Accelerated partial breast irradiation using the strut-adjusted volume implant single-entry hybrid catheter in brachytherapy for breast cancer in the setting of breast augmentation

Bloom, Elizabeth S.; Kirsner, Steve; Mason, Bryan E.; Nelson, Chris L.; Hunt, Kelly K.; Baumann, Donald P.; Gifford, Kent A.

doi:10.1016/j.brachy.2010.06.008

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Volume 10, Issue 3 , Pages 178-183, May 2011

Accelerated partial breast irradiation using the strut-adjusted volume implant single-entry hybrid catheter in brachytherapy for breast cancer in the setting of breast augmentation

Elizabeth S. Bloom
- Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
- Corresponding author. The University of Texas M.D. Anderson Cancer Center, Radiation Treatment Center at Bellaire, 6602 Mapleridge Street, Houston, TX 77081. Tel.: +1-713-745-6123; fax: +1-713-745-2440.
Steve Kirsner
- Division of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Bryan E. Mason
- Division of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Chris L. Nelson
- Division of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Kelly K. Hunt
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Donald P. Baumann
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Kent A. Gifford
- Division of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX

Received 7 May 2010; received in revised form 2 June 2010; accepted 8 June 2010. published online 19 August 2010.

Abstract

Purpose

Accelerated partial breast irradiation (APBI) has gained popularity as an alternative to adjuvant whole breast irradiation; however, owing to limitations of delivery devices for brachytherapy, APBI has not been a suitable option for all the patients. This report evaluates APBI using the strut-adjusted volume implant (SAVI) single-entry catheter to deliver brachytherapy for breast cancer in the setting of an augmented breast.

Methods and Materials

The patient previously had placed bilateral subpectoral saline implants; stereotactic core biopsy revealed estrogen receptor- and progesterone receptor-positive ductal carcinoma in situ of intermediate nuclear grade. The patient underwent needle-localized segmental mastectomy of her left breast; pathologic specimen revealed no residual malignancy. An SAVI 8-1 device was placed within the segmental resection cavity. Treatment consisted of 3.4Gy delivered twice a day for 5 days for a total dose of 34Gy. Treatments were delivered with a high-dose-rate ¹⁹²Ir remote afterloader.

Results

Conformance of the device to the lumpectomy cavity was excellent at 99.2%. Dosimetric values of percentage of the planning target volume for evaluation receiving 90% of the prescribed dose, percentage of the planning target volume for evaluation receiving 95% of the prescribed dose, volume receiving 150% of the prescribed dose, and volume receiving 200% of the prescribed dose were 97.1%, 94.6%, 22.7cc, and 11.6cc, respectively. Maximum skin dose was 115% of the prescribed dose. The patient tolerated treatment well with excellent cosmetic results, and limited acute and late toxicity at 8 weeks and 6 months, respectively.

Conclusions

Breast augmentation should not be an exclusion criterion for the option of APBI. The SAVI single-entry catheter is another option to successfully complete APBI using brachytherapy for breast cancer in the setting of an augmented breast.

Keywords: Accelerated partial breast irradiation, Breast augmentation, Brachytherapy, SAVI