Top

Published in:

01-12-2015 | Breast Oncology

Outcomes of Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation Via Multicatheter Interstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience

Authors: Mitchell Kamrava, MD, Robert R. Kuske, MD, Bethany Anderson, MD, Peter Chen, MD, John Hayes, MD, Coral Quiet, MD, Pin-Chieh Wang, PhD, Darlene Veruttipong, MPH, Margaret Snyder, RN, D. Jeffrey Demanes, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

Abstract

Purpose

To report outcomes for breast-conserving therapy using adjuvant accelerated partial breast irradiation with interstitial multicatheter brachytherapy by a cooperative group of institutions.

Methods

From 1992 to 2013, a total of 1356 patients were treated with breast-conserving surgery and adjuvant accelerated partial breast irradiation using interstitial multicatheter brachytherapy. A total of 1131 patients had >1 year of data available to assess oncologic and cosmesis outcomes. Median age was 59 years old (range 22–90 years). Histologies treated included 1005 (73 %) invasive ductal carcinoma and 240 (18 %) ductal carcinoma-in situ. T stages were 18 % Tis, 75 % T1, and 8 % ≥T2. Nodal status was 73 % N0 and 6 % N1a. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was positive in 83, 70, and 6 %, respectively. Cox multivariate analysis for local control was performed using histology, age, estrogen receptor status, tumor size, grade, margin, and nodal status.

Results

The mean (SD) follow-up was 6.9 years (4.3). The 10-year actuarial risk (95 % confidence interval) of an ipsilateral breast tumor recurrence was 7.6 % (5.6–10.1). Other 10-year actuarial risks (95 % confidence interval) were regional failure 2.3 % (1.4–3.7), distant metastasis 3.8 % (2.5–5.7), cause-specific survival 96.3 % (94.2–97.6), overall survival 86.5 (83.0–89.3), and new contralateral cancers 4.6 % (3.0–6.9). On multivariate analysis, high grade (hazard ratio 2.81) and positive margin status (hazard ratio 18.42) were the only two significant variables associated with an increased risk of local recurrence. Physician-reported cosmesis was excellent/good in 84 % (98 of 116) of patients with >5 years of follow-up.

Conclusions

This is the largest report of outcomes with interstitial breast brachytherapy. This treatment resulted in excellent long-term local control and cosmesis outcomes.

Simone NL, Dan T, Shih J, et al. Twenty-five year results of the National Cancer Institute randomized breast conservation trial. Breast Cancer Res Treat. 2012;132:197–203.PubMedCrossRef

Schroen AT, Brenin DR, Kelly MD, Knaus WA, Slingluff CL. Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. J Clin Oncol. 2005;23:7074–80.PubMedCrossRef

Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.PubMedCrossRef

Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001;12:997–1003.PubMedCrossRef

Presley CJ, Soulos PR, Herrin J, et al. Patterns of use and short-term complications of breast brachytherapy in the national medicare population from 2008–2009. J Clin Oncol. 2012;30:4302–7.PubMedPubMedCentralCrossRef

Polgár C, Fodor J, Major T, Sulyok Z, Kásler M. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol. 2013;108:197–202.PubMedCrossRef

Shah C, Antonucci JV, Wilkinson J Ben, et al. Twelve-year clinical outcomes and patterns of failure with accelerated partial breast irradiation versus whole-breast irradiation: results of a matched-pair analysis. Radiother Oncol. 2011;100:210–4.PubMedCrossRef

Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.PubMedCrossRef

Polgár C, Van Limbergen E, Pötter R, et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group ba. Radiother Oncol. 2010;94:264–73.PubMedCrossRef

10.

Shah C, Vicini F, Wazer DE, Arthur D, Patel RR. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy. 2013;12:267–77.PubMedCrossRef

11.

Wilkinson JB, Beitsch PD, Shah C, et al. Evaluation of current consensus statement recommendations for accelerated partial breast irradiation: a pooled analysis of William Beaumont Hospital and American Society of Breast Surgeon MammoSite Registry Trial Data. Int J Radiat Oncol Biol Phys. 2013;85:1179–85.PubMedCrossRef

12.

Recht A, Silver B, Schnitt S, Connolly J, Hellman S, Harris JR. Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int J Radiat Oncol Biol Phys. 1985;11:1271–6.PubMedCrossRef

13.

Rose MA, Olivotto I, Cady B, et al. Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Arch Surg. 1989;124:153–7.PubMed

14.

Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.PubMedCrossRef

15.

Kuske RR, Young SS. Breast brachytherapy versus whole-breast irradiation: reported differences may be statistically significant but clinically trivial. Int J Radiat Oncol Biol Phys. 2015;88:266–8.CrossRef

16.

