External Beam Accelerated Partial Breast Irradiation Yields Favorable Outcomes in Patients with Prior Breast Augmentation

Abstract

Purpose: To report outcomes in breast cancer patients with prior breast augmentation treated with external beam accelerated partial breast irradiation (EB-APBI) utilizing intensity-modulated radiotherapy or 3-dimensional conformal radiotherapy, both with IGRT.Materials and Methods: Sixteen stage 0/1 breast cancer patients with previous elective bilateral augmentation were treated post-lumpectomy on institutional EB-APBI trials (01185132 and 01185145 on clinicaltrials.gov). Patients received 38.5 Gy in 10 fractions over five consecutive days. Breast/chest wall pain and cosmesis were rated by patient; cosmesis was additionally evaluated by physician per RTOG criteria.Results: The median follow-up from accelerated partial breast irradiation (APBI) completion was 23.9 months (range, 1.2–58.6). Little to no change in cosmesis or pain from baseline was reported. Cosmetic outcomes at last follow-up were judged by patients as excellent/good in 81.2% (13/16), and by physicians as excellent/good in 93.8% (15/16). Ten patients (62.5%) reported no breast/chest wall pain, five (31.2%) reported mild pain, and one (6.2%) reported moderate pain. All patients remain disease free at last follow-up. The median ipsilateral breast, planning target volume (PTV), and implant volumes were 614, 57, and 333 cm3. The median ratios of PTV/ipsilateral breast volume (implant excluded) and PTV/total volume (implant included) were 9 and 6%.Conclusion: These 16 breast cancer cases with prior bilateral augmentation treated with EB-APBI demonstrate favorable clinical outcomes. Further exploration of EB-APBI as a treatment option for this patient population is warranted.

A comparison of dosimetric variance for external-beam partial breast irradiation using three-dimensional and four-dimensional computed tomography

“…Both the CTV and PTV were limited to 5 mm from the skin surface and lung–chest wall interface. 14 The TB volume and PTV were recorded for each patient. The ipsilateral normal breast was delineated based on the 3DCT and 4DCT images.…”

Breast Implants and Radiation

“…Cosmetic outcomes at last follow-up were judged by patients as excellent/good in 81.2% (13/16), and by physicians as excellent/good in 93.8% (15/16). 58 Previous breast augmentation should not be considered a contraindication for breast-conserving therapy in women who are otherwise appropriate candidates from an oncologic perspective.…”

Targeted Intraoperative Radiotherapy During Breast-conserving Surgery for Breast Cancer in Patients After Implant Augmentation

“…The use of a brachytherapy boost instead of an external boost yielded favorable cosmetic outcomes even though patients received additional whole breast irradiation (11). A report on partial breast irradiation after implant-based breast augmentation comprised 16 patients treated with external beam accelerated breast irradiation (38.5 Gy in 10 fractions over 5 days) after breast conserving surgery (12). Follow-up varied from 1.2 to 58 months.…”