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King CA, Shaposhnik G, Sayyed AA, Shoucair S, Farha MJ. Intraoperative Radiation Therapy as a Safe Alternative to Whole Breast Radiation for Treatment of Minimally Invasive Breast Cancers: A Retrospective Cohort Study. Am Surg 2024; 90:190-198. [PMID: 37522359 DOI: 10.1177/00031348231192067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Intraoperative radiation therapy (IORT) in select populations is a viable alternative to whole breast radiation therapy (WBRT) in the treatment of biopsy-proven localized invasive and non-invasive breast cancer. We aim to assess recurrence and complication rates following IORT in lumpectomy patients at a community hospital in Baltimore City. METHODS An IRB-approved retrospective cohort study was conducted on consecutive cases of lumpectomy with IORT from 2013 through 2020 by a single surgeon. Patient demographics, tumor and operative characteristics, and complications were retrieved from electronic medical records. Primary outcomes were postoperative complications and local recurrence rates. RESULTS The final cohort included 117 patients with mean follow-up time of 2.60 + 1.78 years. Mean age was 69.84 + 8.77 years. Thirty-three (28.21%) of patients developed a seroma. Odds of seroma formation were mildly significant for skin spacing [OR: 1.18, 95% CI: (1.02-1.37)] and balloon fill volume [1.04 (1.00-1.08)], but not for age, BMI, diabetes, former or current smoking status, history of WBRT, tumor size, or balloon size. Three (2.6%) patients had local recurrence. Odds of local recurrence were mildly significant for increased tumor size [1.14 (1.04-1.24)] and not significant for any other covariates. CONCLUSIONS IORT exposure did not confer higher rates of complications and the local recurrence rate mirrored that of the general population undergoing lumpectomy and WBRT. This study demonstrates the need for equitable treatment options based on individual needs: IORT is a safe alternative to WBRT in certain subpopulations, especially those with physical, social, or personal limitations preventing participation in a 3- to 7-week time commitment of WBRT.
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Affiliation(s)
- Caroline A King
- Georgetown University School of Medicine, Washington, DC, USA
| | - Guy Shaposhnik
- Georgetown University School of Medicine, Washington, DC, USA
| | - Adaah A Sayyed
- Georgetown University School of Medicine, Washington, DC, USA
| | - Sami Shoucair
- Department of Surgery, MedStar Good Samaritan Hospital, Baltimore, MD, USA
| | - Maen J Farha
- Department of Surgery, MedStar Good Samaritan Hospital, Baltimore, MD, USA
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Huang YJ, Su FCF, Gaffney DK, Kokeny KE, Zhao H, Rassiah-Szegedi P, Salter BJ, Poppe MM. Skin dose estimation using virtual structures for Contura Multi-Lumen Balloon breast brachytherapy. Brachytherapy 2018; 17:956-965. [PMID: 30236908 DOI: 10.1016/j.brachy.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/12/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To propose a workflow that uses ultrasound (US)-measured skin-balloon distances and virtual structure creations in the treatment planning system to evaluate the maximum skin dose for patients treated with Contura Multi-Lumen Balloon applicators. METHODS AND MATERIALS Twenty-three patients were analyzed in this study. CT and US were used to investigate the interfractional skin-balloon distance variations. Virtual structures were created on the planning CT to predict the maximum skin doses. Fitted curves and its equation can be obtained from the skin-balloon distance vs. maximum skin dose plot using virtual structure information. The fidelity of US-measured skin distance and the skin dose prediction using virtual structures were assessed. RESULTS The differences between CT- and US-measured skin-balloon distances values had an average of -0.5 ± 1.1 mm (95% confidence interval [CI] = -1.0 to 0.1 mm). Using virtual structure created on CT, the average difference between the predicted and the actual dose overlay maximum skin dose was -1.7% (95% CI = -3.0 to -0.4%). Furthermore, when applying the US-measured skin distance values in the virtual structure trendline equation, the differences between predicted and actual maximum skin dose had an average of 0.7 ± 6.4% (95% CI = -2.3% to 3.7%). CONCLUSIONS It is possible to use US to observe interfraction skin-balloon distance variation to replace CT acquisition. With the proposed workflow, based on the creation of virtual structures defined on the planning CT- and US-measured skin-balloon distances, the maximum skin doses can be reasonably estimated.
