Skip to main content

Advertisement

SpringerLink
Log in

A phase II trial of balloon-catheter partial breast brachytherapy optimization in the treatment of stage 0, I, and IIA breast carcinoma

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objectives

This study aims to (a) prospectively determine if multiple dwell (multidwell) position dose delivery can decrease skin dose and resultant toxicity over single-dwell balloon-catheter partial breast irradiation and (b) evaluate whether specific skin parameters could be safely used instead of skin–balloon distance alone for predicting toxicity and treatment eligibility.

Methods

A single-arm phase II study using a Simon two-stage design was performed on 28 women with stage 0–II breast cancer. All patients were treated with multidwell position balloon-catheter brachytherapy. The primary endpoint was ≥ grade 2 skin toxicity. Initial entry required a balloon–skin distance of ≥7 mm. Based on the toxicity in the first 16 patients, additional patients were treated irrespective of skin–balloon distance as long as the D max to 1 mm skin thickness was <130 %.

Results

Compared with the phantom single-dwell plans, multidwell planning yielded superior PTV coverage as per median V90, V95, and V100 but had slightly worse V150, V200, and DHI. D max to skin was decreased by multidwell planning at multiple skin thicknesses. The most common acute toxicity was grade 1 erythema (57 %), and only two patients (7 %) developed acute grade 2 toxicity (erythema). Late grade 1 fibrosis was seen in 32 %. No patients experienced grade 3, 4, or 5 toxicity.

Conclusions

Multidwell position planning for balloon-catheter brachytherapy results in lower skin doses with equal to superior PTV coverage and an overall low rate of initial skin toxicity. Our data suggest that limiting the D max to <130 % to 1 mm thick skin is achievable and results in minimal toxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (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(16):1227–1232. doi:10.1056/NEJMoa020989

    Article  PubMed  Google Scholar 

  2. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (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(16):1233–1241. doi:10.1056/NEJMoa022152

    Article  PubMed  Google Scholar 

  3. Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R (2011) 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 378(9804):1707–1716. doi:10.1016/S0140-6736(11)61629-2

    Article  CAS  PubMed  Google Scholar 

  4. Vicini FA, Kestin LL, Goldstein NS (2004) Defining the clinical target volume for patients with early-stage breast cancer treated with lumpectomy and accelerated partial breast irradiation: a pathologic analysis. Int J Radiat Oncol Biol Phys 60(3):722–730. doi:10.1016/j.ijrobp.2004.04.012

    Article  PubMed  Google Scholar 

  5. Polgar C, Fodor J, Major T, Nemeth G, Lovey K, Orosz Z, Sulyok Z, Takacsi-Nagy Z, Kasler 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. doi:10.1016/j.ijrobp.2007.04.022

    Article  PubMed  Google Scholar 

  6. Husain ZA, Mahmood U, Hanlon A, Neuner G, Buras R, Tkaczuk K, Feigenberg SJ (2011) Accelerated partial breast irradiation via brachytherapy: a patterns-of-care analysis with ASTRO consensus statement groupings. Brachytherapy 10(6):479–485. doi:10.1016/j.brachy.2011.05.001

    Article  PubMed  Google Scholar 

  7. Benitez PR, Keisch ME, Vicini F, Stolier A, Scroggins T, Walker A, White J, Hedberg P, Hebert M, Arthur D, Zannis V, Quiet C, Streeter O, Silverstein M (2007) Five-year results: the initial clinical trial of MammoSite balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am J Surg 194(4):456–462. doi:10.1016/j.amjsurg.2007.06.010

    Article  PubMed  Google Scholar 

  8. Keisch M, Vicini F, Kuske RR, Hebert M, White J, Quiet C, Arthur D, Scroggins T, Streeter O (2003) Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 55(2):289–293

    Article  PubMed  Google Scholar 

  9. Polgár C, Major T, Strnad V, Niehoff P, Ott OJ, Kovács G (2006) An overview of European clinical trials of accelerated partial breast irradiation. In: Wazer DE, Arthur DW, Vicini FA (eds) Accelerated partial breast irradiation: techniques and clinical implementation. Springer, Germany, pp 227–245

