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Noninvasive Image-Guided Breast Brachytherapy (NIBB)

  • Jaroslaw T. Hepel
Chapter

Abstract

Noninvasive image-guided breast brachytherapy (NIBB) is a novel APBI technique and holds potential advantages over other APBI techniques. Similar to interstitial and intracavitary brachytherapy, NIBB has the advantage of delivering radiation to the tumor bed with a high degree of precision. This is accomplished by employing breast immobilization and mammographic-like image guidance for each radiation treatment. However, unlike interstitial and intracavitary brachytherapy, NIBB is completely noninvasive making this approach more acceptable to patients not willing to undergo percutaneous catheter placement. The inconvenience and discomfort of managing an indwelling catheter or catheters is eliminated, as is the risk of instrumentation-related infection. Also, oncoplastic reconstruction to enhance the cosmetic outcomes of surgery can be performed with NIBB as long as the tissues at risk are appropriated marked with surgical clips or other fiducials. Furthermore, unlike the 3D-CRT technique, NIBB does not require an additional large margin expansion. With breast immobilization and image guidance, the inaccuracies related to set-up errors and patient or breast motion are essentially eliminated. Additionally, the breast compression used for immobilization displaces nontarget breast tissue out of the irradiation field. This results in further reduction in target and irradiated volumes, thereby reducing the risk of toxicities associated with larger treatment volumes. Altogether, this makes NIBB an attractive and promising approach for the delivery of APBI [9].

Keywords

Planning Target Volume Ipsilateral Breast Tumor Recurrence Skin Dose Deformable Image Registration Equivalent Uniform Dose 
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.

References

  1. 1.
    Hepel JT, Wazer DE. A comparison of brachytherapy techniques for partial breast irradiation. Brachytherapy. 2012;11(3):163–75.CrossRefPubMedGoogle Scholar
  2. 2.
    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(2):467–73.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hepel JT. Late toxicity and cosmetic outcomes related to interstitial multi-catheter brachytherapy for partial breast irradiation. Brachytherapy. 2014;13(1):23–6.CrossRefPubMedGoogle Scholar
  4. 4.
    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(10):3279–85.CrossRefPubMedGoogle Scholar
  5. 5.
    Hepel JT, Tokita M, MacAusland SG, et al. Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2009;75(5):1290–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Leonard KL, Hepel JT, Hiatt JR, et al. The effect of dose-volume parameters and interfraction interval on cosmetic outcome and toxicity after 3-dimensional conformal accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2013;85(3):623–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Jagsi R, Ben-David MA, Moran JM, et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:71–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Olivotto IA, Whelan TJ, Parpia S, et al. interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. 2013;31(32):4038–45.CrossRefPubMedGoogle Scholar
  9. 9.
    Hepel JT, Hiatt JR, Sha S, et al. The rationale, technique, and feasibility of partial breast irradiation using non-invasive image-guided breast brachytherapy (NIBB). Brachytherapy. 2014;13(5):493–501.CrossRefPubMedGoogle Scholar
  10. 10.
    Hepel JT, Leonard KL, Hiatt JR, et al. Factors influencing eligibility for breast boost using noninvasive image-guided breast brachytherapy. Brachytherapy. 2014;13(6):579–83.CrossRefPubMedGoogle Scholar
  11. 11.
    Smith LA, Kuske RR, Cross MJ. Improved targeting of the lumpectomy cavity using a spiral 3-D marker. Int J Rad Oncol Bio Phys. 2014;90(1S):S276.CrossRefGoogle Scholar
  12. 12.
    Rivard MJ, Melhus CS, Wazer DE, et al. Dosimetric characterization of round HDR 192Ir AccuBoost applicators for breast brachytherapy. Med Phys. 2009;36:5027–32.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Yang Y, Melhus CS, Sioshansi S, et al. Treatment planning of a skin-sparing conical breast brachytherapy applicator using conventional brachytherapy software. Med Phys. 2011;38(3):1519–25.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hepel JT, Leonard KL, Sha S, et al. Non-invasive image-guided breast brachytherapy (NIBB) to deliver accelerated partial breast irradiation (APBI): analysis of acute toxicity and early outcomes. Int J Rad Oncol Bio Phys. 2014;90(1S):S136.CrossRefGoogle Scholar
  15. 15.
    Sioshansi S, Rivard MJ, Hiatt JR, et al. Dose modeling of noninvasive image-guided breast brachytherapy in comparison to electron beam boost and three-dimensional conformal accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;80(2):410–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Leonard KL, Rivard MJ, Wazer DE, et al. Prescription dose evaluation for APBI with noninvasive image-guided breast brachytherapy using equivalent uniform dose. Brachytherapy. 2015;14(4):496–501.CrossRefPubMedGoogle Scholar
  17. 17.
    www.clinicaltrials.gov. NCT01961531.
  18. 18.
    Rivard MJ, Ghadyani HR, Bastien AD, et al. Multi-axis dose accumulation of noninvasive image-guided breast brachytherapy through biomechanical modeling of tissue deformation using the finite element method. J Contemp Brachytherapy. 2015;7(1):55–71.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hiatt JR, Rava PS, Leonard KL, et al. Chest wall dose assessment in patients treated using non-invasive image-guided breast brachytherapy APBI. Brachytherapy. 2013;12(2):S47.CrossRefGoogle Scholar
  20. 20.
    Hamid S, Rocchio K, Arthur D, et al. A multi-institutional study of feasibility, implementation, and early clinical results with noninvasive breast brachytherapy for tumor bed boost. Int J Radiat Oncol Biol Phys. 2012;83:1374–80.CrossRefPubMedGoogle Scholar
  21. 21.
    Schuster JM, Chipko C, Saraiya S, et al. Update on a multi-institutional study of noninvasive breast brachytherapy for tumor bed boost: cosmesis and tumor control. Brachytherapy. 2014;13:S19.CrossRefGoogle Scholar
  22. 22.
    Leonard KL, Hepel JT, Styczynski JR, et al. Breast boost using noninvasive image-guided breast brachytherapy vs. external beam: a 2:1 matched-pair analysis. Clin Breast Cancer. 2013;13:455–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Shah C, Vicini F, Wazer DE, et al. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy. 2013;12(4):267–77.CrossRefPubMedGoogle Scholar
  24. 24.
    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(4):987–1001.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Radiation OncologyRhode Island Hospital Warren Alpert Medical School of Brown UniversityProvidenceUSA

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