Top

Published in:

01-08-2014 | Breast Oncology

Timing of Infectious Complications Following Breast-Conserving Therapy with Catheter-Based Accelerated Partial Breast Irradiation

Authors: Alex B. Haynes, MD, MPH, Elizabeth S. Bloom, MD, Isabelle Bedrosian, MD, Henry M. Kuerer, MD, PhD, Rosa F. Hwang, MD, Mark F. Munsell, MS, Roy F. Chemaly, MD, MPH, Linda S. Graviss, MT, CIC, Abigail S. Caudle, MD, Kelly K. Hunt, MD, Welela Tereffe, MD, Simona F. Shaitelman, MD, Gildy V. Babiera, MD

Published in: Annals of Surgical Oncology | Issue 8/2014

Abstract

Background

Accelerated partial breast irradiation (APBI) has been used as an alternative to whole-breast irradiation as part of breast-conserving therapy. Indications and outcomes are topics of ongoing investigation. Previous publications have focused on early postoperative infections and reported low rates of delayed infection. We investigated the pattern of infection after catheter-based APBI at our institution.

Methods

Patients who underwent single-entry catheter-based APBI were identified from an institutional prospective registry including data regarding comorbidities and outcomes. Time of infection was calculated from the date of definitive catheter insertion and classified as early (≤30 days) or delayed.

Results

A total of 91 breast cancer patients were treated with APBI and enrolled in the registry from 2009 to 2011. The median follow-up was 484 days. Breast infection occurred in 13 (14.3 %), with 3 (3.3 %) occurring within 30 days of catheter placement and 10 (11.0 %) in a delayed fashion. Four patients required hospital admission, five underwent percutaneous aspiration, and one underwent incision and drainage. Eight were treated as outpatients with oral antibiotics alone.

Conclusions

Consistent with other reports, we found an overall infection rate of 14.3 % with single-entry catheter-based APBI. There were substantially fewer infections in the early postoperative period than reported elsewhere, but there were more delayed infections. The intensive follow-up in our study likely identified late infections that may not have otherwise been recognized. Vigilance for infectious complications must continue beyond the immediate treatment period in patients undergoing catheter-based APBI. These infections can range in severity but typically can be managed in an outpatient setting.

Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg. 2009;209:269–77.PubMedCrossRef

Calvo FA, Meirino RM, Orecchia R. Intraoperative radiation therapy part 2. Clinical results. Crit Rev Oncol Hematol. 2006;59:116–27.PubMedCrossRef

Polgar C, Fodor J, Major T, et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma: 5-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007;69:694–702.PubMedCrossRef

Polgar C, Major T, Fodor J, et al. Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol. 2010;94:274–9.PubMedCrossRef

Vaidya JS, Baum M, Tobias JS, et al. Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery. Int J Radiat Oncol Biol Phys. 2011;81:1091–7.PubMedCrossRef

Livi L, Buonamici FB, Simontacchi G, et al. Accelerated partial breast irradiation with IMRT: new technical approach and interim analysis of acute toxicity in a phase III randomized clinical trial. Int J Radiat Oncol Biol Phys. 2010;77:509–15.PubMedCrossRef

Olivotto IA, Whelan TJ, Parpia S, et al. Interim toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation (APBI) using 3D conformal external beam radiation (3D CRT). Int J Radiat Oncol Biol Phys. 2013;85:21–2.

Orecchia R. ELIOT Trials in Milan: Results. Presented at the World Congress of Brachytherapy, Barcelona, Spain, 2012.

Chen PY, Vicini FA, Benitez P, et al. Long-term cosmetic results and toxicity after accelerated partial-breast irradiation: a method of radiation delivery by interstitial brachytherapy for the treatment of early-stage breast carcinoma. Cancer. 2006;106:991–9.PubMedCrossRef

10.

Vicini FA, Beitsch PD, Quiet CA, et al. First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer. 2005;104:1138–48.PubMedCrossRef

11.

Cuttino LW, Keisch M, Jenrette JM, et al. Multi-institutional experience using the MammoSite radiation therapy system in the treatment of early-stage breast cancer: 2-year results. Int J Radiat Oncol Biol Phys. 2008;71:107–14.PubMedCrossRef

12.

Chao KK, Vicini FA, Wallace M, et al. Analysis of treatment efficacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial-breast irradiation: the William Beaumont hospital experience. Int J Radiat Oncol Biol Phys. 2007;69:32–40.PubMedCrossRef

13.

Richards GM, Berson AM, Rescigno J, et al. Acute toxicity of high-dose-rate intracavitary brachytherapy with the MammoSite applicator in patients with early-stage breast cancer. Ann Surg Oncol. 2004;11:739–46.PubMedCrossRef

14.

Bunn F, Jones DJ, Bell-Syer S. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev. 2012;1:CD005360.PubMed

15.

Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–9.PubMedCrossRef

16.

Keidan RD, Hoffman JP, Weese JL, et al. Delayed breast abscesses after lumpectomy and radiation therapy. Am Surg. 1990;56:440–4.PubMed

17.

Kuske R, Zannis V. Spacer balloons prior to partial breast irradiation: helpful or hurtful? Ann Surg Oncol. 2011;18:1807–8.PubMedCrossRef

18.

Zannis V, Beitsch P, Vicini F, et al. Descriptions and outcomes of insertion techniques of a breast brachytherapy balloon catheter in 1403 patients enrolled in the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Am J Surg. 2005;190:530–8.PubMedCrossRef

Title: Timing of Infectious Complications Following Breast-Conserving Therapy with Catheter-Based Accelerated Partial Breast Irradiation
Authors: Alex B. Haynes, MD, MPH
Elizabeth S. Bloom, MD
Isabelle Bedrosian, MD
Henry M. Kuerer, MD, PhD
Rosa F. Hwang, MD
Mark F. Munsell, MS
Roy F. Chemaly, MD, MPH
Linda S. Graviss, MT, CIC
Abigail S. Caudle, MD
Kelly K. Hunt, MD
Welela Tereffe, MD
Simona F. Shaitelman, MD
Gildy V. Babiera, MD
Publication date: 01-08-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 8/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3528-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Timing of Infectious Complications Following Breast-Conserving Therapy with Catheter-Based Accelerated Partial Breast Irradiation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2014

Quality of Colorectal Cancer Care Among Veterans: A 10-Year Retrospective Cohort

Incidence Patterns of Primary Bone Cancer in Taiwan (2003–2010): A Population-Based Study

Conservative Hepatectomy for Tumors Involving the Middle Hepatic Vein and Segment 1: The Liver Tunnel

The Impact of Surgical Volume on Racial Disparity in Thyroid and Parathyroid Surgery

Pathological Response to Neoadjuvant Chemotherapy: A New Prognosis Tool for the Curative Management of Peritoneal Colorectal Carcinomatosis

Hedgehog Signaling Between Cancer Cells and Hepatic Stellate Cells in Promoting Cholangiocarcinoma