    Chapter  Google Scholar 

  10. Vicini F, Beitsch P, Quiet C, Gittleman M, Zannis V, Fine R, Whitworth P, Kuerer H, Haffty B, Keisch M, Lyden M (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(3):808–817. doi:10.1016/j.ijrobp.2009.11.043

    Article  PubMed  Google Scholar 

  11. Khan AJ, Arthur D, Vicini F, Beitsch P, Kuerer H, Goyal S, Lyden M, Haffty BG (2012) Six-year analysis of treatment-related toxicities in patients treated with accelerated partial breast irradiation on the American Society of Breast Surgeons MammoSite Breast Brachytherapy registry trial. Ann Surg Oncol 19(5):1477–1483. doi:10.1245/s10434-011-2133-1

    Article  CAS  PubMed  Google Scholar 

  12. Cuttino LW, Heffernan J, Vera R, Rosu M, Ramakrishnan VR, Arthur DW (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. doi:10.1016/j.ijrobp.2010.12.023

    Article  PubMed  Google Scholar 

  13. Vicini FA, Beitsch PD, Quiet CA, Keleher A, Garcia D, Snider HC, Gittleman MA, Zannis VJ, Kuerer H, Whitacre EB, Whitworth PW, Fine RE, Haffty BG, Arrambide LS (2005) First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer 104(6):1138–1148. doi:10.1002/cncr.21289

    Article  PubMed  Google Scholar 

  14. Cuttino LW, Keisch M, Jenrette JM, Dragun AE, Prestidge BR, Quiet CA, Vicini FA, Rescigno J, Wazer DE, Kaufman SA, Ramakrishnan VR, Patel R, Arthur DW (2008) Multi-institutional experience using the MammoSite radiation therapy system in the treatment of early-stage breast cancer: 2-year results. Int J Radiat Oncol Biol Phys 71(1):107–114. doi:10.1016/j.ijrobp.2007.09.046

    Article  PubMed  Google Scholar 

  15. Arthur DW, Vicini FA, Todor DA, Julian TB, Lyden MR (2011) Improvements in critical dosimetric endpoints using the Contura multilumen balloon breast brachytherapy catheter to deliver accelerated partial breast irradiation: preliminary dosimetric findings of a phase iv trial. Int J Radiat Oncol Biol Phys 79(1):26–33. doi:10.1016/j.ijrobp.2009.10.025

    Article  PubMed  Google Scholar 

  16. Vargo JA, Verma V, Kim H, Kalash R, Heron DE, Johnson R, Beriwal S (2014) Extended (5-year) outcomes of accelerated partial breast irradiation using MammoSite balloon brachytherapy: patterns of failure, patient selection, and dosimetric correlates for late toxicity. Int J Radiat Oncol Biol Phys 88(2):285–291. doi:10.1016/j.ijrobp.2013.05.039

    Article  PubMed  Google Scholar 

  17. Turesson I (1990) Individual variation and dose dependency in the progression rate of skin telangiectasia. Int J Radiat Oncol Biol Phys 19(6):1569–1574

    Article  CAS  PubMed  Google Scholar 

Download references

Ethical standards statement

Institutional review board approval was obtained prior to opening this phase II trial, and therefore all research has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all patients before being included in the study.

Conflict of interest

The authors declare no conflict of interest related to this project.

Author information

Authors and Affiliations

  1. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA

    Sameer K. Nath, Zhe J. Chen, Bryan P. Rowe, Sanjay Aneja & Joanne B. Weidhaas

  2. Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA

    Rachel C. Blitzblau

  3. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Baiba J. Grube & Nina R. Horowitz

  4. Department of Therapeutic Radiology, Smilow Cancer Hospital, LL, 35 Park Street, New Haven, CT, 06520, USA

    Joanne B. Weidhaas

Authors
  1. Sameer K. Nath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhe J. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bryan P. Rowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachel C. Blitzblau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sanjay Aneja
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Baiba J. Grube
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nina R. Horowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joanne B. Weidhaas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joanne B. Weidhaas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nath, S.K., Chen, Z.J., Rowe, B.P. et al. A phase II trial of balloon-catheter partial breast brachytherapy optimization in the treatment of stage 0, I, and IIA breast carcinoma. J Radiat Oncol 3, 371–378 (2014). https://doi.org/10.1007/s13566-014-0153-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-014-0153-8

Keywords

Search

Navigation