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Affiliation(s)
| | - Fan-Chi Frances Su
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Kristine E Kokeny
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Hui Zhao
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | | | - Bill J Salter
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Matthew M Poppe
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
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Akhtari M, Abboud M, Szeja S, Pino R, Lewis GD, Bass BL, Miltenburg DM, Butler EB, Teh BS. Clinical outcomes, toxicity, and cosmesis in breast cancer patients with close skin spacing treated with accelerated partial breast irradiation (APBI) using multi-lumen/catheter applicators. J Contemp Brachytherapy 2016; 8:497-504. [PMID: 28115955 PMCID: PMC5241383 DOI: 10.5114/jcb.2016.64830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/07/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Accelerated partial breast irradiation (APBI) using a single-lumen device is associated with better cosmetic outcomes if the spacing between the applicator and skin is > 7 mm. However, there are no reports addressing the late toxicity and clinical outcomes in patients treated with single-entry multi-lumen/catheter applicators who had close skin spacing (7 mm or less). We undertook this study to report clinical outcome, acute and late toxicity as well as cosmesis of early stage breast cancer patients with close skin spacing treated with APBI using multi-lumen or multi-catheter devices. MATERIAL AND METHODS This is a retrospective study of all breast cancer patients who had undergone APBI using single-entry multi-lumen/catheter devices in a single institution between 2008 to 2012. The study was limited to those with ≤ 7 mm spacing between the device and skin. RESULTS We identified 37 patients and 38 lesions with skin spacing of ≤ 7 mm. Seven lesions (18%) had spacing of ≤ 3 mm. Median follow-up was 47.5 months. There was one case of ipsilateral breast recurrence and one ipsilateral axillary recurrence. Based on RTOG criteria, 22 treated lesions experienced grade 1 and 9 lesions experienced grade 2 toxicity. Twenty-one lesions experienced late grade 1 toxicity. One patient had to undergo mastectomy due to mastitis. Twenty-four treated breasts showed excellent and 11 had good cosmetic outcome. Overall cosmesis trended towards a significant correlation with skin spacing. However, all patients with ≤ 3 mm skin spacing experienced acute and late toxicities. CONCLUSIONS Accelerated partial breast irradiation can be safely performed in patients with skin spacing of ≤ 7 mm using single-entry multi-lumen/catheter applicators with excellent cosmetic outcomes and an acceptable toxicity profile. However, skin spacing of ≤ 3 mm is associated with acute and late toxicity and should be avoided if possible.
