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Retrospective review of three-fractioned accelerated partial breast irradiation

      Abstract

      Methods

      This retrospective study evaluated patients who received three-fraction accelerated partial breast irradiation (APBI) via brachytherapy for breast cancer between January 2016 and April 2020. Inclusion criteria included age ≥18 years and early-stage unilateral breast cancer with negative lymph nodes. We evaluated acute toxicity (<6 weeks), late toxicity (≥6 weeks), and cosmetic outcomes. Frequencies of each variable were calculated. Cancer-specific outcomes were determined via the Kaplan-Meier method.

      Results

      Thirty consecutive patients received three-fraction APBI of 2,250 cGy over 2 d. All cancers were stage T2 or less. Median time to last follow-up was 22 months. Local recurrence-free survival was 95.8% at 22 months. Seventeen (56.7%) patients reported an acute toxicity event. All were grade 1 except one patient with grade 2 (fatigue). No patient experienced ≥ grade 3 acute toxicity. One (3.3%) patient reported grade 3 late toxicity (tissue fibrosis). No patients had breast edema, fat necrosis, or non-healing wounds. There were no ≥ grade 3 cosmetic events.

      Discussion

      Three-fraction APBI via brachytherapy was successful in preventing disease recurrence and death in this study, with still limited follow-up. Although acute and late toxicities or adverse cosmetic outcomes were seen, very few were grade 2 or higher and compare favorably to those reported in prior 10-fraction APBI studies.

      Conclusions

      This study provides early single institutional evidence that three-fraction APBI may become a feasible treatment alternative.

      Keywords

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      References

        • Khan A.J.
        • Chen P.Y.
        • Yashar C.
        • et al.
        Three-fraction accelerated partial breast irradiation (APBI) delivered with brachytherapy applicators is feasible and safe: first results from the TRIUMPH-T trial.
        Int J Radiat Oncol Biol Phys. 2019; 104: 67-74https://doi.org/10.1016/j.ijrobp.2018.12.050
        • Clark R.M.
        • McCulloch P.B.
        • Levine M.N.
        • et al.
        Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer.
        J Natl Cancer Inst. 1992; 84: 683-689https://doi.org/10.1093/jnci/84.9.683
        • Fisher B.
        • Anderson S.
        • Bryant J.
        • et al.
        Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.
        N Engl J Med. 2002; 347: 1233-1241https://doi.org/10.1056/NEJMoa022152
        • 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: 1707-1716https://doi.org/10.1016/S0140-6736(11)61629-2
        • Correa C.
        • Harris E.E.
        • Leonardi M.C.
        • et al.
        Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement.
        Pract Radiat Oncol. 2017; 7: 73-79https://doi.org/10.1016/j.prro.2016.09.007
        • Strnad V.
        • Ott O.J.
        • Hildebrandt G.
        • et al.
        5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial.
        Lancet. 2016; 387: 229-238https://doi.org/10.1016/S0140-6736(15)00471-7
        • Castaneda S.A.
        • Strasser J.
        Updates in the treatment of breast cancer with radiotherapy.
        Surg Oncol Clin N Am. 2017; 26: 371-382https://doi.org/10.1016/j.soc.2017.01.013
        • Shah C.
        • Vicini F.
        • Shaitelman S.F.
        • et al.
        The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation.
        Brachytherapy. 2018; 17: 154-170https://doi.org/10.1016/j.brachy.2017.09.004
        • Shah C.
        • Vicini F.
        • Wazer D.E.
        • et al.
        The American Brachytherapy Society consensus statement for accelerated partial breast irradiation.
        Brachytherapy. 2013; 12: 267-277https://doi.org/10.1016/j.brachy.2013.02.001
        • Wallace M.
        • Martinez A.
        • Mitchell C.
        • et al.
        Phase I/II study evaluating early tolerance in breast cancer patients undergoing accelerated partial breast irradiation treated with the mammosite balloon breast brachytherapy catheter using a 2-day dose schedule.
        Int J Radiat Oncol Biol Phys. 2010; 77: 531-536https://doi.org/10.1016/j.ijrobp.2009.05.043
        • Vicini F.A.
        • Cecchini R.S.
        • White J.R.
        • et al.
        Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial.
        Lancet. 2019; 394: 2155-2164https://doi.org/10.1016/S0140-6736(19)32514-0
        • Wilkinson J.B.
        • Martinez A.A.
        • Chen P.Y.
        • et al.
        Four-year results using balloon-based brachytherapy to deliver accelerated partial breast irradiation with a 2-day dose fractionation schedule.
        Brachytherapy. 2012; 11: 97-104https://doi.org/10.1016/j.brachy.2011.05.012
        • Polgár C.
        • Strnad V.
        • Major T.
        Brachytherapy for partial breast irradiation: the European experience.
        Semin Radiat Oncol. 2005; 15: 116-122https://doi.org/10.1016/j.semradonc.2004.10.004
        • Polgár C.
        • Major T.
        • Takácsi-Nagy Z.
        • Fodor J.
        Breast-conserving surgery followed by partial or whole breast irradiation: twenty-year results of a phase 3 clinical study.
        Int J Radiat Oncol Biol Phys. 2021; 109: 998-1006https://doi.org/10.1016/j.ijrobp.2020.11.006
        • Guinot J.L.
        • Gonzalez-Perez V.
        • Meszaros N.
        • et al.
        Very accelerated partial breast irradiation Phase I-II multicenter trial (VAPBI): feasibility and early results.
        Brachytherapy. 2021; 20: 332-338https://doi.org/10.1016/j.brachy.2020.10.010
        • Kinj R.
        • Chand M.E.
        • Gal J.
        • et al.
        Five-year oncological outcome after a single fraction of accelerated partial breast irradiation in the elderly.
        Radiat Oncol. 2019; 14: 234https://doi.org/10.1186/s13014-019-1448-0
        • Hannoun-Lévi J.M.
        • Cham Kee D.L.
        • Gal J.
        • et al.
        Accelerated partial breast irradiation for suitable elderly women using a single fraction of multicatheter interstitial high-dose-rate brachytherapy: early results of the Single-Fraction Elderly Breast Irradiation (SiFEBI) Phase I/II trial.
        Brachytherapy. 2018; 17: 407-414https://doi.org/10.1016/j.brachy.2017.11.008
        • Trombetta M.
        • Julian T.B.
        • Kim Y.
        • et al.
        The allegheny general modification of the Harvard breast cosmesis scale for the retreated breast.
        Oncology (Williston Park). 2009; 23: 954-956
        • Chao K.K.
        • Vicini F.A.
        • 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: 32-40https://doi.org/10.1016/j.ijrobp.2007.02.026
        • Khan A.J.
        • Rafique R.
        • Zafar W.
        • et al.
        Nation-Scale adoption of shorter breast radiation therapy schedules can increase survival in resource constrained economies: results from a markov chain analysis.
        Int J Radiat Oncol Biol Phys. 2017; 97: 287-295https://doi.org/10.1016/j.ijrobp.2016.10.002