Skip to main content

Advertisement

SpringerLink
Log in

Ten-year results of a phase II study with a single fraction of high-dose-rate brachytherapy (FAST-boost) after whole breast irradiation in invasive breast carcinoma

  • Research Articles
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Purpose

We present the results of a prospective ten-year follow-up study to prove the effectiveness of a single fraction of 192-Ir high-dose-rate (HDR) brachytherapy (BT) as a boost.

Patients and methods

Between 1999 and 2000, 84 consecutive patients with invasive breast carcinoma, with over 4 mm free margins after conservative surgery, were treated. All cases were stages T1–2, except for one case, a stage T3, 81% pN0, 19% pN1–2. Chemotherapy was used in 47% and hormonal therapy in 87%. Whole breast external beam radiotherapy (46 Gy) was followed 1–2 weeks later by an implant with metallic needles. A 7 Gy single dose of HDR BT to the 90% isodose line was delivered on an outpatient basis. Dosimetry was performed theoretically. This technique is called FAST-boost because the whole treatment is delivered in about two hours.

Results

With a median follow-up of 120 months, three patients relapsed in the margin of the implant and two in a different quadrant (5/84, 6%). Actuarial local control at five and ten years was 98.5% and 95.6%. Overall survival was 92.7% and 90.2%, and disease-free survival 90.2% and 79.9%. Cosmetic results were good or excellent in 92.5%.

Conclusions

A single-fraction HDR boost with rigid needles (FAST-boost) is a good, quick, simple technique when surgical margins are free.

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

Similar content being viewed by others

References

  1. Fisher B, Anderson S, Bryant J 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 347:1233–1241

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  3. Romestaing P, Lehingue Y, Carrie C et al (1997) Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol 15:963–968

    PubMed  CAS  Google Scholar 

  4. Livi L, Borghesi S, Saieva C et al (2009) Benefit of radiation boost after whole-breast Radiotherapy. Int J Radiat Oncol Biol Phys 75:1029–1034

    Article  PubMed  Google Scholar 

  5. Polgar C, Fodor J, Orosz Z et al (2002) Electron and high-dose-rate brachytherapy boost in the conservative treatment of stage I-II breast cancer. First results of the randomized Budapest Boost Trial. Strahlenther Onkol 178:615–623

    Article  PubMed  Google Scholar 

  6. Bartelink H, Horiot JC, Poortmans P et al (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 Trial. J Clin Oncol 25:3259–3265

    Article  PubMed  Google Scholar 

  7. Perez CA, Taylor ME, Halverson K et al (1996) Brachytherapy or electron beam boost in conservation therapy of carcinoma of the breast: a nonrandomized comparison. Int J Radiat Oncol Biol Phys 34:995–1007

    Article  PubMed  CAS  Google Scholar 

  8. Frazier RC, Kestin LL, Kini V et al (2001) Impact of boost technique on outcome in early-stage cancer patients treated with breast-conserving therapy. Am J Clin Oncol 24:26–32

    Article  PubMed  CAS  Google Scholar 

  9. Moreno F, Guedea F, López Y et al (2000) External beam irradiation plus (192) Ir implant after breast-preserving surgery in women with early breast cancer. Int J Radiat Oncol Biol Phys 48:757–765

    Article  PubMed  CAS  Google Scholar 

  10. Hammer J, Seewald D, Christine MD et al (1994) Breast cancer: primary treatment with external-beam radiation therapy and high-dose-rate iridium implantation. Radiology 193:573–577

    PubMed  CAS  Google Scholar 

  11. Guinot JL, Roldan S, Maroñas M et al (2007) Breast-conservative surgery with close or positive margins: can the breast be preserved with high-dose-rate brachytherapy boost? Int J Radiat Oncol Biol Phys 68:1381–1387

    Article  PubMed  Google Scholar 

  12. Hennequin C, Durdux C, Espié M et al (1999) High-dose-rate brachytherapy for early breast cancer: an ambulatory technique. Int J Radiat Oncol Biol Phys 45:85–90

