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
SCImago Journal & Country Rank

Interview with Professor Janusz Skowronek
ABS 2015
vol. 10
Original paper

Accelerated partial breast irradiation in a single 18 Gy fraction with high-dose-rate brachytherapy: preliminary results

Javier Anchuelo Latorre, Piedad Galdós, Lucía Alonso Buznego, Ana García Blanco, Juan Cardenal, María Ferri, Iván Díaz de Cerio, Elisabet Arrojo, Nicolás Sierrasesúmaga, Mónica González Noriega, Ana De Juan Ferré, Rosa Fabregat, Samuel Ruíz, Pedro J. Prada

J Contemp Brachytherapy 2018; 10, 1: 58–63
Online publish date: 2018/02/28
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
To evaluate the feasibility of acute and chronic toxicity in patients suitable for accelerated partial breast irradiation (APBI) in a single 18 Gy fraction with multicatheter high-dose-rate (HDR) brachytherapy, as well as cosmetic and oncological outcomes.

Material and methods
Between September 2014 and March 2016, twenty consecutive patients with low-risk invasive and ductal carcinoma in situ were treated with interstitial multicatheter HDR brachytherapy in a single 18 Gy fraction.

Median age was 63.5 years (range, 51-79). Acute toxicity was observed in seven patients, while the pain during following days and hematoma were seen in four patients. With a median follow-up of 24 months, late toxicity was found in one patient with fat necrosis g2 and fibrosis g2 in another patient. The overall survival (OS) and locoregional control (LC) was 100%. Disease-free survival (DFS) and distant control was 95%. Good to excellent cosmetic outcomes were noted in 80% of patients and fair in 4 patients (20%).

This is the first report in the medical literature that focuses on feasibility and acute and chronic toxicity, with a median follow-up of 24 months (range, 20-40). The protocol is viable and convenient. However, a longer follow-up is needed to know chronic toxicity and oncologic outcomes.


