The Role of Brachytherapy in the Treatment of Breast Cancer

Abstract

Radiotherapy plays an important part in the management of breast cancer. Especially after breast-conserving surgery, external whole breast irradiation, occasionally with an additional local boost, is an integral part of breast conservation. Besides external radiation techniques, brachytherapy (BT) has long been among the treatment options, especially with regard to local boost application. With the emerging implementation of accelerated partial breast irradiation (APBI), BT in general and interstitial multi-catheter BT in particular, are gaining an increasing role in the management of a selected group of early breast cancer patients. APBI is an approach to reduce the irradiated area to the former tumor bed rather than treating the whole breast tissue in patients with a low baseline local recurrence risk. After a variety of phase I-III clinical studies, it is clearly evident that APBI will play a role in the treatment of this selected patient group. In this review, we focus on the clinical development and different available techniques of breast BT and provide a preview of prospects for its use.

Biological dose summation of external beam radiotherapy for the whole breast and image-guided high-dose-rate interstitial brachytherapy boost in early-stage breast cancer

“…Several randomized trials have confirmed that a local boost after whole breast irradiation significantly decreased the rate of local recurrences [ 4 , 5 , 6 , 7 ]. The most frequently used radiotherapy combination is the whole breast EBRT, with two tangential photon beams and image-guided interstitial brachytherapy (BT), or EBRT boost to the tumor bed [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. This complex combined treatment requires a reliable reporting of dose received by the whole breast, planning target volume (PTV) boost, and critical structures.…”

Experience in multicatheter interstitial high-dose-rate breast brachytherapy: dose-volume histogram analysis of the first results

“…The value of α/β = 4 was chosen as the most suitable, with the total dose and falling under the GEC-ESTRO recommendations [6,8,12,13,14,15]. A model of fractionation agreed with the ABS recommendations: 3.4 Gy per fraction, 2 times a day for 5 days, with a break of at least 6 hours [10].…”

Advances in Breast Radiotherapy: Brachytherapy, Intraoperative Electron Therapy, Protons, and Nodal Irradiation

“…All four papers exemplify the common aim of further reducing adverse effects by further confining the radiation dose to the area that has to be treated [1,2,3] or by discussing the use of radiotherapy instead of surgery in the treatment of regional lymph nodes [4]. …”

“…The two main options for reducing both the irradiated volume and the treatment duration when the bed of the surgically removed tumor needs to be irradiated, either alone - as partial breast irradiation - or as a boost dose, are discussed in the articles on interstitial brachytherapy [1] and on intraoperative radiotherapy [2], respectively. Brachytherapy arguably is the most conformal method to administer radiation, meaning that the radiation dose targeting the volume to be treated is maximally confined, therewith optimally sparing surrounding non-affected breast and connective tissues and organs (heart, lung, ribs).…”

“…Brachytherapy arguably is the most conformal method to administer radiation, meaning that the radiation dose targeting the volume to be treated is maximally confined, therewith optimally sparing surrounding non-affected breast and connective tissues and organs (heart, lung, ribs). Brachytherapy can be delivered via interstitially applied tubes that are inserted into the tumor bed, get loaded consecutively with the radiation source for a few fractions, and are removed after a few days [1]. Interstitial brachytherapy can be used for delivering a boost dose to the tumor bed in addition to whole breast external radiotherapy, or as partial breast irradiation alone if appropriate, the latter reducing the overall treatment duration to only a few days.…”