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Long-Term Control and Toxicity Rates After Accelerated Partial Breast Irradiation With Single-Channel Balloon Brachytherapy for Early Breast Cancer
Abstracts / Brachytherapy 10 (2011) S14eS101
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Median followup was 491 days (min 19 and max 1115). There were 5 relapses and all were elsewhere failures. 2 died of intercurrent disease and 92 were alive with no evidence of disease. Conclusions: The initial data seem show good concordance between physicians and nurses and patients in about 50% of the patients. The presence of seroma and number of re-excisions seem to have an impact on cosmesis. We plan to continue this study by including surgeons in the cosmesis evaluation. The data required breast cup size, laterality and quadrant will be presented at the MTG. Impact of chemotherapy will also be evaluated.
PD11 Impact of Time Interval Between Surgery and Radiation on Partial Breast Radiation and Infection and Cosmesis Kevin G. Leong, BS, Akshay N. Desai, Ghulam S. Khan, MD, Ayesha Aslam, MD, Gopal R. Desai, MD. Radiation Oncology, Saint Peters University Hospital, New Brunswick, NJ. Purpose: The purpose of the study is to investigate the impact of time interval and its effects on patient’s cosmesis, wound healing and infection rates in patients undergoing partial breast radiation for early breast cancer. It is unclear as to what the optimal time interval between lumpectomy and placement of balloon and beginning of radiation should be. We reviewed the charts of patients treated under our institutional IRB approved Partial breast radiation study. Materials and Methods: Charts of 94 breast cancer patients undergoing partial breast radiation(treated between May 2007 and June 2010) with MammoSite Balloon were reviewed. The patients were evaluated for incidence of infection and cosmesis. A majority of the patients were 60 years and above (64%). There were 25 patients in the age group of 50-60 yrs and 10 under the ages of the 45-50 yrs. This group was in line with the NSABP B39 study and the in-house study was later amended to include only patients over the age of 50 yrs. An arbitrary cut off of 7 days or less was chosen as the first group (Group 1), with second group (Group 2) being all with time interval of 8 days or more and groups were stratified with regard to infection and cosmesis. All patients are placed on prophylactic antibiotics at the time of lumpectomy. Median followup was 491 days (min 19 and max 1115). There were 5 relapses and all were elsewhere failures. 2 died of intercurrent disease and 92 were alive with no evidence of disease. Results: The median age of the patients for the entire group was 65 years. (Group 1 67 and 2 66.5). There were 48 patients (51%) who had 7 or fewer days of time between surgery and radiation and 46 patients (49%) who had 8 days or more of time interval between surgery and radiation. Subset analyses of 5 days or less was also done. The length of balloon installation (no. of days) was also noted. There were 32 (34%) patients who had the balloon in for more than 14 days and 62 patients (66%) who had the balloon in for 14 or fewer days. Included in this subset are 16 (33%) of the 48 patients of Group 1. There were 3 patients who developed infections in group 1 and none in the group 2. Cosmesis was comparable in both groups. Three patients who had infection or wound healing issues had a time interval of 5 days or less. Out of the 62 patients in the shorter balloon dwell, 3 had developed infections on the 9th, 10th and 11th days. Conclusions: Shorter time interval between surgery and radiation seems to show a trend towards increased risk of infection. However, the small number of events and other confounding factors that are associated with increased risk of infection are co-morbidities, surgical technique obviate the importance of this finding. Length of balloon dwell did not have impact in this study. The reported incidence of 6% of infection in this series is in line with what has been reported in the literature. The cosmesis rates seem similar in both the groups. Cosmesis is a function of breast size, location of the tumor, surgical technique and comorbidities and evolves with time. We noticed, as expected, increased scarring with time. Data regarding effect of chemotherapy will be presented at the meeting.
