Journal of Radiation Oncology

, Volume 6, Issue 4, pp 353–360 | Cite as

Analysis of treatment effectiveness and complications associated with MammoSite™ breast brachytherapy in patients treated at a single institution

  • Daniel H. Miller
  • Nicholas Pflederer
  • Timothy Malouff
  • Don R. Nguyen
  • Elizabeth Edney
  • Edibaldo Silva-Lopez
  • William Hunter
  • Cam Nguyen
Original Research



The objective of the study was to present treatment and follow-up data over a 5-year period for patients treated with MammoSite™ breast brachytherapy at our institution. Patient data was collected regarding the specific treatment and planning volumes, the complications occurring during and after treatment, and the overall outcome of each patient relating to tumor-free survival.


We performed a retrospective analysis of patients who presented with early stage breast cancer and received breast conserving surgery. These patients elected to receive accelerated partial breast irradiation (APBI) using the MammoSite™ catheter device. Patients were treated with 30.6–34.0 Gy in 3.4 Gy fractions twice daily with a minimum of 6 h between fractions utilizing either a spherical or an ellipsoidal catheter device.


From October 2005 to November 2010, 78 patients eligible for our retrospective analysis were treated with APBI using the MammoSite™ catheter device. The median follow-up time was 80 months. Of the patients in our study, there were a total of 10 recurrences. Five of these recurrences were local, two of the recurrences were local or new primaries that eventually developed into widespread metastatic disease, and three of the recurrences were widespread metastatic disease. Two were considered new primaries due to receptor status change in the new tumor.


This case series of 78 patients having greater than 24 months of follow-up from a single institution provides important data regarding failure analysis with MammoSite™ accelerated partial breast irradiation. Our results show a higher rate of metastatic recurrence in the group of patients with positive nodal disease.


MammoSite Brachytherapy Breast cancer Postoperative radiation 


Compliance of ethical standards


No funding support is associated with this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human or animal subjects performed by any of the authors.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


