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Roman MM, Delrue P, Karler C, Del Marmol V, Bourgeois P. Indo-cyanine green administration to identify loss of lymph after axillary lymph node dissection. Front Oncol 2023; 13:1045495. [PMID: 36994214 PMCID: PMC10040774 DOI: 10.3389/fonc.2023.1045495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/16/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundNear infrared fluorescence imaging with Indocyanine Green (ICG) is now used for the imaging of lymph nodes and lymphatic vessels. In this work, we investigated the impact of its pre-operative and peri-operative administration on our ability to detect axillary lymphatic loss after breast cancer surgery.MethodsOne subcutaneous injection of ICG was administered in the ipsilateral hand of 109 women who were scheduled to have either a mastectomy with total axillary lymph node dissection (CALND) or a lumpectomy with selective lymphadenectomy (SLN) the day before (n = 53) or the same day of surgery (n = 56). The lymph leakages were assessed by means of the application of a compress in the operated armpit and by the presence or absence of fluorescence on it, as well as in the post-operative axillary drains.ResultsThe compress was fluorescent in 28% of SLN patients and 71% of CALND patients. The liquids in the axillary drains were also fluorescent in 71% of patients with CALND. No statistical significance was observed between the ICG injection groups. The association between compressive fluorescent and the presence of fluorescence in the axillary drains is significant in the pre-operative subgroup and in the whole group.ConclusionOur research demonstrates that lymphatic leaks aid in the development of seromas and calls into question the effectiveness of the ligatures and/or cauterizations used during surgery. A prospective, multicentric, randomized trial should be conducted to verify the efficacy of this approach.
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Affiliation(s)
- Mirela Mariana Roman
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- *Correspondence: Mirela Mariana Roman,
| | - Pauline Delrue
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Clarence Karler
- Department of Anesthesia-Algologia Hospital Moliere, Université Libre de Bruxells, Brussels, Belgium
| | - Véronique Del Marmol
- Service of Dermatology, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bourgeois
- Service of Dermatology, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Services of Nuclear Medicine, Institut Jules Bordet and Hôpitaux Iris Sud- Iris Ziekenhuizen Zuid (HIS-IZZ) Hospitals, Université Libre de Bruxelles, Brussels, Belgium
- Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Service of Vascular Surgery, Institut Jules Bordet and Hôpitaux Iris Sud- Iris Ziekenhuizen Zuid (HIS-IZZ) Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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Using Drain-Free Flap Fixation Techniques Versus Traditional Wound Closure With Drain Placement to Prevent Seroma Formation and Its Complications in Breast Cancer Patients Undergoing Mastectomy: A Systematic Review and Meta-analysis. PLASTIC AND AESTHETIC NURSING 2022; 42:206-215. [PMID: 36469391 DOI: 10.1097/psn.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During the past decade, there has been some controversy related to using flap fixation techniques instead of conventional wound closure methods and drain placement during mastectomy procedures. The purpose of our study was to address this controversy using a systematic review and meta-analysis of current published literature. Nineteen studies met our inclusion criteria. Our sample population consisted of 2,956 participants divided into two groups. The study group (SG) consisted of 1,418 individuals and the control group (CG) consisted of 1,538 participants. We found there was a significant reduction in the incidence of seroma formation (odds ratio [OR] = 0.35; 95% confidence interval, CI [0.3, 0.42]; p < .000) and surgical site infection (OR = 0.65; 95% CI [0.48, 0.88]; p = .006) in the SG compared with the CG. The length of hospital stay was also significantly reduced in the SG (0.59 days; 95% CI [0.73, 0.46]; χ 2 [6, N = 502] = 52.88; p < .000) compared with the CG. The results of our study show that using a flap fixation technique after mastectomy can decrease the patient's risk for seroma formation and surgical site infection while reducing their length of hospital stay. Further studies with longer follow-up periods are warranted to evaluate long-term complications associated with using a flap fixation technique compared with using conventional wound closure techniques and drain placement.
