Partial breast irradiation with interstitial high-dose-rate brachytherapy in early breast cancer: Results of a phase II prospective study

Aristei, Cynthia; Palumbo, Isabella; Cucciarelli, F.; A, Cavalli; Tarducci, R.; Raymondi, C.; Perrucci, Elisabetta; Cavaliere, Antonio; Latini, P; Rulli, Antonio

doi:10.1016/j.ejso.2008.06.002

Cited by 21 publications

(8 citation statements)

References 33 publications

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“…Long-term results of the phase II multicenter APBI trials for select early-stage breast cancer were recently reported [8-10,15]. In the RTOG phase II trial [9], 66 patients received HDR brachytherapy (34 Gy in 3.4 Gy bid for 5 days) and 33 patients received low-dose-rate brachytherapy (45 Gy).…”

Section: Discussionmentioning

confidence: 99%

“…Compared to the postoperative implantation [8-10], intraoperative implantation has the advantages of direct visualization of the excision cavity and shorter local treatment period including surgery and radiotherapy [15]. One disadvantage is the inability to select patients properly for implantation based on definitive pathological findings; however, brachytherapy was used as boost radiotherapy before WBI when the pathology indicated that the patient was unsuitable for brachytherapy alone.…”

Section: Discussionmentioning

confidence: 99%

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Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity

et al. 2010

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BackgroundTo investigate the efficacy and safety of accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) multicatheter interstitial brachytherapy for early-stage breast cancer.MethodsBetween 2002 and 2006, 48 prospectively selected patients with early-stage breast cancer received APBI using multicatheter brachytherapy following breast-conserving surgery. Their median age was 52 years (range 36-78). A median of 34 Gy (range 30-34) in 10 fractions given twice daily within 5 days was delivered to the tumor bed plus a 1-2 cm margin. Most (92%) patients received adjuvant systemic treatments. The median follow-up was 53 months (range 36-95). Actuarial local control rate was estimated from surgery using Kaplan-Meier method.ResultsLocal recurrence occurred in two patients. Both were true recurrence/marginal miss and developed in patients with close (< 0.2 cm) surgical margin after 33 and 40 months. The 5-year actuarial local recurrence rate was 4.6%. No regional or distant relapse and death has occurred to date. Late Grade 1 or 2 late skin and subcutaneous toxicity was seen in 11 (22.9%) and 26 (54.2%) patients, respectively. The volumes receiving 100% and 150% of the prescribed dose were significantly higher in the patients with late subcutaneous toxicity (p = 0.018 and 0.034, respectively). Cosmesis was excellent to good in 89.6%.ConclusionsAPBI using HDR multicatheter brachytherapy yielded local control, toxicity, and cosmesis comparable to those of conventional whole breast irradiation for select early-stage breast cancer. Patients with close resection margins may be ineligible for APBI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity

et al. 2010

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“…In the majority of these trials, local tumor control rates were similar to those achieved in other breast-conserving series using conventional WBI. 68,70,71,[74][75][76]78,79 APBI using permanent LDR seed implants Recently, a new technique of APBI using 103 Pd permanent seed implants was implemented by Pignol et al 26 Investigators from the University of Toronto implanted 16 patients with a mean of 70 seeds per patient. A dose of 90 Gy was prescribed as the minimal peripheral dose that was set to cover the PTV, defi ned as the lumpectomy cavity plus a margin of 1 cm.…”

Section: Other Multicatheter Apbi Experiencesmentioning

confidence: 99%

“…As a result, the outcomes of these studies have been much improved (Table 6). 12,[16][17][18][19][20][21][67][68][69][70][71][72][73][74][75][76][77][78][79] Ochsner Clinic experience…”

