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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2020
vol. 12
 
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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
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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

 
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