Partial breast irradiation with interstitial multi-catheter high-dose-rate brachytherapy. Long-term results of a phase II prospective study

Aristei, Cynthia; Maranzano, Ernesto; Lancellotta, Valentina; Chirico, Luigia; Zucchetti, C.; Italiani, M.; Anselmo, Paola; Mariucci, C.; Perrucci, Elisabetta; Arcidiacono, Fabio; Trippa, Fabio; Kovacs, GyÃ¶rgy; Bini, Vittorio; Palumbo, Isabella

doi:10.1016/j.radonc.2017.07.015

Cited by 26 publications

(18 citation statements)

References 41 publications

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“…Furthermore, the development of image-based catheter implantation, implant reconstruction, and dose planning replaced 2D orthogonal-based treatment planning and resulted in a marked improvement in tumor dose coverage. All these efforts promoted the initiation of several prospective trials of modern MIB with strict patient selection criteria [37,38,39,40,41]. The key study to establish MIB APBI as a single treatment option after BCS is a randomized, non-inferiority phase III trial including 1,184 patients from multiple centers in Europe, which was recently published by the GEC-ESTRO Breast Cancer Working Group [42].…”

Section: Role Of Brachytherapy In Accelerated Partial Breast Irradiationmentioning

confidence: 99%

The Role of Brachytherapy in the Treatment of Breast Cancer

Kauer-Dorner

Berger

2018

Breast Care

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Radiotherapy plays an important part in the management of breast cancer. Especially after breast-conserving surgery, external whole breast irradiation, occasionally with an additional local boost, is an integral part of breast conservation. Besides external radiation techniques, brachytherapy (BT) has long been among the treatment options, especially with regard to local boost application. With the emerging implementation of accelerated partial breast irradiation (APBI), BT in general and interstitial multi-catheter BT in particular, are gaining an increasing role in the management of a selected group of early breast cancer patients. APBI is an approach to reduce the irradiated area to the former tumor bed rather than treating the whole breast tissue in patients with a low baseline local recurrence risk. After a variety of phase I-III clinical studies, it is clearly evident that APBI will play a role in the treatment of this selected patient group. In this review, we focus on the clinical development and different available techniques of breast BT and provide a preview of prospects for its use.

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Section: Role Of Brachytherapy In Accelerated Partial Breast Irradiationmentioning

confidence: 99%

The Role of Brachytherapy in the Treatment of Breast Cancer

Kauer-Dorner

Berger

2018

Breast Care

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“…Interstitial multi-catheter brachytherapy in the context of breast conserving therapy (BCT) represents one of the most highly published irradiation techniques for Accelerated Partial Breast Irradiation (APBI) alone, Salvage-APBI and Boost after whole breast irradiation (WBI) [1][2][3][4]. Generally, this technique delivers a highdose to a precise, strictly limited in-breast target volume, avoiding to the greatest possible extent, exposure of adjacent organs at risk (OARs) thus resulting in excellent local control with low rates of side effects [1,[5][6][7][8][9][10][11][12]. To date, APBI using multi-catheter brachytherapy is the only method of breast irradiation with a treatment duration of merely 4-5 days with level 1 evidence showing it to be a valid treatment alternative to WBI after breast conserving surgery (BCS) for low-risk breast cancer patients which is used in clinical routine [1,4,[9][10][11][12].…”

mentioning

confidence: 99%

“…Generally, this technique delivers a highdose to a precise, strictly limited in-breast target volume, avoiding to the greatest possible extent, exposure of adjacent organs at risk (OARs) thus resulting in excellent local control with low rates of side effects [1,[5][6][7][8][9][10][11][12]. To date, APBI using multi-catheter brachytherapy is the only method of breast irradiation with a treatment duration of merely 4-5 days with level 1 evidence showing it to be a valid treatment alternative to WBI after breast conserving surgery (BCS) for low-risk breast cancer patients which is used in clinical routine [1,4,[9][10][11][12]. Sole APBI based on multicatheter brachytherapy is intended first to shorten treatment duration compared with the WBI regimen (40-50 Gy over 3-6 weeks) and second to reduce late side effects to OARs such as the heart,…”

mentioning

confidence: 99%

ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost – GEC-ESTRO Breast Cancer Working Group practical recommendations

Strnad

Major

Polgár

et al. 2018

Radiotherapy and Oncology

129

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Recent standards and guidelines for the use of APBI with different multi-catheter image-guided brachytherapy techniques have been defined. Different techniques are used to insert the catheters. Guidelines are mandatory to assure precise catheter insertion for coverage of the target volume and to guarantee high-quality dosimetry. The same rules apply for brachytherapy based boost irradiation for breast cancer after whole breast irradiation as well as for partial breast re-irradiation.

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“…With respect to late toxicity, the NIO trial found improved long‐term cosmetic outcomes with PBI . In addition, non‐randomized, prospective studies with greater than 10 years of follow‐up have demonstrated low rates of acute toxicity (infection, dermatitis) as well as low rates of chronic toxicity and excellent and stable cosmetic outcomes . Overall, factors associated with toxicity and cosmetic outcome include the presence of acute toxicity, higher dose (LDR), breast volume, the number of dwell positions, and implant volume …”

Section: Discussion/observationsmentioning

confidence: 99%

Accelerated partial breast irradiation—Redefining the treatment target for women with early stage breast cancer

Shah

Vicini

2019

Breast J

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Following breast conserving surgery, the standard of care has been to deliver adjuvant radiation therapy directed to the whole breast (WBI) over a period of 3-7 weeks.Over the past decade, increasing data have supported the concept that treatment to the whole breast may not be required in selected patients, allowing for the emergence of partial breast irradiation (PBI). Multiple randomized trials with 5-10 years of follow-up have been published documenting the safety and efficacy associated with PBI using multiple techniques. Questions that remain to be answered include (a) what is the optimal PBI technique for each clinical scenario, (b) are there additional patients that can be effectively managed with PBI approaches, and (c) are there different techniques/dose schedules that allow for further reduction in treatment duration and/or toxicities? Partial breast irradiation represents a standard approach for appropriately selected patients. PBI provides comparable clinical outcomes to WBI while allowing for a reduction in the duration treatment and the potential for reduced toxicities. Future studies may also help to better define which patients require no radiation, PBI, hypofractionated WBI or conventional WBI, based upon patient, clinical, pathologic features as well as potentially using tumor genetics. K E Y W O R D Saccelerated partial breast irradiation, brachytherapy, breast cancer, breast conserving therapy, radiation therapy, whole breast irradiation | 409 SHAH And VICInI patients, offer guidelines for patient selection and discuss potential future directions for this approach.

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Partial breast irradiation with interstitial multi-catheter high-dose-rate brachytherapy. Long-term results of a phase II prospective study

Cited by 26 publications

References 41 publications

The Role of Brachytherapy in the Treatment of Breast Cancer

The Role of Brachytherapy in the Treatment of Breast Cancer

ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost – GEC-ESTRO Breast Cancer Working Group practical recommendations

Accelerated partial breast irradiation—Redefining the treatment target for women with early stage breast cancer

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