Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy

Abstract

ObjectiveTo evaluate clinical outcome after accelerated partial breast irradiation (APBI) in the elderly after high-dose-rate interstitial multi-catheter brachytherapy (HIBT).Methods and materialsBetween 2005 and 2013, 70 patients underwent APBI using HIBT. Catheter implant was performed intra or post-operatively (referred patients) after lumpectomy and axillary sentinel lymph node dissection. Once the pathological results confirmed the indication of APBI, planification CT-scan was performed to deliver 34 Gy/10f/5d or 32 Gy/8f/4d. Dose-volume adaptation was manually achieved (graphical optimization). Dosimetric results and clinical outcome were retrospectively analyzed. Physician cosmetic evaluation was reported.ResultsWith a median follow-up of 60.9 months [4.6 – 90.1], median age was 80.7 years [62 – 93.1]. Regarding APBI ASTRO criteria, 61.4%, 18.6% and 20% were classified as suitable, cautionary and non-suitable respectively. Axillary sentinel lymph node dissection was performed in 94.3%; 8 pts (11.5%) presented an axillary involvement. A median dose of 34 Gy [32 – 35] in 8 to 10 fractions was delivered. Median CTV was 75.2 cc [16.9 – 210], median D90 EQD2 was 43.3 Gy [35 – 72.6] and median DHI was 0.54 [0.19 – 0.74]. One patient experienced ipsilateral recurrence (5-year local free recurrence rate: 97.6%. Five-year specific and overall survival rates were 97.9% and 93.2% respectively. Thirty-four patients (48%) presented 47 late complications classified grade 1 (80.8%) and grade 2 (19.2%) with no grade ≥ 3. Cosmetic results were considered excellent/good for 67 pts (95.7%).ConclusionAPBI using HIBT and respecting strict rules of implantation and planification, represents a smart alternative between no post-operative irradiation and whole breast irradiation delivered over 6 consecutive weeks.

Accelerated Partial Breast Irradiation in the Elderly:8-year Oncological Outcome and Prognostic Factors

“…Two trials of intraoperative radiotherapy reported higher rates of LR compared with conventional WBI (35,36). The GEC-ESTRO APBI phase III compared WBI versus APBI for selected primary early-stage breast cancer (low and intermediaterisk groups) (37) and the 5-year LRFS was 98.6%, which is similar to our 5-year LRFS of 98.1% previously described (19). With a 12-year median follow-up, Polgar et al (38) reported a 5-year LR rate of 4.7% with 77% of good/excellent cosmetic results.…”

“…We have previously reported the 5-year clinical outcome of a cohort of elderly women treated with APBI based on a high-dose rate interstitial multicatheter brachytherapy (HIBT), but a longer follow-up was needed to assess the consistency of our results. The aim of this report was to update the clinical outcome after APBI in our previously published cohort and discuss prognostic factors (19).…”

The Role of Brachytherapy in the Treatment of Breast Cancer

“…Treatment decisions in elderly cancer patients need to focus not only on local control and overall survival but primarily on quality of life. Sumodhee et al [45 ]and Genebes et al [46] demonstrated in their studies that MIB can perfectly apply sufficient local irradiation with maximum preservation of OAR in a very short treatment period with excellent local control and low acute and chronic side effects. This could be an ideal alternative for elderly breast cancer patients, representing a compromise between omitting radiotherapy and a whole course of WBI.…”

Interstitial HDR Brachytherapy in BCT: A Case Series Study from a Single Institute

“…The cosmetic evaluation was based on the standards set forth in the Harvard criteria, which consisted of a four tiered grading system: excellent, good, fair, and poor. [3] Late toxicity of the skin and subcutaneous tissue was scored according to the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. [4,6] …”

“…This translates into 15 years breast cancer mortality reduction by 5%. [3] BT is used as an adjuvant therapy in BCT either alone or combined with external radiotherapy to boost the primary site provided the facility and expertise is available at the treating centre. Many centers use RT and alternative boost technique like IMRT, Electron beam, coned downed photon, TARGIT or nonradiation local treatment like cryotherapy,RFA ablation, focussed US etc.…”