Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study

Yashar, Catheryn M.; Attai, Deanna J.; Butler, E. Brian; Einck, John; Finkelstein, Steven E.; Han, Ben H.; Hong, Robert; Komarnicky, Lydia; Lyden, Maureen; Mantz, C.A.; Morcovescu, Serban; Nigh, Stephen S.; Perry, Kyle A.; Pollock, Jondavid; Reiff, Jay E.; Scanderbeg, Daniel J.; Snyder, Margaret; Kuske, Robert R.

doi:10.1016/j.brachy.2016.07.002

Cited by 30 publications

(12 citation statements)

References 33 publications

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“…The cumulative incidence of symptomatic (G2–3) seroma in our trial was 8.7%, which is similar to the rate of symptomatic seroma reported in other brachytherapy APBI series. 10–12 We also reported significant associations between seroma, infection, pain, hyperpigmentation, and fibrosis. These data suggest that early treatment-related symptomatic seroma may predispose to infection, and that this robust inflammatory response may ultimately contribute to late tissue responses like hyperpigmentation and fibrosis that adversely affect cosmesis.…”

Section: Discussionmentioning

confidence: 61%

Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy

Stecklein

Shaitelman

Babiera

et al. 2019

Practical Radiation Oncology

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Brachytherapy APBI is associated with higher rates of grade 1 fibrosis and seroma than 3-dimensional CRT but lower rates of grade 1 edema and grade 2 to 3 pain than 3-dimensional CRT. Rates of radiation oncologist-reported fair or poor cosmetic outcomes are higher with brachytherapy. We identified dosimetric parameters that predict reduced risk of adverse cosmetic outcome after brachytherapy-based APBI. Ipsilateral breast recurrence was equivalent for brachytherapy and 3-dimensional CRT.

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Section: Discussionmentioning

confidence: 61%

Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy

Stecklein

Shaitelman

Babiera

et al. 2019

Practical Radiation Oncology

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“…While two population‐based studies found potentially higher complication rates (subsequent mastectomy) with brachytherapy (primarily AB, 5324/6952 cases) as the PBI technique, these results should be interpreted with caution as prospective trial data have not confirmed these findings . Additionally, improvements in toxicity profiles have been seen with newer brachytherapy applicators, which allow for reduced doses to normal breast tissue, the skin and chest wall . With respect to factors associated with outcomes, data from the ASBS registry have identified smaller skin spacing, development of infection, and chemotherapy receipt to be associated with cosmetic outcomes …”

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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“…Brachytherapy has been the most evaluated technique and recent advances beyond multicatheter implantation include balloon or strut brachytherapy as well as permanent breast seed implants (PBSI) [16, 17]. Brachytherapy is generally well tolerated and reported long-term toxicities are acceptable.…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial testing a hyaluronic acid spacer injection for skin toxicity reduction of brachytherapy accelerated partial breast irradiation (APBI): a study protocol

Struik

Godart

Verduijn

et al. 2018

Trials

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BackgroundAccelerated partial breast irradiation (APBI) is a treatment option for selected early stage breast cancer patients. Some APBI techniques lead to skin toxicity with the skin dose as main risk factor. We hypothesize that a spacer injected between the skin and target volume reduces the skin dose and subsequent toxicity in permanent breast seed implant (PBSI) patients.MethodsIn this parallel-group, single-center, randomized controlled trial, the effect of a subcutaneous spacer injection on skin toxicity among patients treated with PBSI is tested. Eligibility for participation is derived from international guidelines for suitable patients for partial breast radiotherapy, e.g. women aged ≥ 50 years with a histologically proven non-lobular breast carcinoma and/or ductal carcinoma in situ (DCIS), tumor size ≤ 3 cm, node-negative, and PBSI technically feasible. Among exclusion criteria are neoadjuvant chemotherapy, lymphovascular invasion, and allergy for hyaluronic acid. For the patients allocated to receive spacer, after the PBSI procedure, 4–10 cc of biodegradable hyaluronic acid (Barrigel™, Palette Life Sciences, Santa Barbara, CA, USA or Restylane SubQ®, Galderma Benelux, Breda, the Netherlands) is injected directly under the skin using ultrasound guidance to create an extra 0.5–1 cm space between the treatment volume and the skin. The primary outcome is the rate of telangiectasia at two years, blindly assessed using Bentzen’s 4-point scale. Secondary outcomes include: local recurrence; disease-free and overall survival rates; adverse events (pain, redness, skin/subcutaneous induration, radiation dermatitis, pigmentation, surgical site infection); skin dose; cosmetic and functional results; and health-related quality of life.A Fisher’s exact test will be used to test differences between groups on the primary outcome.Previous studies found 22.4% telangiectasia at two years. We expect the use of a spacer could reduce the occurrence of telangiectasia to 7.7%. A sample size of 230 patients will allow for a 10% lost to follow-up rate.DiscussionIn this study, the effect of a subcutaneous spacer injection on the skin dose, late skin toxicity, and cosmetic outcome is tested in patients treated with PBSI in the setting of breast-conserving therapy. Our results will be relevant for most forms of breast brachytherapy as well as robotic radiosurgery, as skin spacers could protect the skin with these other techniques.Trial registrationNetherlands Trial Register, NTR6549. Registered on 27 June 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3035-3) contains supplementary material, which is available to authorized users.

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Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study

Cited by 30 publications

References 33 publications

Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy

Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy

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

A randomized controlled trial testing a hyaluronic acid spacer injection for skin toxicity reduction of brachytherapy accelerated partial breast irradiation (APBI): a study protocol

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