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Seroma after Simple Mastectomy in Breast Cancer-The Role of CD4+ T Helper Cells and the Evidence as a Possible Specific Immune Process. Int J Mol Sci 2022; 23:ijms23094848. [PMID: 35563236 PMCID: PMC9101279 DOI: 10.3390/ijms23094848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Seroma development after breast cancer surgery is the most common postoperative complication seen after mastectomy but neither its origin nor its cellular composition is known. To investigate the assumption of immunological significance, one of the first aims of this pilot study is to describe the cellular content of collected seroma fluids and its corresponding serum in patients with simple mastectomy after needle aspiration, as well as the serum of healthy controls. The content of red blood cells (RBC) was measured by haemato-counter analyses, and the lymphocyte identification/quantification was conducted by flow cytometry analyses in seroma fluid (SFl) and the sera of patients (PBp) as well as controls (PBc). Significantly lower numbers of RBCs were measured in SFl. Cytotoxic T cells are significantly reduced in SFl, whereas T helper (Th) cells are significantly enriched compared to PBp. Significantly higher numbers of Th2 cells were found in SFl and PBp compared to PBc. The exact same pattern is seen when analyzing the Th17 subgroup. In conclusion, in contrast to healthy controls, significantly higher Th2 and Th17 cell subgroup-mediated immune responses were measured in seroma formations and were further confirmed in the peripheral blood of breast cancer (including DCIS) patients after simple mastectomy. This could lead to the assumption of a possible immunological cause for the origin of a seroma.
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Wallace AS, Tchatalbachev V, Nelson J, Wang Z, Dale P, Biedermann GB. Long term radiographic findings of breast brachytherapy: Implications of surgical volume. J Surg Oncol 2017; 116:203-207. [PMID: 28445590 PMCID: PMC9744260 DOI: 10.1002/jso.24646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Little is known about long-term radiographic findings after treatment with accelerated partial breast irradiation (APBI). METHODS Univariate and multivariate analysis of factors leading to formation and resolution of seroma were performed in patients treated with lumpectomy and APBI. RESULTS Post-treatment images of 129 patients were reviewed by one radiologist. Median surgical excision volume was 108.9 cc (range 20.5-681.9). Primary mode of imaging was mammogram. Median time from end of RT to first and last surveillance image was 6 and 54 months, respectively. Median number of images was 7 (range 3-12). Seroma was identified in 98 (76%) patients, with median maximum diameter of 3.9 cm. Forty (41%) patients experienced resolution of seroma, at a median time of 29 months (range 6-74). On univariate analysis, surgical excision volume was associated with seroma formation, and tumor stage and margin re-excision were significant on univariate and multivariate analysis. No factors were associated with seroma resolution. CONCLUSION Seroma formation after APBI resolves around 2.5 years for many patients, but persists for others possibly due to primary tumor and surgical excision volumes. With revised criteria on the definition of positive margins, smaller volumes may lead to decreased risk of seroma formation for future patients.
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Affiliation(s)
- Audrey S. Wallace
- University of Missouri School of Medicine, Columbia,Department of Radiation Oncology, University of Alabama Birmingham
| | | | - Jay Nelson
- University of Missouri School of Medicine, Columbia
| | - Zhenyu Wang
- Department of Radiology, University of Missouri, Columbia
| | - Paul Dale
- Division of Surgical Oncology, Navicent Healthcare & Mercer University School of Medicine
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Brachytherapy in the treatment of breast cancer. Int J Clin Oncol 2017; 22:641-650. [PMID: 28664300 DOI: 10.1007/s10147-017-1155-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/14/2017] [Indexed: 11/10/2022]
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Shah S, Holzwanger E, Khwaja R, Fang D, Figueroa-Bodine J, Iannuzzi C, Shi C. A Single-Site Retrospective, Nonrandomized Study of Accelerated Partial Breast Irradiation Brachytherapy for Early-Stage Breast Cancer Treatment to Evaluate Local Tumor Control, Cosmetic Outcome, and Toxicities. Technol Cancer Res Treat 2016. [DOI: 10.1177/1533034615595724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: To evaluate the efficacy and safety of the accelerated partial breast irradiation brachytherapy with a combination of applicators at a community hospital cancer center. Methods and Materials: Between 2005 and 2009, 120 patients with early-stage breast cancer were being followed after treatment with accelerated partial breast irradiation brachytherapy using MammoSite, single or multilumen balloon, or Contura multilumen balloon. After their lumpectomy surgery, each patient was treated with Ir-192 high-dose rate unit following radiation therapy oncology group 0413 guidelines. The patients had multiple follow-ups at 6 months, 1 year, 2 years, 3 years, or more. Results: Based on the Harvard Breast Cosmesis Scale, 95.00% of patients described their cosmetic evaluation as the treated breast essentially the same as the opposite side (excellent) or minimal but identifiable effects were noticed from radiation (good). After a median follow-up of 36 months, the local recurrence rate was 1.66% and a disease-free survival is 98.3%. Forty-two patients reported 85 adverse events, which were fibrosis: 24.70%, hyperpigmentation: 20.00%, radiation skin reaction: 7.05%, seroma: 7.05%, breast pain: 7.05%, erythema: 5.88%, and other events were less than 5.00%. Of all the adverse events recorded, grade 1 to 3 events are 95.29% (n = 81), 2.35% (n = 2), and 2.35% (n = 2). There was no grade 4 or 5 events recorded. Conclusions: Our study has shown promising results for delivering radiation with MammoSite, single or multilumen balloon, or Contura multilumen balloon and has been successful in achieving local control in patients with early-stage breast cancer.
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Affiliation(s)
- Shalin Shah
- Radiation Oncology, Saint Vincent’s Medical Center, Bridgeport, CT, USA
| | - Erik Holzwanger
- Radiation Oncology, Saint Vincent’s Medical Center, Bridgeport, CT, USA
| | - Radhika Khwaja
- Radiation Oncology, Saint Vincent’s Medical Center, Bridgeport, CT, USA
| | - Deborah Fang
- Radiation Oncology, Saint Vincent’s Medical Center, Bridgeport, CT, USA
| | | | | | - Chengyu Shi
- Radiation Oncology, Saint Vincent’s Medical Center, Bridgeport, CT, USA
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Ajkay N, Collett AE, Bloomquist EV, Gracely EJ, Frazier TG, Barrio AV. A Comparison of Complication Rates in Early-Stage Breast Cancer Patients Treated with Brachytherapy Versus Whole-Breast Irradiation. Ann Surg Oncol 2014; 22:1140-5. [DOI: 10.1245/s10434-014-4131-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 11/18/2022]
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Bhatt AD, Barry PN, Sowards KT, Dragun AE. Negative effect of seroma on breast balloon brachytherapy dosimetry. Pract Radiat Oncol 2014; 4:e1-5. [PMID: 24621426 DOI: 10.1016/j.prro.2013.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/01/2013] [Accepted: 03/09/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Balloon brachytherapy is commonly used to deliver Accelerated Partial Breast Irradiation (APBI). Seroma interference is a relatively common phenomenon during APBI. The negative effect of seroma accumulation on the planning target volume evaluation (PTV_Eval) coverage is not well understood. METHODS AND MATERIALS This is a dosimetric replanning study on 10 patients with evidence of seroma collection at time of initial computed tomographic simulation around the catheter. Total dose was 34 Gy given at 3.4 Gy twice a day over 5 treatment days. A total of 20 plans were generated, 10 plans without accounting for and 10 after subtracting the seroma. We then compared the changes seen in PTV_Eval between plans as a factor of the seroma volume. RESULTS Median age was 62 years (51-83). Histology was invasive in 7/10 cases and in situ in 3/10. Median balloon to skin distance was 8.5 mm (3-14). Median balloon volume was 39 cc (30-104). Median seroma volume was 3.34 cc (1.13-13.71). For every 1 cc of accumulated seroma the percentage of PTV_Eval coverage by the 90% isodose line (V90) was found to decrease by 2.45% (P < .0001; confidence interval [CI], 1.87-3.03) and coverage by the 100% isodose line (V100) was decreased by 1.11% (P < .0001; CI, 0.81-1.41). Fifty percent (5/10) of previously acceptable plans with seroma not accounted for failed to meet the V90 ≥90% requirement after subtracting the seroma. CONCLUSIONS Accumulation of seroma was associated with a considerable negative impact on PTV_Eval dosimetry with a greater impact on V90 compared with the V100. Clinicians must be careful in detecting and accounting for such accumulation in treatment plans to prevent underdosing of the at risk target breast tissue.
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Affiliation(s)
- Aashish D Bhatt
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Parul N Barry
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Keith T Sowards
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Anthony E Dragun
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
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Impact of interfraction seroma collection on breast brachytherapy dosimetry - a mathematical model. J Contemp Brachytherapy 2013; 4:101-5. [PMID: 23349651 PMCID: PMC3552631 DOI: 10.5114/jcb.2012.29366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/04/2012] [Accepted: 05/03/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose Balloon brachytherapy is a widely accepted modality for delivery of accelerated partial breast irradiation (APBI). Our hypothesis was that inter-fraction seroma collection around the balloon surface would have an adverse effect on dosimetry of the target. Material and methods This is a dosimetric re-planning study using two volumetric models (30 cc and 45 cc) in a Contura® multi-lumen balloon (MLB) catheter. In a previously treated patient, two customized baseline plans were generated using multiple channels of the Contura® catheter prescribed to the Planning Target Volume Evaluation (PTV_Eval). Symmetric expansions of 1.0 mm (0-9 mm) increments around the balloon surface were performed to simulate a “Virtual Seroma” (VS) accumulation for both balloon volumes and plans were obtained for each expansion using Eclipse Brachyvision™. An analysis of these plans was then performed to evaluate the effect of seroma accumulation on dosimetric parameters of V100 and V90. Results 20 plans were generated and analyzed (10 plans for each balloon volume), representing VS of 6.0-66.0 cc. There was a commensurate decrease in the dose delivered to the PTV_Eval V100 and V90 (as defined by the original treatment plan) with increasing VS accumulation leading to a sub-optimal coverage of the PTV_Eval. For 30 cc MLB catheter, V100 decreased by 1.4% and V90 decreased by 0.9% for every 1 cc of VS. For 45cc MLB catheter, V100 decreased by 1.3% and V90 decreased by 1.15% for every 1.0 cc accumulation of VS. Conclusions Balloon catheter-tissue adherence ensures daily dose delivery to the planned PTV_Eval. Accumulation of seroma, hematoma or air between HDR fractions can significantly impact PTV_Eval dosimetry. Vacuum-port aspiration prior to delivery of each fraction, if available, should be considered to minimize the risk of geographic under dosing.
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Deneve JL, Hoefer RA, Harris EER, Laronga C. Accelerated Partial Breast Irradiation: A Review and Description of an Early North American Surgical Experience with the Intrabeam Delivery System. Cancer Control 2012; 19:295-308. [DOI: 10.1177/107327481201900406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jeremiah L. Deneve
- Department of Women's Oncology H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Richard A. Hoefer
- Dorothy G. Hoefer Comprehensive Breast Center, Sentara Cancer Network, Newport News, Virginia
| | - Eleanor E. R. Harris
- Radiation Oncology Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Christine Laronga
- Department of Women's Oncology H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Hepel JT, Wazer DE. A comparison of brachytherapy techniques for partial breast irradiation. Brachytherapy 2012; 11:163-75. [PMID: 21816686 DOI: 10.1016/j.brachy.2011.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/06/2011] [Accepted: 06/09/2011] [Indexed: 01/31/2023]
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Bhatt AD, Crew JB, Bhatt G, Johnson RR, Sowards KT, Pan J, Dragun AE. Interfraction accumulation of seroma during accelerated partial breast irradiation: preliminary results of a prospective study. Brachytherapy 2011; 11:374-9. [PMID: 21820365 DOI: 10.1016/j.brachy.2011.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 06/21/2011] [Accepted: 06/29/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE To quantify and characterize the process of seroma accumulation during accelerated partial breast irradiation using multicatheter balloon brachytherapy. MATERIALS AND METHODS Twenty-two patients were treated using the Contura Multilumen brachytherapy catheter to a dose of 34Gy in 10 fractions over 5 treatment days. Serial aspirations of the vacuum port of the catheter were performed at the time of CT simulation and before each treatment. Volume and characteristics of fluid drawn were recorded. Univariate analysis was performed to evaluate various factors predictive of seroma formation. RESULTS Median patient age was 59.5 years, body mass index was 31, and volume of surgical specimen was 62.4cm(3). Median time from breast conservation surgery to placement of Contura catheter was 18.5 days. Pericatheter seroma, typically scant with a median volume of 0.75mL, was noted in 91% of patients at CT simulation. A total of 203 aspirations were performed with a median-aspirated seroma volume of 4.05mL. There was no significant correlation between the volume of seroma and histology (invasive vs. in situ), quadrant of location, body mass index, reexcision or reoperation, days from breast conservation surgery to balloon placement, or the volume of specimen removed. Radiation treatment factors, including balloon volume, balloon to skin distance, and planning target volume evaluation, also did not correlate with aspirated seroma. CONCLUSIONS Interfraction seroma accumulation has a variable pattern of development with no discernible predictors of occurrence. Routine pretreatment aspirations via vacuum port may potentially improve dosimetric reproducibility for a minority of patients.
