Partial breast irradiation with interstitial high-dose-rate brachytherapy in early breast cancer: Results of a phase II prospective study

Aristei, C.; Palumbo, I.; Cucciarelli, F.; Cavalli, A.; Tarducci, R.; Raymondi, C.; Perrucci, E.; Cavaliere, A.; Latini, P.; Rulli, A.

doi:10.1016/j.ejso.2008.06.002

« Previous Next »European Journal of Surgical Oncology
Volume 35, Issue 2 , Pages 144-150, February 2009

Partial breast irradiation with interstitial high-dose-rate brachytherapy in early breast cancer: Results of a phase II prospective study

C. Aristei
- Institute of Radiation Oncology, University of Perugia, Ospedale Santa Maria della Misericordia, Via Martiri 28, 35 (Villa Capitini), 06129 Perugia, Italy
- Corresponding author. Tel.: +39 075 5784306; fax: +39 075 5783254.
I. Palumbo
- Institute of Radiation Oncology, University of Perugia, Ospedale Santa Maria della Misericordia, Via Martiri 28, 35 (Villa Capitini), 06129 Perugia, Italy
F. Cucciarelli
- Institute of Radiation Oncology, University of Perugia, Ospedale Santa Maria della Misericordia, Via Martiri 28, 35 (Villa Capitini), 06129 Perugia, Italy
A. Cavalli
- Institute of Radiation Oncology, University of Perugia, Ospedale Santa Maria della Misericordia, Via Martiri 28, 35 (Villa Capitini), 06129 Perugia, Italy
R. Tarducci
- Medical Physics Unit, Perugia General Hospital, via Brunamonti 51, 06122 Perugia, Italy
C. Raymondi
- Medical Physics Unit, Perugia General Hospital, via Brunamonti 51, 06122 Perugia, Italy
E. Perrucci
- Institute of Radiation Oncology, University of Perugia, Ospedale Santa Maria della Misericordia, Via Martiri 28, 35 (Villa Capitini), 06129 Perugia, Italy
A. Cavaliere
- Institute of Pathological Anatomy and Histology, University of Perugia, via Brunamonti 51, 06122 Perugia, Italy
P. Latini
- Institute of Radiation Oncology, University of Perugia, Ospedale Santa Maria della Misericordia, Via Martiri 28, 35 (Villa Capitini), 06129 Perugia, Italy
A. Rulli
- Department of Surgery, University of Perugia, via Brunamonti 51, 06122 Perugia, Italy

Accepted 2 June 2008.

Abstract

Aim

To investigate, in a phase II prospective study, the efficacy of partial breast irradiation administered with high-dose-rate brachytherapy.

Methods

After conservative surgery 80 patients with low-risk early-stage breast cancer received 4Gy twice a day for 4days (total dose 32Gy). Catheter implantation was performed during surgery in 15 cases and postoperatively, at a median of 8weeks from surgery, in 65 patients. Adjuvant therapy was chemotherapy (8) and/or hormone therapy (61).

Results

Cosmetic results were good/excellent in 79 patients. Perioperative toxicity was very low. Acute skin toxicity developed in seven cases (six G1; one G2); late G3 cutaneous toxicity in one patient and late subcutaneous toxicity in five (three G1; two G2). Grade 1 teleangiectasia occurred in eight patients and grade 2 in one. Fat necrosis was symptomatic in one patient and asymptomatic in five. Only one patient presented pain after brachytherapy. A significantly (p=0.001) higher frequency of late toxicity was observed in patients implanted during surgery, the group, which included the only patient with a fair cosmetic result. No local or regional relapses have occurred to date. The median follow-up was 30months (range 3–52).

Conclusion

This strategy is a viable option in selected patients with early-stage breast cancer as it is feasible, reproducible and associated with very low perioperative and acute toxicity. The low incidence of late side effects will probably change as follow-up lengthens.

Keywords: Breast cancer, Conservative surgery, Partial breast irradiation, High-dose-rate brachytherapy