS an investigational category for primary HDR treatment.

Use of Combined Photodynamic Therapy and Radiation to Target Breast Adenocarcinoma Cells: Preclinical Studies

Over the last two decades, breast conservation therapy (lumpectomy plus radiotherapy) has exhibited success rates rivaling those of surgical mastectomy with significantly less morbidity. However, fears of radiation-induced side effects are still a concern in some cases. To address these concerns, radiation oncologists have focused on partnering breast conservation radiotherapy (RT) with additional treatment options (hormonal manipulations, chemotherapy, etc.) to achieve more optimal tumor control while keeping radiation doses within tolerable limits.

Impact of delayed radiotherapy on local control in node-negative breast cancer patients treated with breast-conserving surgery and adjuvant radiotherapy without chemotherapy

To evaluate the effect of the surgery-radiotherapy interval (SRI) on local control in node-negative breast cancer patients treated with breast-conserving surgery and adjuvant radiotherapy without chemotherapy. From February 1992 to January 2002, 171 patients with node-negative breast cancer underwent breast-conserving surgery and adjuvant radiotherapy without chemotherapy. The whole breast was irradiated up to 50.4 Gy in 28 fractions followed by a 10-Gy boost to the tumor bed. Forty-four patients received tamoxifen in addition to radiotherapy. Patients were divided into 2 groups according to the length of SRI: <6 weeks (128 patients) versus ≥6 weeks (43 patients). The median follow-up period was 87 months (range, 22-167). The 8-year local control rates of patients with SRI <6 weeks and ≥6 weeks were 94.5% and 92.7%, respectively (P = 0.1140). When age, tumor size, resection margin status, combination with hormonal therapy, and SRI were incorporated into the Cox proportional hazards model, SRI <6 weeks and age at diagnosis ≥40 years were associated with increased local control (P = 0.0343 and 0.0264, respectively). In the subgroup analysis, SRI <6 weeks was correlated with a higher local control rate for patients aged <40 years (P = 0.0142). Among older patients, however, there was no statistical difference in local control according to SRI (P = 0.6655). Treatment interval had no impact on overall and distant metastasis-free survival. Early radiotherapy within 6 weeks of breast-conserving surgery is associated with increased local control in patients with node-negative breast cancer not undergoing chemotherapy.

A Case of Bullous Pemphigoid Exacerbated by Irradiation After Breast Conservative Radiotherapy

We present a case, considered to be a form of the Koebner phenomenon, of bullous pemphigoid that was exacerbated mainly within the irradiated field after breast conservative radiotherapy. In May 2009, a 60-year-old woman was diagnosed with bullous pemphigoid, which was treated with steroid therapy. The following month, she was diagnosed with breast cancer (invasive ductal carcinoma, pT1cN0M0). After breast conservative surgery in December 2009, conservative radiotherapy to the right breast was performed (50 Gy in 25 fractions). Portal skin showed no serious change (up to grade 1 skin erythema) and no bullous neogenesis during conservative radiotherapy. However, 2 months after conservative radiotherapy, new blisters became exacerbated mainly within the irradiated field but also in the area outside the irradiated field. Increasing the dosage of oral steroid and minocycline resulted in relief of bullous pemphigoid, although patchy skin pigmentation remained especially in the irradiated skin.

Outcomes Following a Community Based Program of Accelerated Partial Breast Irradiation Using HDR Brachytherapy in Early Stage Breast Cancer

spacing of 1.0 cm and V-150%!30% (p 5 0.0001). Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. Conclusions: With median 72 month followup, Breast Conservation radiation therapy utilizing Interstitial Multi-Catheter HDR Implant has yielded local recurrence rates and cosmetic results which compare favorably to EBRT in selected patients. There was no difference in LR between patients with IDC and DCIS. Treatment with anthracycline based Chemotherapy, large (O200 cm) implant volumes, and V-150% O30%, appear to be relative contraindications to Interstitial HDR Implant. Finally, catheter spacing of 1 cm yielded optimal dosimetry and minimized complications. Compared to Mammosite technique, the Interstitial Multi-Catheter method offers greater flexibility of radiation delivery. Advantages include, no concern regarding surgical cavity shape irregularities, balloon conformality to surgical cavity, balloon rupture, balloon movement, air gaps, skin balloon proximity to skin, balloon shape distortion, and catheter movement within the balloon.

