Abstract
Objective
To compare dosimetrically the stereotactic CyberKnife (CK) therapy and multicatheter
high-dose-rate (HDR) brachytherapy (BT) for accelerated partial breast irradiation
(APBI).
Methods
Treatment plans of 25 patients treated with CK were selected, and additional plans
using multicatheter HDR BT were created on the same CT images. The prescribed dose
was 6.25/25 Gy in both plans to the target volume (PTV). The dose-volume parameters
were calculated for both techniques and compared.
Results
The D90 total dose of the PTV was significantly lower with CK than with HDR BT, D90
was 25.7 Gy, and 27.0 Gy (p < 0.001). However, CK plans were more conformal than BT, COIN was 0.87, and 0.81
(p = 0.0030). The V50 of the non-target breast was higher with CK than with BT: 10.5%
and 3.3% (p = 0.0010), while there was no difference in the dose of the contralateral breast
and contralateral lung. Dose to skin, ipsilateral lung, and ribs were higher with
CK than with BT: D1 was 20.6 Gy vs. 11.5 Gy (p = 0.0018) to skin, 11.4 Gy vs. 9.6 Gy (p = 0.0272) to ipsilateral lung and 18.5 Gy vs. 12.3 Gy (p = 0.0013) to ribs, while D0.1 to heart was lower, 3.0 Gy vs. 3.2 Gy (p = 0.0476), respectively.
Conclusions
Multicatheter HDR BT yields more advantageous plans than stereotactic CyberKnife treatment
in accelerated partial breast irradiation, except in terms of dose conformality and
the dose to the heart. There was no difference in the dose of the contralateral breast
and lung.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to BrachytherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. Early Breast Cancer Trialists’ Collaborative Group.N Engl J Med. 1995; 333: 1444-1455
- NIH Consensus Conference: treatment of early-stage breast cancer.JAMA. 1991; 265: 391-395
- Current status and perspectives of brachytherapy for breast cancer.Int J Clin Oncol. 2009; 14: 7-24
- Electron and high-dose-rate brachytherapy boost in the conservative treatment of stage I-II breast cancer first results of the randomized Budapest boost trial.Strahlenther Onkol. 2002; 178: 615-623
- Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial.J Clin Oncol. 2007; 25: 3259-3265
- The role of boost irradiation in the conservative treatment of stage I-II breast cancer.Pathol Oncol Res. 2001; 7: 241-250
- Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France.J Clin Oncol. 1997; 15: 963-968
- External beam accelerated partial breast irradiation: dosimetric assessment of conformal and three different intensity modulated techniques.Radiol Oncol. 2019; 53: 123-130
- Helical tomotherapy as a means of delivering accelerated partial breast irradiation.Technol Cancer Res Treat. 2004; 3: 639-646
- First experience in Korea of stereotactic partial breast irradiation for low-risk early-stage breast cancer.Front Oncol. 2020; 10: 672
- Partial breast irradiation with CyberKnife after breast conserving surgery: a pilot study in early breast cancer.Radiother Oncol. 2018; 13: 49
- Stereotactic accelerated partial breast irradiation for early-stage breast cancer: rationale, feasibility, and early experience using the CyberKnife radiosurgery delivery platform.Front Oncol. 2016; 6: 129
- CyberKnife stereotactic body radiotherapy and CyberKnife accelerated partial breast irradiation for the treatment of early breast cancer.Transl Cancer Res. 2014; 3: 295-302
- Implementation of stereotactic accelerated partial breast irradiation using cyber-knife – technical considerations and early experiences of a phase II clinical study.Pathol Oncol Res. 2020; 26: 2307-2313
- Novel applications of proton therapy in breast carcinoma.Chin Clin Oncol. 2016; 5: 52
- A dosimetric comparison of MammoSite and ClearPath high-dose-rate breast brachytherapy devices.Brachytherapy. 2009; 8: 14-18
- Dosimetric experience with accelerated partial breast irradiation using image-guided interstitial brachytherapy.Radiother Oncol. 2009; 90: 48-55
- SU-E-T-229: Monte Carlo dosimetric study of SAVI HDR applicator for partial breast irradiation.Med Phys. 2012; 39: 37-56
- Brachytherapy is better than external beam therapy for partial breast irradiation?.Med Phys. 2013; 40
- Factors determining outcome in patients treated with interstitial implantation as a radiation boost for breast conservation therapy.Int J Radiat Oncol Biol Phys. 1997; 39: 381-393
- Evaluation of the dosimetric parameters and the late side effects in CT-guided partial breast brachytherapy.Magy Onkol. 2011; 55 ([in Hungarian]): 132
- Dosimetric characteristics of accelerated partial breast irradiation with CT image-based multi-catheter interstitial brachytherapy: a single institution's experience.Brachytherapy. 2011; 10: 421-426
- Assessment of dose homogeneity in conformal interstitial breast brachytherapy with special respect to ICRU recommendations.J Contemp Brachyther. 2011; 3: 150-155
- Dosimetric comparison of inverse optimisation methods versus forward optimisation in HDR brachytherapy of breast, cervix and prostate cancer.Strahlenther Onkol. 2019; 195: 991-1000
- Does the inverse planning improve the plan quality in interstitial high dose rate breast brachytherapy?.J Contemp Brachyther. 2020; 12: 166-174
- The role of brachytherapy in the treatment of breast cancer.Breast Care. 2018; 13: 157-161
- Dosimetric comparison between 3-dimensional conformal and robotic SBRT treatment plans for accelerated partial breast radiotherapy.Technol Cancer Res Treat. 2016; 15: 437-445
- Dosimetric investigation of accelerated partial breast irradiation (APBI) using CyberKnife.Med Phys. 2012; 39: 6621
- Accelerated partial breast irradiation using robotic radiotherapy: a dosimetric comparison with tomotherapy and threedimensional conformal radiotherapy.Radiat Oncol. 2016; 11: 29
- A dosimetric comparison between three different external photon beam techniques for accelerated partial breast irradiation.Clin Oncol. 2018; 3: 1501
- A dosimetric comparison of three-dimensional conformal, intensity-modulated radiation therapy, and MammoSite partial-breast irradiation.Brachytherapy. 2006; 5: 183-188
- Multicatheter interstitial brachytherapy versus intensity modulated external beam therapy for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk.Radiother Oncol. 2017; 122: 17-23
- Long-term risks of secondary cancer for various whole and partial breast irradiation techniques.Radiother Oncol. 2018; 128: 428-433
- Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study.Radiother Oncol. 2010; 94: 274-279
- Recommendations from GEC ESTRO Breast Cancer Working Group (II): target definition and target delineation for accelerated or boost partial breast irradiation using multicatheter interstitial brachytherapy after breast conserving open cavity surgery.Radiother Oncol. 2016; 118: 199-204
- A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy.Int J Radiat Oncol Biol Phys. 1998; 40: 515-524
Article info
Publication history
Published online: November 19, 2020
Accepted:
October 13,
2020
Received in revised form:
October 8,
2020
Received:
August 25,
2020
Footnotes
Declaration of Interest statement: This study was supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences and the ÚNKP-18-4 New National Excellence Program of the Ministry of Human Capacities and by the 2019 Thematic Excellence Program (TUDFO/51757/2019-ITM).
Contributions: GF: worked out the concept, did the analysis, and wrote this paper. NM: made the contouring and discussed the details of this study. VS: made the contouring and discussed the details of this study. GS: performed the treatment plans of the CK and discussed the details of this study. AH: discussed the details. CsP: supported the study, revised the manuscript. TM: supported the study, discussed the details, and helped in composing the manuscript.
Identification
Copyright
© 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
