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Japanese Multi-Institutional Feasibility Study of APBI Using Interstitial Brachytherapy
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Abstracts / Brachytherapy 10 (2011) S14eS101
device was used for both pre- and post-implant planning. Stranded seeds were created and intraoperatively placed in real time using the INSTANT (tm) device. A total dose of 25 Gy was delivered to the biopsy cavity with 1.0cm margin over the life of the isotope. The patients wore a shielded bra for six weeks after the procedure. Pre-planning utilized ultrasound and CT while post planning utilized CT only at one week. A second CT was performed 6 weeks after the seed implant to verify seed stability. Results: Cosmetic results were excellent with no evidence of needle marks by 6 weeks post procedure. Patient tolerance was exceptional, returning to work within 3 days of the procedure with minimal to no breast discomfort. No acute erythema and no radiation mysositis observed over the first 3 months after the procedure. Conclusions: Permanent 103Pd seed implantation as boost therapy appears to be safe. It is inexpensive and is well tolerated. A similar technique has been described by Pignol, et al for the sole local mangement of early stage breast cancer and the technique described in this paper could easily by adjusted to provide the sole local management for early stage breast cancer as well.
PD9 Japanese Multi-Institutional Feasibility Study of APBI Using Interstitial Brachytherapy Takayuki Nose, MD, PhD1, Yuuki Ootani, PhD2, Hiroshi Sekine, MD, PhD2, Takushi Dokiya, MD, PhD2, Toshiaki Saeki, MD, PhD2, Iwao Tsukiyama, MD, PhD3, Shuji Asahi, MD, PhD3, Ken Yoshida, MD, PhD4, Norikazu Masuda, MD, PhD4, Eisaku Yoden, MD, PhD5, Kazutaka Nakashima, MD, PhD5, Yasunari Matsumura, MD, PhD6, Teruhiko Fujii, MD, PhD6, Seiji Tachiiri, MD, PhD7, Yoshio Moriguchi, MD, PhD7, Masahiko Oguchi, MD, PhD8, Takushi Iwase, M8, Jun Itami, MD, PhD9, Takayuki Kinoshita, MD, PhD9, Satoshi Uehara, MD, PhD10, Shinji Ohno, MD, PhD10. 1Radiation Oncology, Nippon Medical School Tamanagayama Hospital, Tama, Tokyo, Japan; 2Radiation Oncology/ Breast Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; 3Radiogy/Surgery, Aidu Chuo Hospital, Aiduwakamatsu, Fukushima, Japan; 4Radiation Oncology/Breast Surgery, Osaka National Hospital, Osaka, Japan; 5Radiation Oncology/Breast Surgery, Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan; 6 Radiogy/Breast Surgery, Kyushu Medical Center, Fukuoka, Japan; 7 Radiation Oncology/Surgery, Kyoto City Hospital, Kyoto, Japan; 8 Radiation Oncology/Breast Surgery, Cancer Institute Hospital, Koto, Tokyo, Japan; 9Radiation Oncology/Breast Surgery, National Cancer Center Hospital, Chuo, Tokyo, Japan; 10Radiation Oncology/Breast Surgery, National Kyushu Cancer Center, Fukuoka, Japan. Purpose: To evaluate the reproducibility of APBI using HDR interstitial brachytherapy in a multi-institutional setting in Japan. Secondary endpoints are sequela ratio, local control ratio, and cosmesis. Materials and Methods: From January 2009, forty-six patients are planned to be recruited to prove the reproducibility of APBI concerning 1: CTV minimum dose represented by the dose for surgical clipsO56 Gy/fr, 2: Irradiated volume constraint principally 40-150cm3, 3: Uniformity of dose distribution represented by Dose Non-Uniformity Ratio (DNR, V150/V100)!0.35. When these three criterion are all met for a given patient, the corresponding plan is considered reproducible. When the No. of non-reproducible patients are !54 at the study completion, APBI of this setting is statistically judged as reproducible. As of October 2010, 18 patients were recruited. Eight institutions are participating in the study and 4 institutions are planning to join. Essential eligibility criterion are histological tumor size!53 cm, pN0, no tumor exposure at surgical margin, age O535 y.o. A dose of 36 Gy/6fr/3-4 days was delivered at a selected isodose-surface for dose prescription using microSelectronHDR (Chiyoda Technol/Nucletron). Results: As of October 2010, 17 patients among 18 were tentatively judged as reproducible. No local recurrences or severe sequelae are reported so far. Conclusions: At 40% completion of patient recruitment, 94% of patients were tentatively judged as reproducible. With the recent accelerated recruitment, the final results are expected before 2012.
