Accelerated Partial Breast Irradiation for Select Breast Cancers in the Presence of Augmentation

Kuske, Robert R.; Chowdhury, Rafiqul I.; Snyder, Margaret; Vega, A.; Sadeghi, Amir

doi:10.1016/j.ijrobp.2012.07.229

Cited by 11 publications

(13 citation statements)

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“…In contrast, reports of cosmetic outcomes following brachytherapy techniques for APBI demonstrate excellent results 23–25 . Intracavitary balloon and multi-catheter interstitial brachytherapy techniques for administering APBI allow for steep dose fall-off and lesser volumes of irradiated normal breast tissue as compared to external beam techniques 24,26,27 .…”

Section: Discussionmentioning

confidence: 96%

Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

Liss

Ben‐David

Jagsi

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity-modulated radiotherapy (IMRT) with active-breathing control (ABC). Methods/Materials Women greater than 40 years old with stages 0–1 breast cancer who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep-inspiration breath-hold. Patients received 38.5 Gy in 3.85 Gy fractions given twice daily over 5 consecutive days. The PTV was defined as the lumpectomy cavity with a 1.5 cm margin. Cosmesis was scored on a 4 category scale by the treating physician. Toxicity was scored according to the National Cancer Institute Common Terminology Criteria For Adverse Events (CTCAE v. 3.0). We report the cosmetic and toxicity results with a median follow-up of 5 years. Results A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women with a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to the CTCAE at last assessment is as follows: 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions In this prospective trial with 5 year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique.

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Section: Discussionmentioning

confidence: 96%

Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

Liss

Ben‐David

Jagsi

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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“…Kuske et al . were the first to report on utilization of B-APBI in the setting of breast augmentation in the abstract form [ 12 ]. Even though they had a median follow-up of 36 months and observed an excellent or good cosmetic outcome in 97% of the patients, the majority were treated with interstitial implants.…”

Section: Discussionmentioning

confidence: 99%

“…The reported experience with B-APBI in the setting of breast augmentation is limited [ 12 , 13 ], with no known specific dose-constraints for breast implants to date. We had also previously reported the long-term outcome and dosimetric considerations in a patient with pre-existing breast implants who was treated with B-APBI [ 14 ].…”

Section: Purposementioning

confidence: 99%

Dosimetric considerations and early clinical experience of accelerated partial breast irradiation using multi-lumen applicators in the setting of breast augmentation

Akhtari¹,

Pino

Scarboro

et al. 2015

jcb

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PurposeAccelerated partial breast irradiation (APBI) is an accepted treatment option in breast-conserving therapy for early stage breast cancer. However, data regarding outcomes of patients treated with multi-lumen catheter systems who have existing breast implants is limited. The purpose of this study was to report treatment parameters, outcomes, and possible dosimetric correlation with cosmetic outcome for this population of patients at our institution.Material and methodsWe report the treatment and outcome of seven consecutive patients with existing breast implants and early stage breast cancer who were treated between 2009 and 2013 using APBI following lumpectomy. All patients were treated twice per day for five days to a total dose of 34 Gy using a high-dose-rate 192Ir source. Cosmetic outcomes were evaluated using the Harvard breast cosmesis scale, and late toxicities were reported using the Radiation Therapy Oncology Group (RTOG) late radiation morbidity schema.ResultsAfter a mean follow-up of 32 months, all patients have remained cancer free. Six out of seven patients had an excellent or good cosmetic outcome. There were no grade 3 or 4 late toxicities. The average total breast implant volume was 279.3 cc, received an average mean dose of 12.1 Gy, and a maximum dose of 234.1 Gy. The average percentage of breast implant volume receiving 50%, 75%, 100%, 150%, and 200% of the prescribed dose was 15.6%, 7.03%, 4.6%, 1.58%, and 0.46%, respectively. Absolute volume of breast implants receiving more than 50% of prescribed dose correlated with worse cosmetic outcomes.ConclusionsAccelerated partial breast irradiation using a multi-lumen applicator in patients with existing breast implants can safely be performed with promising early clinical results. The presence of the implant did not compromise the ability to achieve dosimetric criteria; however, dose to the implant and the irradiated implant volume may be related with worse cosmetic outcomes.

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“…Theoretically, APBI would decrease the implant surface area exposed to radiation and thereby reduce the risk of capsular contracture and unsatisfactory cosmesis. However, there is limited data on the use of APBI in women who have had prior breast augmentation in the affected breast ( 17 – 21 ). The largest data series to date of APBI-treated augmented breasts utilized various brachytherapy techniques ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, there is limited data on the use of APBI in women who have had prior breast augmentation in the affected breast ( 17 – 21 ). The largest data series to date of APBI-treated augmented breasts utilized various brachytherapy techniques ( 17 ). External beam APBI (EB-APBI) using either 3-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) is increasingly being investigated ( 16 , 22 , 23 ), but women with breast augmentation in the affected breast were excluded from B-39 ( 16 ), and many questions regarding the feasibility of external beam APBI in this population remain unanswered: Would APBI using 3D-CRT/IMRT planning cause complications specific to augmented breasts?…”

Section: Introductionmentioning

confidence: 99%

External Beam Accelerated Partial Breast Irradiation Yields Favorable Outcomes in Patients with Prior Breast Augmentation

et al. 2014

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Purpose: To report outcomes in breast cancer patients with prior breast augmentation treated with external beam accelerated partial breast irradiation (EB-APBI) utilizing intensity-modulated radiotherapy or 3-dimensional conformal radiotherapy, both with IGRT.Materials and Methods: Sixteen stage 0/1 breast cancer patients with previous elective bilateral augmentation were treated post-lumpectomy on institutional EB-APBI trials (01185132 and 01185145 on clinicaltrials.gov). Patients received 38.5 Gy in 10 fractions over five consecutive days. Breast/chest wall pain and cosmesis were rated by patient; cosmesis was additionally evaluated by physician per RTOG criteria.Results: The median follow-up from accelerated partial breast irradiation (APBI) completion was 23.9 months (range, 1.2–58.6). Little to no change in cosmesis or pain from baseline was reported. Cosmetic outcomes at last follow-up were judged by patients as excellent/good in 81.2% (13/16), and by physicians as excellent/good in 93.8% (15/16). Ten patients (62.5%) reported no breast/chest wall pain, five (31.2%) reported mild pain, and one (6.2%) reported moderate pain. All patients remain disease free at last follow-up. The median ipsilateral breast, planning target volume (PTV), and implant volumes were 614, 57, and 333 cm3. The median ratios of PTV/ipsilateral breast volume (implant excluded) and PTV/total volume (implant included) were 9 and 6%.Conclusion: These 16 breast cancer cases with prior bilateral augmentation treated with EB-APBI demonstrate favorable clinical outcomes. Further exploration of EB-APBI as a treatment option for this patient population is warranted.

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Accelerated Partial Breast Irradiation for Select Breast Cancers in the Presence of Augmentation

Cited by 11 publications

References 0 publications

Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

Decline of Cosmetic Outcomes Following Accelerated Partial Breast Irradiation Using Intensity Modulated Radiation Therapy: Results of a Single-Institution Prospective Clinical Trial

Dosimetric considerations and early clinical experience of accelerated partial breast irradiation using multi-lumen applicators in the setting of breast augmentation

External Beam Accelerated Partial Breast Irradiation Yields Favorable Outcomes in Patients with Prior Breast Augmentation

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