1
|
Gimeno-Morales M, Motisi L, Rodriguez-Spiteri N, Martínez-Regueira F, Worthington T, Therapist R, Strnad V, Hannoun-Levi JM, Gutierrez C. Post- versus intra-operative implant for breast cancer interstitial brachytherapy: How to choose? J Contemp Brachytherapy 2024; 16:72-83. [PMID: 38584881 PMCID: PMC10993897 DOI: 10.5114/jcb.2024.135635] [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: 12/05/2023] [Accepted: 01/20/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Breast brachytherapy (BB) represents an important radiation therapy modality in modern breast cancer treatments. Currently, BB is mainly used for accelerated partial breast irradiation (APBI), local boost after whole breast radiation therapy (WBRT), and as salvage re-irradiation after second lumpectomy (APBrl). Two multi-catheter interstitial brachytherapy (MIB) techniques can be offered: intra-operative (IOB) and post-operative (POB) brachytherapy. The aim of this article was to summarize current available data on these two different brachytherapy approaches for breast cancer. Material and methods A literature search was performed, and different experiences published by BB expert teams were analyzed and compared. These two different brachytherapy approaches for breast cancer have also been presented and discussed during meetings of the GEC-ESTRO BCWG. In addition, expert recommendations were defined. Results A comprehensive description and practical comparison of both the techniques, i.e., IOB and POB, considering the latest available published data were presented. Different technical, logistic, and clinical aspects of both the methods were thoroughly examined and analyzed. This detailed comparison of the two breast brachytherapy techniques was supported by scientific data from extensive experience of experts, facilitating an objective analysis that, to our knowledge, has not been previously published. Conclusions Based on the comprehensive analysis of both the brachytherapy techniques available, this article serves as a valuable resource to guide breast teams in selecting the optimal BB technique (POB or IOB), considering hospital environment, multi-disciplinary collaboration, and patient logistics.
Collapse
Affiliation(s)
- Marta Gimeno-Morales
- Department of Radiation Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
| | - Laura Motisi
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
| | - Natalia Rodriguez-Spiteri
- Department of Breast Surgical Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Tucker Worthington
- Department of Radiation Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
- Department of Breast Surgical Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d’Azur, Nice, France
- Department of Radiation Oncology, Institut Català d’Oncologia, Barcelona, Spain
| | - Radiation Therapist
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Jean Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d’Azur, Nice, France
| | - Cristina Gutierrez
- Department of Radiation Oncology, Institut Català d’Oncologia, Barcelona, Spain
| | - On behalf of Working Group Breast Cancer of GEC ESTRO
- Department of Radiation Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
- Department of Breast Surgical Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d’Azur, Nice, France
- Department of Radiation Oncology, Institut Català d’Oncologia, Barcelona, Spain
| |
Collapse
|
2
|
Pinheiro J, Rodrigues D, Fernandes P, Pereira A, Trigo L. Synchronous bilateral breast cancer patients submitted to conservative treatment and brachytherapy - The experience of a service. Rep Pract Oncol Radiother 2018; 23:322-330. [PMID: 30127671 DOI: 10.1016/j.rpor.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 02/15/2018] [Accepted: 06/23/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The incidence of breast carcinoma (BC) has increased in the last years. Between 2 and 12% of patients diagnosed with BC will develop bilateral breast carcinoma (BBC). The treatment of these carcinomas is more aggressive than unilateral BC. Purpose To perform a retrospective qualitative analysis of BBC patients whose treatment has included brachytherapy (BT) and to present a revised literature on this issue. Material and methods The cases of BBC whose treatment included brachytherapy were revised. The literature on this issue was refreshed. Results Five women, aged between 54 and 78 at the time of the diagnosis, submitted to conservative surgery followed by external radiotherapy (RT) with boost of BT or exclusive BT (APBI), in the IPO-P BT Service between 2003 and 2016. Discussion The patients with BBC have slightly higher rates of local recurrences, mostly in the tumor bed, where there is a higher risk of local recurrence. Patients treated with BT had lower rates of recurrences than those treated with photons and electrons. Conclusions BBC represents a complex challenge for doctors, because in some cases there is a tendency to use more aggressive treatments and, at the same time, it is not easy to achieve the timing for the correct treatment.
Collapse
Affiliation(s)
- Joana Pinheiro
- Radiotherapy Service of the Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
| | - Darlene Rodrigues
- Radiotherapy Service of the Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
| | - Pedro Fernandes
- Brachytherapy Service of the Instituto Português de Oncologia do Porto, Portugal
| | - Alexandre Pereira
- Medical Physics Service of the Instituto Português de Oncologia do Porto, Portugal
| | - Lurdes Trigo
- Brachytherapy Service of the Instituto Português de Oncologia do Porto, Portugal
| |
Collapse
|
3
|
Major T, Polgár C. Treatment planning for multicatheter interstitial brachytherapy of breast cancer - from Paris system to anatomy-based inverse planning. J Contemp Brachytherapy 2017; 9:89-98. [PMID: 28344609 PMCID: PMC5346613 DOI: 10.5114/jcb.2017.66111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/10/2017] [Indexed: 11/22/2022] Open
Abstract
In the last decades, treatment planning for multicatheter interstitial breast brachytherapy has evolved considerably from fluoroscopy-based 2D to anatomy-based 3D planning. To plan the right positions of the catheters, ultrasound or computed tomography (CT) imaging can be used, but the treatment plan is always based on postimplant CT images. With CT imaging, the 3D target volume can be defined more precisely and delineation of the organs at risk volumes is also possible. Consequently, parameters calculated from dose-volume histogram can be used for quantitative plan evaluation. The catheter reconstruction is also easier and faster on CT images compared to X-ray films. In high dose rate brachytherapy, using a stepping source, a number of forward dose optimization methods (manual, geometrical, on dose points, graphical) are available to shape the dose distribution to the target volume, and these influence dose homogeneities to different extent. Currently, inverse optimization algorithms offer new possibilities to improve dose distributions further considering the requirements for dose coverage, dose homogeneity, and dose to organs at risk simultaneously and automatically. In this article, the evolvement of treatment planning for interstitial breast implants is reviewed, different forward optimization methods are discussed, and dose-volume parameters used for quantitative plan evaluation are described. Finally, some questions of the inverse optimization method are investigated and initial experiences of the authors are presented.