PD10 Interobserver Cosmesis Evalution in Patients Undergoing Partial Breast Radiation Kathy Covert, MS, APN, Kevin G. Leong, BS, Ayesha Aslam, MD, Gopal R. Desai, MD. Radiation Oncology, Saint Peters University Hospital, New Brunswick, NJ. Purpose: There is extensive literature with regards to cosmesis in patients undergoing breast conservation therapy with external beam radiation. We undertook a study to look at physician, patient and nurse perception of cosmesis after partial breast radiation. We reviewed the charts of patients who underwent partial breast radiation as a part of our IRB approved institutional study. Materials and Methods: There were a total of 94 patients treated from May 2007 at our institution. Of these there was data on 47 patients who had cosmesis evaluation by all three. The evaluations were compared. The Harvard scale for cosmesis was used for all three. For physicians and nurse evaluation there were additional evaluation points which included skin telangiectasia, skin atrophy, pigment change, erythema, fat necrosis, fibrosis, volume loss, scarring, and contour defect. These were scored as 0, 1 and 2. Score of 0 meant absence, 1 meant present but does not impact on cosmesis and 2 affecting cosmesis significantly. All patients are placed on prophylactic antibiotics at the time of lumpectomy. Results: Of the 46 cosmesis by the patients, 22 were in excellent category, 20 were in good and 4 were in fair category. There were none in poor category. Of this, nurse evaluation showed excellent, good and fair category. The physician evaluation showed these numbers for different categories. The concordance between all three was 47% and the concordance between two groups was (MDs and nurses: 72% and Nurses and patients 64%, and patients and MDs 66%).
Abstracts / Brachytherapy 10 (2011) S14eS101
device was used for both pre- and post-implant planning. Stranded seeds were created and intraoperatively placed in real time using the INSTANT (tm) device. A total dose of 25 Gy was delivered to the biopsy cavity with 1.0cm margin over the life of the isotope. The patients wore a shielded bra for six weeks after the procedure. Pre-planning utilized ultrasound and CT while post planning utilized CT only at one week. A second CT was performed 6 weeks after the seed implant to verify seed stability. Results: Cosmetic results were excellent with no evidence of needle marks by 6 weeks post procedure. Patient tolerance was exceptional, returning to work within 3 days of the procedure with minimal to no breast discomfort. No acute erythema and no radiation mysositis observed over the first 3 months after the procedure. Conclusions: Permanent 103Pd seed implantation as boost therapy appears to be safe. It is inexpensive and is well tolerated. A similar technique has been described by Pignol, et al for the sole local mangement of early stage breast cancer and the technique described in this paper could easily by adjusted to provide the sole local management for early stage breast cancer as well.
