Perioperative Interstitial Brachytherapy as a Boost in Breast Cancer Conserving Therapy
Author(s)
Dominique J. P. van Uden*,
Elzbieta M. van der Steen-Banasik,
Manuel J. Koppe,
Marcel R. Stam,
Jan van Wijk,
Charlotte F. J. M. Blanken-Peeters
Affiliation(s)
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands. Arnhem Radiotherapy Institute, Arnhem, The Netherlands. Department of Surgery, Zevenaar Hospital, Zevenaar, The Netherlands.
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands. Arnhem Radiotherapy Institute, Arnhem, The Netherlands. Department of Surgery, Zevenaar Hospital, Zevenaar, The Netherlands.
ABSTRACT
Background: The aim of breast-conserving treatment (BCT) in breast cancer, consisting of wide local excision (WLE) and radiotherapy, is to obtain local control of disease as well as an optimal cosmetic result. The application of perioperative brachytherapy allows more precise deposition of the boost radiation dose to the lumpectomy cavity plus margins in a shorter period of time, as compared to external beam radiotherapy. The aim of the present study was to analyze the oncological outcome of interstitial brachytherapy in our patient population of patients with early-stage breast cancer. Patients and Methods: 107 breasts in 105 patients with T1-2 breast cancer were treated between 1996 and 2009 with BCT, including WLE combined with perioperative brachytherapy using Iridium-192 (15 Gy with low dose rate or 9 Gy with high dose rate) followed by whole breast irradiation (50 Gy). Outcomes analyzed included treatment toxicity (according to Common Terminology Criteria for Adverse Events), local recurrence rate, and disease-free and overall survival. Results: Median follow-up of patients still alive was 6.3 years (range 2.0 - 14.5). Mean age was 50.2 years (+/- S.D. 10.5). Mean tumor diameter was 15 mm (+/- S.D. 8 mm. Acute complications consisted of grade 1 and 3 complications, respectively n = 8 and n = 1. Late complications consisted of grade 1 or 2, respectively n = 25 and n = 2. Only three patients (2.8%) developed a local recurrence with a median time to recurrence of 9.3 years (range 3.3 - 9.3). Five- and ten-year local recurrence free survival was 99% and 91%, respectively. Five- and ten-year disease-specific and overall survival was 95% and 84% versus 92% and 78%, respectively. Conclusions: Treatment-related toxicity after brachytherapy for breast cancer was mild. The local recurrence rate is low. Therefore, brachytherapy is a good alternative to conventional radiation boost as a part of breast irradiation in breast conserving treatment in early stage breast cancer.
Background: The aim of breast-conserving treatment (BCT) in breast cancer, consisting of wide local excision (WLE) and radiotherapy, is to obtain local control of disease as well as an optimal cosmetic result. The application of perioperative brachytherapy allows more precise deposition of the boost radiation dose to the lumpectomy cavity plus margins in a shorter period of time, as compared to external beam radiotherapy. The aim of the present study was to analyze the oncological outcome of interstitial brachytherapy in our patient population of patients with early-stage breast cancer. Patients and Methods: 107 breasts in 105 patients with T1-2 breast cancer were treated between 1996 and 2009 with BCT, including WLE combined with perioperative brachytherapy using Iridium-192 (15 Gy with low dose rate or 9 Gy with high dose rate) followed by whole breast irradiation (50 Gy). Outcomes analyzed included treatment toxicity (according to Common Terminology Criteria for Adverse Events), local recurrence rate, and disease-free and overall survival. Results: Median follow-up of patients still alive was 6.3 years (range 2.0 - 14.5). Mean age was 50.2 years (+/- S.D. 10.5). Mean tumor diameter was 15 mm (+/- S.D. 8 mm. Acute complications consisted of grade 1 and 3 complications, respectively n = 8 and n = 1. Late complications consisted of grade 1 or 2, respectively n = 25 and n = 2. Only three patients (2.8%) developed a local recurrence with a median time to recurrence of 9.3 years (range 3.3 - 9.3). Five- and ten-year local recurrence free survival was 99% and 91%, respectively. Five- and ten-year disease-specific and overall survival was 95% and 84% versus 92% and 78%, respectively. Conclusions: Treatment-related toxicity after brachytherapy for breast cancer was mild. The local recurrence rate is low. Therefore, brachytherapy is a good alternative to conventional radiation boost as a part of breast irradiation in breast conserving treatment in early stage breast cancer.
Cite this paper
D. van Uden, E. van der Steen-Banasik, M. Koppe, M. Stam, J. van Wijk and C. Blanken-Peeters, "Perioperative Interstitial Brachytherapy as a Boost in Breast Cancer Conserving Therapy," Journal of Cancer Therapy, Vol. 3 No. 6, 2012, pp. 1119-1124. doi: 10.4236/jct.2012.36146.
D. van Uden, E. van der Steen-Banasik, M. Koppe, M. Stam, J. van Wijk and C. Blanken-Peeters, "Perioperative Interstitial Brachytherapy as a Boost in Breast Cancer Conserving Therapy," Journal of Cancer Therapy, Vol. 3 No. 6, 2012, pp. 1119-1124. doi: 10.4236/jct.2012.36146.
