Clinical experience with the MammoSite® radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial

Niehoff, Peter; Polgár, Csaba; Ostertag, Horst; Major, Tibor; Sulyok, Zoltán; Kimmig, B.; Kovács, G.

doi:10.1016/j.radonc.2006.05.010

Cited by 84 publications

(45 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2 Several radiation-induced skin effects have been reported in the literature for MammoSite treatments. [5][6][7][8][9][10][11][12][13] With the advent of several new intracavitary APBI devices that claim to modify the dose distribution and reduce the exit skin dose, it is particularly important to quantify the actual skin doses received. Most brachytherapy treatment planning systems ͑TPSs͒ calculate dose using the formalism proposed by the American Association of Physicists in Medicine Task Group 43 ͑TG-43͒, which assumes a homogeneous water medium.…”

Section: Introductionmentioning

confidence: 99%

Determination of exit skin dose for intracavitary accelerated partial breast irradiation with thermoluminescent dosimeters

et al. 2010

View full text Add to dashboard Cite

Purpose: Intracavitary accelerated partial breast irradiation ͑APBI͒ has become a popular treatment for early stage breast cancer in recent years due to its shortened course of treatment and simplified treatment planning compared to traditional external beam breast conservation therapy. However, the exit dose to the skin is a major concern and can be a limiting factor for these treatments. Most treatment planning systems ͑TPSs͒ currently used for high dose-rate ͑HDR͒ 192Ir brachytherapy overestimate the exit skin dose because they assume a homogeneous water medium and do not account for finite patient dimensions. The purpose of this work was to quantify the TPS overestimation of the exit skin dose for a group of patients and several phantom configurations. Methods: The TPS calculated skin dose for 59 HDR 192 Ir APBI patients was compared to the skin dose measured with LiF:Mg,Ti thermoluminescent dosimeters ͑TLDs͒. Additionally, the TPS calculated dose was compared to the TLD measured dose and the Monte Carlo ͑MC͒ calculated dose for eight phantom configurations. Four of the phantom configurations simulated treatment conditions with no scattering material beyond the point of measurement and the other four configurations simulated the homogeneous scattering conditions assumed by the TPS. Since the calibration TLDs for this work were irradiated with 137 Cs and the experimental irradiations were performed with 192 Ir, experiments were performed to determine the intrinsic energy dependence of the TLDs. Correction factors that relate the dose at the point of measurement ͑center of TLD͒ to the dose at the point of interest ͑basal skin layer͒ were also determined and applied for each irradiation geometry. Results: The TLD intrinsic energy dependence for 192 Ir relative to 137 Cs was 1.041Ϯ 1.78%. The TPS overestimated the exit skin dose by an average of 16% for the group of 59 patients studied, and by 9%-15% for the four phantom setups simulating treatment conditions. For the four phantom setups simulating the conditions assumed by the TPS, the TPS calculated dose agreed well with the TLD and MC results ͑within 3% and 1%, respectively͒. The inverse square geometry correction factor ranged from 1.023 to 1.042, and an additional correction factor of 0.978 was applied to account for the lack of charged particle equilibrium in the TLD and basal skin layer. Conclusions: TPS calculations that assume a homogeneous water medium overestimate the exit skin dose for intracavitary APBI treatments. It is important to determine the actual skin dose received during intracavitary APBI to determine the skin dose-response relationship and establish dose limits for optimal skin sparing. This study has demonstrated that TLDs can measure the skin dose with an expanded uncertainty ͑k =2͒ of 5.6% when the proper corrections are applied.

show abstract

Section: Introductionmentioning

confidence: 99%

Determination of exit skin dose for intracavitary accelerated partial breast irradiation with thermoluminescent dosimeters

et al. 2010

View full text Add to dashboard Cite

show abstract

“…In general, total dose is 34 Gy over10 fractions , so 3.4 Gy per fraction, twice daily (minimum of 6 hours between fractions) over 1week. MBS has Good /excellent cosmesis with low risk of recurrence [39,40,41,42]. MBS has various disadvantages including: its central source channel does not allow for shaping radiation iso-dose curves in the direction perpendicular to the central channel; it is an invasive device and its applicator can be placed into the lumpectomy cavity at the time of surgery or in a separate procedure after surgery, using old or new incision; when applicator is inserted under ultrasound guidance, it needs good experience; it is not suitable technique for small breast or for tumors located in the upper-inner quadrant, due to needing of skin-cavity distances (Figure 4 a,b,c).…”

Section: Single-entry Intracavitary Brachytherapy:-catheters:-a-mammomentioning

confidence: 99%

Accelerated Partial-Breast Irradiation: A State of the Art Strategy.