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Affiliation(s)
- Aashish D Bhatt
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA.
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Patel PS, Yan W, Trichter S, Sabbas A, Rosenblatt R, Drotman MB, Swistel A, Clifford Chao KS, Nori D, Hayes MK. Seroma is an Expected Consequence and not a Complication of MammoSite Brachytherapy. Breast J 2011; 17:498-502. [DOI: 10.1111/j.1524-4741.2011.01127.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dragun AE, Harper JL, Olyejar SE, Zunzunegui RG, Wazer DE. The use of adjuvant high-dose-rate breast brachytherapy in patients with collagen vascular disease: A collaborative experience. Brachytherapy 2011; 10:121-7. [DOI: 10.1016/j.brachy.2010.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 05/06/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
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Cuttino LW, Todor D, Rosu M, Arthur DW. A Comparison of Skin and Chest Wall Dose Delivered With Multicatheter, Contura Multilumen Balloon, and MammoSite Breast Brachytherapy. Int J Radiat Oncol Biol Phys 2011; 79:34-8. [DOI: 10.1016/j.ijrobp.2009.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 10/15/2009] [Accepted: 10/15/2009] [Indexed: 10/19/2022]
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Wilder RB, Curcio LD, Khanijou RK, Eisner ME, Kakkis JL, Chittenden L, Agustin J, Lizarde J, Mesa AV, Macedo JC, Ravera J, Tokita KM. Preliminary Results in 173 Breast Cancer Patients Treated with Post-Lumpectomy MammoSite Single-Lumen Brachytherapy or Multi-Catheter Brachytherapy. Breast J 2010; 16:581-6. [DOI: 10.1111/j.1524-4741.2010.00977.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Biagioli MC, Harris EE. Accelerated Partial Breast Irradiation: Potential Roles following Breast-Conserving Surgery. Cancer Control 2010; 17:191-204. [DOI: 10.1177/107327481001700308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Multiple randomized trials comparing mastectomy to lumpectomy and whole breast irradiation (WBI) have shown equivalent survival outcomes in early-stage breast cancer. WBI requires a treatment course of several weeks, which has resulted in limited access to breast-conserving therapy in certain populations. A shorter accelerated course of partial breast irradiation (APBI) has been investigated recently. Methods This article reviews the current medical literature, including randomized trials and prospective institutional studies of APBI and the current recommendations regarding the use of this emerging technique. Results Several APBI techniques have been developed, including brachytherapy and external beam methods. The longest follow-up data are available for multicatheter interstitial brachytherapy, a technique that is not commonly used. Other methods, including balloon brachytherapy and external beam three-dimensional conformal techniques, have limited follow-up that shows similar local control rates to whole breast irradiation in highly selected patients. Guidelines for the appropriate use of APBI have been published. Conclusions While APBI may increase access to breast conservation therapy for some women with early-stage breast cancer, follow-up data demonstrating the efficacy of this relatively new treatment approach are limited. Therefore, strict evidence-based selection criteria should be applied when evaluating patients who may be appropriate for APBI.
