Multi-catheter interstitial accelerated partial breast irradiation – tips and tricks for a good insertion

Tang, Johann I.; Tan, Poh Wee; Koh, Vivien

doi:10.5114/jcb.2014.40767

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Within 8 weeks of lumpectomy and axillary nodal evaluation, patients underwent an interstitial implant using the template method performed in the supine position. 17 , 18 Once the cavity was localized, the ipsilateral breast area was surgically prepared under sterile conditions. To avoid injuring the underlying chest wall structures or causing a pneumothorax, the overlying breast was pinched and gently lifted off the chest wall before applying the template and securing it.…”

Section: Methodsmentioning

confidence: 99%

Accelerated partial breast irradiation in an Asian population: dosimetric findings and preliminary results of a multicatheter interstitial program

Koh

Tan

Iau

et al. 2016

OTT

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IntroductionAccelerated partial breast irradiation (APBI) using the multicatheter method has excellent cosmesis and low rates of long-term toxicity. However, there are few studies looking at the feasibility of this procedure and the outcomes in an Asian population. This study aims to look at outcomes at our hospital.MethodsWe identified 121 patients treated with APBI at our center between 2008 and 2014. The median follow-up for our patient group was 30 months (range 3.7–66.5). The prescribed dose per fraction was 3.4 Gy in 10 fractions. In this study population, 71% of the patients were Chinese while 15% (n=19) were of other Asian ethnicity.ResultsIn this study, the median breast volume was 850 cc (range 216–2,108) with 59.5% (n=72) patients with a breast volume of <1,000 cc. The average planning target volume was 134 cc (range 28–324). The number of catheters used ranged from 8 to 25 with an average of 18 catheters used per patient. We achieved an average dose homogeneity index of 0.76 in our patients. The average D90(%) was 105% and the average D90(Gy) was 3.6 Gy per fraction. The median volume receiving 100% of the prescribed dose (V100) was 161.7 cc (range 33.9–330.1), 150% of the prescribed dose (V150) and 200% of the prescribed dose (V200) was 39.4 cc (range 14.6–69.6) and 14.72 cc (range 6.48–22.25), respectively. Our dosimetric outcomes were excellent even in patients with breast volume under 1,000 cc. There were no cases of grade 3 skin toxicity or acute pneumonitis. Two patients had a postoperative infection and two patients had fat necrosis postprocedure.ConclusionMulticatheter high dose rate APBI is a safe and feasible procedure that can be carried out with minimal toxicity in Asian patients with breast volumes under 1,000 cc.

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Section: Methodsmentioning

confidence: 99%

Accelerated partial breast irradiation in an Asian population: dosimetric findings and preliminary results of a multicatheter interstitial program

Koh

Tan

Iau

et al. 2016

OTT

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“…However, MIB is the oldest and time tested technique of delivering breast brachytherapy with respect to mature clinical outcome data [ 3 ]. In fact, it is being practiced since almost a decade before the guidelines for APBI were formulated [ 4 , 5 ]. As it is technically demanding and delivered without the need of any expensive device, it is not a very popular technique.…”

Section: Purposementioning

confidence: 99%

Multi-catheter interstitial brachytherapy for partial breast irradiation: an audit of implant quality based on dosimetric evaluation comparing intra-operative versus post-operative placement

Gurram¹,

Wadasadawala²,

Joshi

et al. 2016

jcb

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PurposeThe use of multicatheter interstitial brachytherapy (MIB) for accelerated partial breast irradiation (APBI) in early breast cancer (EBC) patients outside the trial setting has increased. Hence, there is a need to critically evaluate implant quality. Moreover, there is a scarcity of reports using an open cavity technique. We report the dosimetric indices of open and closed cavity MIB techniques.Material and methodsThe dosimetric parameters of 60 EBC patients treated with MIB (open and closed cavity) who underwent three dimensional, computerized tomography (CT) based planning for APBI from November 2011 to July 2015 were evaluated. Coverage Index (CI), Dose Homogeneity Index (DHI), Conformity Index (COIN), Plan Quality Index (PQI), and Dose Non-uniformity Index (DNR) were assessed.ResultsForty-one patients underwent open cavity and 19 patients underwent closed cavity placement of brachytherapy catheters. The median number of planes was 4 and median number of needles was 20. Median dose was 34 Gy with dose per fraction of 3.4 Gy, given twice a day, 6 hours apart. The D90 of the cavity and clinical target volume (CTV) were 105% and 89%, respectively. The median doses to the surgical clips were greater than 100%. The median CI of the cavity and CTV was 0.96 and 0.82, respectively. The DHI and COIN index of the CTV was 0.73 and 0.67. There were no significant differences in the dosimetric parameters based on whether the technique was done open or closed.ConclusionsCritical evaluation of the dosimetric parameters of MIB-APBI is important for optimal results. While the open and closed techniques have similar dosimetry, our institutional preference is for an open technique which eases the procedure due to direct visualization of the tumor cavity.

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“…Initially, CT imaging was used only for evaluation purpose after standard fluoroscopy-guided implantation [ 12 , 13 , 14 , 15 , 29 ], but afterwards, the implantations themselves were performed using 3D CT information [ 15 , 16 , 30 , 31 , 32 , 33 ]. These and other studies confirmed that with introduction of image-guided implantation techniques, the treatment plans improved considerably compared to the traditional fluoroscopy-guided implantation and planning [ 11 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment planning for multicatheter interstitial brachytherapy of breast cancer – from Paris system to anatomy-based inverse planning

Major

Polgár

2017

jcb

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In the last decades, treatment planning for multicatheter interstitial breast brachytherapy has evolved considerably from fluoroscopy-based 2D to anatomy-based 3D planning. To plan the right positions of the catheters, ultrasound or computed tomography (CT) imaging can be used, but the treatment plan is always based on postimplant CT images. With CT imaging, the 3D target volume can be defined more precisely and delineation of the organs at risk volumes is also possible. Consequently, parameters calculated from dose-volume histogram can be used for quantitative plan evaluation. The catheter reconstruction is also easier and faster on CT images compared to X-ray films. In high dose rate brachytherapy, using a stepping source, a number of forward dose optimization methods (manual, geometrical, on dose points, graphical) are available to shape the dose distribution to the target volume, and these influence dose homogeneities to different extent. Currently, inverse optimization algorithms offer new possibilities to improve dose distributions further considering the requirements for dose coverage, dose homogeneity, and dose to organs at risk simultaneously and automatically. In this article, the evolvement of treatment planning for interstitial breast implants is reviewed, different forward optimization methods are discussed, and dose-volume parameters used for quantitative plan evaluation are described. Finally, some questions of the inverse optimization method are investigated and initial experiences of the authors are presented.

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Multi-catheter interstitial accelerated partial breast irradiation – tips and tricks for a good insertion

Cited by 6 publications

References 17 publications

Accelerated partial breast irradiation in an Asian population: dosimetric findings and preliminary results of a multicatheter interstitial program

Accelerated partial breast irradiation in an Asian population: dosimetric findings and preliminary results of a multicatheter interstitial program

Multi-catheter interstitial brachytherapy for partial breast irradiation: an audit of implant quality based on dosimetric evaluation comparing intra-operative versus post-operative placement

Treatment planning for multicatheter interstitial brachytherapy of breast cancer – from Paris system to anatomy-based inverse planning

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