PD9 Japanese Multi-Institutional Feasibility Study of APBI Using Interstitial Brachytherapy Takayuki Nose, MD, PhD1, Yuuki Ootani, PhD2, Hiroshi Sekine, MD, PhD2, Takushi Dokiya, MD, PhD2, Toshiaki Saeki, MD, PhD2, Iwao Tsukiyama, MD, PhD3, Shuji Asahi, MD, PhD3, Ken Yoshida, MD, PhD4, Norikazu Masuda, MD, PhD4, Eisaku Yoden, MD, PhD5, Kazutaka Nakashima, MD, PhD5, Yasunari Matsumura, MD, PhD6, Teruhiko Fujii, MD, PhD6, Seiji Tachiiri, MD, PhD7, Yoshio Moriguchi, MD, PhD7, Masahiko Oguchi, MD, PhD8, Takushi Iwase, M8, Jun Itami, MD, PhD9, Takayuki Kinoshita, MD, PhD9, Satoshi Uehara, MD, PhD10, Shinji Ohno, MD, PhD10. 1Radiation Oncology, Nippon Medical School Tamanagayama Hospital, Tama, Tokyo, Japan; 2Radiation Oncology/ Breast Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; 3Radiogy/Surgery, Aidu Chuo Hospital, Aiduwakamatsu, Fukushima, Japan; 4Radiation Oncology/Breast Surgery, Osaka National Hospital, Osaka, Japan; 5Radiation Oncology/Breast Surgery, Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan; 6 Radiogy/Breast Surgery, Kyushu Medical Center, Fukuoka, Japan; 7 Radiation Oncology/Surgery, Kyoto City Hospital, Kyoto, Japan; 8 Radiation Oncology/Breast Surgery, Cancer Institute Hospital, Koto, Tokyo, Japan; 9Radiation Oncology/Breast Surgery, National Cancer Center Hospital, Chuo, Tokyo, Japan; 10Radiation Oncology/Breast Surgery, National Kyushu Cancer Center, Fukuoka, Japan. Purpose: To evaluate the reproducibility of APBI using HDR interstitial brachytherapy in a multi-institutional setting in Japan. Secondary endpoints are sequela ratio, local control ratio, and cosmesis. Materials and Methods: From January 2009, forty-six patients are planned to be recruited to prove the reproducibility of APBI concerning 1: CTV minimum dose represented by the dose for surgical clipsO56 Gy/fr, 2: Irradiated volume constraint principally 40-150cm3, 3: Uniformity of dose distribution represented by Dose Non-Uniformity Ratio (DNR, V150/V100)!0.35. When these three criterion are all met for a given patient, the corresponding plan is considered reproducible. When the No. of non-reproducible patients are !54 at the study completion, APBI of this setting is statistically judged as reproducible. As of October 2010, 18 patients were recruited. Eight institutions are participating in the study and 4 institutions are planning to join. Essential eligibility criterion are histological tumor size!53 cm, pN0, no tumor exposure at surgical margin, age O535 y.o. A dose of 36 Gy/6fr/3-4 days was delivered at a selected isodose-surface for dose prescription using microSelectronHDR (Chiyoda Technol/Nucletron). Results: As of October 2010, 17 patients among 18 were tentatively judged as reproducible. No local recurrences or severe sequelae are reported so far. Conclusions: At 40% completion of patient recruitment, 94% of patients were tentatively judged as reproducible. With the recent accelerated recruitment, the final results are expected before 2012.
PD10 Interobserver Cosmesis Evalution in Patients Undergoing Partial Breast Radiation Kathy Covert, MS, APN, Kevin G. Leong, BS, Ayesha Aslam, MD, Gopal R. Desai, MD. Radiation Oncology, Saint Peters University Hospital, New Brunswick, NJ. Purpose: There is extensive literature with regards to cosmesis in patients undergoing breast conservation therapy with external beam radiation. We undertook a study to look at physician, patient and nurse perception of cosmesis after partial breast radiation. We reviewed the charts of patients who underwent partial breast radiation as a part of our IRB approved institutional study. Materials and Methods: There were a total of 94 patients treated from May 2007 at our institution. Of these there was data on 47 patients who had cosmesis evaluation by all three. The evaluations were compared. The Harvard scale for cosmesis was used for all three. For physicians and nurse evaluation there were additional evaluation points which included skin telangiectasia, skin atrophy, pigment change, erythema, fat necrosis, fibrosis, volume loss, scarring, and contour defect. These were scored as 0, 1 and 2. Score of 0 meant absence, 1 meant present but does not impact on cosmesis and 2 affecting cosmesis significantly. All patients are placed on prophylactic antibiotics at the time of lumpectomy. Results: Of the 46 cosmesis by the patients, 22 were in excellent category, 20 were in good and 4 were in fair category. There were none in poor category. Of this, nurse evaluation showed excellent, good and fair category. The physician evaluation showed these numbers for different categories. The concordance between all three was 47% and the concordance between two groups was (MDs and nurses: 72% and Nurses and patients 64%, and patients and MDs 66%).