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Strut-adjusted volume implant (SAVI) brachytherapy-based accelerated partial breast irradiation (APBI) in African American women

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Abstract

Purpose

To examine the clinical outcomes of postmenopausal African American (AA) women treated with strut-adjusted volume implant brachytherapy-based accelerated partial breast irradiation for early-stage node-negative breast cancer.

Methods

From January 2011 through April 2015, a total of 50 AA patients, meeting criteria to receive APBI as defined by the National Surgical Adjuvant Breast and Bowel Project B-39 (NASBP B-39), completed treatment with the SAVI breast brachytherapy device at Howard University Hospital.

Results

4% ipsilateral breast tumor recurrence and 2% breast cancer-specific mortality was observed. Median follow-up has been 3.8 years with a range of 0.29–4.69 years. Dosimetry parameters yielded a median V90 of 96.22% (range 77.86–105.00%), a median V150 of 31.27 cm3 (range 23.30–49.15 mL), and a median V200 of 14.53 cm3 (range 5.92–19.38 mL). Cosmesis was excellent. There were no infections, persistent seromas, fat necrosis, or telangiectasias observed to date.

Conclusions

This study is the first study to describe the use of SAVI as APBI in an exclusively AA population. This study has demonstrated excellent local control in appropriately selected patients, similar clinical outcomes to the general population, and good to excellent cosmesis in AA women to date.

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References

  1. McGuire A, Brown JA, Malone C, McLaughlin R, Kerin MJ (2015) Effects of age on the detection and management of breast cancer. Cancers (Basel) 7(2):908–929

    Article  Google Scholar 

  2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108

    Article  PubMed  Google Scholar 

  3. Byers T, Wender RC, Jemal A, Baskies AM, Ward EE, Brawley OW (2016) The American Cancer Society challenge goal to reduce US cancer mortality by 50% between 1990 and 2015: results and reflections. CA Cancer J Clin 66(5):359–369

    Article  PubMed  Google Scholar 

  4. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

  5. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  6. Fowble B (1999) Ipsilateral breast tumor recurrence following breast conserving surgery for early stage invasive cancer. Acta Oncol Suppl 13:9–17

    Article  Google Scholar 

  7. Veronesi U, Luini A, del Vecchio M et al (1993) Radiotherapy after breast preserving surgery in women with localized cancer of the breast. N Engl J Med 328:1587–1591

    Article  CAS  PubMed  Google Scholar 

  8. Fowble B, Soli LJ, Schultz DJ et al (1990) Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic finding from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys 19:833–842

    Article  CAS  PubMed  Google Scholar 

  9. Polgár C, Fodor J, Major T, Németh G, Lövey K, Orosz Z, Sulyok Z, Takácsi-Nagy Z, Kásler M (2007) Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma—5-year results of a randomized trial. Int J Radiat Oncol Biol Phys 69(3):694–702

    Article  PubMed  Google Scholar 

  10. Recht A, Ancukiewicz M, Alm El-Din MA, Lu XQ, Martin C, Berman SM, Hirsch AE, Kachnic LA, Katz A, MacDonald S, Nedea EA, Stevenson MA, Powell SN, Taghian AG (2009) Lung dose-volume parameters and the risk of pneumonitis for patients treated with accelerated partial-breast irradiation using three-dimensional conformal radiotherapy. J Clin Oncol 27(24):3887–3893

    Article  PubMed  Google Scholar 

  11. Hepel JT, Tokita M, MacAusland SG, Evans SB, Hiatt JR, Price LL, DiPetrillo T, Wazer DE (2009) Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 75(5):1290–1296

    Article  PubMed  Google Scholar 

  12. Gupta S, Scanderbeg DJ, Kamrava M, Yashar CM (2009) Unexpected toxicity in a patient treated with 3D conformal accelerated partial breast radiotherapy. Brachytherapy 8(2):207–209

    Article  PubMed  Google Scholar 

  13. Yashar CM et al (2011) Initial clinical experience with the strut-adjusted volume implant (SAVI) breast brachytherapy device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up. Int J Radiat Oncol Biol Phys 80(3):765–770

    Article  PubMed  Google Scholar 

  14. Scanderbeg D, Yashar C, Rice R et al (2009) Clinical implementation of a new HDR brachytherapy device for partial breast irradiation. Radiother Oncol 90:36–42

    Article  PubMed  Google Scholar 

  15. American Brachytherapy Society: Breast Brachytherapy Task Group (2007) Breast Brachytherapy. American Brachytherapy Society Web site. http://www.americanbrachytherapy.org/guidelines/abs_breast_brachytherapy_taskgroup.pdf. Accessed 2016

  16. Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, Julian TB, Marks LB, Todor DA, Vicini FA, Whelan TJ, White J, Wo JY, Harris JR (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 74(4):987–1001

