Minimally invasive tumor bed implant (MITBI) and peri-operative high-dose-rate brachytherapy (PHDRBT) for accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost) in breast-conserving surgery for ductal carcinoma in situ
| Autor: | Mauricio Cambeiro, Felipe Angel Calvo Manuel, Rafael Martínez-Monge, Natalia Rodriguez-Spiteri, Luis Isaac Ramos, Luis Pina, Marta Abengozar, Carolina Sobrido Sampedro, Arlette Elizalde, Marta Gimeno Morales, Miguel Angel Idoate, Antonio Esgueva, B. Olartecoechea, Isabel T. Rubio, Fernando Martínez-Regueira |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Original Paper
medicine.medical_specialty medicine.diagnostic_test business.industry partial breast irradiation medicine.medical_treatment Brachytherapy Partial Breast Irradiation Perioperative Ductal carcinoma High-Dose Rate Brachytherapy dcis Oncology high-dose-rate brachytherapy Biopsy Breast-conserving surgery medicine Medicine Radiology Nuclear Medicine and imaging Radiology External beam radiotherapy business |
| Zdroj: | Journal of Contemporary Brachytherapy, Vol 12, Iss 6, Pp 521-532 (2020) Journal of Contemporary Brachytherapy |
| ISSN: | 2081-2841 |
| Popis: | Purpose To evaluate our institutional experience of minimally invasive tumor bed implantation (MITBI) during breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) to deliver peri-operative high-dose-rate brachytherapy (PHDRBT) as accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost). Material and methods Patients older than 40, with clinical and radiological unifocal DCIS < 3 cm were considered potential candidates for accelerated partial breast irradiation (APBI) and were implanted during BCS using MITBI-technique. Patients who in final pathology reports showed free margins and no other microscopic tumor foci, received AMBI with PHDRBT (3.4 Gy BID in 5 days). Patients with adverse features received A-PHDRBT-boost with post-operative external beam radiotherapy (EBRT). Results Forty-one patients were implanted, and 36 were treated and analyzed. According to final pathology, 24 (67%) patients were suitable for AMBI and 12 (33%) were qualified for A-PHDRBT-boost. Reoperation rate for those with clear margins was 16.6% (6/36); this rate increased to 33% (4/12) for G3 histology, and 66% (4/6) were rescued using AMBI. Early complications were documented in 5 patients (14%). With a median follow-up of 97 (range, 42-138) months, 5-year rates of local, elsewhere, locoregional, and distant control were all 97.2%. 5-year ipsilateral breast tumor recurrence rates (IBTR) were 5.6% (2/36), 8.3% (2/24) for AMBI, and 0% (0/12) for A-PHDRBT-boost patients. Both instances of IBTR were confirmed G3 tumors in pre-operative biopsies; no IBTR was documented in G1-2 tumors. Cosmetic outcomes were excellent/good in 96% of AMBI vs. 67% in A-PHDRBT-boost (p = 0.034). Conclusions The MITBI-PHDRBT program allows selection of patients with excellent prognoses (G1-2 DCIS with negative margins and no multifocality), for whom AMBI could be a good alternative with low recurrence rate, decrease of unnecessary radiation, treatment logistics improvement, and over-treatment reduction. Patients whose pre-operative biopsy showed G3 tumor, presents with inferior local control and more risk of reoperation due to positive margins. |
| Databáze: | OpenAIRE |
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