Clinically evident fat necrosis in women treated with high-dose-rate brachytherapy alone for early-stage breast cancer

Wazer, David E.; Lowther, D; Boyle, Teresa; Ulin, Kenneth; Neuschatz, Andrew C.; Ruthazer, Robin; DiPetrillo, Thomas A.

doi:10.1016/s0360-3016(00)01541-8

Cited by 136 publications

(77 citation statements)

References 13 publications

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“…In addition, the maximum dose to the skin and ipsilateral lung ( 7 ) was assessed. To reduce the incidence of fat necrosis ( 6 , 11 ) and dose inhomogeneity in the target, the NSABP B39/RTOG 0413 protocol limited the volume of breast tissue receiving excessive doses (V150[cc]

< 50

cc and V200[cc]

< 10

cc). ( 6 ) Hence, the V150[cc] and V200[cc] values were evaluated.…”

Section: Methodsmentioning

confidence: 99%

Comparison of single and multiple dwell position methods in MammoSite high dose rate (HDR) brachytherapy planning

Kim

Trombetta

Miften

2010

J Applied Clin Med Phys

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The purpose of this study is to dosimetrically compare two plans generated using single dwell position method (SDPM) and multiple dwell position methods (MDPM) in MammoSite high dose rate (HDR) brachytherapy planning for 19 breast cancer patients. In computed tomography (CT) image‐based HDR planning, a surface optimization technique was used in both methods. Following dosimetric parameters were compared for fraction 1 plans: %PTV_EVAL (planning target volume for plan evaluation) coverage, dose homogeneity index (DHI), dose conformal index (COIN), maximum dose to skin and ipsilateral lung, and breast tissue volume receiving 150% (V150[cc]) and 200% (V200[cc]) of the prescribed dose. In addition, a plan was retrospectively generated for each fraction 2–10 to simulate the clinical situation where the fraction 1 plan was used for fractions 2–10 without modification. In order to create nine derived plans for each method and for each of the 19 patients, the catheter location and contours of target and critical structures were defined on the CT images acquired prior to each fraction 2–10, while using the same dwell‐time distribution as used for fraction 1 (original plan). Interfraction dose variations were evaluated for 19 patients by comparing the derived nine plans (each for fractions 2–10) with the original plan (fraction 1) using the same dosimetric parameters used for fraction 1 plan comparison. For the fraction 1 plan comparison, the MDPM resulted in slightly increased %PTV_EVAL coverage, COIN, V150[cc] and V200[cc] values by an average of 1.2%, 0.025, 0.5 cc and 0.7 cc, respectively, while slightly decreased DHI, maximum skin and ipsilateral lung dose by an average of 0.003, 3.2 cGy and 5.8 cGy, respectively. For the interfraction dose variation comparison, the SDPM resulted in slightly smaller variations in %PTV_EVAL coverage, DHI, maximum skin dose and V150[cc] values by an average of 0.4%, 0.0005, 0.5 cGy and 0.2 cc, respectively, while slightly higher average variations in COIN, maximum ipsilateral lung dose and V200[cc] values by 0.0028, 0.2 cGy and 0.2 cc, respectively. All differences were too small to be clinically significant. Compared to the MDPM, the SDPM combined with a surface optimization technique can generate a clinically comparable fraction 1 treatment plan with a similar interfraction dose variation if a single source is carefully positioned at the center of the balloon catheter.PACS number: 87.53.Jw

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< 50

cc and V200[cc]

< 10

cc). ( 6 ) Hence, the V150[cc] and V200[cc] values were evaluated.…”

Section: Methodsmentioning

confidence: 99%

Comparison of single and multiple dwell position methods in MammoSite high dose rate (HDR) brachytherapy planning

Kim

Trombetta

Miften

2010

J Applied Clin Med Phys

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“…While several studies have evaluated risk factors and incidence of fat necrosis with interstitial brachytherapy, reports dedicated to the evaluation of fat necrosis in BBB are limited [12,14,16,17]. To our knowledge, this is the first study dedicated to the evaluation of fat necrosis specifically in BBB.…”

Section: Purposementioning

confidence: 99%

“…A benign inflammatory process, fat necrosis is commonly caused by trauma but has also been a documented complication from radiotherapy [12][13][14][15][16]. Several studies have evaluated its incidence in brachytherapy, which ranges from 2% to 52% [2,3,5,6,9,[11][12][13][14][15][16][17][18].…”

Section: Purposementioning

confidence: 99%

The Incidence of Fat Necrosis in Balloon-Based Breast Brachytherapy

Paryani

Vallow

Magalhaes

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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“…Even when comparing relatively similar brachy-therapy techniques for delivering APBI, there remains uncertainty regarding the appropriate dosimetric criteria needed to minimize the risk of toxicities such as fat necrosis. In the initial clinical experiences with interstitial catheter-based brachy-therapy, symptomatic fat necrosis reported range from 2% to 21% of cases [81,82] .The current guidelines in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG 0413 protocol regarding the volume of higher doses of radiation permissible on study are based on earlier dosimetric analyses from Tufts University and Virginia Commonwealth University that correlated larger volumes of high doses of radiation in the breast with the development of fat necrosis [83]. It is difficult to know how to translate these dosimetric constraints from one brachytherapy modality to another, which is important given that balloon and single-entry catheter based brachytherapy catheters yield significantly different dose distributions.…”

Section: Comparison Of Apbi Modalities:-mentioning

confidence: 99%

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

Hamoud¹,

Ghorbel²,

Falfali³

et al. 2017

IJAR

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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:

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Clinically evident fat necrosis in women treated with high-dose-rate brachytherapy alone for early-stage breast cancer

Cited by 136 publications

References 13 publications

Comparison of single and multiple dwell position methods in MammoSite high dose rate (HDR) brachytherapy planning

Comparison of single and multiple dwell position methods in MammoSite high dose rate (HDR) brachytherapy planning

The Incidence of Fat Necrosis in Balloon-Based Breast Brachytherapy

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

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