Postoperative Accelerated Partial Radiotherapy for Breast Cancer

Česká verze

Authors: A. Molnárová; L. Bezák
Authors place of work: Odd. brachyterapie, Klinika radiačnej onkológie, Onkologický ústav sv. Alžbety, s. r. o., Bratislava, Slovenská republika
Published in the journal: Klin Onkol 2010; 23(6): 433-438
Category: Původní práce

Summary

Backgrounds:
Interstitial accelerated partial breast irradiation is generally limited to patients with extremely low risk of local recurrence.

Materials and Methods:
Between 2004 and 2008, 53 women in the early‑stage of breast cancer were treated with multicatheter interstitial brachytherapy in very short general anaesthesia. All patients had T1 (1– 22 mm) tumour with no positive auxiliary node and with negative surgical margins. Implants were positioned using a template guide. The dose was prescribed to the tumour bed plus 2 cm margin. A total of 32.0 Gy was delivered in 8 fractions of 4.0 Gy, each given twice a day over a 4– 5 day period, using high‑dose‑rate 192Ir brachytherapy. The follow up of all patients was 2– 50 months (median 40 months).

Results:
Preoperative morbidity: bacterial infection of the implant in 3 patients, haematoma in 43 patients. Acute toxicity: radio dermatitis – no patients. Late toxicity: mild breast pain in two patients, fat necrosis in 1 patient, oil cyst in 1 patient, dis- pigmentation in no patients, fibrosis in no patients. Cosmetic results: Excellent and good in 50 patients.

Conclusion:
This analysis indicates that accelerated partial breast irradiation with 192- iridium interstitial multicatheter HDR- implants is feasible with low preoperative morbidity, low acute and mild late toxicity at a median follow up of 40 months. The cosmetic result is not significantly affected. Our short‑term results with multicatheter interstitial brachytherapy continue to demonstrate excellent local and regional control rates and cosmetic results.

Key words:
breast cancer – brachytherapy – radiotherapy

Zdroje

1. Jacobson JA et al. Ten-year results of a comparison of conservation with mastectomy in the teratment of stage I and II breast cancer. N Engl J Med 1995; 332: 907– 911.

2. Fischer B et al. Reanalysis and results after 12 years of follow‑up a randomized clinical trial comparing total mastectomy with lumpectomywith or without irradiation in the teratment of breast cancer. N Engl J Med 1995; 333(22): 1456– 1461.

3. Van Linbergen E, Weltens C. New trends in radiotherapy for breast cancer. Curr Opin Oncol 2006; 18(6): 555– 562.

4. Smith BD, Arthur DW, Bucholz TA et al. The concept of APBI– Scientific rationale – Clinical basis. Int J Radiat Oncol Biol Phys 2000; 48(5): 1281– 1289.

5. Heimann R, Powers C, Halpem HJ et al. Breast preservation in stage I and II carcinoma of the breast. Cancer 1996; 78(8): 1722– 1730.

6. Sauer G et al. Partial breast irradiation after breast‑ conserving surgery. Strahender Onkol 2005; 181(1): 1– 8.

7. Kaufman SA, DiPetrillo TA, Price LL et al. Long‑term outcome and toxicity in a Phase III trial using HDR multicateter interstitial brachytherapy for T1/ T2 breast cancer. Brachytherapy 2007; 6(4): 286– 292.

8. Kuske RR et al. A phase I/ II trial of brachythetrapy alone following lumpectomy select breast cancer: toxicity analysis of Radiation Therapy Oncology Group 9517. Int J Radiat Oncol Biol Phys 2002; 54 (2 Suppl 1): A– 151.

9. Kuske RR et al. A phase II trial of brachythetrapy alone following lumpectomy for stage I or II breast cancer: initial outcomes of Radiation Therapy Oncology Group 9517. J Clin Oncol 2004; 22 (Suppl 14): A– 565.

10. Das RK, Patel R, Shah H et al. 3D CT‑based HDR breas brachytherapy implants: Treatment planning and quality assurance. Int J Radiat Oncol Biol Phys 2004; 59(4): 1224– 1228.

11. Patel RR, Christensen ME, Hodge CW et al. Clinical outcome analysis in“high‑risk“versus“low‑ risk patients eligible for national surgical adjuvant brest RTOG 0413trial: five‑year results. Int J Radiat Oncol Biol Phys 2008; 70(4): 970– 973.

12. Polgar C, Major T, Fodor J et al. HDR brachytherapy alone vs whole breast radiotherapy with or without tumor bed boost after breast‑ conserving surgery:seven‑year results of a comparative study. Int J Radiat Oncol Biol Phys 2004; 60(4): 1173– 1181.

