Skip to main content

Advertisement

SpringerLink
Log in

A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using multicatheter interstitial brachytherapy: clinical results with a median follow-up of 60 months

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

We carried out the first multi-institutional prospective study on accelerated partial breast irradiation (APBI) via multicatheter interstitial brachytherapy in a shorter period for early breast cancer in Japan.

Methods

Patient eligibility criteria included positive hormone receptors, tumors ≤ 3 cm and TNM stage pN0M0. After breast-conserving surgery (Japanese cylindrical resection) and histological confirmation of negative surgical margins and the absence of lymph node metastasis, applicator implantation was performed either postoperatively or intraoperatively. High-dose-rate brachytherapy of 36 Gy in 6 fractions was delivered.

Results

Forty-six patients from six institutions received this treatment regimen, and the median follow-up time was 60 months (range 57–67 months). The median resected breast tissue volume was 81 cm3 (range 28–260 cm3). No Grade 4 late sequela, local recurrence nor death due to breast cancer were observed. Grade 2–3 sequelae such as rib fracture (2%), soft tissue necrosis (9%), fibrosis (20%), and breast pain (9%) were observed. The resected breast tissue volumes of the patients who had Grade ≥ 2 fibrosis and Grade < 2 fibrosis were 105.9 ± 32.3 cm3 and 76.3 ± 45.6 cm3, respectively, p = 0.02.

The overall cosmetic outcome score of Excellent/Good was 74% at 60 months after APBI. Grade ≥ 1 fibrosis was observed in 44% and 92% of patients who scored Excellent/Good and Fair/Poor, respectively, p = 0.004.

Conclusions

This study showed excellent local control and survival results with minimal late sequelae.

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.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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;347:1233–41.

    Article  Google Scholar 

  2. Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 2000;355:1757–70.

    Article  Google Scholar 

  3. Whelan T, MacKenzie R, Julian J, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94:1143–50.

    Article  Google Scholar 

  4. Olivotto IA, Weir LM, Kim-Sing C, et al. Late cosmetic results of short fractionation for breast conservation. Radiother Oncol. 1996;41:7–13.

    Article  CAS  Google Scholar 

  5. National Comprehensive Cancer Network. National Comprehensive Cancer Network Guideline Version 1.2022, https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1419 [accessed 25 November 2021].

  6. King TA, Bolton JS, Kuske RR, et al. 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. 2000;180:299–304.

    Article  CAS  Google Scholar 

  7. Keynes G. The place of radium in the treatment of cancer of the breast. Ann Surg. 1937;106:619–30.

    Article  CAS  Google Scholar 

  8. Strnad V, Ott OJ, 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;387:229–38.

    Article  Google Scholar 

  9. Nose T, Komoike Y, Yoshida K, et al. A pilot study of wider use of accelerated partial breast irradiation: intraoperative margin-directed re-excision combined with sole high-dose-rate interstitial brachytherapy. Breast Cancer. 2006;13:289–99.

    Article  Google Scholar 

  10. Yoshida K, Nose T, Masuda N, et al. Preliminary result of accelerated partial breast irradiation after breast-conserving surgery. Breast Cancer. 2009;16:105–12.

    Article  Google Scholar 

  11. Otani Y, Nose T, Dokiya T, et al. A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: treatment planning and quality assurance. Radiat Oncol. 2015;10:126.

    Article  Google Scholar 

  12. Nose T, Otani Y, Asahi S, et al. A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: clinical results with a median follow-up of 26 months. Breast Cancer. 2016;23:861–8.

    Article  Google Scholar 

  13. Yoden E, Nose T, Otani Y, et al. Uncertainty of cosmetic evaluation after accelerated partial breast irradiation: interim analysis of a Japanese prospective multi-institutional feasibility study. Jpn J Radiol. 2017;35:381–8.

    Article  CAS  Google Scholar 

  14. Nose T. APBI: Japanese experience and Asian trend. in Brachytherapy techniques and evidences. In: Yoshioka Y, Itami J, Oguchi M, Nakano T, editors. Brachytherapy Singapore. Springer; 2019. p. 209–20.

    Chapter  Google Scholar 

  15. Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stage I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5:257–61.

    Article  CAS  Google Scholar 

  16. Polgár C, Sulyok Z, Fodor J, et al. Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: five-year results of a phase I-II study and initial findings of a randomized phase III trial. J Surg Oncol. 2002;80:121–8.

    Article  Google Scholar 

  17. Aliyev JA, Isayev IH, Akbarov KS, et al. High-dose-rate interstitial brachytherapy for accelerated partial breast irradiation—trial results of Azerbaijan National Center of Oncology. J Contemp Brachytherapy. 2017;9:106–11.