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Kraus-Tiefenbacher U, Welzel G, Brade J, Hermann B, Siebenlist K, Wasser KS, Schneider FS, Sütterlin M, Wenz F. Postoperative Seroma Formation After Intraoperative Radiotherapy Using Low-Kilovoltage X-Rays Given During Breast-Conserving Surgery. Int J Radiat Oncol Biol Phys 2010; 77:1140-5. [DOI: 10.1016/j.ijrobp.2009.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 05/26/2009] [Accepted: 06/04/2009] [Indexed: 11/16/2022]
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Jeruss JS, Kuerer HM, Beitsch PD, Vicini FA, Keisch M. Update on DCIS outcomes from the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Ann Surg Oncol 2010; 18:65-71. [PMID: 20577822 DOI: 10.1245/s10434-010-1192-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND Since the initial reports on use of MammoSite accelerated partial breast irradiation (APBI) for treatment of ductal carcinoma in situ (DCIS), additional follow-up data were collected. We hypothesized that APBI delivered via MammoSite would continue to be well tolerated, associated with a good cosmetic outcome, and carry a low risk for recurrence in patients with DCIS. MATERIALS AND METHODS From 2002-2004, 194 patients with DCIS were enrolled in a registry trial to assess the MammoSite. Follow-up data were available for all 194 patients. Median follow-up was 54.4 months; 63 patients had at least 5 years of follow-up. Data obtained included patient-, tumor-, and treatment-related factors, and recurrence incidence. RESULTS Of the 194 patients, 87 (45%) had the MammoSite placed at lumpectomy; 107 patients (55%) had the device placed postlumpectomy. In the first year of follow-up, 16 patients developed a breast infection, though the method of device placement was not associated with infection risk. Also, 46 patients developed a seroma that was associated with applicator placement at the time of lumpectomy (P = 0.001). For patients with at least 5 years of follow-up, 92% had favorable cosmetic results. There were 6 patients (3.1%) who had an ipsilateral breast recurrence, with 1 (0.5%) experiencing recurrence in the breast and axilla, for a 5-year actuarial local recurrence rate of 3.39%. CONCLUSIONS During an extended follow-up period, APBI delivered via MammoSite continued to be well tolerated for patients with DCIS. Use of this device may make lumpectomy possible for patients who would otherwise choose mastectomy because of barriers associated with standard radiation therapy.
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Affiliation(s)
- Jacqueline S Jeruss
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Ahmed HM, DiPiro PJ, Devlin PM, Nguyen ML, Bellon JR. Mammographic Appearance Following Accelerated Partial Breast Irradiation by Using MammoSite Brachytherapy. Radiology 2010; 255:362-8. [DOI: 10.1148/radiol.10091625] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ravi A, Lee S, Karsif K, Osian A, Nori D. Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence. Brachytherapy 2010; 9:76-80. [DOI: 10.1016/j.brachy.2009.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/14/2009] [Accepted: 08/20/2009] [Indexed: 12/01/2022]
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Wilder RB, Curcio LD, Khanijou RK, Eisner ME, Kakkis JL, Chittenden L, Agustin J, Lizarde J, Mesa AV, Ravera J, Tokita KM. A Contura catheter offers dosimetric advantages over a MammoSite catheter that increase the applicability of accelerated partial breast irradiation. Brachytherapy 2009; 8:373-8. [PMID: 19736045 DOI: 10.1016/j.brachy.2009.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 04/17/2009] [Accepted: 04/30/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study was to determine whether a Contura catheter (SenoRx, Inc, Aliso Viejo, CA) can increase the applicability of accelerated partial breast irradiation. METHODS AND MATERIALS One hundred eighty-two women with early stage breast carcinomas were treated with postlumpectomy brachytherapy using a Contura multilumen catheter (n=45) or a MammoSite single-lumen catheter (Cytyc Corp, Marlborough, MA) (n=137). Hypothetical MammoSite catheter treatment plans were created for the Contura patients. Treatment planning goals were to (1) avoid a radiation "hot spot" in the skin and (2) have only a small air/fluid pocket next to the balloon. RESULTS The median followup was 16 months. Eighty-nine percent (40 of 45) of Contura plans satisfied both treatment planning goals vs. only 36% (16 of 45) of MammoSite plans (p<0.0001). A Contura catheter did not require explantation in 16% (7 of 45) of patients where balloon-to-skin spacing was only 3-6mm and 11% (5 of 45) of patients where there was an air/fluid pocket >10% of the planning target volume for plan evaluation (PTV_EVAL). A MammoSite catheter was explanted in 10% of cases where the minimum balloon-to-skin distance was <7mm and in 13% of cases where there was a large air/fluid pocket next to the balloon. Our incidence rates of acute toxicity with a Contura catheter were similar to those with a MammoSite catheter. CONCLUSIONS A Contura catheter provides important dosimetric advantages over a MammoSite catheter and does not require explantation in cases where balloon-to-skin spacing is only 3-6mm or an air/fluid pocket next to the balloon is >10% of PTV_EVAL.
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Limbergen EV. Accelerated partial breast irradiation with intracavitary balloon brachytherapy may be not as simple as it was supposed to be. Radiother Oncol 2009; 91:147-9. [DOI: 10.1016/j.radonc.2009.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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