    Article  PubMed  Google Scholar 

  17. Howlader N, Noone AM, Krapcho M et al (eds) (2014) National Cancer Institute. SEER Cancer Statistics Review, 1975–2011 [November 2013 data submission, posted April 2014]. http://www.seer.cancer.gov/csr/1975_2011/. Accessed 15 Apr 2014

  18. Surveillance E, Results E (2014) SEER*Stat Database: incidence: total US, 1969 2012. http://www.seer.cancer.gov. Accessed 15 Apr 2014

  19. Iqbal J, Ginsburg O, Rochon PA et al (2015) Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA 313(2):165–173

    Article  CAS  PubMed  Google Scholar 

  20. Aizer AA, Wilhite TJ, Chen MH, Graham PL, Choueiri TK, Hoffman KE, Martin NE, Trinh QD, Hu JC, Nguyen PL (2014) Lack of reduction in racial disparities in cancer-specific mortality over a 20-year period. Cancer 120(10):1532–1539

    Article  PubMed  Google Scholar 

  21. Lautner M, Lin H, Shen Y et al (2015) Disparities in the use of breast-conserving therapy among patients with early-stage breast cancer. JAMA Surg. 150(8):778–786

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pierce L, Fowble B, Solin LJ, Schultz DJ, Rosser C, Goodman RL (1992) Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome. Cancer 69(11):2831–2841

    Article  CAS  PubMed  Google Scholar 

  23. Roach M 3rd, Cirrincione C, Budman D, Hayes D, Berry D, Younger J, Hart R, Henderson IC (1997) Race and survival from breast cancer: based on Cancer and Leukemia Group B trial 8541. Cancer J Sci Am 3(2):107–112

    PubMed  Google Scholar 

  24. Newman LA, Kuerer HM, Hunt KK, Singh G, Ames FC, Feig BW, Ross MI, Taylor S, Singletary SE (1999) Local recurrence and survival among black women with early-stage breast cancer treated with breast-conservation therapy or mastectomy. Ann Surg Oncol 6(3):241–248

    Article  CAS  PubMed  Google Scholar 

  25. Connor CS, Touijer AK, Krishnan L, Mayo MS (2000) Local recurrence following breast conservation therapy in African-American women with invasive breast cancer. Am J Surg 179(1):22–26

    Article  CAS  PubMed  Google Scholar 

  26. Moran MS, Yang Q, Harris LN, Jones B, Tuck DP, Haffty BG (2008) Long-term outcomes and clinicopathologic differences of African-American versus white patients treated with breast conservation therapy for early-stage breast cancer. Cancer 113(9):2565–2574

    Article  PubMed  Google Scholar 

  27. Perez CA (2010) Breast conservation therapy in patients with stage T1-T2 breast cancer: current challenges and opportunities. Am J Clin Oncol 33(5):500–510

    Article  PubMed  Google Scholar 

  28. Edwards-Bennett SM, Jacks LM, McCormick B, Zhang Z, Azu M, Ho A, Powell S, Brown C (2011) Patterns of utilization of adjuvant radiotherapy and outcomes in black women after breast conservation at a large multidisciplinary cancer center. Int J Radiat Oncol Biol Phys 80(4):1102–1108

    Article  PubMed  Google Scholar 

  29. White J, Winter K, Kuske RR, Bolton JS, Arthur DW, Scroggins T, Rabinovitch RA, Kelly T, Toonkel LM, Vicini FA, McCormick B (2016) Long-term cancer outcomes from study NRG oncology/RTOG 9517: a phase 2 study of accelerated partial breast irradiation with multicatheter brachytherapy after lumpectomy for early-stage breast cancer. Int J Radiat Oncol Biol Phys 95(5):1460–1465

    Article  PubMed  PubMed Central  Google Scholar 

  30. Vicini FA, Antonucci JV, Wallace M, Gilbert S, Goldstein NS, Kestin L, Chen P, Kunzman J, Boike T, Benitez P, Martinez A (2007) Long-term efficacy and patterns of failure after accelerated partial breast irradiation: a molecular assay-based clonality evaluation. Int J Radiat Oncol Biol Phys 68(2):341–346. Epub 2007 Feb 15

    Article  PubMed  Google Scholar 

  31. Dodwell DJ, Dyker K, Brown J, Hawkins K, Cohen D, Stead M, Ash D (2005) A randomised study of whole-breast vs tumour-bed irradiation after local excision and axillary dissection for early breast cancer. Clin Oncol (R Coll Radiol) 17(8):618–622

    Article  CAS  Google Scholar 

  32. Polgar C, Major T, Fodor J et al (2004) High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: seven-year results of a comparative study. Int J Radiat Oncol Biol Phys 60:1173–1181