    PubMed  CAS  Google Scholar 

  13. Wazer DE, DiPetrillo TA, Schmidt-Ullrich RK et al (1992) Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early stage breast carcinoma. J Clin Oncol 10:356–363

    PubMed  CAS  Google Scholar 

  14. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346

    Article  PubMed  CAS  Google Scholar 

  15. Clarke M, Collins R, Darby S et al (2005) 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 366:2087–2106

    PubMed  CAS  Google Scholar 

  16. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717

    Article  Google Scholar 

  17. Komoike Y, Akiyama F, Iino Y et al (2006) Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer 106:35–41

    Article  PubMed  Google Scholar 

  18. Antonini N, Jones H, Horiot JC et al (2007) Effect of age and radiation dose on local control after breast conserving treatment: EORTC trial 22881-10882. Radiother Oncol 82:265–271

    Article  PubMed  Google Scholar 

  19. Van der Laan HP, Hurkmans CW, Kuten A, Westenberg HA (2010) Current technological clinical practice in breast radiotherapy: results of a survey in EORTC-Radiation Oncology Group affiliated institutions. Radiother Oncol 94:280–285

    Article  PubMed  Google Scholar 

  20. Benda RK, Yasuda G, Sethi A et al (2003) Breast boost: are we missing the target? Cancer 97:905–909

    Article  PubMed  Google Scholar 

  21. Poortmans P, Bartelink H, Horiot JC et al (2004) The influence of the boost technique on local control in breast conserving treatment in the EORTC ‘boost versus no boost’ randomised trial. Radiother Oncol 72:25–33

    Article  PubMed  Google Scholar 

  22. Hurkmans CW, Borger JH, Pieters BR et al (2001) Variability in target volume delineation on CT scans of the breast. Int J Radiat Oncol Biol Phys 50:1366–1372

    Article  PubMed  CAS  Google Scholar 

  23. Whipp E, Beresford M, Sawyer E, Halliwell M (2010) True local recurrence rate in the conserved breast after magnetic resonance imaging-targeted radiotherapy. Int J Radiat Oncol Biol Phys 76: 984–990

    Article  PubMed  Google Scholar 

  24. Kovner F, Agay R, Merimsky O et al (1999) Clips and scar as the guidelines for breast radiation boost after lumpectomy. Eur J Surg Oncol 25: 483–486

    Article  PubMed  CAS  Google Scholar 

  25. Hepel JT, Evans SB, Hiatt JR et al (2009) Planning the breast boost: comparison of three techniques and evolution of tumor bed during treatment. Int J Radiat Oncol Biol Phys 74:458–463

    Article  PubMed  Google Scholar 

  26. Sharma R, Spierer M, Mutyala S et al (2009) Change in seroma volume during whole-breast radiation therapy. Int J Radiat Oncol Biol Phys 75:89–93

    Article  PubMed  Google Scholar 

  27. Oh KS, Kong FM, Griffith KA et al (2006) Planning the breast tumor bed boost: changes in the excision cavity volume and surgical scar location after breast-conserving surgery and whole-breast irradiation. Int J Radiat Oncol Biol Phys 66:680–686

    Article  PubMed  Google Scholar 

  28. Intra M, Luini A, Gatti G et al (2006) Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: a lesson learned by over 1000 procedures. Surgery 140: 467–471

    Article  PubMed  Google Scholar 

  29. Vaidya JS, Tobias JS, Baum M et al (2005) TAR-Geted Intraoperative radiotherapy (TARGIT): an innovative approach to partial-breast irradiation. Semin Radiat Oncol 15:84–91

    Article  PubMed  Google Scholar 

  30. Graham P, Fourquet A (2006) Placing the boost in breast-conservation radiotherapy: a review of the role, indications and techniques for breast-boost radiotherapy. Clin Oncol 18:210–219

    Article  CAS  Google Scholar 

  31. Fein DA, Fowble BL, Hanlon AL et al (1996) Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast-conserving surgery and irradiation. Int J Radiat Oncol Biol Phys 34:1009–1017

