Ten-year Results of a Phase II Study with a Single Fraction of High-dose-rate Brachytherapy (FAST-boost) After Whole Breast Irradiation in Invasive Breast Carcinoma

Overview

Journal Clin Transl Oncol

Specialty Oncology

Date 2012 Feb 4

PMID 22301399

Citations 3

Authors

Jose Luis Guinot

M Isabel Tortajada

Maria Carrascosa

Vicente Crispin

Ana Otero

Belen Rios

Eleonor Rivin

Miguel Santos

Pablo Soler

Leoncio Arribas

Affiliations

Soon will be listed here.

Abstract

Purpose: We present the results of a prospective ten-year follow-up study to prove the effectiveness of a single fraction of 192-Ir high-dose-rate (HDR) brachytherapy (BT) as a boost.

Patients And Methods: Between 1999 and 2000, 84 consecutive patients with invasive breast carcinoma, with over 4 mm free margins after conservative surgery, were treated. All cases were stages T1-2, except for one case, a stage T3, 81% pN0, 19% pN1-2. Chemotherapy was used in 47% and hormonal therapy in 87%. Whole breast external beam radiotherapy (46 Gy) was followed 1-2 weeks later by an implant with metallic needles. A 7 Gy single dose of HDR BT to the 90% isodose line was delivered on an outpatient basis. Dosimetry was performed theoretically. This technique is called FAST-boost because the whole treatment is delivered in about two hours.

Results: With a median follow-up of 120 months, three patients relapsed in the margin of the implant and two in a different quadrant (5/84, 6%). Actuarial local control at five and ten years was 98.5% and 95.6%. Overall survival was 92.7% and 90.2%, and disease-free survival 90.2% and 79.9%. Cosmetic results were good or excellent in 92.5%.

Conclusions: A single-fraction HDR boost with rigid needles (FAST-boost) is a good, quick, simple technique when surgical margins are free.

Citing Articles

Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis.

Sanz J, Rodriguez N, Foro P, Dengra J, Reig A, Perez P Clin Transl Oncol. 2016; 19(4):464-469.

PMID: 27655367 DOI: 10.1007/s12094-016-1548-3.

A review of the clinical experience in pulsed dose rate brachytherapy.

Balgobind B, Koedooder K, Ordonez Zuniga D, Davila Fajardo R, Rasch C, Pieters B Br J Radiol. 2015; 88(1055):20150310.

PMID: 26290399 PMC: 4743453. DOI: 10.1259/bjr.20150310.

Conservative surgery, external radiotherapy, and HDR brachytherapy in a single fraction of 7 Gy in early breast cancer: long-term toxicity and esthetic assessment.

Rodriguez Perez A, Lopez Carrizosa M, Samper Ots P, Perez-Regadera Gomez J, Zapatero Ortuno J, Saez Garrido J Clin Transl Oncol. 2012; 14(12):953-60.

PMID: 22975899 DOI: 10.1007/s12094-012-0881-4.

References

Lopez Carrizosa M, Samper Ots P, Vallejo Ocana C, Rodriguez Perez A, Saez Garrido J, Delgado Perez J . Early stage breast cancer conserving treatment: high dose rate brachytherapy boost to the tumour bed. Clin Transl Oncol. 2005; 7(8):344-50. DOI: 10.1007/BF02716550. View

Bartelink H, Horiot J, Poortmans P, Struikmans H, Van den Bogaert W, Fourquet A . Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007; 25(22):3259-65. DOI: 10.1200/JCO.2007.11.4991. View

Cox J, Stetz J, Pajak T . Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5):1341-6. DOI: 10.1016/0360-3016(95)00060-C. View

Moreno F, Guedea F, Lopez Y, Ferrer F, Gutierrez C, Petriz L . External beam irradiation plus (192)Ir implant after breast-preserving surgery in women with early breast cancer. Int J Radiat Oncol Biol Phys. 2000; 48(3):757-65. DOI: 10.1016/s0360-3016(00)00676-3. View

Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V . Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 366(9503):2087-106. DOI: 10.1016/S0140-6736(05)67887-7. View