APBI, brachytherapy, breast cancer, morbidity

Fisher B, Anderson S, Bryant J et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233-1124.
Veronesi U, Cascinelli N, Mariani L et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227-1232.
Litière S, Werutsky G, Fentiman IS et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20-year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol 2012; 13: 412-419.
Whelan TJ, Pignol JP, Levine MN et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010; 362: 513-520.
Showalter SL, Grover S, Sharma S et al. Factors influencing surgical and adjuvant therapy in stage I breast cancer: a SEER 18 database analysis. Ann Surg Oncol 2013; 20: 1287-1294.
Husain ZA, Mahmood U, Hanlon A et al. Accelerated Partial Breast Irradiation via brachytherapy: a patterns-of-care analysis with ASTRO consensus groupings. Brachytherapy 2011; 10: 479-485.
Lettmaier S, Kreppner S, Lotter M et al. Radiation exposure of the heart, lung and skin by radiation therapy for breast cancer: a dosimetric comparison between partial breast irradiation using multicatheter brachytherapy and whole breast teletherapy. Radiother Oncol 2011; 100: 189-194.
Major T, Stelczer G, Pesznyák C et al. Multicatheter interstitial brachytherapy versus intensity modulated external beam therapy for accelerated partial breast irradiation: A comparative treatment planning study with respect to dosimetry of organs at risk. Radiother Oncol 2017; 122: 17-23.
Fleming I, Cooper JS, Henson DE et al. AJCC Cancer staging Manual. 5th ed. Lippincitt-Raven, Philadelphia 1997.
Harris JR, Levene MB, Svensson G et al. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 1979; 5: 257-261.
Ribeiro GG, Dunn G, Swindell R et al. Conservation of the breast using two different radiotherapy techniques: interim report of a clinical trial. Clin Oncol (R Coll Radiol) 1990; 2: 27-34.
Fentiman IS, Poole C, Tong D et al. Iridium implant treatment without external radiotherapy for operable breast cancer: a pilot study. Eur J Cancer 1991; 27: 447-450.
King TA, Bolton JS, Kuske RR et al. Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T breast cancer. Am J Surg 2000; 180: 299-304.
Baglan KL, Martinez AA, Frazier RC et al. The use of high dose- rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2001; 50: 1003-1011.
Kuske RR, Winter K, Arthur DW et al. Phase II trial of brachytherapy alone after lumpectomy for select breast cancer: toxicity analysis of RTOG 95-17. Int J Radiat Oncol Biol Phys 2006; 65: 45-51.
Shah C, Wobb J, Manyam B et al. Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow. J Contemp Brachytherapy 2016; 8: 90-94.
Polgár C, Fodor J, Major T et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma – 5-year results of a randomized trial. Int J Radiat Oncol Biol Phys 2007; 69: 694-702.
Polgár C, Sulyok Z, Fodor J et al. Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: five-year results of a phase I-II study and initial findings of a randomized phase III trial. J Surg Oncol 2002; 80: 121-128.
Ott OJ, Strnad V, Hildebrandt G et al. GEC-ESTRO multicenter phase 3-trial: Accelerated partial breast irradiation with interstitial multicatheter brachytherapy versus external beam whole breast irradiation: Early toxicity and patient compliance. Radiother Oncol 2016; 120: 119-123.
Strnad V, Ott OJ, Hildebrandt G et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, noninferiority trial. Lancet 2016; 387: 229-238.
Nose T, Otani Y, Asahi S et al. A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: clinical results with a median follow-up of 26 months. Breast Cancer 2016; 23: 861-868.
Aliyev JA, Isayev IH, Akbarov KS et al. High-dose-rate interstitial brachytherapy for accelerated partial breast irradiation – trial results of Azerbaijan National Center of Oncology. J Contemp Brachytherapy 2017; 9: 106-111.
Khan AJ, Vicini FA, Brown S et al. Dosimetric feasibility and acute toxicity in a prospective trial of ultrashort-course accelerated partial breast irradiation (APBI) using a multi-lumen balloon brachytherapy device. Ann Surg Oncol 2013; 20: 1295-1301.
Wilkinson, Chen PY, Wallace MF et al. Six-Year Results from a Phase I/II Trial for Hypofractionated Accelerated Partial Breast Irradiation Using a 2-Day Dose Schedule. Am J Clin Oncol 2017; doi: 10.1097/COC.0000000000000402.
Hannoun-Lévi JM, Cham Kee DL, Gal J et al. Accelerated partial breast irradiation for suitable elderly women using a single fraction of multicatheter interstitial high-dose-rate brachytherapy: Early results of the Single-Fraction Elderly Breast Irradiation (SiFEBI) Phase I/II trial. Brachytherapy 2018; doi: 10.1016/j.brachy.2017.11.008.
Horton JK, Blitzblau RC, Yoo S et al. Preoperative Single-Fraction Partial Breast Radiation Therapy: A Novel Phase 1, Dose-Escalation Protocol with Radiation Response Biomarkers. Int J Radiat Oncol Biol Phys 2015; 92: 846-855.
Vaidya JS, Joseph DJ, Tobias JS et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010; 376: 91-102.
Veronesi U, Orecchia R, Maisonneuve P et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013; 14: 1269-1277.
Brown JM, Carlson DJ, Brenner DJ et al. The Tumor Radiobiology of SRS and SBRT: Are More Than the 5 R’s Involved? Int J Radiat Oncol Biol Phys 2014; 88: 254-262.
Brenner DJ. The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction. Semin Radiat Oncol 2008; 18: 234-239.
Hannoun-Levi JM, Chand-Fouche ME, Dejean C et al. Dose gradient impact on equivalent dose at 2 Gy for high dose rate interstitial brachytherapy. J Contemp Brachytherapy 2012; 4: 14-20.
Akhtari M, Abboud M, Szeja S et al. Clinical outcomes, toxicity, and cosmesis in breast cancer patients with close skin spacing treated with accelerated partial breast irradiation (APBI) using multi-lumen/catheter applicators. J Contemp Brachytherapy 2016; 8: 497-504.
Upreti RR, Budrukkar A, Upreti U et al. Change of target volume and its dosimetric impact during the course of accelerated partial breast irradiation using intraoperative multicatheter interstitial brachytherapy after open cavity surgery. Brachytherapy 2017; 16: 1028-1034.
Gurram L, Wadasadawala T, Joshi K et al. Multi-catheter interstitial brachytherapy for partial breast irradiation: an audit of implant quality based on dosimetric evaluation comparing intra-operative versus post-operative placement. J Contemp Brachytherapy 2016; 8: 116-121.
Bitter SM, Heffron-Cartwright P, Wennerstrom C et al. WBRT vs. APBI: an interim report of patient satisfaction and outcomes. J Contemp Brachytherapy 2016; 8: 17-22.
Harat A, Harat M, Makarewicz R. Whole breast irradiation vs. APBI using multicatheter brachytherapy in early breast cancer - simulation of treatment costs based on phase 3 trial data. J Contemp Brachytherapy 2016; 8: 505-511.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe