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Rahimi A, Zhang Y, Kim DW, Morgan H, Hossain F, Leitch M, Wooldridge R, Seiler S, Goudreau S, Haley B, Rao R, Rivers A, Spangler A, Ahn C, Stevenson S, Staley J, Albuquerque K, Ding C, Gu X, Zhao B, Timmerman R. Risk Factors for Fat Necrosis After Stereotactic Partial Breast Irradiation for Early-Stage Breast Cancer in a Phase 1 Clinical Trial. Int J Radiat Oncol Biol Phys 2020; 108:697-706. [PMID: 32464155 DOI: 10.1016/j.ijrobp.2020.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study reports predictive dosimetric and physiologic factors for fat necrosis after stereotactic-partial breast irradiation (S-PBI). METHODS AND MATERIALS Seventy-five patients with ductal carcinoma-in situ or invasive nonlobular epithelial histologies stage 0, I, or II, with tumor size <3 cm were enrolled in a dose-escalation, phase I S-PBI trial between January 2011 and July 2015. Fat necrosis was evaluated clinically at each follow-up. Treatment data were extracted from the Multiplan Treatment Planning System (Cyberknife, Accuray). Univariate and stepwise logistic regression analyses were conducted to identify factors associated with palpable fat necrosis. RESULTS With a median follow-up of 61 months (range: 4.3-99.5 months), 11 patients experienced palpable fat necrosis, 5 cases of which were painful. The median time to development of fat necrosis was 12.7 months (range, 3-42 months). On univariate analyses, higher V32.5-47.5 Gy (P < .05) and larger breast volume (P < .01) were predictive of any fat necrosis; higher V35-50 Gy (P < .05), receiving 2 treatments on consecutive days (P = .02), and higher Dmax (P = .01) were predictive of painful fat necrosis. On multivariate analyses, breast volume larger than 1063 cm3 remained a predictive factor for any fat necrosis; receiving 2 treatments on consecutive days and higher V45 Gy were predictive of painful fat necrosis. Breast laterality, planning target volume (PTV), race, body mass index, diabetic status, and tobacco or drug use were not significantly associated with fat necrosis on univariate analysis. CONCLUSIONS Early-stage breast cancer patients treated with breast conserving surgery and S-PBI in our study had a fat necrosis rate comparable to other accelerated partial breast irradiation modalities, but S-PBI is less invasive. To reduce risk of painful fat necrosis, we recommend not delivering fractions on consecutive days; limiting V42.5 < 50 cm3, V45 < 20 cm3, V47.5 < 1 cm3, Dmax ≤ 48 Gy and PTV < 100 cm3 when feasible; and counseling patients about the increased risk for fat necrosis when constraints are not met and for those with breast volume >1000 cm3.
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Affiliation(s)
- Asal Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Yuanyuan Zhang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dong W Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Howard Morgan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ferzana Hossain
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marilyn Leitch
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rachel Wooldridge
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen Seiler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sally Goudreau
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Barbara Haley
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roshni Rao
- Department of Surgery, Columbia University, New York, New York
| | - Aeisha Rivers
- Department of Surgery, Memorial Health care System, Miramar, Florida
| | - Ann Spangler
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chul Ahn
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stella Stevenson
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jason Staley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chuxiong Ding
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xuejun Gu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bo Zhao
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
Breast brachytherapy represents a radiation technique that can be utilized as both monotherapy and as a tumor bed boost following breast conserving surgery. As monotherapy, the rationale for brachytherapy is that the majority of residual disease and therefore recurrences occur in close proximity to the lumpectomy cavity; for boost treatment, brachytherapy represents a technique that provided a more conformal approach prior to 3D treatment planning, and more recently can be used in conjunction with oncoplastic surgery. Multiple guidelines are available to assist clinicians with patient selection for accelerated partial breast irradiation (APBI), and recent guidelines support brachytherapy as an appropriate technique to deliver APBI. Modern breast brachytherapy can be performed with interstitial or applicator-based brachytherapy with multilumen and strut devices offering the ability to provide greater skin, chest wall, and normal breast sparing than previous devices. Novel strategies are being evaluated, including high dose rate perioperative/intraoperative radiotherapy, permanent breast seed implants, and noninvasive breast brachytherapy. Additionally, studies are evaluating shorter courses of brachytherapy. Multiple Level I studies are now available supporting interstitial brachytherapy to deliver APBI while prospective data and the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 trial are available with applicator brachytherapy and provide standardized prescriptions, target volume definitions, and dosimetric goals.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Alvaro Martinez
- 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI
| | - Matthew Kolar
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Frank Vicini
- 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI.
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Altman MB, Mooney KE, Edward S, Garcia-Ramirez JL, Dewees TA, Thomas MA, Zoberi I, Zoberi JE. Efficiency of using the day-of-implant CT for planning of SAVI APBI. Brachytherapy 2017; 17:40-49. [PMID: 28869144 DOI: 10.1016/j.brachy.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to develop an optimized, efficient workflow for using the day-of-implant (DOI) CT for treatment planning of accelerated partial breast irradiation brachytherapy using the strut-adjusted volume implant (SAVI) device. METHODS AND MATERIALS For 62 consecutive SAVI patients, a DOI CT was acquired and used for treatment planning. A "verification" CT was acquired 24-72 h after implant and immediately before the first fraction, then registered to the DOI CT. If the DOI CT-based plan was no longer optimal, a replan was performed. An array of metrics describing the geometry of the device and its relative position in the patient from the DOI CTs for these patients was collected. These metrics from the DOI CT were evaluated to determine what features could predict for the need to replan before the first treatment fraction. Logistical regression analysis including χ2 tests was used to determine if different factors correlated with replanning. RESULTS Twenty-two of 62 patients (35%) required replanning. Only the presence of splayed struts, where splay was toward the skin, and the use of a nine strut ("8-1") SAVI were significantly correlated (p < 0.05) with replanning. Within these individual populations, no additional factors showed a significant statistical correlation for requiring replanning. CONCLUSIONS For strut-based accelerated partial breast irradiation brachytherapy, it was feasible to treat with a plan based on the DOI CT for a majority (65%) of patients. Some factors correlate to needing replanning; recognizing these could be used to optimize treatment workflow for certain patients, increasing clinical efficiency while enhancing the quality of patient care.
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Affiliation(s)
- Michael B Altman
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO.
| | - Karen E Mooney
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Sharbacha Edward
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | | | - Todd A Dewees
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
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4
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Mooney KE, Altman MB, Edward S, Garcia-Ramirez J, Thomas MA, Zoberi I, DeWees T, Mullen D, Zoberi JE. Accelerated partial breast irradiation dosimetric criteria for the strut-adjusted volume implant. Brachytherapy 2016; 15:616-24. [DOI: 10.1016/j.brachy.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/27/2022]
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Thrower SL, Shaitelman SF, Bloom E, Salehpour M, Gifford K. Comparison of Dose Distributions With TG-43 and Collapsed Cone Convolution Algorithms Applied to Accelerated Partial Breast Irradiation Patient Plans. Int J Radiat Oncol Biol Phys 2016; 95:1520-1526. [PMID: 27315666 DOI: 10.1016/j.ijrobp.2016.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/03/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the treatment plans for accelerated partial breast irradiation calculated by the new commercially available collapsed cone convolution (CCC) and current standard TG-43-based algorithms for 50 patients treated at our institution with either a Strut-Adjusted Volume Implant (SAVI) or Contura device. METHODS AND MATERIALS We recalculated target coverage, volume of highly dosed normal tissue, and dose to organs at risk (ribs, skin, and lung) with each algorithm. For 1 case an artificial air pocket was added to simulate 10% nonconformance. We performed a Wilcoxon signed rank test to determine the median differences in the clinical indices V90, V95, V100, V150, V200, and highest-dosed 0.1 cm(3) and 1.0 cm(3) of rib, skin, and lung between the two algorithms. RESULTS The CCC algorithm calculated lower values on average for all dose-volume histogram parameters. Across the entire patient cohort, the median difference in the clinical indices calculated by the 2 algorithms was <10% for dose to organs at risk, <5% for target volume coverage (V90, V95, and V100), and <4 cm(3) for dose to normal breast tissue (V150 and V200). No discernable difference was seen in the nonconformance case. CONCLUSIONS We found that on average over our patient population CCC calculated (<10%) lower doses than TG-43. These results should inform clinicians as they prepare for the transition to heterogeneous dose calculation algorithms and determine whether clinical tolerance limits warrant modification.
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Affiliation(s)
- Sara L Thrower
- The University of Texas Graduate School of Biomedical Sciences at Houston, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth Bloom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mohammad Salehpour
- Department of Radiation Physics, The University of Texas Graduate School of Biomedical Sciences at Houston, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kent Gifford
- Department of Radiation Physics, The University of Texas Graduate School of Biomedical Sciences at Houston, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Trifiletti DM, Romano KD, Showalter SL, Reardon KA, Libby B, Showalter TN. Accelerated partial breast irradiation with brachytherapy: patient selection and technique considerations. BREAST CANCER-TARGETS AND THERAPY 2015; 7:211-21. [PMID: 26251627 PMCID: PMC4524268 DOI: 10.2147/bctt.s55860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Accelerated partial breast irradiation (APBI) through breast brachytherapy is a relatively recent development in breast radiotherapy that has gained international favor because of its reduction in treatment duration and normal tissue irradiation while maintaining favorable cancer-specific and cosmetic outcomes. Despite the fact that several large national trials have not reported final results yet, many providers are currently offering APBI to select patients and APBI is listed as a treatment option for selecting patients in the National Comprehensive Cancer Network guidelines. Multiple consensus guidelines exist in selecting patients for APBI, some with conflicting recommendations. In this review, the existing patient selection guidelines are reported, compared, and critiqued, grouping them in helpful subcategories. Unique patient and technical selection factors for APBI with brachytherapy are explored.
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Affiliation(s)
- Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kara D Romano
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Shayna L Showalter
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelli A Reardon
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bruce Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Roth AM, Kauer-Dorner D, Resch A, Schmid A, Thill M, Niehoff P, Melchert C, Berger D, Kovács G. Is oncoplastic surgery a contraindication for accelerated partial breast radiation using the interstitial multicatheter brachytherapy method? Brachytherapy 2014; 13:394-9. [DOI: 10.1016/j.brachy.2013.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/06/2013] [Accepted: 09/07/2013] [Indexed: 10/25/2022]
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Dose correction in lung for HDR breast brachytherapy. J Contemp Brachytherapy 2013; 4:106-10. [PMID: 23349652 PMCID: PMC3552632 DOI: 10.5114/jcb.2012.29367] [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: 04/03/2012] [Revised: 05/16/2012] [Accepted: 06/06/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the dosimetric impact of lung tissue in Ir-192 APBI. Material and methods In a 40 × 40 × 40 cm3 water tank, an Accelerated Partial Breast Irradiation (APBI) brachytherapy balloon inflated to 4 cm diameter was situated directly below the center of a 30 × 30 × 1 cm3 solid water slab. Nine cm of solid water was stacked above the 1 cm base. A parallel plate ion chamber was centered above the base and ionization current measurements were taken from the central HDR source dwell position for channels 1, 2, 3 and 5 of the balloon. Additional ionization data was acquired in the 9 cm stack at 1 cm increments. A comparable data set was also measured after replacing the 9 cm solid water stack with cork slabs. The ratios of measurements in the two phantoms were calculated and compared to predicted results of a commercial treatment planning system. Results Lower dose was measured in the cork within 1 cm of the cork/solid water interface possibly due to backscatter effects. Higher dose was measured beyond 1 cm from the cork/solid water interface, increasing with path length up to 15% at 9 cm depth in cork. The treatment planning system did not predict either dose effect. Conclusions This study investigates the dosimetry of low density material when the breast is treated with Ir-192 brachytherapy. HDR dose from Ir-192 in a cork media is shown to be significantly different than in unit density media. These dose differences are not predicted in most commercial brachytherapy planning systems. Empirical models based on measurements could be used to estimate lung dose associated with HDR breast brachytherapy.
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9
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On the feasibility of treating to a 1.5 cm PTV with a commercial single-entry hybrid applicator in APBI breast brachytherapy. J Contemp Brachytherapy 2013; 4:29-33. [PMID: 23346137 PMCID: PMC3551370 DOI: 10.5114/jcb.2012.27949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/20/2012] [Accepted: 02/04/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate and determine whether 30 patients previously treated with the SAVI™ device could have been treated to a PTV_EVAL created with a 1.5 cm expansion. This determination was based upon dosimetric parameters derived from current recommendations and dose-response data. Material and methods Thirty patients were retrospectively planned with PTV_EVALs generated with a 1.5 cm expansion (PTV_EVAL_1.5). Plans were evaluated based on PTV_EVAL_1.5 coverage (V90, V95, V100), skin and rib maximum doses (0.1 cc maximum dose as a percentage of prescription dose), as well as V150 and V200 for the PTV_EVAL_1.5. The treatment planning goal was to deliver ≥90% of the prescribed dose to ≥90% of the PTV_EVAL_1.5. Skin and rib maximum doses were to be ≤125% of the prescription dose and preferably ≤100% of the prescription dose. V150 and V200 were not allowed to exceed 52.5 cc and 21 cc, respectively. Plans not meeting the above criteria were recomputed with a 1.25 cm expanded PTV_EVAL and re-evaluated. Results Based on the above dose constraints, 30% (9/30) of the patients evaluated could have been treated with a 1.5 cm PTV_EVAL. The breakdown of cases successfully achieving the above dose constraints by applicator was: 0/4 (0%) 6-1, 6/15 (40%) 8-1, and 3/11 (27%) 10-1. For these PTV_EVAL_1.5 plans, median V90% was 90.3%, whereas the maximum skin and rib doses were all less than 115.2% and 117.6%, respectively. The median V150 and V200 volumes were 39.2 cc and 19.3, respectively. The treated PTV_EVAL_1.5 was greater in volume than the PTV_EVAL by 41.7 cc, and 60 cc for the 8-1, and 10-1 applicators, respectively. All remaining plans (17) successfully met the above dose constraints to be treated with a 1.25 cm PTV_EVAL (PTV_EVAL_1.25). For the PTV_EVAL_1.25 plans, V90% was 93.7%, and the maximum skin and rib doses were all less than 109.2% and 102.5%, respectively. The median V150 and V200 volumes were 41.2 cc and 19.3, respectively. The treated PTV_EVAL_1.25 was greater in volume than the PTV_EVAL by 16 cc, 24.9 cc, and 33.5 cc for the 6-1, 8-1 and 10-1 applicators, respectively. Conclusions It is dosimetrically possible to treat beyond the currently advised 1.0 cm expanded PTV_EVAL. Most patients should be able to be treated with a 1.25 cm PTV_EVAL and a select group with a 1.5 cm PTV_EVAL. Applicator size appears to determine the ability to expand to a 1.5 cm PTV_EVAL, as smaller devices were not as propitious in this regard. Further studies may identify additional patient groups that would benefit from this approach.
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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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Lu SM, Scanderbeg DJ, Barna P, Yashar W, Yashar C. Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue. Med Dosim 2012; 37:9-14. [PMID: 21458981 DOI: 10.1016/j.meddos.2010.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 11/12/2010] [Accepted: 12/08/2010] [Indexed: 12/28/2022]
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Yashar C. Counterpoint: the device with the most dose modulation capacity. Brachytherapy 2011; 10:436-9; discussion 440-1. [PMID: 22051406 DOI: 10.1016/j.brachy.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Catheryn Yashar
- Department of Radiation Oncology, Moores Cancer Center, University of California San Diego, La Jolla, CA 92093-0843, USA.
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Cuttino LW. Point: balloon versus strut brachytherapy-which device offers the most dose modulation capability and normal tissue sparing? Brachytherapy 2011; 10:433-5. [PMID: 22051405 DOI: 10.1016/j.brachy.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laurie W Cuttino
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23229, USA.
