Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1–T2 breast cancer: First long time results from a clinical study

Abstract 

Background and purpose

To evaluate the long time outcome with regard to local tumour control, cosmetic outcome and side effects of a short (5 days) accelerated interstitial brachytherapy treatment delivered to the surroundings of the operated sector.

Patients and methods

Between 1993 and 2003 we treated 50 women with early T1 and T2 breast cancer. Radical sector resection was performed and followed later with an interstitial pulsed dose rate (PDR) brachytherapy of 50Gy in 5 days. The treatment was centred on the tumour with a margin of 30mm. One patient was treated bilaterally. The patients were followed for a median of 86 (32–126) months.

Results

Ipsilateral breast cancer recurrence was seen in 3 patients (6%). Two of them occurred outside the treated volume. The 5- and 7-year rates of actuarial local control were 96% and 96%, respectively, overall survival 88% and 85%, disease free survival 88% and 88%, respectively. A dosimetrical analysis showed that the partial breast irradiation covered a median of 31% of the total breast volume. Fat necrosis was seen in 12% and local (moderate–strong) fibrosis in 26% of the patients. Independent cosmetic scoring showed good or excellent result in 56% of the patients.

Conclusions

Local outcome is favourable and very similar to other published studies of accelerated partial breast irradiation. Our long time cosmetic results are lower than other published results.

Keywords: Brachytherapy, Pulsed dose rate, Breast cancer, Accelerated partial breast irradiation, Cosmetics, Outcome, Radiotherapy