Section: London (Ontario) Regional Cancer Center's Pilot Studymentioning

confidence: 99%

Current status and perspectives of brachytherapy for breast cancer

Polgár

Major

2009

Int J Clin Oncol

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Before the era of breast-conserving therapy, brachytherapy implants were used to treat large inoperable breast tumors. In later years, interstitial brachytherapy with rigid needles or multiple flexible catheters has been used to deliver an additional (boost) dose to the tumor bed after breast-conserving surgery and whole-breast irradiation. Reexcision followed by reirradiation using interstitial breast implants has also been implemented as an alternative to mastectomy to treat ipsilateral breast local recurrence after previous breast-conserving therapy. In the past two decades, the new concept of accelerated partial breast irradiation opened a new perspective for breast brachytherapy. The first technique utilized in early accelerated partial breast irradiation studies was multicatheter interstitial brachytherapy. Beyond classical interstitial brachytherapy, recently, new intracavitary applicators have been developed in the United States to decrease the existing barriers against the widespread use of multicatheter brachytherapy. Furthermore, interstitial low-dose-rate seed implants have also been implemented as an alternative for stepping-source multicatheter brachytherapy. In this article, we give an overview of the past achievements, current status, and future perspectives of breast brachytherapy.

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“…These findings are related to a relatively slow CT scanner, so that breathing artifacts and partial volume effects are included in the catheter reconstruction. Nevertheless, Aristei et al [87], Cuttino et al [88], and Das et al [89] showed the benefits of 3D-CT based catheter reconstruction over 2D-techniques. A cohort of 50 consecutive patients underwent CT-based treatment planning and dosimetric results were compared against conventional orthogonal film dosimetry using the Manchester system.…”

Section: Uncertainties At the Patient Levelmentioning

confidence: 99%

Review of clinical brachytherapy uncertainties: Analysis guidelines of GEC-ESTRO and the AAPM

Kirisits

Rivard

Baltas

et al. 2014

Radiotherapy and Oncology

266

210

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Background and purposeA substantial reduction of uncertainties in clinical brachytherapy should result in improved outcome in terms of increased local control and reduced side effects. Types of uncertainties have to be identified, grouped, and quantified.MethodsA detailed literature review was performed to identify uncertainty components and their relative importance to the combined overall uncertainty.ResultsVery few components (e.g., source strength and afterloader timer) are independent of clinical disease site and location of administered dose. While the influence of medium on dose calculation can be substantial for low energy sources or non-deeply seated implants, the influence of medium is of minor importance for high-energy sources in the pelvic region. The level of uncertainties due to target, organ, applicator, and/or source movement in relation to the geometry assumed for treatment planning is highly dependent on fractionation and the level of image guided adaptive treatment. Most studies to date report the results in a manner that allows no direct reproduction and further comparison with other studies. Often, no distinction is made between variations, uncertainties, and errors or mistakes. The literature review facilitated the drafting of recommendations for uniform uncertainty reporting in clinical BT, which are also provided. The recommended comprehensive uncertainty investigations are key to obtain a general impression of uncertainties, and may help to identify elements of the brachytherapy treatment process that need improvement in terms of diminishing their dosimetric uncertainties. It is recommended to present data on the analyzed parameters (distance shifts, volume changes, source or applicator position, etc.), and also their influence on absorbed dose for clinically-relevant dose parameters (e.g., target parameters such as D90 or OAR doses). Publications on brachytherapy should include a statement of total dose uncertainty for the entire treatment course, taking into account the fractionation schedule and level of image guidance for adaptation.ConclusionsThis report on brachytherapy clinical uncertainties represents a working project developed by the Brachytherapy Physics Quality Assurances System (BRAPHYQS) subcommittee to the Physics Committee within GEC-ESTRO. Further, this report has been reviewed and approved by the American Association of Physicists in Medicine.

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Partial breast irradiation with interstitial high-dose-rate brachytherapy in early breast cancer: Results of a phase II prospective study

Cited by 21 publications

References 33 publications

Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity

Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity

Current status and perspectives of brachytherapy for breast cancer

Review of clinical brachytherapy uncertainties: Analysis guidelines of GEC-ESTRO and the AAPM

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