Advantages of intraoperative implant for interstitial brachytherapy for accelerated partial breast irradiation either frail patients with early-stage disease or in locally recurrent breast cancer

Abstract

PurposeTo describe the intraoperative multicatheter implantation technique for accelerated partial breast irradiation (APBI) delivered with high-dose-rate brachytherapy (HDR-BT). Secondarily, to evaluate outcomes and toxicity in a series of 83 patients treated with this technique at our institution.Material and methodsRetrospective analysis of a series of patients treated with HDR-BT APBI after intraoperative multicatheter interstitial implant between November 2006 and June 2017 at our institution. We assessed cosmesis, toxicity, overall survival (OS), and disease-free survival (DFS).ResultsEighty-three patients were included: 59 patients (71.1%) with primary early-stage breast cancer and 24 (28.9%) with locally recurrent breast cancer. Tumorectomy was performed in all cases, with intraoperative tumor margin assessment and sentinel node biopsy. Median age was 82 years (range, 44-92). The total prescribed dose was 32 Gy (8 treatment fractions) in 60 patients (72.3%), and 34 Gy (10 fractions) in 23 patients (27.7%). Median follow-up was 40 months (range, 1-136 months). Three-year OS and DFS in the recurrent and primary cancer groups were 87% vs. 89%, and 96 % vs. 97.8%, respectively. Five patients died from non-cancer related causes. No local relapses were observed. Rates of acute and late toxicity were low in both groups. The cosmesis was good or excellent in most of patients treated for primary disease; in patients who underwent salvage brachytherapy for local recurrence, cosmesis was good in 49 patients and fair in 6.ConclusionsThis technique, although time-consuming, achieves good local disease control with a satisfactory toxicity profile in both early-stage and local recurrent breast cancer patients. It may be especially suitable for frail patients.

Single fraction of accelerated partial breast irradiation in the elderly: early clinical outcome

“…Post-operative irradiation does permit treating only validated candidates for APBI due to an appropriate definitive pathological report compatible with APBI criteria while the number of transportation remains significantly higher compared to IORT. Furthermore, MIB-APBI allows best target coverage [ 21 ]. In this frame, a post-operative single fraction APBI appeared as an attractive technical option by drastically reducing the number of transportations and in the same time, alleviating the treatment related constraints mainly for elderly patients with frequent comorbidities [ 22 ].…”

Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion

“…Only one study is randomized [36], two studies are phase II [37,38], and 4 studies are retrospective investigations [39][40][41][42]. Following the defined selection criteria, only data from the APBI treatments in elderly patients were extracted and considered for the analysis.…”

Catheter-based delineation of lumpectomy cavity for accurate target definition in partial-breast irradiation with multicatheter interstitial brachytherapy

“…In partial-breast brachytherapy, the timing of implant and types of catheter used are other important factors that influence accurate delineation of the minimum target volume. Although post-operative implant procedures are more frequent than the intraoperative ones, because of the lack of the final pathology report, the single-stage BCT using partial-breast brachytherapy has gradually become a popular technique to prevent the need for a second surgical procedure [35,36,37,38,39,40,41]. Post-operative implant can result in geographic miss due to complex cavity and seroma accumulation [42], which increases local recurrence risk when radiation field is reduced [43].…”