Outcomes of Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation Via Multicatheter Interstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience
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To report outcomes for breast-conserving therapy using adjuvant accelerated partial breast irradiation with interstitial multicatheter brachytherapy by a cooperative group of institutions.
From 1992 to 2013, a total of 1356 patients were treated with breast-conserving surgery and adjuvant accelerated partial breast irradiation using interstitial multicatheter brachytherapy. A total of 1131 patients had >1 year of data available to assess oncologic and cosmesis outcomes. Median age was 59 years old (range 22–90 years). Histologies treated included 1005 (73 %) invasive ductal carcinoma and 240 (18 %) ductal carcinoma-in situ. T stages were 18 % Tis, 75 % T1, and 8 % ≥T2. Nodal status was 73 % N0 and 6 % N1a. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was positive in 83, 70, and 6 %, respectively. Cox multivariate analysis for local control was performed using histology, age, estrogen receptor status, tumor size, grade, margin, and nodal status.
The mean (SD) follow-up was 6.9 years (4.3). The 10-year actuarial risk (95 % confidence interval) of an ipsilateral breast tumor recurrence was 7.6 % (5.6–10.1). Other 10-year actuarial risks (95 % confidence interval) were regional failure 2.3 % (1.4–3.7), distant metastasis 3.8 % (2.5–5.7), cause-specific survival 96.3 % (94.2–97.6), overall survival 86.5 (83.0–89.3), and new contralateral cancers 4.6 % (3.0–6.9). On multivariate analysis, high grade (hazard ratio 2.81) and positive margin status (hazard ratio 18.42) were the only two significant variables associated with an increased risk of local recurrence. Physician-reported cosmesis was excellent/good in 84 % (98 of 116) of patients with >5 years of follow-up.
This is the largest report of outcomes with interstitial breast brachytherapy. This treatment resulted in excellent long-term local control and cosmesis outcomes.
KeywordsLocal Recurrence Estrogen Receptor Status Contralateral Breast Cancer Breast Irradiation Accelerate Partial Breast Irradiation
This work was supported by an unrestricted educational grant from Elekta.
The authors declare no conflict of interest.
- 9.Polgár C, Van Limbergen E, Pötter R, et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group ba. Radiother Oncol. 2010;94:264–73.PubMedCrossRefGoogle Scholar
- 11.Wilkinson JB, Beitsch PD, Shah C, et al. Evaluation of current consensus statement recommendations for accelerated partial breast irradiation: a pooled analysis of William Beaumont Hospital and American Society of Breast Surgeon MammoSite Registry Trial Data. Int J Radiat Oncol Biol Phys. 2013;85:1179–85.PubMedCrossRefGoogle Scholar
- 18.White JR, Winter KA, Kuske RR, et al. Long-term outcome from RTOG 9517: a phase I/II study of accelerated partial breast irradiation (APBI) with mulitcatheter brachytherapy (MCT) following lumpectomy for early-stage breast cancer. Paper presented at: 2012 Breast Cancer Symposium. Available at: http://meetinglibrary.asco.org/content/102772-125. Accessed 24 Dec 2014.