A Multi-institutional Study of Implementation, Tolerance and Early Clinial Results With Non-invasive Image-Guided Breast Brachytherapy for Tumor Bed Boost

interstitial implant and High-dose-rate (HDR) radiation afterloading compares very favorably to EBRT in selected patients. We report median 6 year followup in 273 cases. Materials andMethods: Patients with Tis, T1, and T2 tumors measuring# 4 cm, negative surgical margins, and#3 axillary lymph nodes were judged to be candidates for interstitial implant. Implants were performed under stereotactic mammographic guidance with conscious sedation and local anesthesia. The implants were placed using a custom designed template with 3 to 8 planes, and 8 to 74 needles. Catheters were subsequently threaded thru the needles, and the needles removed. Catheter spacing was 1.0 to 1.5 cm. Radiation treatment planning was performed using CT scanning and the Plato System. Treatment volumes ranged from 25 cm to 458 cm. HDR treatment was given using the Nucletron afterloading system. The breast implant volume received 3400 cGy in 10 fractions prescribed to the planning target volume, given BID over 5 days. Results: Between 2000 and 2010, 273 patients underwent interstitial HDR implant. The procedure was well tolerated. No patient required hospital admission. With a median followup 72 months (range 6e132 months), local recurrence occurred in 4.0% (11/273). Cosmetic results were good to excellent in 89.0% (243/273) of the patients. There were no infections. Wound healing complications developed in 2.9% (8/273). Three of these patients had received anthracycline based Chemotherapy. The other five had large (O200 cm) implant volumes. In patients with catheter spacing of 1.5 cm and V-150% O30%, 9.5% (8/84) developed wound complications vs. 0% (0/189) in patients with catheter spacing of 1.0 cm and V-150% !30% (p 5 0.0001). Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. Conclusions: With median 72-month followup, breast conservation radiation therapy utilizing interstitial multi-catheter HDR implant has yielded local recurrence rates and cosmetic results which compare favorably to EBRT in selected patients. Treatment with anthracyclinebased chemotherapy, large (O200 cm) implant volumes, and V-150% O30%, appear to be relative contraindications to interstitial HDR implant. Finally, catheter spacing of 1 cm yielded optimal dosimetry and minimized complications. Compared to MammoSite technique, the interstitial multi-catheter method offers greater flexibility of radiation delivery. Advantages, include no concern regarding surgical cavity shape irregularities, balloon conformality to surgical cavity, balloon rupture, balloon movement, air gaps, skin balloon proximity to skin, balloon shape distortion, and catheter movement within the balloon.

Interstitial High-Dose-Rate Brachytherapy for Breast Cancer in Women ≤50 Years of Age Compared to >50 Years of Age: Median 6-Year Followup in 273 Cases Using Multicatheter Technique

Purpose: External beam radiation therapy (EBRT) has been the standard of care for breast conservation radiation therapy, for more than 20 years. It is well known that pre-menopausal women have a worse prognosis than post-menopausal women. However, it is also known that mastectomy does not confer a better prognosis than breast conservation in these younger women. Hence, the American College of Radiology does not have an age limit for breast conservation candidacy. Recent data indicates that interstitial implant and high-dose-rate (HDR) radiation afterloading compares very favorably to EBRT in early stage breast cancer.

Breast conservation surgery and radiation for a patient with synchronous primary breast cancers and BRCA1/BRCA2 positivity: is mastectomy required?

AbstractThe role of breast conservation in patients expressing BRCA1 and BRCA2 genetic mutations is controversial. A patient who was found to have bilateral synchronous breast cancers and expressed a BRCA genetic mutation was recently evaluated. The patient had a strong desire for breast preservation. This case and a review of the pertinent literature are presented to discuss the role of breast conservation and radiation in patients with BRCA1 or BRCA2 genetic mutations.

Abstract P1-15-07: Improved Outcomes of Breast-Conserving Surgery (BCS) and Radiation Therapy (RT) for Ductal Carcinoma In Situ (DCIS)

Abstract Background: DCIS patients treated at our center from 1976 to 1990 had an actuarial 10-year local recurrence (LR) rate of 15%. Since then, improved mammographic and pathologic evaluation and greater attention to achieving negative margins may have translated to lower risk of LR following BCS + RT for DCIS. However, the clinical implications of hormone-receptor and HER2 status in DCIS remain unclear. We sought to determine 1) if LR rates following BCS + RT have improved with this more modern approach, 2) the relation between the LR rate and HER2 status, and 3) clinical and pathologic factors associated with HER2+ tumors. Methods: We reviewed records of 246 consecutive patients who underwent BCS and adjuvant RT for DCIS at a single academic institution from 2001 to 2007. The median age at diagnosis was 54 years. One hundred and forty-one patients (57%) were postmenopausal and 226 (92%) were diagnosed after routine screening mammogram. Fifty percent of patients underwent re-excision. The median volume of excised tissue was 78 cm3 (interquartile range, 43-143 cm3) and the median number of tissue blocks with DCIS was 3 (interquartile range, 2-7). Forty tumors (16%) were grade I, 110 (45%) were grade II and 96 (39%) were grade III. Final margins were negative (&amp;gt;2 mm) for 222 patients (90%), close (≥2 mm) for 23 (9%) and positive for 1 (0%). The median dose to the whole breast was 44 Gy (range, 40-52 Gy) and 244 (99%) received a boost to the primary site of median dose 16 Gy (range, 8-18 Gy). Routine estrogen-receptor (ER), progesterone-receptor (PR), and HER2 testing was instituted in 2003. Of the 163 patients with HER2 testing, 33 (20%) had HER2+ tumors (3+ on immunohistochemistry). Of the 186 patients with ER and/or PR testing, 174 (94%) had ER and/or PR+ tumors and of these, 104 (60%) received adjuvant hormonal therapy. Logistic regression was used to evaluate the association of clinical and pathologic factors with HER2 status. Results: With a median follow-up period of 58 months (range, 4.2-110 months), there were no LRs among the 246 patients. Seven patients (3%) developed contralateral breast cancer, of which 4 were invasive and 3 were in situ. Seven patients (3%) died of causes unrelated to breast cancer. On univariate analysis, HER2+ was significantly associated with grade III, ER-/PR-, central necrosis, comedo subtype, more extensive DCIS (based on the number of tissue blocks with DCIS), and postmenopausal status. When adjusted for ER/PR and grade, postmenopausal status remained significantly associated with HER2+ (odds ratio 3.3; 95% CI 1.2-8.7; p=0.019). Conclusions: In an era of routine detailed mammographic and pathologic evaluation, widely negative margins and the use of a boost to the primary site in patients with DCIS, we observed no local recurrences with a median follow-up time of 58 months, even among patients with HER2+ DCIS. Factors associated with HER2+ tumors included postmenopausal status and more extensive DCIS, as well as grade III, ER-/PR-, central necrosis, and comedo subtype. Further follow-up and additional studies are required to confirm these results. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-15-07.

Abstract P4-10-05: Factors Associated with Ipsilateral Breast Tumor Recurrence in Breast Cancer Patients Treated with Breast Conserving Surgery and Radiotherapy after Preoperative Chemotherapy

