Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study

Polgár, Csaba; Major, Tibor; Fodor, János; Sulyok, Zoltán; Somogyi, András; Lövey, Katalin; Németh, György; Kásler, Miklós

doi:10.1016/j.radonc.2010.01.019

« Previous Next »Radiotherapy & Oncology
Volume 94, Issue 3 , Pages 274-279, March 2010

Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study

Csaba Polgár
- Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Corresponding author. Address: Department of Radiotherapy, National Institute of Oncology, Ráth György u. 7-9, Budapest H-1122, Hungary.
Tibor Major
- Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
János Fodor
- Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
Zoltán Sulyok
- Department of General and Thoracic Surgery, National Institute of Oncology, Budapest, Hungary
András Somogyi
- Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
Katalin Lövey
- Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
György Németh
- Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
Miklós Kásler
- National Institute of Oncology, Budapest, Hungary

Received 12 September 2009; received in revised form 26 January 2010; accepted 29 January 2010. published online 24 February 2010.

Abstract

Background and purpose

To report the 12-year updated results of accelerated partial-breast irradiation (APBI) using multicatheter interstitial high-dose-rate (HDR) brachytherapy (BT).

Patients and methods

Forty-five prospectively selected patients with T1N0-N1mi, nonlobular breast cancer without the presence of an extensive intraductal component and with negative surgical margins were treated with APBI after breast-conserving surgery (BCS) using interstitial HDR BT. A total dose of 30.3Gy (n=8) and 36.4Gy (n=37) in seven fractions within 4days was delivered to the tumour bed plus a 1–2cm margin. The median follow-up time was 133months for surviving patients. Local and regional control, disease-free (DFS), cancer-specific (CSS), and overall survival (OS), as well as late side effects, and cosmetic results were assessed.

Results

Four (8.9%) ipsilateral breast tumour recurrences were observed, for a 5-, 10-, and 12-year actuarial rate of 4.4%, 9.3%, and 9.3%, respectively. A total of two regional nodal failures were observed for a 12-year actuarial rate of 4.4%. The 12-year DFS, CSS, and OS was 75.3%, 91.1%, and 88.9%, respectively. Grade 3 fibrosis was observed in one patient (2.2%). No patient developed grade 3 teleangiectasia. Fat necrosis requiring surgical intervention occurred in one woman (2.2%). Cosmetic results were rated excellent or good in 35 patients (77.8%).

Conclusions

Twelve-year results with APBI using HDR multicatheter interstitial implants continue to demonstrate excellent long-term local tumour control, survival, and cosmetic results with a low-rate of late side effects.

Keywords: Breast-conserving therapy, Accelerated partial-breast irradiation, High-dose-rate brachytherapy