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Safety and Efficacy of Breast Re-Irradiation With High-Dose-Rate Brachytherapy
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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.
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.