Interstitial High Dose Rate (Hdr) Brachytherapy For Breast Cancer In Women < 50 Years Of Age Compared To > 50 Years Of Age: Median 6 Year Follow-Up In 283 Cases Using Multi-Catheter Technique

Purpose/Objective(s)External Beam Radiation Therapy (EBRT) has been the standard of care for breast conservation radiation therapy, for more than 20 years. It is well known that pre-menopausal women have a worse prognosis than post-menopausal women. However, it is also known that mastectomy does not confer a better prognosis than breast conservation in these younger women. Hence, the American College of Radiology does not have an age limit for breast conservation candidacy. Recent data indicates that Interstitial Implant and High Dose Rate (HDR) radiation afterloading compares very favorably to EBRT in early stage breast cancer. There is controversy regarding the use of HDR in patients < 50 years of age. We present our data in patients < 50 years of age compared to > 50 years of age.Materials/MethodsPatients with Tis, T1, and T2 tumors measuring < 4 cm, negative surgical margins, and 1-3 positive axillary lymph nodes were judged to be candidates for Interstitial Implant. Implants were performed under Stereotactic Mammographic guidance with conscious sedation and local anesthesia. Radiation Treatment planning was performed using CT Scanning and the Plato System. Treatment volumes ranged from 25 cm3 to 359 cm3. The breast implant volume received 3400 cGy in 10 fractions prescribed to the Planning Target Volume, given BID over 5 days.ResultsBetween 2000 and 2010, 283 patients underwent Interstitial HDR Implant. The procedure was well tolerated. No patient required hospital admission. With a median follow-up 72 months (range 6-140 months), local recurrence (LR) occurred in 4.2% (12/283). Cosmetic results were good to excellent in 89.8% (254/283) of the patients. LR occurred in 6.1% (2/33) of patients < 50 years of age vs. 4.0% (10/250) in patients > 50 years of age (p = 0.63). There were no infections. Wound healing complications developed in 2.8% (8/283). Three of these patients had received anthracycline based Chemotherapy. All eight patients had large (> 200 cm3) implant volumes, catheter spacing of 1.5 cm, and V-150% of > 30%. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis.ConclusionsWith median 72 month follow-up, Breast Conservation radiation therapy utilizing Interstitial Multi-Catheter HDR Implant has yielded LR rates and cosmetic results which compare favorably to EBRT in selected patients. There was no statistically significant difference in LR between patients < 50 years of age vs. > 50 years of age. While there was a trend towards higher LR in patients < 50 years, LR appears comparable to patients treated with EBRT. Therefore, we believe that age < 50 years should not be a contraindication for HDR for breast conservation. Purpose/Objective(s)External Beam Radiation Therapy (EBRT) has been the standard of care for breast conservation radiation therapy, for more than 20 years. It is well known that pre-menopausal women have a worse prognosis than post-menopausal women. However, it is also known that mastectomy does not confer a better prognosis than breast conservation in these younger women. Hence, the American College of Radiology does not have an age limit for breast conservation candidacy. Recent data indicates that Interstitial Implant and High Dose Rate (HDR) radiation afterloading compares very favorably to EBRT in early stage breast cancer. There is controversy regarding the use of HDR in patients < 50 years of age. We present our data in patients < 50 years of age compared to > 50 years of age. External Beam Radiation Therapy (EBRT) has been the standard of care for breast conservation radiation therapy, for more than 20 years. It is well known that pre-menopausal women have a worse prognosis than post-menopausal women. However, it is also known that mastectomy does not confer a better prognosis than breast conservation in these younger women. Hence, the American College of Radiology does not have an age limit for breast conservation candidacy. Recent data indicates that Interstitial Implant and High Dose Rate (HDR) radiation afterloading compares very favorably to EBRT in early stage breast cancer. There is controversy regarding the use of HDR in patients < 50 years of age. We present our data in patients < 50 years of age compared to > 50 years of age. Materials/MethodsPatients with Tis, T1, and T2 tumors measuring < 4 cm, negative surgical margins, and 1-3 positive axillary lymph nodes were judged to be candidates for Interstitial Implant. Implants were performed under Stereotactic Mammographic guidance with conscious sedation and local anesthesia. Radiation Treatment planning was performed using CT Scanning and the Plato System. Treatment volumes ranged from 25 cm3 to 359 cm3. The breast implant volume received 3400 cGy in 10 fractions prescribed to the Planning Target Volume, given BID over 5 days. Patients with Tis, T1, and T2 tumors measuring < 4 cm, negative surgical margins, and 1-3 positive axillary lymph nodes were judged to be candidates for Interstitial Implant. Implants were performed under Stereotactic Mammographic guidance with conscious sedation and local anesthesia. Radiation Treatment planning was performed using CT Scanning and the Plato System. Treatment volumes ranged from 25 cm3 to 359 cm3. The breast implant volume received 3400 cGy in 10 fractions prescribed to the Planning Target Volume, given BID over 5 days. ResultsBetween 2000 and 2010, 283 patients underwent Interstitial HDR Implant. The procedure was well tolerated. No patient required hospital admission. With a median follow-up 72 months (range 6-140 months), local recurrence (LR) occurred in 4.2% (12/283). Cosmetic results were good to excellent in 89.8% (254/283) of the patients. LR occurred in 6.1% (2/33) of patients < 50 years of age vs. 4.0% (10/250) in patients > 50 years of age (p = 0.63). There were no infections. Wound healing complications developed in 2.8% (8/283). Three of these patients had received anthracycline based Chemotherapy. All eight patients had large (> 200 cm3) implant volumes, catheter spacing of 1.5 cm, and V-150% of > 30%. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. Between 2000 and 2010, 283 patients underwent Interstitial HDR Implant. The procedure was well tolerated. No patient required hospital admission. With a median follow-up 72 months (range 6-140 months), local recurrence (LR) occurred in 4.2% (12/283). Cosmetic results were good to excellent in 89.8% (254/283) of the patients. LR occurred in 6.1% (2/33) of patients < 50 years of age vs. 4.0% (10/250) in patients > 50 years of age (p = 0.63). There were no infections. Wound healing complications developed in 2.8% (8/283). Three of these patients had received anthracycline based Chemotherapy. All eight patients had large (> 200 cm3) implant volumes, catheter spacing of 1.5 cm, and V-150% of > 30%. Two patients healed after 6 months of conservative treatment. Surgery was required in six patients who developed fat necrosis. ConclusionsWith median 72 month follow-up, Breast Conservation radiation therapy utilizing Interstitial Multi-Catheter HDR Implant has yielded LR rates and cosmetic results which compare favorably to EBRT in selected patients. There was no statistically significant difference in LR between patients < 50 years of age vs. > 50 years of age. While there was a trend towards higher LR in patients < 50 years, LR appears comparable to patients treated with EBRT. Therefore, we believe that age < 50 years should not be a contraindication for HDR for breast conservation. With median 72 month follow-up, Breast Conservation radiation therapy utilizing Interstitial Multi-Catheter HDR Implant has yielded LR rates and cosmetic results which compare favorably to EBRT in selected patients. There was no statistically significant difference in LR between patients < 50 years of age vs. > 50 years of age. While there was a trend towards higher LR in patients < 50 years, LR appears comparable to patients treated with EBRT. Therefore, we believe that age < 50 years should not be a contraindication for HDR for breast conservation.