References
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[1] J. Borger, H. Kemperman, A. Hart, H. Peterse, D. J. van and H. Bartelink, “Risk Factors in Breast-Conservation Therapy,” Journal of Clinical Oncology, Vol. 12, No. 4, 1994, pp. 653-660. [2] A. de la Rochefordiere, B. Asselain, F. Campana, S. M. Scholl, J. Fenton, J. R. Vilcoq, J. C. Durand, P. Pouillart, H. Magdelenat and A. Fourquet, “Age as Prognostic Factor in Premenopausal Breast Carcinoma,” Lancet, Vol. 341, No. 8852, 1993, pp. 1039-1043. doi:10.1016/0140-6736(93)92407-K [3] P. H. Elkhuizen, A. C. Voogd, L. C. van den Broek, I. T. Tan, H. C. van Houwelingen, J. W. Leer and M. J. van de Vijver, “Risk Factors for Local Recurrence after Breast-Conserving Therapy for Invasive Carcinomas: A Case-Control Study of Histological Factors and Alterations in Oncogene Expression,” International Journal of Radiation Oncology*Biology*Physics, Vol. 45, No. 1, 1999, pp. 73-83. [4] J. M. Kurtz, J. Jacquemier, R. Amalric, H. Brandone, Y. Ayme, D. Hans, C. Bressac, J. Roth and J. M. Spitalier, “Risk Factors for Breast Recurrence in Premenopausal and Postmenopausal Patients with Ductal Cancers Treated by Conservation Therapy,” Cancer, Vol. 65, No. 8, 1990, pp. 1867-1878. doi:10.1002/1097-0142(19900415)65:8<1867::AID-CNCR2820650833>3.0.CO;2-I [5] A. Stotter, E. N. Atkinson, B. A. Fairston, M. McNeese, M. J. Oswald and C. M. Balch, “Survival Following Locoregional Recurrence after Breast Conservation Therapy for Cancer,” Annals of Surgery, Vol. 212, No. 2, 1990, pp. 166-172. doi:10.1097/00000658-199008000-00009 [6] U. Veronesi, E. Marubini, L. Mariani, V. Galimberti, A. Luini, P. Veronesi, B. Salvadori and R. Zucali, “Radiotherapy after Breast-Conserving Surgery in Small Breast Carcinoma: Long-Term Results of a Randomized Trial,” Annals of Oncology, Vol. 12, No. 7, 2001, pp. 997-1003. doi:10.1023/A:1011136326943 [7] J. M. Kurtz, R. Amalric, H. Brandone, Y. Ayme, J. Jacquemier, J. C. Pietra, D. Hans, J. F. Pollet, C. Bressac, J. M. Spitalier, “Local Recurrence after Breast-Conserving Surgery and Radiotherapy. Frequency, Time Course, and Prognosis,” Cancer, Vol. 63, No. 10, 1989, pp. 1912-1917. doi:10.1002/1097-0142(19890515)63:10<1912::AID-CNCR2820631007>3.0.CO;2-Y [8] S. Bensaleh, E. Bezak and M. Borg, “Review of MammoSite Brachytherapy: Advantages, Disadvantages and Clinical Outcomes,” Acta Oncologica, Vol. 48, No. 4, 2009, pp. 487-494. doi:10.1080/02841860802537916 [9] R. Garza, K. Albuquerque and A. Sethi, “Lung and Cardiac Tissue Doses in Left Breast Cancer Patients Treated with Single-Source Breast Brachytherapy Compared to External Beam Tangent Fields,” Brachytherapy, Vol. 5, No. 4, 2006, pp. 235-238. doi:10.1016/j.brachy.2006.08.001 [10] S. B. Edge and C. C. Compton, “The American Joint Committee on Cancer: The 7th Edition Of the AJCC Cancer Staging Manual and the Future of TNM,” Annals of Surgical Oncology, Vol. 17, No. 6, 2010, pp. 1471-1474. [11] A. Trotti, A. D. Colevas, A. Setser, V. Rusch, D. Jaques, V. Budach, C. Langer, B. Murphy, R. Cumberlin, C. N. Coleman and P. Rubin, “CTCAE v3.0: Development of a Comprehensive Grading System for the Adverse Effects of Cancer Treatment,” Seminars in Radiation Oncology, Vol. 13, No. 3, 2003, pp. 176-181. doi:10.1016/S1053-4296(03)00031-6 [12] B. Pierquin, A. Dutreix, C. H. Paine, D. Chassagne, G. Marinello and D. Ash, “The Paris System in Interstitial Radiation Therapy,” Acta Radiologica: Oncology, Radiation, Physics, Biology, Vol. 17, No. 1, 1978, pp. 33-48. [13] P. Poortmans, H. Bartelink, J. C. Horiot, H. Struikmans, W. Van Den Bogaert, A. Fourquet, J. Jager, W. Hoogenraad, P. Rodrigus, C. Warlam-Rodenhuis, L. Collette and M. Pierart, “The Influence of the Boost Technique on Local Control in Breast Conserving Treatment in the EORTC ‘Boost versus no Boost’ Randomised Trial,” Radiotherapy & Oncology, Vol. 72, No. 1, 2004, pp. 25-33. doi:10.1016/j.radonc.2004.03.007 [14] D. Curran, J. P. van Dongen, N. K. Aaronson, G. Kiebert, I. S. Fentiman, F. Mignolet and H. Bartelink, “Quality of Life of Early-Stage Breast Cancer Patients Treated with Radical Mastectomy or Breast-Conserving Procedures: Results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-Operative Group (BCCG),” European Journal of Cancer, Vol. 34, No. 3, 1998, pp. 307-314. doi:10.1016/S0959-8049(97)00312-2 [15] S. Collette, L. Collette, T. Budiharto, J. C. Horiot, P. M. Poortmans, E. Salamon, R. Mirimanoff, M. Bolla, M. Van der Hulst, C. C. Warlam-Rodenhuis and H. Bartelink, “Predictors of the Risk of Fibrosis at 10 Years after Breast Conserving Therapy for Early Breast Cancer: A Study Based on the EORTC Trial 22881-10882 ‘Boost versus no Boost’,” European Journal of Cancer, Vol. 44, No. 17, 2008, pp. 2587-2599. doi:10.1016/j.ejca.2008.07.032