Preliminary results of a phase I/II study of HDR brachytherapy alone for T1/T2 breast cancer
Language: 
English
Abstract: 

PURPOSE: To investigate the feasibility, toxicity, cosmetic outcome, and local control of high-dose-rate (HDR) brachytherapy alone without whole breast external beam irradiation for early-stage breast carcinoma. METHODS AND MATERIALS: Between June 1997 and August 1999, 32 women diagnosed with a total of 33 AJCC Stage I/II breast carcinomas underwent surgical breast excision and postoperative irradiation using HDR brachytherapy interstitial implantation as part of a multi-institutional clinical Phase I/II protocol. Eligible patients included those with T1, T2, N0, N1 (< or =3 nodes positive), and M0 tumors of nonlobular histologic features with negative surgical margins, no extracapsular lymph node extension, and a negative postexcision mammogram. Brachytherapy catheters were placed at the initial excision, reexcision, or either sentinel or full-axillary sampling. Direct visualization, surgical clips, and ultrasound and/or CT scan assisted in the delineation of the target volume, defined as the excision cavity plus a 2-cm margin. High-activity 192Ir (3-10 Ci) was used to deliver 340 cGy/fraction, 2 fractions/d, for 5 consecutive days, to a total dose of 34 Gy to the target volume. Source position and dwell times were calculated using standard volume optimization techniques. RESULTS: The median follow-up of all patients was 33 months, and the mean patient age was 63 years. The mean tumor size was 1.3 cm, and 55% had an extensive intraductal component. Three patients had positive axillary nodes. Two patients experienced moderate perioperative pain that required narcotic analgesics. No peri- or postoperative infections occurred. No wound healing problems and no significant skin reactions related to the implant developed. The Radiation Therapy Oncology Group late radiation morbidity scoring scheme was applied to the entire 33-case cohort. In the assessment of the skin, 30 cases were Grade 0-1 and 3 cases were Grade 2. Subcutaneous toxicity was scored as 11 patients with Grade 0, 3 with Grade 1, 8 with Grade 2, 3 with Grade 3, and 8 with Grade 4. Clinically evident fat necrosis occurred in 8 patients at a median of 7.5 months after HDR brachytherapy completion. The only variables significantly associated with Grade 3-4 toxicity were the number of source dwell positions and the volume of tissue encompassed by the prescription isodose shell. The global cosmetic scores after a minimum of 18 months' follow-up were 0 cases with poor, 4 with fair, 5 with good, and 24 with excellent scores. One case of ipsilateral breast tumor recurrence was diagnosed 23 months after HDR brachytherapy, for a 4-year actuarial recurrence rate of 3%. This failure appeared to be a new primary tumor, because it was histologically distinct from the initial tumor and was located 9 cm from the initial tumor bed and 3 cm from the edge of the implant volume. CONCLUSION: Radiotherapy of the tumor bed alone with HDR interstitial brachytherapy is associated with a 33% incidence of Grade 3-4 s.c. toxicity, but with generally favorable overall cosmetic results. The risk of toxicity appears to be primarily related to the implant volume. With limited follow-up, the incidence of ipsilateral breast tumor recurrence was low.

Author(s): 
Wazer, David E.
Berle, Lisa
Graham, Roger
Chung, Maureen
Rothschild, Janice
Graves, Theresa
Cady, Blake
Ulin, Kenneth
Ruthazer, Robin
DiPetrillo, Thomas A.
Item Type: 
Journal Article
Publication Title: 
International Journal of Radiation Oncology, Biology, Physics
Journal Abbreviation: 
Int. J. Radiat. Oncol. Biol. Phys.
Publication Date: 
7/15/2002
Publication Year: 
2002
Pages: 
889-897
Volume: 
53
Issue: 
4
ISSN: 
0360-3016
Library Catalog: 
NCBI Published Medical (?)
Extra: 
PMID: 12095554

Turabian/Chicago Citation

David E. Wazer, Lisa Berle, Roger Graham, Maureen Chung, Janice Rothschild, Theresa Graves, Blake Cady, Kenneth Ulin, Robin Ruthazer and Thomas A. DiPetrillo. 7/15/2002. "Preliminary results of a phase I/II study of HDR brachytherapy alone for T1/T2 breast cancer." International Journal of Radiation Oncology, Biology, Physics 53: 4: 889-897.

Wikipedia Citation

<ref> {{Cite journal | doi = | issn = 0360-3016 | volume = 53 | pages = 889-897 | last = Wazer | first = David E. | coauthors = Berle, Lisa, Graham, Roger, Chung, Maureen, Rothschild, Janice, Graves, Theresa, Cady, Blake, Ulin, Kenneth, Ruthazer, Robin, DiPetrillo, Thomas A. | title = Preliminary results of a phase I/II study of HDR brachytherapy alone for T1/T2 breast cancer | journal = International Journal of Radiation Oncology, Biology, Physics | date = 7/15/2002 | pmid = | pmc = }} </ref>