Multi-catheter interstitial brachytherapy for partial breast irradiation: an audit of implant quality based on dosimetric evaluation comparing intra-operative versus post-operative placement

Budrukkar

et al. 2020

jcb

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Purpose: The aim of this study was to propose an index for evaluating dosimetric impact of inter-observer target delineation variability in brachytherapy. Material and methods: The coverage with dosimetric concordance index (CDCI) is expressed as CDCI common and CDCI pair. The CDCI common is the mean coverage of target volume with common volume irradiated by prescription dose among all observers and represents the condition of worst target coverage. CDCI pair is the generalized form of CDCI, which is mean target coverage with common prescription volume obtained between all possible pairs of observers and represents more realistic coverage of target with dosimetric concordance. The index was used to evaluate the dosimetric impact of target delineation variability in optimized conformal plans on target volumes of five radiation oncologists for twenty patients of multi-catheter interstitial partial breast brachytherapy. Results: The mean decline of 5.6 ±3.2% and 11.3 ±5.7% in CDCI pair and CDCI common , respectively, was observed comparing to coverage index (CI) of target volume in all patients due to inter-observer target variability. CDCI common and CDCI pair were found to have significant linear correlation (r = 0.964, p < 0.000). The difference between CDC and CI increased with the mean relative target volume among observers. Significant correlation (r = 0.962, p < 0.000) was also noted for the difference (Δ) in CDCI common and CDCI pair with CI of target volume. Conclusions: The recommended indices and difference between the dosimetric coverage of target volume (CI) with CDCI (∆CDCI) can be used for evaluating dosimetric impact of the inter-observer target delineation variability.

Section: Target Delineation and Treatment Planningsupporting

confidence: 80%

Coverage with dosimetric concordance index (CDCI): a tool for evaluating dosimetric impact of inter-observer target variability in brachytherapy

Budrukkar

et al. 2020

jcb

Self Cite

“…Several advances have been made since including the arrival of multi-lumen applicators in the form of Contura ® and multi-catheter applicators in the form of SAVI ® . These newer devices allow some flexibility in dose distribution, therefore, theoretically allowing patients with close skin spacing to undergo treatment with acceptable outcomes as long as the skin dose constraints are met [15]. …”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes, toxicity, and cosmesis in breast cancer patients with close skin spacing treated with accelerated partial breast irradiation (APBI) using multi-lumen/catheter applicators

Akhtari

Abboud

Szeja

et al. 2016

jcb

PurposeAccelerated partial breast irradiation (APBI) using a single-lumen device is associated with better cosmetic outcomes if the spacing between the applicator and skin is > 7 mm. However, there are no reports addressing the late toxicity and clinical outcomes in patients treated with single-entry multi-lumen/catheter applicators who had close skin spacing (7 mm or less). We undertook this study to report clinical outcome, acute and late toxicity as well as cosmesis of early stage breast cancer patients with close skin spacing treated with APBI using multi-lumen or multi-catheter devices.Material and methodsThis is a retrospective study of all breast cancer patients who had undergone APBI using single-entry multi-lumen/catheter devices in a single institution between 2008 to 2012. The study was limited to those with ≤ 7 mm spacing between the device and skin.ResultsWe identified 37 patients and 38 lesions with skin spacing of ≤ 7 mm. Seven lesions (18%) had spacing of ≤ 3 mm. Median follow-up was 47.5 months. There was one case of ipsilateral breast recurrence and one ipsilateral axillary recurrence. Based on RTOG criteria, 22 treated lesions experienced grade 1 and 9 lesions experienced grade 2 toxicity. Twenty-one lesions experienced late grade 1 toxicity. One patient had to undergo mastectomy due to mastitis. Twenty-four treated breasts showed excellent and 11 had good cosmetic outcome. Overall cosmesis trended towards a significant correlation with skin spacing. However, all patients with ≤ 3 mm skin spacing experienced acute and late toxicities.ConclusionsAccelerated partial breast irradiation can be safely performed in patients with skin spacing of ≤ 7 mm using single-entry multi-lumen/catheter applicators with excellent cosmetic outcomes and an acceptable toxicity profile. However, skin spacing of ≤ 3 mm is associated with acute and late toxicity and should be avoided if possible.

“…Also, the costs of CT scans (not qualified as the cost of APBI in Poland) were included. Interstitial brachytherapy is an invasive procedure that could be performed as open or closed technique [11], and as such requires an anesthesia. In the hereby presented analysis, the costs of anesthesiologist’s consultation, pre-procedure examination (electrocardiography, blood testing), and anesthesia itself were considered as the components of brachytherapy price, and therefore, did not represent an additional expenditure from the payer’s perspective.…”

Section: Methodsmentioning

confidence: 99%

“…Cost-effectiveness analysis was based on the values of incremental cost-effectiveness ratio (ICER), calculated from the formula: (Cost WBI – Cost APBI /Outcome WBI – Outcome APBI ) [9, 10, 11]. The outcome was defined as an overall local control rate at 5-years (98.56% for APBI and 99.08% for WBI) [8].…”

Section: Methodsmentioning

confidence: 99%

Whole breast irradiation vs. APBI using multicatheter brachytherapy in early breast cancer – simulation of treatment costs based on phase 3 trial data

Harat¹,

Harat²,

Makarewicz³

2016

jcb

PurposeA recent large phase 3 trial demonstrated that the efficacy of accelerated partial-breast irradiation (APBI) in the treatment of early breast cancer is non-inferior to that of whole breast irradiation (WBI) commonly used in this indication. The aim of this study was to compare the costs of treatment with APBI and WBI in a population of patients after conserving surgery for early breast cancer, and to verify if the use of APBI can result in direct savings of a public payer.Material and methodsThe hereby presented cost analysis was based on the results of GEC-ESTRO trial. Expenditures for identified cost centers were estimated on the basis of reimbursement data for the public payer. After determining the average cost of early breast cancer treatment with APBI and WBI over a 5-year period, the variance in this parameter resulting from fluctuations in the price per single procedure was examined on univariate sensitivity analysis. Then, incremental cost-effectiveness ratio (ICER) was calculated to verify the cost against clinical outcome. Finally, a simulation of public payer’s expenditures for the treatment of early breast cancer with APBI and WBI in 2013 and 2025 has been conducted.ResultsThe average cost of treatment with APBI is lower than for WBI, even assuming a potential increase in the unit price of the former procedure. There was no additional health benefit of WBI and the calculation of cost-effectiveness was based on the absolute difference in overall local control rate. However, this difference (0.92% vs. 1.44%) was fairly minimal and was not identified as statistically significant during 5 years.ConclusionsThe use of APBI as an alternative to WBI in the treatment of early breast cancer would substantially reduce healthcare expenditures in both 2013 and 2025, even assuming an increase in the price per single APBI procedure.