PD12 Long-Term Control and Toxicity Rates After Accelerated Partial Breast Irradiation With Single-Channel Balloon Brachytherapy for Early Breast Cancer Sophy Y. Hernandez, MD, Edward Melian, MD, Linda Millbrandt, RN, Kevin A. Albuquerque, MD. Radiation Oncology, Loyola University Medical Center, Maywood, IL. Purpose: To report cancer control, complications and cosmetic outcome of patients treated with single-channel balloon brachytherapy after breast conservation surgery from a single institution with prolonged followup. Materials and Methods: Forty-five patients,O45 years old with unilateral, non-lobular, T1N0 breast cancer or DCIS were treated with adjuvant radiation therapy using accelerated partial breast irradiation (APBI) with single-channel balloon brachytherapy from 2003 to 2009 on an institutional Phase IV protocol. The balloon catheter was placed within 4 weeks of breast-conserving surgery. All patients were given prophylactic antibiotics. PTV was lumpectomy site plus 1 cm margin. Dose was 34 Gy using high-dose-rate Ir-192 prescribed to 1cm from surface of balloon delivered in 10 fractions given BID 6 hours apart. All patients had CT simulation planning. X-ray verification was done before each fraction to confirm position and stability of the implant. Results: At the time of treatment, the median age of patients was 66 years old (range 46-84). The majority of patients had invasive disease; 34 of 45 patients (75%) had infiltrating ductal carcinoma and 3 patients had other histology (1 infiltrating tubular, 1 infiltrating papillary, and 1 infiltrating mucinous carcinoma). Eight of the 45 patients (17%) had DCIS. Acute and chronic toxicity was graded per RTOG guidelines. Eighteen patients
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Abstracts / Brachytherapy 10 (2011) S14eS101
(40%) developed acute grade 1 skin reaction, 3 developed grade II-III skin toxicity. Six patients (13%) developed acute infections, 5 had cellulitis and 1 had a yeast infection with a draining sinus tract requiring excision. With regards to chronic skin toxicity, 18 patients (40%) developed a seroma, 1 required treatment with antibiotics and 3 required aspiration. Cosmetic result is good with 9 patients (20%) developing moderate telangiectasias and 2 patients with pigmentation changes. Subcutaneous tissue toxicity grade 1 and 2 was seen in 29% and 42% of patients, respectively. Only 1 patient had a grade 3 subcutaneous tissue reaction. The rate of chest wall toxicity is low in this group with only 1 patient found to have a rib fracture without trauma. The mean followup was 47 months. Two patients developed ipsilateral breast cancer, which are considered local failures based on the NSABP definition. Of note, these two lesions had different histologies and hormone status with respect to their primary cancer. Two patients developed distant failures, 1 brain metastasis and 1 bone (rib) metastasis, biopsy proven. Both of these patients eventually died of disease. Conclusions: APBI with single-channel balloon brachytherapy is an effective means of delivering post-lumpectomy radiation therapy with actuarial 5-year locoregional recurrence free survival of 97%. Overall cosmetic result is good with patient satisfaction. However, considerable morbidity persists at long-term followup with regards to chronic subcutaneous skin toxicity on objective assessment.
PD13 Acute Toxicity and Early Cosmetic Outcome in Patients Treated With Multicatheter Balloon Brachytherapy With Skin Spacing #7.0 Millimeters Kiwhoon Lee, MD1, Keith T. Sowards, MS1, Dustin W. Dillon, BA1, Allison R. Hatmaker, MD3, C. Matthew Brown, MD4, Amy R. Quillo, MD2, Anees B. Chagpar, MD2, Anthony E. Dragun, MD1. 1Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY; 2Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY; 3Surgery, Baptist Hospital East, Breast Care Center, Louisville, KY; 4 PLLC, Louisville General Surgery, Louisville, KY. Purpose: To review institutional experience treating patients who underwent breast conserving surgery and adjuvant accelerated partial breast irradiation with multicatheter balloon brachytherapy with close skin spacing (#7 mm). Materials and Methods: Since December 2008, sixty (60) patients were treated with breast-conserving therapy and adjuvant multicatheter balloon brachytherapy and were followed in a prospective database. Of these, twenty-six (26) were found to have skin spacing #7.0 mm at the time of brachytherapy planning. Patients were treated with either the Contura or MammoSite ML catheter to at total dose of 34 Gy in 10 fractions. Patents were assessed for acute toxicity at the completion of treatment and 1month post treatment. Cosmesis and late toxicity were assessed at threemonth intervals thereafter. Only patients with at least 3 months followup are included for analysis. Results: The median age of the patients was 56 years (range 5 50-81) and median followup time was 9 months (range 5 3.0-16). The median minimum skin spacing was 5.8 mm (range 5 2.6-7.0). Sixteen (16) patients were treated with spacing of 5.0-7.0 mm, 10 with !5.0mm. The median percentage of the tissue target (PTV_EVAL) receiving 95% of the prescription dose was 95.6% (range 5 89.9-99.1). The median volume of PTV_EVAL receiving 200% of the prescription dose was 6.1cc (range 5 1.5-10.0). The most commonly observed acute toxicity was grade 1-2 dermatitis (65.4%). Acute toxicity grade 3 was observed in 1 patient who experienced a post-treatment breast abscess. The rate of post-treatment seroma and infection was 38.5% and 3.8%, respectively. The percentage of patients with excellent/good cosmetic results at the time of last followup was 92.3%. Conclusions: Multicatheter balloon brachytherapy is safe and feasible in patients with close skin spacing, with acute toxicity and early cosmesis similar to other published series. These devices may broaden the
application of balloon brachytherapy in patients previously excluded from this treatment based on anatomy or tumor location considerations.
