Accelerated partial breast irradiation in the elderly: 5-Year results of the single fraction elderly breast irradiation (SiFEBI) phase I/II trial

Abstract

PURPOSE: To evaluate the clinical outcomes of a very-accelerated partial breast irradiation (vAP-BI) in the elderly based on a single fraction of multicatheter interstitial high-dose rate brachytherapy (MIB). Mature results with a median follow-up of 5 years. METHODS AND MATERIALS: From November 2012 to September 2014, 26 patients (pts) ($70) with early breast cancer were enrolled in a prospective phase II trial (NCT01727011). After lumpectomy, intraoperative catheter implant was performed for postoperative APBI (single fraction 16 Gy). Surveillance was performed twice a year after APBI. Oncologic outcome (local [LRFS], metastasis-free survival, cancer-specific survival, and overall survival [OS]) as well as late toxicity and cosmetic outcome were investigated. RESULTS: Median age was 77 years [69e89]. After a median follow-up of 63 months [60e68], 5-year LRFS, metastasis-free survival, cancer-specific survival, and overall survival rates were 100%, 95.5%, 100%, and 88.5%, respectively. Late toxicity was observed in 5 pts (19.2%) with a total of five events: 3 pts G1 (60%); and 2 pts G2 (40%). The observed late side effects were breast pain in 1 pt (G2 cytosteatonecrosis with occasional acetaminophen consumption), hypopigmentation (puncture site) in 2 pts (G1) and breast fibrosis in 2 pts (G1: 1 pt; G2: 1 pt). Cosmetic evaluation was excellent for 21 pts (81%) and good for 2 pts (19%). CONCLUSION: For elderly with early breast cancer, a vAPBI using a single fraction of postoperative MIB (16 Gy) provides excellent oncologic results, mainly in terms of local control and cancer death. Late toxicity and cosmetic profile are acceptable.

Accelerated partial breast irradiation in the elderly: 8-year oncological outcomes and prognostic factors

“…For selected patients, APBI could also be considered as a viable alternative to the omission of adjuvant RT which has been considered for elderly patients, as it drastically reduces the number of transportations, alleviates the treatment-related constraints, in particular for elderly patients with frequent comorbidities, without compromising local control. Currently, some protocols want to get further by proposing single-fraction HIBT with promising results (47,48).…”

Accelerated Partial Breast Irradiation in the Elderly:8-year Oncological Outcome and Prognostic Factors

“…For selected patients, APBI could also be considered as a viable alternative to the omission of adjuvant RT which has been considered for elderly patients, as it drastically reduces the number of transportations, alleviates the treatment related constraints, in particular for elderly patients with frequent comorbidities, without compromising local control. Currently, some protocols wants to get further proposing singlefraction HIBT with promising results (46,47).…”

The Case for Brachytherapy: Why It Deserves a Renaissance

“…The phase II Triumph-T trial showed excellent local tumor control (albeit short median follow up) and breast cosmesis using a 3-fraction breast brachytherapy technique, and a similar 4-fraction regimen had excellent cosmesis with no locoregional recurrences at 6 years (37, 39). Furthermore, in elderly patients, single fraction regimens have also demonstrated excellent oncologic outcomes (40), and a recent study comparing PBI to PBI plus endocrine therapy or endocrine therapy alone in women over the age of 70 with low-risk, hormone-J o u r n a l P r e -p r o o f positive early-stage breast cancer demonstrated that PBI was superior when compliance with endocrine therapy was poor (41) and tested compliance interventions have demonstrated no improvement (42,43).…”