Accelerated Partial Breast Irradiation With Interstitial Implants: Risk Factors Associated With Increased Local Recurrence

Journal Article · Mon Aug 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.04.032· OSTI ID:21587648

Hildebrandt, Guido ^[1]; Poetter, Richard ^[2]; Hammer, Josef ^[3]; Hindemith, Marion ^[1]; Resch, Alexandra ^[2]; Spiegl, Kurt ^[3]; Lotter, Michael ^[4]; Uter, Wolfgang ^[5]; Kortmann, Rolf-Dieter ^[1]; Schrauder, Michael; Beckmann, Matthias W ^[6]; Fietkau, Rainer; Strnad, Vratislav ^[4]

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1. University Hospital Leipzig, Department of Radiation Oncology, Leipzig (Germany)
2. University Hospital AKH Vienna, Department of Radiation Oncology and Radiobiology, Vienna (Austria)
3. Barmherzige Schwestern Hospital, Department of Radiation Oncology, Linz (Austria)
4. University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany)
5. Departments of Medical Informatics, Biometry and Epidemiology, University Erlangen-Nuremberg, Erlangen (Germany)
6. University Hospital Erlangen, Department of Gynecology, Erlangen (Germany)

Purpose: To analyze patient, disease, and treatment-related factors regarding their impact on local control after interstitial multicatheter accelerated partial breast irradiation (APBI). Methods and Materials: Between November 2000 and April 2005, 274 patients with early breast cancer were recruited for the German-Austrian APBI Phase II trial ( (ClinicalTrials.gov) identifier: NCT00392184). In all, 64% (175/274) of the patients received pulsed-dose-rate (PDR) brachytherapy and 36% (99/274) received high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3 to 4 days. Results: The median follow-up time was 64 months (range, 9-110). The actuarial 5-year local recurrence free survival rate (5-year LRFS) was 97.7%. Comparing patients with an age <50 years (49/274) vs. {>=}50 years (225/274), the 5-year LRFS resulted in 92.5% and 98.9% (exact p = 0.030; 99% confidence interval, 0.029-0.032), respectively. Antihormonal treatment (AHT) was not applied in 9% (24/274) of the study population. The 5-year LRFS was 99% and 84.9% (exact p = 0.0087; 99% confidence interval, 0.0079-0.0094) in favor of the patients who received AHT. Lobular histology (45/274) was not associated with worse local control compared with all other histologies (229/274). The 5-year LRFS rates were 97.6% and 97.8%, respectively. Conclusions: Local control at 5 years is excellent and comparable to therapeutic successes reported from corresponding whole-breast irradiation trials. Our data indicate that patients <50 years of age ought to be excluded from APBI protocols, and that patients with hormone-sensitive breast cancer should definitely receive adjuvant AHT when interstitial multicatheter APBI is performed. Lobular histology need not be an exclusion criterion for future APBI trials.

• OSTI ID: 21587648
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 80; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
BRACHYTHERAPY
DISEASES
DOSE RATES
DOSES
GLANDS
HAZARDS
HISTOLOGY
HORMONES
IMPLANTS
IRRADIATION
MAMMARY GLANDS
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
RADIATION DOSES
RADIATION SOURCE IMPLANTS
RADIATION SOURCES
RADIOLOGY
RADIOTHERAPY
THERAPY