PD14 Safety and Efficacy of Breast Re-Irradiation With High-Dose-Rate Brachytherapy Boris Bahoric, MD, Gabriela Stroian, PhD, Slobodan Devic, PhD, Francois DeBlois, PhD, Thierry Muanza, MD, Khalil Sultanem, MD, Tamim Niazi, MD, Te Vuong, MD. Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada. Purpose: To evaluate the safety and efficacy of high-dose-rate 192Ir (HDR) brachytherapy for breast cancer patients, previously treated with whole breast external beam radiotherapy (EBRT) post lumpectomy. Materials and Methods: From May 2003 to December 2008 11 women with recurrent carcinoma of the breast received HDR brachytherapy post first or second recurrence. The margins at the resections were positive in 6/11 patients and close (less than 2 mm) in the rest. The median dose of brachytherapy was 30 Gy (25-31.2) in 12 fractions (10-12). The treatment was given with two to three plain implants with 1 cm margin for PTV around the contoured cavity. Distance to the skin was maintained at 0.5 cm. 100% dose was allowed to 1cm2 of skin. Results: With a median followup of 3.3 years (1.7-5.9) 1/11 patients recurred in the irradiated field 2.6 years after brachytherapy. The same patient died of metastatic disease 5 years following brachytherapy. Three more patients developed metastatic disease without local recurrence. One died 3.7 years post brachytherapy of metastatic disease. There was no grade 3 toxicity, with grade 1 telangiectasia in two patients. The cosmetic result was considered fair to good in all patients, mostly because of previous surgeries and external beam radiotherapy. Conclusions: Lumpectomy and adjuvant HDR brachytherapy is an effective alternative to total mastectomy for recurrent carcinoma of the breast previously irradiated with EBRT. Despite close or positive margins and PTV of only 1 cm, 10/11 patients were free of local recurrence. Distant metastasis remains a major problem in this population of patients.
PD15 Analysis of Cosmesis, Dosimetric End Points and Local Control Using the Contura Multilumen and MammoSite Balloon Catheters for Accelerated Partial Breast Irradiation Elizabeth Hanlon, DO, Mark Yudelev, PhD, Praveen Dalmia, MS, Kaitlin Hanlon, OMS III, Stephen Cahill, DO, Lynn Mathia, DO, Arthur Frazier, MD. Mount Clemens Regional Medical Center, Mount Clemens, MI. Purpose: To review our institution’s experience treating patients with the Contura multilumen and MammoSite balloon catheters to deliver accelerated partial breast irradiation (APBI). We investigated cosmesis, dosimetric end points and local control. Materials and Methods: A total of seventy-seven patients from January 2005 to September 2010, treated with breast-conserving therapy received APBI. Forty-nine patients received adjuvant radiation using the MammoSite (34 Gy in 3.4-Gy fractions prescribed to 10 mm from the balloon surface). Ten patients received adjuvant radiation using the MammoSite at a dose less than 34 Gy individualized by the radiation oncologist, eight of them had subsequent external beam radiation. Fifteen patients received adjuvant radiation using the Contura multilumen balloon (34 Gy in 3.4-Gy fractions prescribed to 10 mm from the balloon surface). Three patients received adjuvant radiation using the Contura multilumen balloon at an individualized dose less than 34 Gy with subsequent external beam radiation at the discretion of the radiation oncologist. On treatment planning images a 2 mm thickness of skin was defined in the high dose region, and the dose to 1 ccm, 5 ccm, 10 ccm and 20 ccm volumes was extracted from the plan. Seventeen patients (22.1%) had Stage 0, 46 (59.7%) had Stage I and 14 (18.2%) had Stage II breast cancer. The median followup was 20.5 months.