Abstract Background: Although preoperative chemotherapy (PCT) was originally used to make locally advanced breast cancers (BC) operable, it is now frequently utilized to make relatively large primary tumors small enough for breast conserving treatment (BCT). A large number of studies have been performed to identify risk factors of ipsilateral breast tumor recurrence (IBTR) after breast conserving treatment for originally small tumors. However, those studies for patients (Pts) who received BCT after PCT for relatively large tumors are limited. We have done a multicenter retrospective study to identify factors which were associated with IBTR in Pts treated with BCT after PCT. Patients and methods: From 7 Japanese hospitals, data, which regard characteristics of tumors and Pts, and treatment, of Pts who fulfilled the following criteria; 1. Female BC Pts who started PCT before January 2007 2. Her tumor was invasive, clinically solitary, and 2 cm or largerby palpation at diagnosis 3. She received 3 or more cycles of PCT 4. She received breast conserving surgery as a definitive surgery after PCT including axillary dissection or sentinel node biopsy 5. She received radiotherapy at least to the conserved breast. Pts with inflammatory BC and BC Pts who received preoperative treatment(s) other than chemotherapy were excluded. Kaplan-Meier method was used to estimate cumulative recurrence rates. Log rank test and Cox's proportional hazard model were used for statistical analyses. Receiver Operating Characteristic (ROC) Curves and C statistics were used for evaluating the prediction ability of Cox's proportional hazard model about IBTR. Results: A total of 324 Pts were registered. The median age at diagnosis of them was 48 years old. The median size of the primary tumors by palpation at diagnosis was 4 cm. For PCT anthracycline-based regimens were used for 83 Pts, taxane-based regimens were for 29, and anthracycline-taxane regimens were for 212. One hundred forty two Pts (43.8%) received postoperative chemotherapy, 180 (55.6%) had postoperative endocrine therapy, and only 7 had postoperative trastuzumab therapy. The median follow-up period was 45 months. Nineteen Pts (5.9%) developed IBTR. The cumulative 4-year IBTR rate was 5.5%. Univariate analyses revealed that estrogen receptor (ER) status both before and after PCT, pathological nodal status after PCT, and pathologically residual invasive tumor (solitary vs. multifocal, 1.7 cm or smaller vs. 1.8 cm or larger) were statistically significantly associated with IBTR (P &amp;lt; 0.05 for all of them). Pathological margin status did not affect IBTR rate (P=0.73). ER status prior to PCT (positive vs. negative)(Hazard Ratio [HR], 6.76; P=0.012), size of the residual invasive tumor (1.7 cm or smaller vs. 1.8 cm or larger)(HR, 4.74; P=0.020), and pathological nodal status after PCT (0-3 positive nodes vs. 4 or more)(HR, 3.03; P=0.041) were associated with IBTR on multivariate analysis. C statistic was 78.3%. Conclusion: Mastectomy may be a better choice for the Pts who have tumors with negative ER, pathologically large (1.8 cm or larger) residual invasive lesions after PCT, or 4 or more pathologically positive nodes after PCT in terms of local control. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-05.

Interstitial High Dose Rate (HDR) Brachytherapy for Ductal Carcinoma In Situ of the Breast: Median 6 Year Results of 63 Cases using Multi-catheter Technique

External Beam Radiation Therapy (EBRT) has been the standard of care for breast conservation radiation therapy, in both Invasive Ductal Carcinoma (IDC) and Ductal Carcinoma In Situ (DCIS). Recent data indicates that Interstitial Implant and High Dose Rate (HDR) radiation afterloading compares very favorably to EBRT in selected cases of IDC. There is little data regarding HDR in DCIS. We report our HDR results in 63 patients with DCIS. Patients with Tis, T1, and T2 tumors measuring ≤ 4 cm, negative surgical margins, and ≤ 3 axillary lymph nodes were judged to be candidates for Interstitial Implant. Implants were performed under Stereotactic Mammographic guidance with conscious sedation and local anesthesia. The implants were placed with a custom designed template using from 3 to 8 planes, and 8 to 74 needles. Catheters were subsequently threaded thru the needles, and the needles removed. Catheter spacing was 1.0 to 1.5 cm. Radiation Treatment planning was performed using CT Scanning and the Plato System. Treatment volumes ranged from 25 cm3 to 359 cm3. HDR treatment was given using the Nucletron afterloading system. The breast implant volume received 3400 c Gy in 10 fractions prescribed to the Planning Target Volume, given BID over 5 days. Between 2000 and 2010, 268 patients underwent Interstitial HDR Implant. The procedure was well tolerated. No patient required hospital admission. With a median follow-up 72 months (range, 6-128 months), local recurrence (LR) occurred in 3.7% (10/268). LR occurred in 3.5% (7/205) of patient with IDC vs. 4.8% (3/63) in DCIS (p = 0.70). Cosmetic results were good to excellent in 89.5% (240/268) of the patients. There were no infections. Wound healing complications developed in 3.0% (8/268). Three of these patients had received anthracycline based Chemotherapy. The other five had large (> 200 cm3) implant volumes, catheter spacing of 1.5 cm, and V-150% of > 30%. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. With median 72 month follow-up, Breast Conservation radiation therapy utilizing Interstitial Multi-Catheter HDR Implant has yielded local recurrence rates and cosmetic results which compare favorably to EBRT in selected patients. There was no difference in LR between patients with IDC and DCIS. Treatment with anthracycline based Chemotherapy, large (> 200 cm3) implant volumes, and V-150% > 30%, appear to be relative contraindications to Interstitial HDR Implant. Finally, catheter spacing of 1 cm yielded optimal dosimetry and minimized complications.