Collapse
Affiliation(s)
- Tibor Major
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Csaba Polgár
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| |
Collapse
|
4
|
Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer. J Contemp Brachytherapy 2017; 8:492-496. [PMID: 28115954 PMCID: PMC5241379 DOI: 10.5114/jcb.2016.64512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/17/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT) with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. Material and methods Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT) including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT). The BT dose of 15 Gy (1 Gy/pulse/h) was given on the following day after surgery. Results No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%), subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years), among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96%) and 87% (95% CI: 80-94%), respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97%) and 89% (95% CI: 82-96%), respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91%) evaluable patients. Conclusions Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation of primary diagnosis.
Collapse
|
5
|
Transition from Paris dosimetry system to 3D image-guided planning in interstitial breast brachytherapy. J Contemp Brachytherapy 2016; 7:479-84. [PMID: 26816505 PMCID: PMC4716128 DOI: 10.5114/jcb.2015.56492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate our first experience with 3D image-guided breast brachytherapy and to compare dose distribution parameters between Paris dosimetry system (PDS) and image-based plans. MATERIAL AND METHODS First 49 breast cancer patients treated with 3D high-dose-rate interstitial brachytherapy as a boost were selected for the study. Every patient underwent computed tomography, and the planning target volume (PTV) and organs at risk (OAR) were outlined. Two treatment plans were created for every patient. First, based on a Paris dosimetry system (PDS), and the second one, imaged-based plan with graphical optimization (OPT). The reference isodose in PDS implants was 85%, whereas in OPT plans the isodose was chosen to obtain proper target coverage. Dose and volume parameters (D90, D100, V90, V100), doses at OARs, total reference air kerma (TRAK), and quality assurance parameters: dose nonuniformity ratio (DNR), dose homogeneity index (DHI), and conformity index (COIN) were used for a comparison of both plans. RESULTS The mean number of catheters was 7 but the mean for 20 first patients was 5 and almost 9 for the next 29 patients. The mean value of prescribed isodose for OPT plans was 73%. The mean D90 was 88.2% and 105.8%, the D100 was 59.8% and 75.7%, the VPTV90 was 88.6% and 98.1%, the VPTV100 was 79.9% and 98.9%, and the TRAK was 0.00375 Gym(-1) and 0.00439 Gym(-1) for the PDS and OPT plans, respectively. The mean DNR was 0.29 and 0.42, the DHI was 0.71 and 0.58, and the COIN was 0.68 and 0.76, respectively. CONCLUSIONS The target coverage in image-guided plans (OPT) was significantly higher than in PDS plans but the dose homogeneity was worse. Also, the value of TRAK increased because of change of prescribing isodose. The learning curve slightly affected our results.
Collapse
|
7
|
Evaluation of BEBIG HDR (60)Co system for non-invasive image-guided breast brachytherapy. J Contemp Brachytherapy 2015; 7:469-78. [PMID: 26816504 PMCID: PMC4716133 DOI: 10.5114/jcb.2015.56766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/03/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose HDR 60Co system has recently been developed and utilized for brachytherapy in many countries outside of the U.S. as an alternative to 192Ir. In addition, the AccuBoost® technique has been demonstrated to be a successful non-invasive image-guided breast brachytherapy treatment option. The goal of this project is to evaluate the possibility of utilizing the BEBIG HDR 60Co system for AccuBoost treatment. These evaluations are performed with Monte Carlo (MC) simulation technique. Material and methods In this project, the MC calculated dose distributions from HDR 60Co for various breast sizes have been compared with the simulated data using an HDR 192Ir source. These calculations were performed using the MCNP5 code. The initial calculations were made with the same applicator dimensions as the ones used with the HDR 192Ir system (referred here after as standard applicator). The activity of the 60Co source was selected such that the dose at the center of the breast would be the same as the values from the 192Ir source. Then, the applicator wall-thickness for the HDR 60Co system was increased to diminish skin dose to levels received when using the HDR 192Ir system. With this geometry, dose values to the chest wall and the skin were evaluated. Finally, the impact of a conical attenuator with the modified applicator for the HDR 60Co system was analyzed. Results These investigations demonstrated that loading the 60Co sources inside the thick-walled applicators created similar dose distributions to those of the 192Ir source in the standard applicators. However, dose to the chest wall and breast skin with 60Co source was reduced using the thick-walled applicators relative to the standard applicators. The applicators with conical attenuator reduced the skin dose for both source types. Conclusions The AccuBoost treatment can be performed with the 60Co source and thick-wall applicators instead of 192Ir with standard applicators.
Collapse
|