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Median followup was 491 days (min 19 and max 1115). There were 5 relapses and all were elsewhere failures. 2 died of intercurrent disease and 92 were alive with no evidence of disease. Conclusions: The initial data seem show good concordance between physicians and nurses and patients in about 50% of the patients. The presence of seroma and number of re-excisions seem to have an impact on cosmesis. We plan to continue this study by including surgeons in the cosmesis evaluation. The data required breast cup size, laterality and quadrant will be presented at the MTG. Impact of chemotherapy will also be evaluated.
PD11 Impact of Time Interval Between Surgery and Radiation on Partial Breast Radiation and Infection and Cosmesis Kevin G. Leong, BS, Akshay N. Desai, Ghulam S. Khan, MD, Ayesha Aslam, MD, Gopal R. Desai, MD. Radiation Oncology, Saint Peters University Hospital, New Brunswick, NJ. Purpose: The purpose of the study is to investigate the impact of time interval and its effects on patient’s cosmesis, wound healing and infection rates in patients undergoing partial breast radiation for early breast cancer. It is unclear as to what the optimal time interval between lumpectomy and placement of balloon and beginning of radiation should be. We reviewed the charts of patients treated under our institutional IRB approved Partial breast radiation study. Materials and Methods: Charts of 94 breast cancer patients undergoing partial breast radiation(treated between May 2007 and June 2010) with MammoSite Balloon were reviewed. The patients were evaluated for incidence of infection and cosmesis. A majority of the patients were 60 years and above (64%). There were 25 patients in the age group of 50-60 yrs and 10 under the ages of the 45-50 yrs. This group was in line with the NSABP B39 study and the in-house study was later amended to include only patients over the age of 50 yrs. An arbitrary cut off of 7 days or less was chosen as the first group (Group 1), with second group (Group 2) being all with time interval of 8 days or more and groups were stratified with regard to infection and cosmesis. All patients are placed on prophylactic antibiotics at the time of lumpectomy. Median followup was 491 days (min 19 and max 1115). There were 5 relapses and all were elsewhere failures. 2 died of intercurrent disease and 92 were alive with no evidence of disease. Results: The median age of the patients for the entire group was 65 years. (Group 1 67 and 2 66.5). There were 48 patients (51%) who had 7 or fewer days of time between surgery and radiation and 46 patients (49%) who had 8 days or more of time interval between surgery and radiation. Subset analyses of 5 days or less was also done. The length of balloon installation (no. of days) was also noted. There were 32 (34%) patients who had the balloon in for more than 14 days and 62 patients (66%) who had the balloon in for 14 or fewer days. Included in this subset are 16 (33%) of the 48 patients of Group 1. There were 3 patients who developed infections in group 1 and none in the group 2. Cosmesis was comparable in both groups. Three patients who had infection or wound healing issues had a time interval of 5 days or less. Out of the 62 patients in the shorter balloon dwell, 3 had developed infections on the 9th, 10th and 11th days. Conclusions: Shorter time interval between surgery and radiation seems to show a trend towards increased risk of infection. However, the small number of events and other confounding factors that are associated with increased risk of infection are co-morbidities, surgical technique obviate the importance of this finding. Length of balloon dwell did not have impact in this study. The reported incidence of 6% of infection in this series is in line with what has been reported in the literature. The cosmesis rates seem similar in both the groups. Cosmesis is a function of breast size, location of the tumor, surgical technique and comorbidities and evolves with time. We noticed, as expected, increased scarring with time. Data regarding effect of chemotherapy will be presented at the meeting.