    Article  PubMed  CAS  Google Scholar 

  32. Resch A, Pötter R, Van Limbergen E et al (2002) Long-term results (10 years) of intensive breast conserving therapy including a high-dose and large-volume interstitial brachytherapy boost (LDR/HDR) for T1/T2 breast cancer. Radiother Oncol 63:47–58

    Article  PubMed  Google Scholar 

  33. Neumanova R, Petera J, Frgala T et al (2007) Long-term outcome with interstitial brachytherapy boost in the treatment of women with early-stage breast cancer. Neoplasma 54:413–423

    PubMed  CAS  Google Scholar 

  34. Knauerhase H, Strietzel M, Gerber B et al (2008) Tumor location, interval between surgery and radiotherapy, and boost technique influence local control after breast-conserving surgery and radiation: retrospective analysis of mono-institutional long-term results. Int J Radiat Oncol Biol Phys 72:1048–1055

    Article  PubMed  Google Scholar 

  35. Budrukkar AN, Sarin R, Shrivastasa SK et al (2007) Cosmesis, late sequelae and local control after breast-conserving therapy: influence of type of tumour bed boost and adjuvant chemotherapy. Clin Oncol 19:596–603

    Article  CAS  Google Scholar 

  36. López C, Samper P, Vallejo C et al (2005) Early stage breast cancer conserving treatment: high dose rate brachytherapy boost to the tumor bed. Clin Transl Oncol 7:344–350

    Article  Google Scholar 

  37. Beato I, Guinot JL, Arribas L et al (2005) Sobreimpresión en fracción única con braquiterapia intersticial de alta tasa en el tratamiento conservador del carcinoma de mama. Clin Transl Oncol 7: 404–408

    Article  Google Scholar 

  38. Rodriguez A, Saez JD, Samper PM et al (2010) Early stage breast cancer conserving treatment: high dose rate brachytherapy boost to the tumor bed. Radiother Oncol 96[Suppl 1]:S235

    Google Scholar 

  39. Casquero F, Cacicedo J, Gómez-Iturriaga A et al (2010) Brachytherapy boost with high dose rate in conservative treatment of breast cancer. Radiother Oncol 96[Suppl 1]:S231

    Google Scholar 

  40. Kramer BA, Arthur DW, Ulin K et al (1999) Cosmetic outcome in patients receiving an interstitial implant as part of breast-conservation therapy. Radiology 213:61–66

    PubMed  CAS  Google Scholar 

  41. Wazer DE, Kramer B, Schmid C et al (1997) Factors determining outcome in patients treated with interstitial implantation as a radiation boost for breast conservation therapy. Int J Radiat Oncol Biol Phys 39:381–393

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología (IVO), C/ Profesor Beltrán Baguena, 8, ES-46006, Valencia, Spain

    José Luis Guinot, M. Isabel Tortajada, María Carrascosa, Miguel Santos, Pablo Soler & Leoncio Arribas

  2. Department of Radiation Physics, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain

    Vicente Crispín

  3. Department of Radiation Oncology, Hospital Reina Sofía, Córdoba, Spain

    Ana Otero & Eleonor Rivin

  4. Department of Radiation Oncology, Hospital Virgen de las Nieves, Granada, Spain

    Belén Ríos

Authors
  1. José Luis Guinot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Isabel Tortajada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. María Carrascosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vicente Crispín
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana Otero
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Belén Ríos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eleonor Rivin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Miguel Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Pablo Soler
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Leoncio Arribas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José Luis Guinot.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guinot, J.L., Tortajada, M.I., Carrascosa, M. et al. Ten-year results of a phase II study with a single fraction of high-dose-rate brachytherapy (FAST-boost) after whole breast irradiation in invasive breast carcinoma. Clin Transl Oncol 14, 109–115 (2012). https://doi.org/10.1007/s12094-012-0769-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-012-0769-3

Keywords

Search

Navigation