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Affiliation(s)
- Mani Akhtari
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX
| | - Mirna Abboud
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX
| | - Sean Szeja
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX
| | - Ramiro Pino
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX
| | - Gary D. Lewis
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX
| | - Barbara L. Bass
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | | | - E. Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX
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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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WBRT vs. APBI: an interim report of patient satisfaction and outcomes. J Contemp Brachytherapy 2016; 8:17-22. [PMID: 26985193 PMCID: PMC4793068 DOI: 10.5114/jcb.2016.57816] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/20/2016] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To determine differences in patient's reported quality of life and self-reported breast cosmesis between whole breast radiation therapy (WBRT) and accelerated partial breast irradiation (APBI) via single and multi-lumen high-dose-rate (HDR) brachytherapy for women with early stage breast cancer. MATERIAL AND METHODS Patient information was retrospectively reviewed and survey data were prospectively collected for women treated between 2004 to 2014 (APBI) and 2012 to 2014 (WBRT). Criteria for APBI treatments were ER+ (after 2010), N0 (after 2010), T < 3 cm, and post-menopausal. All patients were given a survey with modified FACIT (Functional Assessment of Chronic Illness Therapy) breast quality of life questions to rate their amount of pain, self-consciousness, low energy, presence of lymphedema, and breast cosmesis. RESULTS 242 APBI patients and 59 WBRT patients were identified. In the WBRT cohort, 34 women met departmental criteria for APBI treatment (WBRT who were APBI eligible). The FACIT survey was completed by 80 women treated with APBI (33%; mean follow-up time of 14 months), and 26 women treated with WBRT who were APBI eligible (76%; mean follow-up time of 26 months). During the first year post-treatment, low energy (p = 0.009), self-consciousness (p = 0.0004), and lymphedema (p = 0.0002) scores were significantly lower in the APBI cohort when compared to women treated with WBRT who were APBI eligible. During the second year post-treatment, women treated with APBI reported significantly better breast cosmesis (p = 0.04). The single-lumen balloon (score = 6.3/10) was found to be associated with worse cosmesis compared to the multi-lumen balloons (Mammosite ML and Contura; score = 8.2/10; p = 0.002). There were no significant differences in rates of recurrence between balloons or treatments (p > 0.05). CONCLUSIONS APBI treated patients reported higher cosmetic satisfaction than patients in the matched WBRT cohort. Quality of life scores tended to improve over time. Multi-lumen catheters provided superior cosmetic results compared to single-lumen catheters.
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Brachytherapy in breast cancer: an effective alternative. MENOPAUSE REVIEW 2014; 13:48-55. [PMID: 26327829 PMCID: PMC4520341 DOI: 10.5114/pm.2014.41090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 02/19/2014] [Accepted: 02/19/2014] [Indexed: 11/17/2022]
Abstract
Breast conserving surgery (BCS) with following external beam radiation therapy (EBRT) of the conserved breast has become widely accepted in the last decades for the treatment of early invasive breast cancer. The standard technique of EBRT after BCS is to treat the whole breast up to a total dose of 42.5 to 50 Gy. An additional dose is given to treated volume as a boost to a portion of the breast. In the early stage of breast cancer, research has shown that the area requiring radiation treatment to prevent the cancer from local recurrence is the breast tissue that surrounds the area where the initial cancer was removed. Accelerated partial breast irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1-2 cm margin rather than the whole breast and as a result allows accelerated delivery of the radiation dose in four to five days. There has been a growing interest for APBI and various approaches have been developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy (3D-EBRT) and intra-operative radiation therapy (IORT). Balloon-based brachytherapy approaches include MammoSite, Axxent electronic brachytherapy, Contura, hybrid brachytherapy devices. Another indication for breast brachytherapy is reirradiation of local recurrence after mastectomy. Published results of brachytherapy are very promising. We discuss the current status, indications, and technical aspects of breast cancer brachytherapy.
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Goble RN, Drukteinis JS, Lee MC, Khakpour N, Kiluk JV, Laronga C. Early experience with ultrasound features after intrabeam intraoperative radiation for early stage breast cancer. J Surg Oncol 2014; 109:751-5. [DOI: 10.1002/jso.23581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Rachel N. Goble
- Department of Women's Oncology; Moffitt Cancer Center; Tampa Florida
| | | | - M. Catherine Lee
- Department of Women's Oncology; Moffitt Cancer Center; Tampa Florida
| | - Nazanin Khakpour
- Department of Women's Oncology; Moffitt Cancer Center; Tampa Florida
| | - John V. Kiluk
- Department of Women's Oncology; Moffitt Cancer Center; Tampa Florida
| | - Christine Laronga
- Department of Women's Oncology; Moffitt Cancer Center; Tampa Florida
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Haverkamp U, Moustakis C. Berechnungen der „equivalent uniform dose“ zur akzelerierten Teilbrustbestrahlung mit dem MammoSite-Applikator. Strahlenther Onkol 2014; 190:235-6. [DOI: 10.1007/s00066-013-0524-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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