PD12 Long-Term Control and Toxicity Rates After Accelerated Partial Breast Irradiation With Single-Channel Balloon Brachytherapy for Early Breast Cancer Sophy Y. Hernandez, MD, Edward Melian, MD, Linda Millbrandt, RN, Kevin A. Albuquerque, MD. Radiation Oncology, Loyola University Medical Center, Maywood, IL. Purpose: To report cancer control, complications and cosmetic outcome of patients treated with single-channel balloon brachytherapy after breast conservation surgery from a single institution with prolonged followup. Materials and Methods: Forty-five patients,O45 years old with unilateral, non-lobular, T1N0 breast cancer or DCIS were treated with adjuvant radiation therapy using accelerated partial breast irradiation (APBI) with single-channel balloon brachytherapy from 2003 to 2009 on an institutional Phase IV protocol. The balloon catheter was placed within 4 weeks of breast-conserving surgery. All patients were given prophylactic antibiotics. PTV was lumpectomy site plus 1 cm margin. Dose was 34 Gy using high-dose-rate Ir-192 prescribed to 1cm from surface of balloon delivered in 10 fractions given BID 6 hours apart. All patients had CT simulation planning. X-ray verification was done before each fraction to confirm position and stability of the implant. Results: At the time of treatment, the median age of patients was 66 years old (range 46-84). The majority of patients had invasive disease; 34 of 45 patients (75%) had infiltrating ductal carcinoma and 3 patients had other histology (1 infiltrating tubular, 1 infiltrating papillary, and 1 infiltrating mucinous carcinoma). Eight of the 45 patients (17%) had DCIS. Acute and chronic toxicity was graded per RTOG guidelines. Eighteen patients
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Abstracts / Brachytherapy 10 (2011) S14eS101
(40%) developed acute grade 1 skin reaction, 3 developed grade II-III skin toxicity. Six patients (13%) developed acute infections, 5 had cellulitis and 1 had a yeast infection with a draining sinus tract requiring excision. With regards to chronic skin toxicity, 18 patients (40%) developed a seroma, 1 required treatment with antibiotics and 3 required aspiration. Cosmetic result is good with 9 patients (20%) developing moderate telangiectasias and 2 patients with pigmentation changes. Subcutaneous tissue toxicity grade 1 and 2 was seen in 29% and 42% of patients, respectively. Only 1 patient had a grade 3 subcutaneous tissue reaction. The rate of chest wall toxicity is low in this group with only 1 patient found to have a rib fracture without trauma. The mean followup was 47 months. Two patients developed ipsilateral breast cancer, which are considered local failures based on the NSABP definition. Of note, these two lesions had different histologies and hormone status with respect to their primary cancer. Two patients developed distant failures, 1 brain metastasis and 1 bone (rib) metastasis, biopsy proven. Both of these patients eventually died of disease. Conclusions: APBI with single-channel balloon brachytherapy is an effective means of delivering post-lumpectomy radiation therapy with actuarial 5-year locoregional recurrence free survival of 97%. Overall cosmetic result is good with patient satisfaction. However, considerable morbidity persists at long-term followup with regards to chronic subcutaneous skin toxicity on objective assessment.
PD13 Acute Toxicity and Early Cosmetic Outcome in Patients Treated With Multicatheter Balloon Brachytherapy With Skin Spacing #7.0 Millimeters Kiwhoon Lee, MD1, Keith T. Sowards, MS1, Dustin W. Dillon, BA1, Allison R. Hatmaker, MD3, C. Matthew Brown, MD4, Amy R. Quillo, MD2, Anees B. Chagpar, MD2, Anthony E. Dragun, MD1. 1Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY; 2Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY; 3Surgery, Baptist Hospital East, Breast Care Center, Louisville, KY; 4 PLLC, Louisville General Surgery, Louisville, KY. Purpose: To review institutional experience treating patients who underwent breast conserving surgery and adjuvant accelerated partial breast irradiation with multicatheter balloon brachytherapy with close skin spacing (#7 mm). Materials and Methods: Since December 2008, sixty (60) patients were treated with breast-conserving therapy and adjuvant multicatheter balloon brachytherapy and were followed in a prospective database. Of these, twenty-six (26) were found to have skin spacing #7.0 mm at the time of brachytherapy planning. Patients were treated with either the Contura or MammoSite ML catheter to at total dose of 34 Gy in 10 fractions. Patents were assessed for acute toxicity at the completion of treatment and 1month post treatment. Cosmesis and late toxicity were assessed at threemonth intervals thereafter. Only patients with at least 3 months followup are included for analysis. Results: The median age of the patients was 56 years (range 5 50-81) and median followup time was 9 months (range 5 3.0-16). The median minimum skin spacing was 5.8 mm (range 5 2.6-7.0). Sixteen (16) patients were treated with spacing of 5.0-7.0 mm, 10 with !5.0mm. The median percentage of the tissue target (PTV_EVAL) receiving 95% of the prescription dose was 95.6% (range 5 89.9-99.1). The median volume of PTV_EVAL receiving 200% of the prescription dose was 6.1cc (range 5 1.5-10.0). The most commonly observed acute toxicity was grade 1-2 dermatitis (65.4%). Acute toxicity grade 3 was observed in 1 patient who experienced a post-treatment breast abscess. The rate of post-treatment seroma and infection was 38.5% and 3.8%, respectively. The percentage of patients with excellent/good cosmetic results at the time of last followup was 92.3%. Conclusions: Multicatheter balloon brachytherapy is safe and feasible in patients with close skin spacing, with acute toxicity and early cosmesis similar to other published series. These devices may broaden the
application of balloon brachytherapy in patients previously excluded from this treatment based on anatomy or tumor location considerations.