  1. 1.
    Arthur DW et al (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(2):467–473CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Abbott AM, Habermann EB, Tuttle TM (2011) Trends in the use of implantable accelerated partial breast irradiation therapy for early stage breast cancer in the United States. Cancer 117(15):3305–3310CrossRefPubMedGoogle Scholar
  3. 3.
    Fisher B 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(16):1233–1241CrossRefPubMedGoogle Scholar
  4. 4.
    Morrow M et al (2001) Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol 19(8):2254–2262CrossRefPubMedGoogle Scholar
  5. 5.
    Vicini F 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(3):808–817CrossRefPubMedGoogle Scholar
  6. 6.
    Vicini F et al (2008) Three-year analysis of treatment efficacy, cosmesis, and toxicity by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation (APBI). Cancer 112(4):758–766CrossRefPubMedGoogle Scholar
  7. 7.
    Dickler A et al (2004) Treatment volume and dose optimization of MammoSite breast brachytherapy applicator. Int J Radiat Oncol Biol Phys 59(2):469–474CrossRefPubMedGoogle Scholar
  8. 8.
    Kirk M et al (2005) Surface optimization technique for MammoSite breast brachytherapy applicator. Int J Radiat Oncol Biol Phys 62(2):366–372CrossRefPubMedGoogle Scholar
  9. 9.
    Chen S et al (2007) Patterns of failure after MammoSite brachytherapy partial breast irradiation: a detailed analysis. Int J Radiat Oncol Biol Phys 69(1):25–31CrossRefPubMedGoogle Scholar
  10. 10.
    McHaffie DR et al (2011) Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features. Int J Radiat Oncol Biol Phys 81(1):46–51CrossRefPubMedGoogle Scholar
  11. 11.
    Smith BD et al (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg 209(2):269–277CrossRefPubMedGoogle Scholar
  12. 12.
    Correa, C. et al (2016) Accelerated partial breast irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Pract Radiat OncolGoogle Scholar
  13. 13.
    Chao KK et al (2007) 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 69(1):32–40CrossRefPubMedGoogle Scholar
  14. 14.
    Khan AJ 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 MammoSite Breast Brachytherapy registry trial. Ann Surg Oncol 19(5):1477–1483CrossRefPubMedGoogle Scholar
  15. 15.
    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):765–770CrossRefPubMedGoogle Scholar
  16. 16.
    Dragun AE et al (2007) Predictors of cosmetic outcome following MammoSite breast brachytherapy: a single-institution experience of 100 patients with two years of follow-up. Int J Radiat Oncol Biol Phys 68(2):354–358CrossRefPubMedGoogle Scholar
  17. 17.
    Brashears JH, Dragun AE, Jenrette JM (2009) Late chest wall toxicity after MammoSite breast brachytherapy. Brachytherapy 8(1):19–25CrossRefPubMedGoogle Scholar
  18. 18.
    Cuttino LW et al (2014) Long-term results from the Contura multilumen balloon breast brachytherapy catheter phase 4 registry trial. Int J Radiat Oncol Biol Phys 90(5):1025–1029CrossRefPubMedGoogle Scholar
  19. 19.
    Yashar C et al (2016) Strut-based accelerated partial breast irradiation: report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study. Brachytherapy 15(6):780–787CrossRefPubMedGoogle Scholar
  20. 20.
    Wolmark N et al. (2011) NSABP protocol B-39/RTOG protocol 0413: a randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancerGoogle Scholar
  21. 21.
    Offersen BV et al (2009) Accelerated partial breast irradiation as part of breast conserving therapy of early breast carcinoma: a systematic review. Radiother Oncol 90(1):1–13CrossRefPubMedGoogle Scholar
  22. 22.
    Julian T et al (2011) Updated Early Toxicity Results with 3-D Conformal External Beam Therapy (CRT) from the NSABP B-39/RTOG 0413 Accelerated Partial Breast Irradiation (APBI) Trial. In: ASCO Annual Meeting. doi: 10.1200/jco.2011.29.15_suppl.1011
  23. 23.
    Benitez PR et al (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):456–462CrossRefPubMedGoogle Scholar
  24. 24.
    Shah C et al (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(2):210–214CrossRefPubMedGoogle Scholar
  25. 25.
    Beitsch PD et al (2012) Tumor bed control with balloon-based accelerated partial breast irradiation: incidence of true recurrences versus elsewhere failures in the American Society of Breast Surgery MammoSite(®) Registry Trial. Ann Surg Oncol 19(10):3165–3170CrossRefPubMedGoogle Scholar
  26. 26.
    Haley M et al (2009) MammoSite accelerated partial breast irradiation: a single-institution outcomes analysis with 2 years of followup. Brachytherapy 8(1):9–13CrossRefPubMedGoogle Scholar
  27. 27.
    DiFronzo LA et al (2005) Breast conserving surgery and accelerated partial breast irradiation using the MammoSite system: initial clinical experience. Arch Surg 140(8):787–794CrossRefPubMedGoogle Scholar
  28. 28.
    Niehoff P et al (2006) Clinical experience with the MammoSite radiation therapy system for brachytherapy of breast cancer: results from an international phase II trial. Radiother Oncol 79(3):316–320CrossRefPubMedGoogle Scholar
  29. 29.
    Niehoff P et al (2006) Early European experience with the MammoSite radiation therapy system for partial breast brachytherapy following breast conservation operation in low-risk breast cancer. Breast 15(3):319–325CrossRefPubMedGoogle Scholar
  30. 30.
    Sadeghi A et al (2006) Evaluation of the surface radiation dose and dose gradient in early stage breast cancer using high-dose-rate brachytherapy MammoSite applicator. Brachytherapy 5(4):230–234Google Scholar
  31. 31.
    Tsai PI et al (2006) Accelerated partial breast irradiation using the MammoSite device: early technical experience and short-term clinical follow-up. Am Surg 72(10):929–934PubMedGoogle Scholar
  32. 32.
    Beitsch P et al (2010) Five-year outcome of patients classified in the "unsuitable" category using the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite® Registry trial. Ann Surg Oncol 17(Suppl 3):219–225CrossRefPubMedGoogle Scholar
  33. 33.
    Harper JL et al (2005) Acute complications of MammoSite brachytherapy: a single institution's initial clinical experience. Int J Radiat Oncol Biol Phys 61(1):169–174CrossRefPubMedGoogle Scholar
  34. 34.
    Cuttino LW et al (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):107–114CrossRefPubMedGoogle Scholar
  35. 35.
    Rosenkranz KM et al (2013) Increased rates of long-term complications after MammoSite brachytherapy compared with whole breast radiation therapy. J Am Coll Surg 217(3):497–502CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Radiation OncologyJacksonvilleUSA
  2. 2.Department of Radiation OncologyCreighton University Medical CenterOmahaUSA
  3. 3.Department of RadiologyUniversity of Nebraska Medical CenterOmahaUSA
  4. 4.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  5. 5.Department of PathologyCreighton University Medical CenterOmahaUSA

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