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15
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Rebuttal to Dr. Cuttino. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yashar CM, Scanderbeg D, Kuske R, Wallace A, Zannis V, Blair S, Grade E, Swenson VH, Quiet C. Initial Clinical Experience With the Strut-Adjusted Volume Implant (SAVI) Breast Brachytherapy Device for Accelerated Partial-Breast Irradiation (APBI): First 100 Patients With More Than 1 Year of Follow-Up. Int J Radiat Oncol Biol Phys 2011; 80:765-70. [DOI: 10.1016/j.ijrobp.2010.02.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 01/08/2010] [Accepted: 02/20/2010] [Indexed: 10/19/2022]
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17
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Bloom ES, Kirsner S, Mason BE, Nelson CL, Hunt KK, Baumann DP, Gifford KA. Accelerated partial breast irradiation using the strut-adjusted volume implant single-entry hybrid catheter in brachytherapy for breast cancer in the setting of breast augmentation. Brachytherapy 2011; 10:178-83. [PMID: 20719576 DOI: 10.1016/j.brachy.2010.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/02/2010] [Accepted: 06/08/2010] [Indexed: 02/03/2023]
Abstract
PURPOSE Accelerated partial breast irradiation (APBI) has gained popularity as an alternative to adjuvant whole breast irradiation; however, owing to limitations of delivery devices for brachytherapy, APBI has not been a suitable option for all the patients. This report evaluates APBI using the strut-adjusted volume implant (SAVI) single-entry catheter to deliver brachytherapy for breast cancer in the setting of an augmented breast. METHODS AND MATERIALS The patient previously had placed bilateral subpectoral saline implants; stereotactic core biopsy revealed estrogen receptor- and progesterone receptor-positive ductal carcinoma in situ of intermediate nuclear grade. The patient underwent needle-localized segmental mastectomy of her left breast; pathologic specimen revealed no residual malignancy. An SAVI 8-1 device was placed within the segmental resection cavity. Treatment consisted of 3.4 Gy delivered twice a day for 5 days for a total dose of 34 Gy. Treatments were delivered with a high-dose-rate (192)Ir remote afterloader. RESULTS Conformance of the device to the lumpectomy cavity was excellent at 99.2%. Dosimetric values of percentage of the planning target volume for evaluation receiving 90% of the prescribed dose, percentage of the planning target volume for evaluation receiving 95% of the prescribed dose, volume receiving 150% of the prescribed dose, and volume receiving 200% of the prescribed dose were 97.1%, 94.6%, 22.7 cc, and 11.6 cc, respectively. Maximum skin dose was 115% of the prescribed dose. The patient tolerated treatment well with excellent cosmetic results, and limited acute and late toxicity at 8 weeks and 6 months, respectively. CONCLUSIONS Breast augmentation should not be an exclusion criterion for the option of APBI. The SAVI single-entry catheter is another option to successfully complete APBI using brachytherapy for breast cancer in the setting of an augmented breast.
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Affiliation(s)
- Elizabeth S Bloom
- Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77081, USA.
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Gurdalli S, Kuske RR, Quiet CA, Ozer M. Dosimetric performance of Strut-Adjusted Volume Implant: A new single-entry multicatheter breast brachytherapy applicator. Brachytherapy 2011; 10:128-35. [DOI: 10.1016/j.brachy.2010.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/26/2010] [Accepted: 03/31/2010] [Indexed: 12/31/2022]
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Yashar C, Mahmood U. Strut-adjusted volume implant: a targeted radiation treatment in breast cancer. Future Oncol 2010; 6:1813-6. [PMID: 21142853 DOI: 10.2217/fon.10.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Beitsch PD, Patel RR, Lorenzetti JD, Wurzer JC, Tucker JC, Laduzinsky SJ, Kugler MA. Post-surgical treatment of early-stage breast cancer with electronic brachytherapy: an intersociety, multicenter brachytherapy trial. Onco Targets Ther 2010; 3:211-8. [PMID: 21124748 PMCID: PMC2994203 DOI: 10.2147/ott.s14514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Electronic brachytherapy (EBT) was developed to allow accelerated partial breast irradiation to be performed in a patient procedure room with minimal shielding. This observational, nonrandomized, multicenter study evaluated EBT as a post-surgical adjuvant radiation therapy for early stage breast cancer. METHODS This study included women aged 50 years or more with invasive carcinoma or ductal carcinoma in situ, tumor size ≤3 cm, negative lymph node status, and negative surgical margins. The endpoints were skin and subcutaneous toxicities, efficacy outcomes, cosmetic outcomes, and device performance. In this interim report, 1-month, 6-month, and 1-year follow-up data are available on 68, 59, and 37 patients, respectively. RESULTS The EBT device performed consistently, delivering the prescribed 34 Gy to all 69 patients (10 fractions/patient). Most adverse events were Grade 1 and included firmness, erythema, breast tenderness, hyperpigmentation, pruritis, field contracture, seroma, rash/desquamation, palpable mass, breast edema, hypopigmentation, telangiectasia, and blistering, which were anticipated. Breast infection occurred in two (2.9%) patients. No tumor recurrences were reported. Cosmetic outcomes were excellent or good in 83.9%-100% of evaluable patients at 1 month, 6 months, and 1 year. CONCLUSION This observational, nonrandomized, multicenter study demonstrates that this EBT device was reliable and well tolerated as an adjuvant radiation therapy for early stage breast cancer.
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