Smith GL, Xu Y, Buchholz TA, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA. 2012;307:1827–37.PubMedPubMedCentral

17.

Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.PubMedCrossRef

18.

White JR, Winter KA, Kuske RR, et al. Long-term outcome from RTOG 9517: a phase I/II study of accelerated partial breast irradiation (APBI) with mulitcatheter brachytherapy (MCT) following lumpectomy for early-stage breast cancer. Paper presented at: 2012 Breast Cancer Symposium. Available at: http://meetinglibrary.asco.org/content/102772-125. Accessed 24 Dec 2014.

19.

Ribeiro GG, Magee B, Swindell R, Harris M, Banerjee SS. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5:278–83.PubMedCrossRef

20.

Póti Z, Nemeskéri C, Fekésházy A, et al. Partial breast irradiation with interstitial (60)Co brachytherapy results in frequent grade 3 or 4 toxicity. Evidence based on a 12-year follow-up of 70 patients. Int J Radiat Oncol Biol Phys. 2004;58:1022–33.PubMedCrossRef

21.

Polgár 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

22.

Liljegren G, Holmberg L, Bergh J, et al. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol. 1999;17:2326–33.PubMed

23.

Hattangadi JA, Powell SN, MacDonald SM, et al. Accelerated partial breast irradiation with low-dose-rate interstitial implant brachytherapy after wide local excision: 12-year outcomes from a prospective trial. Int J Radiat Oncol Biol Phys. 2012;83:791–800.PubMedPubMedCentralCrossRef

24.

Arthur DW, Winter K, Kuske RR, et al. A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 95-17. Int J Radiat Oncol Biol Phys. 2008;72:467–73.PubMedPubMedCentralCrossRef

25.

King TA, Bolton JS, Kuske RR, Fuhrman GM, Scroggins TG, Jiang XZ. Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer. Am J Surg. 2000;180:299–304.PubMedCrossRef

26.

Wobb JL, Chen PY, Shah C, et al. Nomogram for predicting the risk of locoregional recurrence in patients treated with accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2015;91:312–8.PubMedCrossRef

27.

Bane AL, Whelan TJ, Pond GR, et al. Tumor factors predictive of response to hypofractionated radiotherapy in a randomized trial following breast conserving therapy. Ann Oncol. 2014;25:992–8.PubMedCrossRef

28.

Haviland JS, Yarnold JR, Bentzen SM. Hypofractionated radiotherapy for breast cancer. N Engl J Med. 2010;362:1843.PubMedCrossRef

29.

Rabinovitch R, Winter K, Kuske R, et al. RTOG 95-17, a phase II trial to evaluate brachytherapy as the sole method of radiation therapy for stage I and II breast carcinoma—year-5 toxicity and cosmesis. Brachytherapy. 2014;13:17–22.PubMedCrossRef

30.

Shah C, Badiyan S, Ben Wilkinson J, et al. Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American Society of Breast Surgeons MammoSite(^®) breast brachytherapy registry trial. Ann Surg Oncol. 2013;20:3279–85.PubMedCrossRef

31.

Dodwell D, Dyker K, Brown J et al. A randomized study of whole-breast vs tumor-bed irradiation after local excision and axillary dissection for early breast cancer. Clin Oncol. 2005;17:618–22CrossRef

Title: Outcomes of Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation Via Multicatheter Interstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience
Authors: Mitchell Kamrava, MD
Robert R. Kuske, MD
Bethany Anderson, MD
Peter Chen, MD
John Hayes, MD
Coral Quiet, MD
Pin-Chieh Wang, PhD
Darlene Veruttipong, MPH
Margaret Snyder, RN
D. Jeffrey Demanes, MD
Publication date: 01-12-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4563-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcomes of Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation Via Multicatheter Interstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Special Issue 3/2015

Managing Endometrial Cancer: The Role of Pelvic Lymphadenectomy and Secondary Surgery

Oncoplastic Resection of Breast Cancers Located in the Lower-Inner or Lower-Outer Quadrant with the Modified McKissock Mammaplasty Technique

Prognosis and Treatment After Diagnosis of Recurrent Esophageal Carcinoma Following Esophagectomy with Curative Intent

Nuclear PROX1 is Associated with Hypoxia-Inducible Factor 1α Expression and Cancer Progression in Esophageal Squamous Cell Carcinoma

Comparison of Secondary and Primary Thyroid Cancers: Patient Characteristics and Postoperative Outcomes

A Study Comparing Free-Flap Reconstruction via the Retroauricular Approach and the Traditional Transcervical Approach for Head and Neck Cancer: A Matched Case–Control Study