eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
Current Issue Archive Supplements Articles in Press Journal Information Aims and Scope Editorial Office Editorial Board Register as Author Register as Reviewer Instructions for Authors Abstracting and indexing Subscription Advertising Information Links
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank

6/2020
vol. 12
 
Share:
Share:
abstract:
Original paper

Minimally invasive tumor bed implant (MITBI) and peri-operative high-dose-rate brachytherapy (PHDRBT) for accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost) in breast-conserving surgery for ductal carcinoma in situ

Marta Gimeno Morales
1
,
Fernando Martinez-Regueira
2
,
Natalia Rodriguez-Spiteri
2
,
Begoña Olartecoechea
2
,
Isabel Rubio
2
,
Antonio Esgueva
2
,
Luis Pina
3
,
Arlette Elizalde
3
,
Carolina Sobrido Sampedro
3
,
Miguel Angel Idoate
4
,
Marta Abengozar
4
,
Luis Ramos
1
,
Felipe Calvo Manuel
1
,
Rafael Martínez-Monge
1
,
Mauricio Cambeiro
1

  1. Department of Oncology, University of Navarra, Pamplona-Madrid, Spain
  2. Breast Surgical Oncology Unit, University of Navarra, Pamplona-Madrid, Spain
  3. Department of Radiology, University of Navarra, Pamplona-Madrid, Spain
  4. Department of Pathology, University of Navarra, Pamplona-Madrid, Spain
J Contemp Brachytherapy 2020; 12, 6: 521–532
Online publish date: 2020/12/18
View full text Get citation
 
Purpose
To evaluate our institutional experience of minimally invasive tumor bed implantation (MITBI) during breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) to deliver peri-operative high-dose-rate brachytherapy (PHDRBT) as accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost).

Material and methods
Patients older than 40, with clinical and radiological unifocal DCIS < 3 cm were considered potential candidates for accelerated partial breast irradiation (APBI) and were implanted during BCS using MITBI-technique. Patients who in final pathology reports showed free margins and no other microscopic tumor foci, received AMBI with PHDRBT (3.4 Gy BID in 5 days). Patients with adverse features received A-PHDRBT-boost with post-operative external beam radiotherapy (EBRT).

Results
Forty-one patients were implanted, and 36 were treated and analyzed. According to final pathology, 24 (67%) patients were suitable for AMBI and 12 (33%) were qualified for A-PHDRBT-boost. Reoperation rate for those with clear margins was 16.6% (6/36); this rate increased to 33% (4/12) for G3 histology, and 66% (4/6) were rescued using AMBI. Early complications were documented in 5 patients (14%). With a median follow-up of 97 (range, 42-138) months, 5-year rates of local, elsewhere, locoregional, and distant control were all 97.2%. 5-year ipsilateral breast tumor recurrence rates (IBTR) were 5.6% (2/36), 8.3% (2/24) for AMBI, and 0% (0/12) for A-PHDRBT-boost patients. Both instances of IBTR were confirmed G3 tumors in pre-operative biopsies; no IBTR was documented in G1-2 tumors. Cosmetic outcomes were excellent/good in 96% of AMBI vs. 67% in A-PHDRBT-boost (p = 0.034).

Conclusions
The MITBI-PHDRBT program allows selection of patients with excellent prognoses (G1-2 DCIS with negative margins and no multifocality), for whom AMBI could be a good alternative with low recurrence rate, decrease of unnecessary radiation, treatment logistics improvement, and over-treatment reduction. Patients whose pre-operative biopsy showed G3 tumor, presents with inferior local control and more risk of reoperation due to positive margins.

keywords:

partial breast irradiation, DCIS, high-dose-rate brachytherapy

 
Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.