Hurkmans C, Borger J, Pieters B, Russell N, Jansen E, Mijnheer B . Variability in target volume delineation on CT scans of the breast. Int J Radiat Oncol Biol Phys. 2001; 50(5):1366-72. DOI: 10.1016/s0360-3016(01)01635-2. View

Hepel J, Evans S, Hiatt J, Price L, DiPetrillo T, Wazer D . Planning the breast boost: comparison of three techniques and evolution of tumor bed during treatment. Int J Radiat Oncol Biol Phys. 2008; 74(2):458-63. DOI: 10.1016/j.ijrobp.2008.08.051. View

Wazer D, DiPetrillo T, Schmidt-Ullrich R, Weld L, Smith T, MARCHANT D . Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992; 10(3):356-63. DOI: 10.1200/JCO.1992.10.3.356. View

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A . 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(16):1227-32. DOI: 10.1056/NEJMoa020989. View

10.

Sharma R, Spierer M, Mutyala S, Thawani N, Cohen H, Hong L . Change in seroma volume during whole-breast radiation therapy. Int J Radiat Oncol Biol Phys. 2009; 75(1):89-93. DOI: 10.1016/j.ijrobp.2008.10.037. View

11.

Graham P, Fourquet A . Placing the boost in breast-conservation radiotherapy: A review of the role, indications and techniques for breast-boost radiotherapy. Clin Oncol (R Coll Radiol). 2006; 18(3):210-9. DOI: 10.1016/j.clon.2005.11.008. View

12.

Livi L, Borghesi S, Saieva C, Fambrini M, Iannalfi A, Greto D . Benefit of radiation boost after whole-breast radiotherapy. Int J Radiat Oncol Biol Phys. 2009; 75(4):1029-34. DOI: 10.1016/j.ijrobp.2008.12.038. View

13.

Komoike Y, Akiyama F, Iino Y, Ikeda T, Akashi-Tanaka S, Ohsumi S . Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer. 2005; 106(1):35-41. DOI: 10.1002/cncr.21551. View

14.

Intra M, Luini A, Gatti G, Ciocca M, Gentilini O, Viana A . Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: a lesson learned by over 1000 procedures. Surgery. 2006; 140(3):467-71. DOI: 10.1016/j.surg.2006.03.019. View

15.

Poortmans P, Bartelink H, Horiot J, Struikmans H, Van den Bogaert W, Fourquet A . The influence of the boost technique on local control in breast conserving treatment in the EORTC 'boost versus no boost' randomised trial. Radiother Oncol. 2004; 72(1):25-33. DOI: 10.1016/j.radonc.2004.03.007. View

16.

Polgar C, Fodor J, Orosz Z, Major T, Takacsi-Nagy Z, Mangel L . Electron and high-dose-rate brachytherapy boost in the conservative treatment of stage I-II breast cancer first results of the randomized Budapest boost trial. Strahlenther Onkol. 2002; 178(11):615-23. DOI: 10.1007/s00066-002-1053-1. View

17.

Budrukkar A, Sarin R, Shrivastava S, Deshpande D, Dinshaw K . Cosmesis, late sequelae and local control after breast-conserving therapy: influence of type of tumour bed boost and adjuvant chemotherapy. Clin Oncol (R Coll Radiol). 2007; 19(8):596-603. DOI: 10.1016/j.clon.2007.06.008. View

18.

Fein D, Fowble B, Hanlon A, Hoffman J, Sigurdson E, Eisenberg B . Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast-conserving surgery and irradiation. Int J Radiat Oncol Biol Phys. 1996; 34(5):1009-17. DOI: 10.1016/0360-3016(95)02258-9. View

19.

Hammer J, Seewald D, Track C, Zoidl J, Labeck W . Breast cancer: primary treatment with external-beam radiation therapy and high-dose-rate iridium implantation. Radiology. 1994; 193(2):573-7. DOI: 10.1148/radiology.193.2.7972782. View

20.

Kramer B, Arthur D, Ulin K, Schmidt-Ullrich R, Zwicker R, Wazer D . Cosmetic outcome in patients receiving an interstitial implant as part of breast-conservation therapy. Radiology. 1999; 213(1):61-6. DOI: 10.1148/radiology.213.1.r99oc1861. View