Hamoud¹,

Ghorbel²,

Falfali³

et al. 2017

IJAR

View full text Add to dashboard Cite

Breast conservative surgery, partial breast irradiation, whole breast irradiation, , cosmetic results, Brachytherapy Breast-conserving therapy consists of wide local excision (WLE) followed by whole-breast irradiation (WBI).It is already widely accepted as an alternative to mastectomy. It is used for the treatment of patients with early-stage breast cancer. Accelerated partial-breast irradiation (APBI) is a new strategy. It is characterized by being shorter & an alternative radiation technique for a highly selected patients with favorable early-stage breast cancer. The objective of this review article is to analyze different modalities of APBI delivery and discuss the possible benefits and harms associated with this new platform. …………………………………………………………………………………………………….... Introduction:-Breast cancer has the highest incidence among all cancers in female. In early-stage breast cancer (stage ≤ II), the use of breast-conserving therapy (BCT) is a well-established treatment option. It is comparable to total mastectomy with good results as far as rates of local-regional control and overall survival. It enables patients to maintain their breasts with an acceptable cosmetic results [1]. In the initial trials regarding BCT that were done in the 1970s and 1980s, the new strategy typically involved segmental mastectomy with level I & II axillary lymph node dissection, followed by whole-breast irradiation (WBI). Radiation therapy (RT) is given with a dose of 45-50 Gy over the course of 5 weeks, with or without a boost to the tumor bed. WBI is a relatively well-tolerated treatment. This modality has resulted in good long-term cosmetic results, with low rates of treatment-associated morbidity. The Early Breast Cancer Trialists' Collaborative Group in their meta-analysis has demonstrated that the addition of radiation therapy (RT) to breast-conserving surgery has improved not only local-regional control, but also long-term overall survival [2]. In accelerated partial breast irradiation (APBI) a limited volume of breast tissue is irradiated. This includes tumor bed, lumpectomy or wide local excision with safety margins. It is delivered over a short period of time with increasing the fraction dose. Changing the strategy from whole breast irradiation to a small target (only part of the breast) as in APBI needs full investigation & scrutiny not only because of potential changes in local control but also for its possible impact on the overall survival . Aim of This Review:-Despite of the presence of advanced studies, the role, indication and the optimum APBI technique are still yet to be clearly identified. Therefore, in this review, we will try to find an answer for a number of controversial issues for better identification of the following:

show abstract

“…Larger clinical studies reported failure rates of 3%-13% (Keisch et. al., 2003;Niehoff et. al., 2006;Hattangadi et.…”

Section: Outline Of the Problemmentioning

confidence: 99%

Verification of Balloon Integrity by Ultrasound Imaging in Accelerated Partial Breast Irradiation

Christensen

Trombetta

Gayou

2016

CCO

View full text Add to dashboard Cite

Purpose: An overview of the ultrasound imaging artifacts encountered in Mammosite balloon APBI is presented. Analysis of ultrasound measurement errors and the dosimetric impact of balloon leakage were used to determine whether clinically relevant changes in balloon size can be reliably detected. Methods: Ultrasound imaging of a Mammosite balloon phantom was performed to better understand measurement errors and accuracy. The dose to the prescription point as a function of balloon diameter was computed for different sized balloons. The results were compared to phantom measurements of balloon diameter versus filling volume to assess the dose change that would result from tissue moving inward with a shrinking balloon boundary. In APBI patients undergoing a course of 10 treatment fractions, the accuracy and variability of balloon size measured with ultrasound imaging was compared to CT. Results: Ultrasound artifacts combine to form a false image of the distal balloon boundary. Proper US probe orientation and choice of measurement point locations improved distance measurement accuracy. A 1 mm change in balloon diameter is measurable with ±0.1 mm error and corresponds to <4% change in dose 1 cm from the balloon. Measurement errors relative to CT averaged less than 1.4 mm and variability (standard deviation) over the course of treatment averaged 1.9 mm. Conclusions: Properly performed ultrasound image acquisition and analysis can detect dosimetrically relevant changes in the size of a leaking balloon. This study confirms that US imaging is a valid method of verifying APBI balloon integrity over the course of treatment.

show abstract

Clinical experience with the MammoSite® radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial

Cited by 84 publications

References 22 publications

Determination of exit skin dose for intracavitary accelerated partial breast irradiation with thermoluminescent dosimeters

Determination of exit skin dose for intracavitary accelerated partial breast irradiation with thermoluminescent dosimeters

Accelerated Partial-Breast Irradiation: A State of the Art Strategy.

Verification of Balloon Integrity by Ultrasound Imaging in Accelerated Partial Breast Irradiation

Contact Info

Product

Resources

About