    Article  Google Scholar 

  18. Polgár C, Ott OJ, Hildebrandt G, et al. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18:259–68.

    Article  Google Scholar 

  19. Georg P, Kirisits C, Goldner G, Dörr W, Hammer J, Pötzi R, Berger D, Dimopoulos J, Georg D, Pötter R. Correlation of dose–volume parameters, endoscopic and clinical rectal side effects in cervix cancer patients treated with definitive radiotherapy including MRI-based brachytherapy. Radiother Oncol. 2009;91:173–80.

    Article  Google Scholar 

  20. Yoshida K, Otani Y, Nose T, et al. Case report of a dose-volume histogram analysis of rib fracture after accelerated partial breast irradiation: interim analysis of a Japanese prospective multi-institutional feasibility study. J Contemp Brachyther. 2018;10:274–8.

    Article  Google Scholar 

  21. Polat AV, Soran A, Andacoglu O, Kamali Polat A, McGuire K, Diego E, Johnson R. The importance of pre-operative needle core breast biopsy results on resected tissue volume, margin status, and cosmesis. J BUON. 2013;18:601–7.

    CAS  PubMed  Google Scholar 

  22. Nozaki M, Kagami Y, Mitsumori M, et al. Multicenter investigation of late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated whole-breast radiation therapy. Jpn J Clin Oncol. 2012;42:522–7.

    Article  Google Scholar 

  23. Sato K, Fuchikami H, Takeda N, et al. Efficacy of single-plane implant technique in partial breast brachytherapy in small-breasted patients. Int J Radiat Oncol Biol Phys. 2020;106:830–7.

    Article  CAS  Google Scholar 

  24. Chagpar AB, Killelea BK, Tsangaris TN, et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373:503–10.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported in part by Japan Agency for Medical Research and Development (17K10496).

Author information

Authors and Affiliations

  1. Department of Radiology, Kansai Medical University Medical Center, 10-15, Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan

    Ken Yoshida

  2. Department of Radiation Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan

    Takayuki Nose

  3. Department of Radiology, Kaizuka City Hospital, Kaizuka, Japan

    Yuki Otani

  4. Department of Surgery, Aidu Chuo Hospital, Aizuwakamatsu, Japan

    Shuuji Asahi

  5. Department of Radiology, Aidu Chuo Hospital, Aizuwakamatsu, Japan

    Iwao Tsukiyama

  6. Department of Radiology, Kyoundo Hospital, Tokyo, Japan

    Takushi Dokiya

  7. Department of Breast Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan

    Toshiaki Saeki

  8. Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan

    Ichirou Fukuda

  9. Department of Radiology, The Jikei University Daisan Hospital, Tokyo, Japan

    Hiroshi Sekine

  10. Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan

    Yu Kumazaki

  11. Department of Palliative Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan

    Takao Takahashi

  12. Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Tadayuki Kotsuma

  13. Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan

    Norikazu Masuda

  14. Department of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan

    Eisaku Yoden

  15. Department of Surgery, Kawasaki Medical School, Kurashiki, Japan

    Kazutaka Nakashima

  16. Department of Radiology, Karatsu Red Cross Hospital, Saga, Japan

    Taisei Matsumura

  17. Department of Surgery, National Hospital Organization National Kyushu Medical Center, Fukuoka, Japan

    Shino Nakagawa

  18. Department of Radiation Oncology, Uji-Tokushukai Medical Center, Kyoto, Japan

    Seiji Tachiiri

  19. Department of Breast Surgery, Kyoto City Hospital, Kyoto, Japan

    Yoshio Moriguchi

  20. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan

    Jun Itami

  21. Department of Radiation Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan

    Masahiko Oguchi

Authors
  1. Ken Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takayuki Nose
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuki Otani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuuji Asahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Iwao Tsukiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takushi Dokiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toshiaki Saeki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ichirou Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroshi Sekine
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yu Kumazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takao Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tadayuki Kotsuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Norikazu Masuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Eisaku Yoden
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Kazutaka Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Taisei Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Shino Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Seiji Tachiiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Yoshio Moriguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Jun Itami
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Masahiko Oguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ken Yoshida.

Ethics declarations

Conflict of interest

One of the authors (Ken Yoshida) assumes an advisory role of Chiyoda Technol® dealing with remote afterloader (microSelectron-HDR) in Japan.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshida, K., Nose, T., Otani, Y. et al. A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using multicatheter interstitial brachytherapy: clinical results with a median follow-up of 60 months. Breast Cancer 29, 636–644 (2022). https://doi.org/10.1007/s12282-022-01339-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-022-01339-z

Keywords

Search

Navigation