Abstract
Purpose
Mammographically based noninvasive image-guided breast brachytherapy (NIBB) partial
breast irradiation (PBI) is ideally suited for preoperative treatment. We hypothesize
that delivering NIBB PBI to the preoperative tumor volume compared with the postoperative
lumpectomy bed would simplify target identification and allow for a reduction in irradiated
volume along each orthogonal axis.
Methods and Materials
Patients with invasive breast cancer treated with NIBB PBI at our institution were
identified. Preoperative NIBB treatments were modeled along orthogonal craniocaudal
and mediolateral axes with an applicator encompassing the gross lesion plus a 1 cm
clinical target volume margin. Preoperative treatment volumes were calculated along
each axis using the selected applicator surface area multiplied by the preoperative
mammogram separation. The actual applicator size and breast separation from the first
fraction of postoperative treatment was used to calculate the postoperative treatment
volume. Paired -test was used to compare the preoperative and postoperative treatment
separation, area, and volume for each patient.
Results
Forty-eight patients with Stage I–II breast cancer had imaging and treatment data
available for review. Along the axis, the mean preoperative treatment volume was significantly
less than the mean postoperative treatment volume (116 cm 3 vs. 204 cm 3, respectively; p < 0.0001). Similarly, along the mediolateral axis, the mean preoperative treatment
volume was significantly less than the mean postoperative treatment volume (125 cm
3 vs. 216 cm 3, respectively; p < 0001).
Conclusions
Based on our retrospective comparison, PBI delivered using NIBB to the preoperative
tumor may reduce the volume of healthy breast tissue receiving radiation as compared
with NIBB to the postoperative tumor bed.
Keywords
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Article info
Publication history
Published online: December 05, 2020
Accepted:
October 30,
2020
Received in revised form:
September 29,
2020
Received:
August 21,
2020
Footnotes
This work was presented in part at the American Society of Brachytherapy Meeting, San Francisco, CA, 2018.
Disclosures: David E. Wazer is a consultant for Advanced Radiation Therapy, Inc. The other authors have no relevant COI.
Identification
Copyright
© 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