Outcomes of Young Women with Ductal Carcinoma In Situ Treated with Breast-conserving Surgery and Radiotherapy: A Population-based Analysis

Outcomes of Young Women with Ductal Carcinoma In Situ Treated with Breast-conserving Surgery and Radiotherapy: A Population-based Analysis

Interstitial High Dose Rate Brachytherapy for Early Stage Breast Cancer: Median 6 Year Follow-up of 268 Cases Using Multi-catheter Technique

External Beam Radiation Therapy (EBRT) has been the standard of care for breast conservation radiation therapy. Recent data indicates that Interstitial Implant and High Dose Rate (HDR) radiation afterloading compares very favorably to EBRT in selected patients.

Clinical observation of early breast cancer after breastconserving surgery and radiotherapy

Objective To observe the oncololigcal and cosmetic outcomes and complication of breastconserving surgery and radiotherapy for early breast cancer. Methods A total of 78 early breast cancer patients, who were treated in the First People's Hospital of Pingdingshan between January 2001 and September 2008, were identified and followed. Among them, 36 were in stage Ⅰ and 42 in stage Ⅱ. Tangential irradiation was used with a dose of 50 Gy. Tumor bed received a boost dose of 10 Gy electron beam. For axillary lymph node-positive patients, ipsilateral supraclavicular field was hybrid irradiated with 50 Gy X and electron beam.Results The total follow-up ranged from 6 to 98 months. Local recurrence was observed among 4.9% of the patients. The 3-year and 5-year overall survival rate were 96.6% and 92.7% ,respectively. The breast cosmetic satisfaction rate was 94.9%. The main complications reported were acute skin reaction and upper limb edema.Conclusion Breast-conserving surgery and post-operative radiotherapy in early breast cancer patients can lead to satisfactory survival rates and cosmetic effects and hence improved life quality. Key words: Breast neoplasms; Breast conserving therapy; Radiotherapy

Clinical observation of combination of breast-conserving surgery with postoperative radiotherapy for early stage of breast cancer

Objective To observe the short effect, cosmetic effect and toxicity of combination of breastconserving surgery with postoperative radiotherapy for early stage of breast cancer. Methods Forty-two patients with early stage of breast cancer received combination of breast-conserving surgery with postoperative radiotherapy, whole breast received 46 to 50 Gy in 23 to 25 fractions delivered by conventional tangent field and boost to tumor bed with 10 to 14 Gy in 5 to 7 fractions was given after whole breast irradiation. Results Followed up for 12 to 48 months, 1-year survival rate was 100% ,3-year survival rate was 97.62% ,3-year local recurrent rate was 4. 76%, recent satisfaction rate of cosmetic result was 92. 86%. Local recurrence was found in 2 patients,distant metastasis was found in 2 patients. Two patients appeared 3 grade of radiation-induced pneumonitis and three patients appeared 3 grade of radiation-induced dermatitis. Conclusion Recent survival rate and cosmetic result is satisfactory for the patients with early stage of breast cancer treated with combination of breast-conserving surgery and radiotherapy, the acute toxicity is acceptable. Key words: Breast cancer; Breast-conserving surgery; Radiotherapy

Poly(ADP-ribose) polymerase-1 (PARP-1) expression in patients treated with breast-conserving surgery and radiation therapy (BCS+RT).

