Partial breast irradiation with interstitial 60CO brachytherapy results in frequent grade 3 or 4 toxicity. evidence based on a 12-year follow-up of 70 patients

Póti, Zsuzsa; Nemeskéri, Csaba; Fekésházy, Attila; Sáfrány, Géza; Bajzik, Gábor; Nagy, Z.; Bidlek, Mária; Sinkovics, István; Udvarhelyi, Nóra; Liszkay, Gabriella; Romics, Imre; Galuska, László; Trón, Lajos; Mayer, A.; Ésik, Olga

doi:10.1016/j.ijrobp.2003.08.013

Cited by 48 publications

(29 citation statements)

References 56 publications

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“…6,7 Early APBI trials Several European and American centers pioneered the use of different APBI regimens for unselected patients in the 1980s and early 1990s. [8][9][10][11]13,61,62 However, results in all but one of these early studies were poor, with high LR rates ( Table 5). The high rates of local failure seen in these early APBI studies refl ect inadequate patient selection critera and/or suboptimal treatment technique and lack of appropriate quality assurance (QA) procedures.…”

Section: Brachytherapy In the Treatment Of Breast Recurrencesmentioning

confidence: 99%

“…6,63-65 One of the fi rst prospective APBI studies using interstitial implants was conducted in Hungary at the Uzsoki Hospital between 1987 and 1992. 61 Due to the limited availability of modern teletherapy equipments and the lack of iridium-192 wires in Hungary, special cobalt-60 sources were designed and manufactured to allow the manual afterloading of interstitial BT catheters. During this period, 70 patients were treated with these needles following conservative surgery, without the use of WBI.…”

Section: Brachytherapy In the Treatment Of Breast Recurrencesmentioning

confidence: 99%

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Current status and perspectives of brachytherapy for breast cancer

Polgár

Major

2009

Int J Clin Oncol

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Before the era of breast-conserving therapy, brachytherapy implants were used to treat large inoperable breast tumors. In later years, interstitial brachytherapy with rigid needles or multiple flexible catheters has been used to deliver an additional (boost) dose to the tumor bed after breast-conserving surgery and whole-breast irradiation. Reexcision followed by reirradiation using interstitial breast implants has also been implemented as an alternative to mastectomy to treat ipsilateral breast local recurrence after previous breast-conserving therapy. In the past two decades, the new concept of accelerated partial breast irradiation opened a new perspective for breast brachytherapy. The first technique utilized in early accelerated partial breast irradiation studies was multicatheter interstitial brachytherapy. Beyond classical interstitial brachytherapy, recently, new intracavitary applicators have been developed in the United States to decrease the existing barriers against the widespread use of multicatheter brachytherapy. Furthermore, interstitial low-dose-rate seed implants have also been implemented as an alternative for stepping-source multicatheter brachytherapy. In this article, we give an overview of the past achievements, current status, and future perspectives of breast brachytherapy.

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Section: Brachytherapy In the Treatment Of Breast Recurrencesmentioning

confidence: 99%

Section: Brachytherapy In the Treatment Of Breast Recurrencesmentioning

confidence: 99%

Current status and perspectives of brachytherapy for breast cancer

Polgár

Major

2009

Int J Clin Oncol

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“…However, we await the results of a large trial comparing the efficacy of APBI with WBI, i.e., NSABP B39/Radiation Therapy Oncology Group 0413 Phase III trial. We did not publish our data until the median follow-up period had passed 2.5 years, because the median follow-up period of most reports on APBI-induced late toxicities was longer than 20 months [31][32][33] and the peak hazard of recurrence is between 12 and 24 months [34]. Hazard likelihood decreases steadily between 2 and 5 years [34].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Open-Cavity Implant for Accelerated Partial Breast Irradiation Using High-Dose Rate Multicatheter Brachytherapy in Japanese Breast Cancer Patients: A Single-Institution Registry Study

Sato¹,

Mizuno²,

Kato³

et al. 2012

JCT

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Background: Previous research has compared the efficacies of accelerated partial breast irradiation (APBI) and wholebreast irradiation (WBI). APBI immediately after surgery may provide more benefit after intraoperative insertion of catheters. Although balloon catheter-based APBI is available in the US, it is difficult in Japanese women, who have relatively small breasts. With the applicators being implanted during tumor removal, APBI can be started immediately after surgery. The aim of this study was to assess the safety and efficacy of APBI using the intraoperative open-cavity implant technique. Method: Patients (age ≥ 40 years) with invasive breast cancer (diameter ≤ 3 cm) were enrolled. Before lumpectomy, the insertion of applicators and delivery doses were simulated by computed tomography (CT). After confirmation of free margins and negative sentinel nodes (SNs) using frozen section analysis, applicators were inserted. Postoperative CT-based dose distribution analysis was performed using dose-volume histograms. APBI was started on the day of surgery, delivering 32 Gy in 8 fractions over the following 5 -6 days, and it covered a distance of 2 cm from tumor margins. This observational study was approved by the institutional review board of our hospital. Results: From October 2008 to July 2012, 157 women (160 lesions) were enrolled (age 55.0 years, <40:9, SN + : 25, for patients' request). The mean number of applicators used was 6.4 (2 -15) and mean planning target volume was 35.8 cm 3 (6.5 -137.1 cm 3 ). All radiotherapy-related toxicities were mild. However, 12 patients (7.5%) experienced wound breakdown because of surgical site infection. Two patients developed ipsilateral breast tumor recurrence (1 marginal, 1 at a distant site). Conclusions: Despite the small number of participants and a short follow-up period, our results suggest that this technique could be helpful in establishing clinical safety and efficacy.

