Article Name: The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy
Author: Kathy L. Baglan M.D., Alvaro A. Martinez M.D., F.A.C.R., Robert C. Frazier M.D., Vijay R. Kini M.D., Larry L. Kestin M.D., Peter Y. Chen, M.D., Greg Edmundson M.S., Elizabeth Mele M.S., David Jaffray Ph.D., and Frank A. Vicini M.D.
Institution: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Published Date: July 15, 2001
We present the preliminary results of our in-house protocol using outpatient high-dose-rate (HDR) brachytherapy as the sole radiation modality following lumpectomy in patients with early-stage breast cancer.
Methods and Materials
Thirty-seven patients with 38 Stage I-II breast cancers received radiation to the lumpectomy cavity alone using an HDR interstitial implant with 192Ir. A minimum dose of 32 Gy was delivered on an outpatient basis in 8 fractions of 4 Gy to the lumpectomy cavity plus a 1- to 2-cm margin over consecutive 4 days.
Median follow-up is 31 months. There has been one ipsilateral breast recurrence for a crude failure rate of 2.6% and no regional or distant failures. Wound healing was not impaired in patients undergoing an open-cavity implant. Three minor breast infections occurred, and all resolved with oral antibiotics. The cosmetic outcome was good to excellent in all patients.
In selected patients with early-stage breast cancer, treatment of the lumpectomy cavity alone with outpatient HDR brachytherapy is both technically feasible and well tolerated. Early results are encouraging, however, longer follow-up is necessary before equivalence to standard whole-breast irradiation can be established and to determine the most optimal radiation therapy technique to be employed.
Article Name: Accelerated partial breast irradiation using MammoSite brachytherapy: a multidisciplinary approach to breast-conservation therapy
Author: Kim N. Vu, M.D., Anthony E. Dragun, M.D., David J. Cole, M.D., and Joseph M. Jenrette, M.D.
Institution: Departments of Radiation Oncology and General Surgery, Medical University of South Carolina, Charleston, SC
Published Date: November/December 2005
Medical Journal: Community Oncology, Volume 2, Number 6, Pages 477-482
MammoSite balloon brachytherapy (MBT) is a relatively new technique for the delivery of adjuvant radiation therapy in the setting of breast conservation. Its application is gaining widespread popularity for its ease of reproducibility and its capacity to reduce the overall treatment time and morbidity traditionally associated with whole-breast radiotherapy. The Medical University of South Carolina was one of the first institutions in the country to adopt the use of MBT, and over the past 3 years we have treated almost 100 patients with this system. Initiation of an MBT program requires close coordination between the treating radiation oncologist and breast surgeon in order to maximize the potential advantages of MBT and minimize its pitfalls. This article will describe the steps that we have used for successful MammoSite implantation and treatment and will detail how our technique has evolved with time and experience.
Article Name: Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy.
Author: Martin Keisch M.D., Frank Vicini M.D., Robert R. Kuske M.D., Mary Hebert M.D., Julia White M.D., Coral Quiet M.D., Doug Arthur M.D., Troy Scroggins M.D., and Oscar Streeter M.D.
Institutions: Department of Radiation Oncology, Mount Sinai Medical Center, Miami Beach, FL; Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI; Department of Radiation Oncology, University of Wisconsin, Madison, WI; Department of Radiation Oncology, US Oncology, Sherman, TX; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Arizona Oncology, Phoenix, AZ; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA; Department of Radiation Oncology, Ochsner Clinic, New Orleans, LA; Department of Radiation Oncology, University of Southern California Norris Cancer Center, Los Angeles, CA
Published Date: February 1, 2003
We present the results of the previous initial clinical testing of the MammoSite balloon breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy.
Methods and Materials
Seventy patients were enrolled in a multicenter prospective trial testing the applicator for safety and performance. Fifty-four patients were implanted, and 43 patients were ultimately eligible for and received brachytherapy as the sole radiation modality after lumpectomy. Patients were staged T1N0M0 with negative pathologic margins and age >45 years. A dose of 34 Gy was delivered in 10 fractions over 5 days prescribed to 1 cm from the applicator surface using 192Ir high-dose-rate brachytherapy. A minimum skin-to-balloon surface distance of 5 mm was required for treatment. Device performance, complications, and cosmesis were assessed.
Computed tomography imaging post-balloon inflation showed 8, 14, and 21 patients with 5-6 mm, 7-9 mm, and >10 mm of skin spacing, respectively. Two patients were explanted because of inadequate skin spacing and 7 because of suboptimal conformance of the surgical cavity to the applicator balloon. One patient was explanted because of positive nodal status and another because of age. The most common side effects related to device placement included mild erythema, drainage, pain, and echymosis. No severe side effects related to implantation, brachytherapy, or explantation occurred. Side effects related to radiation therapy were generally mild with erythema, pain, and dry desquamation being the most common. At 1 month, 88% of patients were evaluated as having good-to-excellent cosmetic results.
The MammoSite balloon breast brachytherapy applicator performed well clinically. All eligible patients completed treatment. Side effects were mild to moderate and self-limiting. Skin-balloon surface distance and balloon-cavity conformance were the main factors limiting the previous initial use of the device.