Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 404–411 | Cite as

Outcomes of Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation Via Multicatheter Interstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience

  • Mitchell KamravaEmail author
  • Robert R. Kuske
  • Bethany Anderson
  • Peter Chen
  • John Hayes
  • Coral Quiet
  • Pin-Chieh Wang
  • Darlene Veruttipong
  • Margaret Snyder
  • D. Jeffrey Demanes
Breast Oncology



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.


Local Recurrence Estrogen Receptor Status Contralateral Breast Cancer Breast Irradiation Accelerate Partial Breast Irradiation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by an unrestricted educational grant from Elekta.


The authors declare no conflict of interest.


  1. 1.
    Simone NL, Dan T, Shih J, et al. Twenty-five year results of the National Cancer Institute randomized breast conservation trial. Breast Cancer Res Treat. 2012;132:197–203.PubMedCrossRefGoogle Scholar
  2. 2.
    Schroen AT, Brenin DR, Kelly MD, Knaus WA, Slingluff CL. Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. J Clin Oncol. 2005;23:7074–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001;12:997–1003.PubMedCrossRefGoogle Scholar
  5. 5.
    Presley CJ, Soulos PR, Herrin J, et al. Patterns of use and short-term complications of breast brachytherapy in the national medicare population from 2008–2009. J Clin Oncol. 2012;30:4302–7.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Polgár C, Fodor J, Major T, Sulyok Z, Kásler M. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol. 2013;108:197–202.PubMedCrossRefGoogle Scholar
  7. 7.
    Shah C, Antonucci JV, Wilkinson J Ben, et al. 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. 2011;100:210–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Shah C, Vicini F, Wazer DE, Arthur D, Patel RR. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy. 2013;12:267–77.PubMedCrossRefGoogle Scholar
  11. 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
  12. 12.
    Recht A, Silver B, Schnitt S, Connolly J, Hellman S, Harris JR. Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int J Radiat Oncol Biol Phys. 1985;11:1271–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Rose MA, Olivotto I, Cady B, et al. Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Arch Surg. 1989;124:153–7.PubMedGoogle Scholar
  14. 14.
    Darby S, McGale P, Correa C, et al. 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. 2011;378(9804):1707–16.PubMedCrossRefGoogle Scholar
  15. 15.
    Kuske RR, Young SS. Breast brachytherapy versus whole-breast irradiation: reported differences may be statistically significant but clinically trivial. Int J Radiat Oncol Biol Phys. 2015;88:266–8.CrossRefGoogle Scholar
  16. 16.
    Smith GL, Xu Y, Buchholz TA, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA. 2012;307:1827–37.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Clarke M, Collins R, Darby S, et al. 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. 2005;366(9503):2087–106.PubMedCrossRefGoogle Scholar
  18. 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: Accessed 24 Dec 2014.
  19. 19.
    Ribeiro GG, Magee B, Swindell R, Harris M, Banerjee SS. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5:278–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Póti Z, Nemeskéri C, Fekésházy A, et al. Partial breast irradiation with interstitial (60)Co brachytherapy results in frequent grade 3 or 4 toxicity. Evidence based on a 12-year follow-up of 70 patients. Int J Radiat Oncol Biol Phys. 2004;58:1022–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Polgár C, Major T, Fodor J, et al. Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol. 2010;94:274–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Liljegren G, Holmberg L, Bergh J, et al. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol. 1999;17:2326–33.PubMedGoogle Scholar
  23. 23.
    Hattangadi JA, Powell SN, MacDonald SM, et al. Accelerated partial breast irradiation with low-dose-rate interstitial implant brachytherapy after wide local excision: 12-year outcomes from a prospective trial. Int J Radiat Oncol Biol Phys. 2012;83:791–800.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Arthur DW, Winter K, Kuske RR, et al. 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. 2008;72:467–73.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    King TA, Bolton JS, Kuske RR, Fuhrman GM, Scroggins TG, Jiang XZ. 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.PubMedCrossRefGoogle Scholar
  26. 26.
    Wobb JL, Chen PY, Shah C, et al. Nomogram for predicting the risk of locoregional recurrence in patients treated with accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2015;91:312–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Bane AL, Whelan TJ, Pond GR, et al. Tumor factors predictive of response to hypofractionated radiotherapy in a randomized trial following breast conserving therapy. Ann Oncol. 2014;25:992–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Haviland JS, Yarnold JR, Bentzen SM. Hypofractionated radiotherapy for breast cancer. N Engl J Med. 2010;362:1843.PubMedCrossRefGoogle Scholar
  29. 29.
    Rabinovitch R, Winter K, Kuske R, et al. RTOG 95-17, a phase II trial to evaluate brachytherapy as the sole method of radiation therapy for stage I and II breast carcinoma—year-5 toxicity and cosmesis. Brachytherapy. 2014;13:17–22.PubMedCrossRefGoogle Scholar
  30. 30.
    Shah C, Badiyan S, Ben Wilkinson J, et al. Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American Society of Breast Surgeons MammoSite(®) breast brachytherapy registry trial. Ann Surg Oncol. 2013;20:3279–85.PubMedCrossRefGoogle Scholar
  31. 31.
    Dodwell D, Dyker K, Brown J et al. A randomized study of whole-breast vs tumor-bed irradiation after local excision and axillary dissection for early breast cancer. Clin Oncol. 2005;17:618–22CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Mitchell Kamrava
    • 1
    Email author
  • Robert R. Kuske
    • 2
  • Bethany Anderson
    • 3
  • Peter Chen
    • 4
  • John Hayes
    • 5
  • Coral Quiet
    • 2
  • Pin-Chieh Wang
    • 1
  • Darlene Veruttipong
    • 1
  • Margaret Snyder
    • 2
  • D. Jeffrey Demanes
    • 1
  1. 1.Department of Radiation OncologyUniversity of California Los AngelesLos AngelesUSA
  2. 2.Arizona Breast Cancer SpecialistsScottsdaleUSA
  3. 3.Department of Radiation OncologyUniversity of WisconsinMadisonUSA
  4. 4.Department of Radiation OncologyWilliam Beaumont HospitalRoyal OakUSA
  5. 5.Gamma West Cancer ServicesSalt Lake CityUSA

Personalised recommendations