Accelerated Partial Breast Irradiation Using Multicatheter High-Dose-Rate Brachytherapy for Selected Early-Stage Breast Cancer

PurposeTo report the feasibility, toxicity, cosmesis, efficacy and treatment related factors on outcome of accelerated partial breast irradiation (APBI) using interstitial multi-catheter high-dose-rate brachytherapy for early-stage breast cancer.Materials and MethodsBetween March 2004 and June 2013, 377 selected patients with stages 0-I-IIA (AJCC-the 7th edition 2010) breast cancer received APBI using multi-catheter brachytherapy following breast-conserving surgery. Eighty percent of patients had invasive carcinoma, and 20% had ductal carcinoma in situ. The pathological stage was 0: 20%, I: 68% and II: 12%. Most patients were estrogen (86%) and progesterone receptors positives (79%), HER2 negative (82%) and 63% were grade 3. The prescription dose was 34 Gy in 10 fractions, 3.4 Gy per fraction, twice a day, in intervals of more than 6 hours and was delivered to the tumor bed plus a 1-2 cm margin.ResultsThe median follow-up time was 50.5 months. The median age of the patients was 59 years. Mean tumor size was 1.37cm. Local recurrence occurred in twelve patients (3.18%). Regional lymph node recurrence was observed in two patients (0.53%), distant metastasis in seven patients (1.86%), and contralateral breast recurrence in one patient (0.27%). Seven patients died for any cause (1.86%). The 2-year, 5-year and 10-year local recurrence free survival rate were 99.3%, 97.1% and 83.8%. In a univariate analysis, Her2-negative cases (OR: 16.42, 95% CI: 1.63-165.13, p=0.01) and negative estrogen/progesterone receptor (OR: 4.17, 95% CI: 1.30-13.36, p=0.01) were statistically significant to local recurrence. No local infection was observed. Acute and late skin reactions were rare and long-term cosmetic outcome was very good to excellent.ConclusionsAPBI with interstitial multi-catheter high-dose-rate brachytherapy is feasible in selected patients with early-stage breast cancer. Local control and cosmesis were excellent with acceptable rates of acute and late toxicities. In a univariate analysis, Her2-negative cases and negative estrogen/progesterone receptor were statistically significant to local recurrence. PurposeTo report the feasibility, toxicity, cosmesis, efficacy and treatment related factors on outcome of accelerated partial breast irradiation (APBI) using interstitial multi-catheter high-dose-rate brachytherapy for early-stage breast cancer. To report the feasibility, toxicity, cosmesis, efficacy and treatment related factors on outcome of accelerated partial breast irradiation (APBI) using interstitial multi-catheter high-dose-rate brachytherapy for early-stage breast cancer. Materials and MethodsBetween March 2004 and June 2013, 377 selected patients with stages 0-I-IIA (AJCC-the 7th edition 2010) breast cancer received APBI using multi-catheter brachytherapy following breast-conserving surgery. Eighty percent of patients had invasive carcinoma, and 20% had ductal carcinoma in situ. The pathological stage was 0: 20%, I: 68% and II: 12%. Most patients were estrogen (86%) and progesterone receptors positives (79%), HER2 negative (82%) and 63% were grade 3. The prescription dose was 34 Gy in 10 fractions, 3.4 Gy per fraction, twice a day, in intervals of more than 6 hours and was delivered to the tumor bed plus a 1-2 cm margin. Between March 2004 and June 2013, 377 selected patients with stages 0-I-IIA (AJCC-the 7th edition 2010) breast cancer received APBI using multi-catheter brachytherapy following breast-conserving surgery. Eighty percent of patients had invasive carcinoma, and 20% had ductal carcinoma in situ. The pathological stage was 0: 20%, I: 68% and II: 12%. Most patients were estrogen (86%) and progesterone receptors positives (79%), HER2 negative (82%) and 63% were grade 3. The prescription dose was 34 Gy in 10 fractions, 3.4 Gy per fraction, twice a day, in intervals of more than 6 hours and was delivered to the tumor bed plus a 1-2 cm margin. ResultsThe median follow-up time was 50.5 months. The median age of the patients was 59 years. Mean tumor size was 1.37cm. Local recurrence occurred in twelve patients (3.18%). Regional lymph node recurrence was observed in two patients (0.53%), distant metastasis in seven patients (1.86%), and contralateral breast recurrence in one patient (0.27%). Seven patients died for any cause (1.86%). The 2-year, 5-year and 10-year local recurrence free survival rate were 99.3%, 97.1% and 83.8%. In a univariate analysis, Her2-negative cases (OR: 16.42, 95% CI: 1.63-165.13, p=0.01) and negative estrogen/progesterone receptor (OR: 4.17, 95% CI: 1.30-13.36, p=0.01) were statistically significant to local recurrence. No local infection was observed. Acute and late skin reactions were rare and long-term cosmetic outcome was very good to excellent. The median follow-up time was 50.5 months. The median age of the patients was 59 years. Mean tumor size was 1.37cm. Local recurrence occurred in twelve patients (3.18%). Regional lymph node recurrence was observed in two patients (0.53%), distant metastasis in seven patients (1.86%), and contralateral breast recurrence in one patient (0.27%). Seven patients died for any cause (1.86%). The 2-year, 5-year and 10-year local recurrence free survival rate were 99.3%, 97.1% and 83.8%. In a univariate analysis, Her2-negative cases (OR: 16.42, 95% CI: 1.63-165.13, p=0.01) and negative estrogen/progesterone receptor (OR: 4.17, 95% CI: 1.30-13.36, p=0.01) were statistically significant to local recurrence. No local infection was observed. Acute and late skin reactions were rare and long-term cosmetic outcome was very good to excellent. ConclusionsAPBI with interstitial multi-catheter high-dose-rate brachytherapy is feasible in selected patients with early-stage breast cancer. Local control and cosmesis were excellent with acceptable rates of acute and late toxicities. In a univariate analysis, Her2-negative cases and negative estrogen/progesterone receptor were statistically significant to local recurrence. APBI with interstitial multi-catheter high-dose-rate brachytherapy is feasible in selected patients with early-stage breast cancer. Local control and cosmesis were excellent with acceptable rates of acute and late toxicities. In a univariate analysis, Her2-negative cases and negative estrogen/progesterone receptor were statistically significant to local recurrence.