PD14 Safety and Efficacy of Breast Re-Irradiation With High-Dose-Rate Brachytherapy Boris Bahoric, MD, Gabriela Stroian, PhD, Slobodan Devic, PhD, Francois DeBlois, PhD, Thierry Muanza, MD, Khalil Sultanem, MD, Tamim Niazi, MD, Te Vuong, MD. Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada. Purpose: To evaluate the safety and efficacy of high-dose-rate 192Ir (HDR) brachytherapy for breast cancer patients, previously treated with whole breast external beam radiotherapy (EBRT) post lumpectomy. Materials and Methods: From May 2003 to December 2008 11 women with recurrent carcinoma of the breast received HDR brachytherapy post first or second recurrence. The margins at the resections were positive in 6/11 patients and close (less than 2 mm) in the rest. The median dose of brachytherapy was 30 Gy (25-31.2) in 12 fractions (10-12). The treatment was given with two to three plain implants with 1 cm margin for PTV around the contoured cavity. Distance to the skin was maintained at 0.5 cm. 100% dose was allowed to 1cm2 of skin. Results: With a median followup of 3.3 years (1.7-5.9) 1/11 patients recurred in the irradiated field 2.6 years after brachytherapy. The same patient died of metastatic disease 5 years following brachytherapy. Three more patients developed metastatic disease without local recurrence. One died 3.7 years post brachytherapy of metastatic disease. There was no grade 3 toxicity, with grade 1 telangiectasia in two patients. The cosmetic result was considered fair to good in all patients, mostly because of previous surgeries and external beam radiotherapy. Conclusions: Lumpectomy and adjuvant HDR brachytherapy is an effective alternative to total mastectomy for recurrent carcinoma of the breast previously irradiated with EBRT. Despite close or positive margins and PTV of only 1 cm, 10/11 patients were free of local recurrence. Distant metastasis remains a major problem in this population of patients.
PD15 Analysis of Cosmesis, Dosimetric End Points and Local Control Using the Contura Multilumen and MammoSite Balloon Catheters for Accelerated Partial Breast Irradiation Elizabeth Hanlon, DO, Mark Yudelev, PhD, Praveen Dalmia, MS, Kaitlin Hanlon, OMS III, Stephen Cahill, DO, Lynn Mathia, DO, Arthur Frazier, MD. Mount Clemens Regional Medical Center, Mount Clemens, MI. Purpose: To review our institution’s experience treating patients with the Contura multilumen and MammoSite balloon catheters to deliver accelerated partial breast irradiation (APBI). We investigated cosmesis, dosimetric end points and local control. Materials and Methods: A total of seventy-seven patients from January 2005 to September 2010, treated with breast-conserving therapy received APBI. Forty-nine patients received adjuvant radiation using the MammoSite (34 Gy in 3.4-Gy fractions prescribed to 10 mm from the balloon surface). Ten patients received adjuvant radiation using the MammoSite at a dose less than 34 Gy individualized by the radiation oncologist, eight of them had subsequent external beam radiation. Fifteen patients received adjuvant radiation using the Contura multilumen balloon (34 Gy in 3.4-Gy fractions prescribed to 10 mm from the balloon surface). Three patients received adjuvant radiation using the Contura multilumen balloon at an individualized dose less than 34 Gy with subsequent external beam radiation at the discretion of the radiation oncologist. On treatment planning images a 2 mm thickness of skin was defined in the high dose region, and the dose to 1 ccm, 5 ccm, 10 ccm and 20 ccm volumes was extracted from the plan. Seventeen patients (22.1%) had Stage 0, 46 (59.7%) had Stage I and 14 (18.2%) had Stage II breast cancer. The median followup was 20.5 months.