    Article  PubMed  Google Scholar 

  33. Wallace M, Martinez A, Mitchell C, et al (2009) 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

  34. Cuttino L, Heffernan J, Vera R et al (2011) Association between maximal skin dose and breast brachytherapy outcome: a proposal for more rigorous dosimetric constraints. Int J Radiat Oncol Biol Phys 81(3):e173–e177

    Article  PubMed  Google Scholar 

  35. Shah C, Badiyan S, Ben Wilkinson J, Vicini F, Beitsch P, Keisch M, Arthur D, Lyden M (2013) 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 20:3279–3285

    Article  PubMed  Google Scholar 

  36. Cuttino LW, Arthur DW, Vicini F, Todor D, Julian T, Mukhopadhyay N (2014) Long-term results from the Contura multilumen balloon breast brachytherapy catheter phase 4 registry trial. Int J Radiat Oncol Biol Phys 90:1025–1029

    Article  PubMed  Google Scholar 

  37. Strnad V, Hildebrandt G, Pötter R, Hammer J, Hindemith M, Resch A, Spiegl K, Lotter M, Uter W, Bani M et al (2011) Accelerated partial breast irradiation: 5-year results of the German-Austrian multicenter phase II trial using interstitial multicatheter brachytherapy alone after breast-conserving surgery. Int J Radiat Oncol Biol Phys 80:17–24

    Article  PubMed  Google Scholar 

  38. Arthur DW, Winter K, Kuske RR, Bolton J, Rabinovitch R, White J, Hanson WF, Wilenzick RM, McCormick B (2008) 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 72:467–473

    Article  PubMed  PubMed Central  Google Scholar 

  39. King TA, Bolton JS, Kuske RR, Fuhrman GM, Scroggins TG, Jiang XZ (2000) 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 180:299–304

    Article  CAS  PubMed  Google Scholar 

  40. Polgár C, Major T, Fodor J, Sulyok Z, Somogyi A, Lövey K, Németh G, Kásler M (2010) Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol 94:274–279

    Article  PubMed  Google Scholar 

  41. Rabinovitch R, Winter K, Kuske R, Bolton J, Arthur D, Scroggins T, Vicini F, McCormick B, White J (2014) 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 13:17–22

    Article  PubMed  Google Scholar 

  42. Shah C, Antonucci JV, Wilkinson JB, Wallace M, Ghilezan M, Chen P, Lewis K, Mitchell C, Vicini F (2011) 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 100:210–214

    Article  PubMed  Google Scholar 

  43. Ott OJ, Hildebrandt G, Pötter R, Hammer J, Hindemith M, Resch A, Spiegl K, Lotter M, Uter W, Kortmann RD et al (2011) Accelerated partial breast irradiation with interstitial implants: risk factors associated with increased local recurrence. Int J Radiat Oncol Biol Phys 80:1458–1463

    Article  PubMed  Google Scholar 

  44. Ott OJ, Hildebrandt G, Pötter R, Hammer J, Lotter M, Resch A, Sauer R, Strnad V (2007) Accelerated partial breast irradiation with multi-catheter brachytherapy: local control, side effects and cosmetic outcome for 274 patients. Results of the German-Austrian multi-centre trial. Radiother Oncol 82:281–286

    Article  PubMed  Google Scholar 

  45. Antonucci JV, Wallace M, Goldstein NS, Kestin L, Chen P, Benitez P, Dekhne N, Martinez A, Vicini F (2009) Differences in patterns of failure in patients treated with accelerated partial breast irradiation versus whole-breast irradiation: a matched-pair analysis with 10-year follow-up. Int J Radiat Oncol Biol Phys 74:447–452

    Article  PubMed  Google Scholar 

  46. Silverstein MJ, Fastner G, Maluta S, Reitsamer R, Goer DA, Vicini F, Wazer D (2014) Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 2–TARGIT. Ann Surg Oncol 21:3793–3799

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Howard University College of Medicine, Washington, DC, USA

    Amir Isbell, Jacquelyn Dunmore-Griffith & Olubunmi Abayomi

  2. Department of Radiation Oncology, Howard University Hospital, Washington, DC, USA

    Jacquelyn Dunmore-Griffith & Olubunmi Abayomi

Authors
  1. Amir Isbell
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  2. Jacquelyn Dunmore-Griffith
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  3. Olubunmi Abayomi
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Correspondence to Jacquelyn Dunmore-Griffith.

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Isbell, A., Dunmore-Griffith, J. & Abayomi, O. Strut-adjusted volume implant (SAVI) brachytherapy-based accelerated partial breast irradiation (APBI) in African American women. Breast Cancer Res Treat 162, 69–76 (2017). https://doi.org/10.1007/s10549-016-4091-6

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  • DOI: https://doi.org/10.1007/s10549-016-4091-6

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