Interstitial HDR Brachytherapy in BCT: A Case Series Study from a Single Institute

Abstract

Background: Radiotherapy (RT) plays an integral part in the management of breast cancer. In BCT there is 20% reduction in loco regional failure and 15 years breast cancer mortality reduction by 5% when RT is used as adjuvant therapy. Adjuvant radiation therapy can be delivered by External Beam Radiotherapy (EBRT) with brachytherapy (BT) or BT alone. Aims: Loco regional control of disease with good cosmesis. Primary end point is loco regional failure. Methods: A total of 30 cases of early breast cancers (T1, T2 N0M0) treated during May 2008 to Dec 2012 and followed up till July 2015 were studied. External radiation dose of 45 to 50 Gy by Telecobalt-60 followed by boost implant BT with dose of 15 to 20Gy in 3 to 4 fractions was used (BED = 84.4 ± 1.1 Gy) for combined external plus BT as per departmental protocol. A total of 30 Gy in 6 fractions was used (BED = 47.8 Gy) for BT alone as per departmental protocol. Ir-192 Micro selectron HDR rigid needle template or flexible catheter implant to primary site was used. Dosimetry was done with Plato sunrise treatment planning System. Results: Age ranges from 23 to 50 years. Median follow up was 54 months. None had local recurrence. Only 1 had mild needle wound sepsis and all had good to excellent acceptable cosmetic results. Radiation skin reaction and sub cutaneous fibrosis were grade I and 2. Three had disease recurrence at distant sites and one patient had moderate telangiectasia at the irradiated site. Conclusion: BCT with EBRT and HDR BT boost or HDR BT alone has shown good results in both loco regional control of disease with good to excellent cosmesis.