Abstract
Objective
This study was conducted to report the initial experience of treating patients with synchronous bilateral breast ductal carcinomas in situ (DCIS) treated with accelerated partial breast irradiation (APBI).
Methods
Between August 2008 and September 2012, five patients with bilateral DCIS were treated with Contura Multi-Lumen high-dose rate (HDR) brachytherapy to 34 Gy in ten fractions twice daily. The dose was prescribed to 1 cm from the applicator surface. We report on the tumor characteristics and dosimetric data as well as clinical outcomes and toxicities according to RTOG 9517 and RTOG 9804. Median follow-up was 35 months (range 8–37 months).
Results
The median age was 61 years (range 61–75). All patients had bilateral DCIS. Contralateral DCIS was detected with preoperative magnetic resonance imaging (MRI) performed before lumpectomy. Median tumor size was 4.8 mm on the right and 10 mm on the left. Two patients had grade 1, one patient had grade 2, and two patients had no acute skin toxicity, respectively. At last follow-up, grade 1 late skin toxicity was reported in two patients, and the remaining patients did not have any residual skin reaction. Cosmesis was described as minimal or no difference in the size, shape, or texture of both breasts. There was no loco-regional recurrence.
Conclusion
Our initial experience of using APBI to treat bilateral DCIS is safe and effective and associated with excellent cosmetic outcome in this small population of patients. Long-term results in a larger population are needed.
Similar content being viewed by others
References
Vicini F, Beitsch P, Quiet C (2011) Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons Mammosite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 79:808–817
Antonucci JV, Wallace M, Goldstein NS (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
Shah C, Antonucci JV, Wilkinson JB (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
Kuhl CK, Schrading S, Bieling HB et al (2007) MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 370:485–492
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. N Engl J Med 347:1233–1241
Litière S, Werutsky G, Fentiman IS et al (2012) Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol 4:412–419
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. N Engl J Med 347:1227–1232
Veronesi U, Marubini E, Mariani L et al (2001) Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 12:997–1003
Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366:2087–2106
Vinh-Hung V, Verschraegen C (2004) Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 96:115–121
Wapnir IL, Dignam JJ, Fisher B et al (2011) Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 103:478–488
Bijker N, Meijnen P, Peterse JL et al (2006) Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 24:3381–3387
Fowble B, Solin LJ, Schultz DJ et al (1990) Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys 19:833–842
Gage I, Recht A, Gelman R et al (1995) Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Oncol Biol Phys 33:245–251
Smith TE, Lee D, Turner BC et al (2000) True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys 48:1281–1289
Holli K, Saaristo R, Isola J et al (2001) Lumpectomy with or without postoperative radiotherapy for breast cancer with favorable prognostic features: results of a randomized study. Br J Cancer 84:164–169
Huang E, Buchholz TA, Meric F et al (2002) Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences. Cancer 95:2059–2067
Malmstrom P, Holmberg L, Anderson H et al (2003) Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: a randomised clinical trial in a population with access to public mammography screening. Eur J Cancer 39:1690–1697
Kwa SL, Lebesque JV, Theuws JC et al (1998) Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 42:1–9
Kahan Z, Csenki M, Varga Z et al (2007) The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys 68:673–681
Darby SC, McGale P, Taylor CW et al (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol 6:557–565
Kounalakis N, Pezner R, Staud CL et al (2011) Partial breast irradiation in a patient with bilateral breast cancers and CREST syndrome. Brachytherapy 10:486–490
Khan AJ, Arthur D, Vicini F et al (2012) Six-year analysis of treatment-related toxicities in patients treated with accelerated partial breast irradiation on the American Society of Breast Surgeons Mammo Site Breast Brachytherapy Registry Trial. Ann Surg Oncol 19:1477–1483
Vicini F, Beitsch P, Quiet C et al (2011) Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 79:808–817
Brown S, McLaughlin M, Pope K et al (2009) Initial radiation experience evaluating early tolerance and toxicities in patients undergoing accelerated partial breast irradiation using the Contura multi-lumen balloon breast brachytherapy catheter. Brachytherapy 8:227–233
Orel SG, Reynolds C, Schnall MD et al (1997) Breast carcinoma: MR imaging before reexcisional biopsy. Radiology 205:429–436
Heywang-Kobrunner SH, Viehweg P, Heinig A et al (1997) Contrast-enhanced MRI of the breast: accuracy, value, controversies, solutions. Eur J Radiol 24:94–108
Orel SG, Schnall MD (2001) MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 220:13–3030
Liberman L, Morris EA, Lee MJ et al (2002) Breast lesions detected on MR imaging: features and positive predictive value. Am J Roentgenol 179:171–178
Elmore JG, Armstrong K, Lehman CD (2005) Screening for breast cancer. JAMA 293:1245–1255
Liberman L, Morris EA, Dershaw DD et al (2003) MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. Am J Roentgenol 180:901–910
Smith BD, Arthur DW, Buchholz TA et al (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 74:987–1001
Godinez J, Gombos EC, Chikarmane SA et al (2008) Breast MRI in the evaluation of eligibility for accelerated partial breast irradiation. Am J Roentgenol 191:272–277
Tendulkar RD, Chellman-Jeffers M, Rybicki LA et al (2009) Preoperative breast magnetic resonance imaging in early breast cancer: implications for partial breast irradiation. Cancer 115:1621–1630
Kühr M, Wolfgarten M, Stölzle M et al (2011) Potential impact of preoperative magnetic resonance imaging of the breast on patient selection for accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 81:e541–e546
Kowalchik KV, Vallow LA, McDonough M et al (2012) The role of preoperative bilateral breast magnetic resonance imaging in patient selection for partial breast irradiation in ductal carcinoma in situ. Int J Surg Oncol 2012:206342
Dorn PL, Al-Hallaq HA, Haq F et al (2013) A prospective study of the utility of magnetic resonance imaging in determining candidacy for partial breast irradiation. Int J Radiat Oncol Biol Phys 85:615–622
Vicini F, Shah C, Wilkinson J et al (2013) Should ductal carcinoma-in-situ (DCIS) be removed from the ASTRO consensus panel cautionary group for off-protocol use of accelerated partial breast irradiation (APBI)? A pooled analysis of outcomes for 300 patients with DCIS treated with APBI. Ann Surg Oncol 20(4):1275–1281
Conflict of interest
Mirna Abboud, Paige Nitsch, Marie Weidman-Johnson, Snehal Desai, Sherry Lim, Darlene M. Miltenburg, Barbara Bass, and Bin S. Teh declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abboud, M., Nitsch, P., Weidman-Johnson, M. et al. Patients with bilateral breast ductal carcinoma in situ treated with accelerated partial breast irradiation—initial experience. J Radiat Oncol 3, 293–298 (2014). https://doi.org/10.1007/s13566-014-0147-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13566-014-0147-6