Partial breast brachytherapy after lumpectomy: Low-dose-rate and high-dose-rate experience

Arthur, Douglas W.; Koo, Derrick; Zwicker, Robert D.; Tong, Shidong; Bear, Harry D.; Kaplan, Brian J.; Kavanagh, Brian D.; Warwicke, Laurel A; Holdford, David A.; Amir, Cyrus; Archer, Kellie J.; Schmidt‐Ullrich, Rupert

doi:10.1016/s0360-3016(03)00120-2

Cited by 175 publications

(86 citation statements)

References 27 publications

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“…Brachytherapy can be delivered with either low-dose rate (LDR) or high-dose rate (HDR) radiation sources. With LDR techniques, a dose of [45][46][47][48][49][50] Gy is delivered to the clinical target volume at a rate of approximately 30 -70 centigrays/hour. This technique requires that the patient be admitted to the hospital for approximately 4 days.…”

Section: Brachytherapymentioning

confidence: 99%

“…Recently, based on the initial experience with brachytherapy after lumpectomy for patients with early-stage breast carcinoma, a total dose of 34 Gy delivered in twice-daily fractions of 3.4 Gy over 5-7 days has evolved as an attractive and well tolerated schedule. 47 The use of brachytherapy has several theoretic potential advantages for patients, one of the most appealing of which is a reduction in treatment time. With brachytherapy, the delivery of radiation therapy to the breast is generally completed over a period of 4 -5 days, and all local therapy can be completed before systemic therapy is initiated.…”

Section: Brachytherapymentioning

confidence: 99%

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Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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Section: Brachytherapymentioning

confidence: 99%

Section: Brachytherapymentioning

confidence: 99%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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“…Unlike LDR, where there are continuous radiation safety concerns for medical personnel and family, with HDR, the radiation is confined to the patient. Because it is typically administered in a series of treatments over approximately 1 week, HDR can be conveniently performed in an outpatient setting [40].…”

Section: Treatment Methodsmentioning

confidence: 99%

Assessment of Accelerated Partial Breast Irradiation as Monotherapy Following Breast Conserving Surgery in the Treatment of Favorable Risk Breast Cancer

Sharma¹,

Ansari²,

Churchill³

et al. 2018

ABCR

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“…Recent prospective studies have thus explored the techniques of only treating the tumor bed of the breast, i.e. partial breast irradiation (PBI), for patients with early-stage breast cancer using different technical approaches [16][17][18][19][20][21][22][23][24]. These studies have investigated the use of low-dose-rate and high-doserate brachytherapy and the use of External-Beam Radiotherapy (EBRT) for partial breast irradiation.…”

Section: Introductionmentioning

confidence: 99%

Hypofractioned Radiation Therapy in the Treatment of Partial Breast: 30 Gy in Five Consecutive Fractions

Terenzi¹,

Barbarino²,

Falco³

et al. 2012

JCT

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Background and Purpose: Recent prospective studies have explored the partial breast irradiation (PBI) for patients with early-stage breast cancer using different technical approaches. The purpose of this study is to explore feasibility, tumor control and acute and late toxicity of a specific hypo-fractionated 3D-CRT when treating postmenopausal patients with early breast cancer with partial breast irradiation, using five fractions in five consecutive days. Materials and Methods: Ten patients, aged  70 underwent breast conservative surgery for invasive breast carcinoma with a complete microscopic resection; no lymphovascular invasion was found and negative axillary node status was assessed. Metal clips were positioned in the surgical bed at the time of surgery. All of the patients provided an informed consent for breast irradiation. Seven patients received Tamoxifen. Of the ten patients, five were treated for left breast disease, and five for right breast disease. The dose fractionation schedule was 3000 cGy delivered to the isocenter in 5 fractions (600 cGy/fr) using 6 MV photons. According to the linear quadratic model and a / ratio of 4 Gy this prescription is equivalent to 50 Gy in a standard 2-Gy fractionation schedule. Patients were treated in the supine position. A comercial breast board was used as immobilization device in order to keep the arms of the patient raised. The clinical target volume (CTV) was drawn with a uniform 1-cm three-dimensional margin around the surgical clips. The CTV was limited to 3 mm from the skin surface and 3 mm from the lung-chest wall interface. A three-dimensional margin was added to the CTV to obtain the planning target volume (PTV). The ipsilateral and controlateral breast, the ipsilateral and controlateral lung, heart and spinal cord were contoured as organs at risk (OAR). The treatment was developed using Precise Plan Treatment Planning System and four no-coplanar fields. The constraints used have been: uninvolved breast (ipsilateral breast-PTV): V 15  50%; heart: V 3  10%; ipsilateral lung: V 10  20%; controlateral lung: V 5  10% and controlateral breast: maximum dose  1 Gy. We required PTV coverage of 90%. Patient set-up was verified every day before treatment using portal images. No tumour bed boost was delivered. Clinical assessments of early normal tissue reaction were carried out every day during radiotherapy and 10 days after the end of the treatment. After radiotherapy, we visited all patients every 3 months during the first 2 years and every six month thereafter. Frontal and lateral pictures of the breast were taken on the first day of treatment (baseline), at the end of treatment, 10 days after the end of treatment and at the first follow-up. Any change in breast appearance compared with the baseline picture was scored on a four-point RTOG for acute and late radiation morbidity scoring scale. Results: No local or distant recurrences were observed and then confirmed by mammograms performed every year and breast ultrasound performed every six mont...

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Partial breast brachytherapy after lumpectomy: Low-dose-rate and high-dose-rate experience

Cited by 175 publications

References 27 publications

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Assessment of Accelerated Partial Breast Irradiation as Monotherapy Following Breast Conserving Surgery in the Treatment of Favorable Risk Breast Cancer

Hypofractioned Radiation Therapy in the Treatment of Partial Breast: 30 Gy in Five Consecutive Fractions

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