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“…és klinikai leírással ennek mértékét úgynevezett skála-rendszeren lehet rögzíteni. Saját beteganyagunkban az emlődaganatok MDR (medium dose rate -közepes dó-zisteljesítményű) interstitialis (szövetközi) brachytherapiáját követő késői sugárkárosodását ultrahanggal, MRrel és SPECT/PET/CT-vel is vizsgáltuk Póti és munkatársainak módszerével [8]. Hasonló feldolgozást készítettünk az előrehaladott méhnyakrákok egyedüli sugárterápiáját követő korai/késői sugárkárosodásokról is [9].…”

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Paradigmaváltás szükségessége a sugárterápiában

2015

Self Cite

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A sugárterápia helye és indikációja az utóbbi évtizedben alapjaiban változott és bővült. Az új technikák és sugárbio-lógiai kutatások, valamint informatikai fejlesztések jelentősen javították a szolid tumorok és metasztázisok sugárkeze-lésében a lokális eredményességet. A komputertomográfi a-alapú (egyéb metszetképalkotó vizsgálatokkal adaptált) kiegészített sugárterápiás célterület kijelölésével a tumoros és környező ép szövetek pontosabb ábrázolása vált lehetővé. Az új sugárterápiás technikák közül az intenzitás-vagy térfogatmodulált ívbesugárzással (volumetric modulated arc therapy) a célterületben a dózis optimálisan emelhető a környező ép szövetek sugárkárosodása nélkül. Ezek segít-ségével ugyanakkor lehetőség van új indikációkra is. Ezek között említendő az intracranialis metasztázisok mellett az extracranialis, úgynevezett oligometasztázisok közel kuratív (hosszú évekig tartó stabil állapot vagy remisszió) stereotaxiás sugárterápiája. Az oligometasztázisok között talán leglátványosabb eredményeket a máj-, tüdő-és gerincmetasztázisok egy vagy több frakcióban történő stereotaxiás sugárkezelésével lehet elérni, amelynek elengedhetetlen feltétele a kép-és esetenként a légzésvezérelt technika megléte. Orv. Hetil., 2015, 156(44), 1763-1768.Kulcsszavak: szolid tumorok, tumoros hypoxia, sugaras károsodás, stereotaxiás sugársebészet-sugárterápia, oligometasztázisok, hagyományostól eltérő frakcionálás The need for a paradigm shift in radiotherapyThe status and indications of radiotherapy have signifi cantly changed in the past decade because novel techniques, radiobiological research and major advances in informatics have made better local control possible. Using supplemented marking of the target volume with computer tomography based other image-making methods adapted made it possible to defi ne the tumor and intact surrounding tissues more precisely. With novel radiotherapy techniques the dosage of the homogenity and the covering in the target volume can be raised optimally, especially with intensity modulated arc radiotherapy (volumetric modulated arc therapy) without causing radiation injury or damage to intact surrounding tissues. Furthermore, with novel techniques and target volume marking, new indications have appeared in clinical practice and besides sterotactic radiotherapy for intracranial metastases, the extracranial so-called oligometastic conditions can be maintained close to a curative state (or in remission) for many years. Among these, perhaps the most striking is the stereotactic radiotherapy treatment of liver, lung and spinal cord metastases in one or more fractions, for which the indispensable condition is the image or respiratory guided technique.Keywords: solid tumors, tumor hypoxia, radiation injuri, stereotactic radiosurgery or radiotherapy, oligometastasis, alterated fractionation Mayer, Á., Katona, Cs., Farkas, R., Póti, Zs. [The need for a paradigm shift in radiotherapy]. Orv. Hetil., 2015, 156(44), 1763-1768. ÖSSZEFOGLALÓ KÖZLEMÉNYRövidítések BED = biológiailag azonos (ekvivalens) dóz...

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Partial breast irradiation with interstitial 60CO brachytherapy results in frequent grade 3 or 4 toxicity. evidence based on a 12-year follow-up of 70 patients

Cited by 48 publications

References 56 publications

Current status and perspectives of brachytherapy for breast cancer

Current status and perspectives of brachytherapy for breast cancer

Intraoperative Open-Cavity Implant for Accelerated Partial Breast Irradiation Using High-Dose Rate Multicatheter Brachytherapy in Japanese Breast Cancer Patients: A Single-Institution Registry Study

Paradigmaváltás szükségessége a sugárterápiában

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