582 Background: Poly(ADP-ribose) polymerase-1 (PARP-1) is a nuclear protein involved in single- and double-stranded DNA break repair. PARP deficiency has been implicated in leading to the developme...

Is short interval mammogram necessary after breast-conservation surgery and radiation treatment in breast cancer patients?

603 Background: The optimum timing and frequency of mammograms in breast cancer patients following breast-conserving therapy (BCT) are controversial. The National Comprehensive Cancer Network (NCCN...

Interstitial High-Dose-Rate Brachytherapy for Early Stage Breast Cancer: Median 6-Year Followup of 251 Cases Using Multi-Catheter Technique

Purpose: External beam radiation therapy (EBRT) has been the standard of care for breast conservation radiation therapy. Recent data indicate that interstitial implant and high-dose-rate (HDR) radiation afterloading compares very favorably to EBRT in selected patients.Materials and Methods: Patients with Tis, T1, and T2 tumors measuring ≤4 cm, negative surgical margins, and ≤3 axillary lymph nodes were judged to be candidates for Interstitial Implant. Implants were performed under Stereotactic Mammographic guidance with conscious sedation and local anesthesia. The implants were placed using the Anderson-Nair Template using from 3 to 8 planes, and 8 to 62 needles. Catheters were subsequently threaded through the needles, and the needles removed. Catheter spacing was 1.0 to 1.5 cm. Radiation treatment planning was performed using CT scanning and the Plato™ system. Treatment volumes ranged from 25 cm3 to 359 cm3. HDR treatment was given using the Nucletron afterloading system. The breast implant volume received 3400 cGy in 10 fractions prescribed to the planning target volume, given BID over 5 days.Results: Between 2000 and 2009, 251 patients underwent interstitial HDR implant. The procedure was well tolerated. No patient required hospital admission. With a median followup 72 months (range 6-120 months), local recurrence occurred in 4.0% (10/251). Cosmetic results were good to excellent in 89.2% (224/251) of the patients. There were no infections. Wound healing complications developed in 3.2% (8/251). Three of these patients had received anthracycline based Chemotherapy. The other five had large (>200 cm3) implant volumes, catheter spacing of 1.5 cm, and V-150% of >30%. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis.Conclusions: With median 72 month followup, breast conservation radiation therapy utilizing interstitial multi-catheter HDR implant has yielded local recurrence rates and cosmetic results which compare favorably to EBRT in selected patients. Treatment with anthracycline-based chemotherapy, large (>200 cm3) implant volumes, and V-150% > 30%, appear to be relative contraindications to interstitial HDR implant. Finally, catheter spacing of 1 cm yielded optimal dosimetry and minimized complications. Compared to MammoSite® technique, the interstitial multi-catheter method offers greater flexibility of radiation delivery. Advantages, include no concern regarding surgical cavity shape irregularities, balloon conformality to surgical cavity, balloon rupture, balloon movement, air gaps, skin balloon proximity to skin, balloon shape distortion, and catheter movement within the balloon. Purpose: External beam radiation therapy (EBRT) has been the standard of care for breast conservation radiation therapy. Recent data indicate that interstitial implant and high-dose-rate (HDR) radiation afterloading compares very favorably to EBRT in selected patients. Materials and Methods: Patients with Tis, T1, and T2 tumors measuring ≤4 cm, negative surgical margins, and ≤3 axillary lymph nodes were judged to be candidates for Interstitial Implant. Implants were performed under Stereotactic Mammographic guidance with conscious sedation and local anesthesia. The implants were placed using the Anderson-Nair Template using from 3 to 8 planes, and 8 to 62 needles. Catheters were subsequently threaded through the needles, and the needles removed. Catheter spacing was 1.0 to 1.5 cm. Radiation treatment planning was performed using CT scanning and the Plato™ system. Treatment volumes ranged from 25 cm3 to 359 cm3. HDR treatment was given using the Nucletron afterloading system. The breast implant volume received 3400 cGy in 10 fractions prescribed to the planning target volume, given BID over 5 days. Results: Between 2000 and 2009, 251 patients underwent interstitial HDR implant. The procedure was well tolerated. No patient required hospital admission. With a median followup 72 months (range 6-120 months), local recurrence occurred in 4.0% (10/251). Cosmetic results were good to excellent in 89.2% (224/251) of the patients. There were no infections. Wound healing complications developed in 3.2% (8/251). Three of these patients had received anthracycline based Chemotherapy. The other five had large (>200 cm3) implant volumes, catheter spacing of 1.5 cm, and V-150% of >30%. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. Conclusions: With median 72 month followup, breast conservation radiation therapy utilizing interstitial multi-catheter HDR implant has yielded local recurrence rates and cosmetic results which compare favorably to EBRT in selected patients. Treatment with anthracycline-based chemotherapy, large (>200 cm3) implant volumes, and V-150% > 30%, appear to be relative contraindications to interstitial HDR implant. Finally, catheter spacing of 1 cm yielded optimal dosimetry and minimized complications. Compared to MammoSite® technique, the interstitial multi-catheter method offers greater flexibility of radiation delivery. Advantages, include no concern regarding surgical cavity shape irregularities, balloon conformality to surgical cavity, balloon rupture, balloon movement, air gaps, skin balloon proximity to skin, balloon shape distortion, and catheter movement within the balloon.