13. Heeres PH, Mak AC, te Loo HJ et al. Breast preserving therapy: shorter treatment duration by the peroperative introduction of irridium guide needles. Ned Tijdschr Geneeskd 1991; 135(24): 1084– 1088.

14. Cuttino LW, Todor D, Arthur DW et al. CT‑ guided multi-catheter insertion technique for partial breast brachytherapy: reliable target coverage and dose homogenity. Brachytherapy 2005; 4(1): 7– 10.

15. Perera F, Chisela F, Stitt L et al. TLD skin dose measurements and acute and late effects after lumpectomy and HDR brachytherapy only for early breast cancer. Int J Radiat Oncol Biol Phys 2005; 62(5): 1283– 1290.

16. Soumarová et al. Principles of pot-resection brachytherapy of solid tumors using HDR afterloading. Rozhl Vhir 2003; 82(6): 301– 306.

17. Johansson B et al. Phantom study of radiation doses outside the target volume brachytherapy verus external radiotherapy of early breast cancer. Radiother Oncol 2003; 69 (1): 107– 12; 27.

18. Nag S. HDR brachytherapy: its clinical applications and treatment gudelines. Technol Cancer Res Treat 2004; 3(3): 269– 287.

19. Blamey R. British Assotiationof Surgical Oncology (BASO)II trial: Comparing wide local excision alone with wide local excision plus radiotherapy in small well differentiated breast cancers. Europ J Canc 2000; 36 (Suppl. 5).

20. Soumarová R et al. Faktory ovlivňující vznik lokálnírecidivy a vzdálené diseminace u pacientek s prs zachovávajícím chirurugickýn výkonem a pooperační radioterapií. Onkologie v gynekologii a mammologii 2001; 88– 91.

21. Růžičková J et al. Samostatná peroperační intersticiální HDR Brachyradioterapie u časných stadií karcinomu prsu‑ první výsledky klinické studie. Klin Onkol 2005; 18(1): 15– 18, 22.

22. Major T et al. Dosimetric comparisons between HDR interstitial and MammoSite baloon brachytherapy for breast cancer. Radiother Oncol 2006; 79(3): 321– 328.

23. Vicini FA, Antonoucci JV, Wallace M et al. Long‑term fficacy and patterns of faikure after accelerated partial breast irradiationa molecular assay‑based clonality avluation. Int J Radiat Oncol Biol Phys 2007; 68(2): 341– 346.

24. Bickell NA, Wang JJ, Oluwole S et al. Missed opportunities:radica disparirie in adjuvant breast cancer treatment. J Clin Oncol 2006; 24(9): 1357– 1362.

25. Albrand G, Terret C D. Early breast cancer in the elderly: assessment and management considerations. Drugs Aging 2008; 25(1): 35– 45.

26. Bovi J, Qi XS, White J et al. Comparison of three accelerated partial breast irradiation techniques: treatment affectivenes based upon biological models. Radiother Oncol 2007; 84(3): 226–227.

27. Wazer DE, Lowther D, Boyle T et al. Clinically evident fat necrosis treated with HDR brachytherapy alone or early‑stage breast cancer. Int J Radiat Oncol Biol Phys 2001; 50(1): 107– 111.

28. Benitez PR, Chen PY, Vicini PA et al. Partial breast irradiation in breast consrving, therapy by way of interstitial brachytherapy. AM J Surg 2004; 188(4): 355– 364.

29. Wazer DE, Berle L, Graham R et al. Preliminary results of a phase I/ II study of HDR brachytherapy alone for T1/ T2 breast cancer. Int J Radiat Oncol Biol Phys 2002; 53(4): 889– 897.

30. Nose T, Komoike Y, Yoshida K et al. A pilot studa of wider use of accelerated partial breast irradiation: intraoperative margin‑directed re‑excision combined with sole HDR interstitial brachytherapy. Breast Cancer 2006; 13(3): 289– 299; 25.

31. Hannoun‑ Lévi JM, Marsiglia H, Garbay JR. Preview Irradiation partielle du sein: pourquoi, comment? (fre; includes abstract) Cancer Radiothérapie: Journal De La Société Française De Radiothérapie Oncologique 2003; 7(3): 200– 209.

32. Stevens MJ, Cooper SG, Cross P et al. Accelerated paertial breast irradiation using interstitial high dose rate iridium brachytherapy: Early Autralian experience and review of the literature. Australas Radiol 2006; 50(2): 143.