Interstitial High-Dose-Rate Brachytherapy for Ductal Carcinoma In Situ of the Breast: Median 6-Year Results of 59 Cases Using Multi-Catheter Technique

Purpose: External beam radiation therapy (EBRT) has been the standard of care for breast conservation radiation therapy, in both invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Recent data indicate that interstitial implant and high-dose-rate (HDR) radiation afterloading compares very favorably to EBRT in selected cases of IDC. There are little data regarding HDR in DCIS. We report our HDR results in 59 patients with DCIS. Materials and Methods: Patients with Tis, T1, and T2 tumors measuring ≤4 cm, negative surgical margins, and ≤3 axillary lymph nodes were judged to be candidates for interstitial implant. Implants were performed under stereotactic mammographic guidance with conscious sedation and local anesthesia. The implants were placed using the Anderson-Nair template using from 3 to 8 planes, and 8 to 62 needles. Catheters were subsequently threaded thru the needles, and the needles removed. Catheter spacing was 1.0 to 1.5 cm. Radiation treatment planning was performed using CT scanning and the Plato™ system (Nucletron B.V., Veenendaal, The Netherlands). Treatment volumes ranged from 25 cm3 to 359 cm3. HDR treatment was given using the Nucletron afterloading system. The breast implant volume received 3400 cGy in 10 fractions prescribed to the planning target volume, given BID over 5 days. Results: Between 2000 and 2009, 251 patients underwent interstitial HDR implant. The procedure was well tolerated. No patient required hospital admission. With a median followup 72 months (range 6-120 months), local recurrence occurred in 4.0% (10/251). LR occurred in 3.6% (7/192) of patient with IDC vs. 5.1% (3/59) in DCIS (p = 0.70). Cosmetic results were good to excellent in 89.2% (224/251) of the patients. There were no infections. Wound healing complications developed in 3.2% (8/251). Three of these patients had received anthracycline based Chemotherapy. The other five had large (>200 cm3) implant volumes, catheter spacing of 1.5 cm, and V-150% of >30%. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. Conclusions: With median 72-month followup, breast conservation radiation therapy utilizing interstitial multi-catheter HDR implant has yielded local recurrence rates and cosmetic results which compare favorably to EBRT in selected patients. There was no difference in LR between patients with IDC and DCIS. Treatment with anthracycline-based chemotherapy, large (>200 cm3) implant volumes, and V-150% >30%, appear to be relative contraindications to interstitial HDR implant. Finally, catheter spacing of 1 cm yielded optimal dosimetry and minimized complications. Compared to MammoSite® technique, the interstitial multi-catheter method offers greater flexibility of radiation delivery. Advantages include, no concern regarding surgical cavity shape irregularities, balloon conformality to surgical cavity, balloon rupture, balloon movement, air gaps, skin balloon proximity to skin, balloon shape distortion, and catheter movement within the balloon.