Three-Fraction Intracavitary Accelerated Partial Breast Brachytherapy: Early Provider and Patient-Reported Outcomes of a Novel Regimen

Abstract

Purpose/objectives: To report early adverse events and patient-reported outcomes (PROs) of 3fraction intracavitary catheter-based partial breast brachytherapy (ICBB). Materials/methods: Eligible women ≥ 50 years of age with ≤2.5 cm, lymph node negative invasive or in-situ breast cancer underwent breast conserving surgery and placement of a brachytherapy applicator. ICBB was initiated on the second weekday after surgery and prescribed to 21 Gy in three, once daily, fractions. Common Terminology Criteria for Adverse Events (CTCAE) v 4.0, 10-point Linear Analog Scales Assessment, PROs version of the CTCAE (PRO-CTCAE), and Harvard Breast Cosmesis Scale were utilized for provider and patient-reported assessments. Results: 73 women were treated for invasive (79%) or in-situ (21%) breast cancer. The median time to completion of surgery and radiotherapy was 6 days. After 14 months median follow-up, two patients (3%) had developed breast infections that resolved with oral antibiotics. There was no other treatment-associated adverse event ≥ grade 2. The grade 1 seroma rate at 3 months was 20% which dropped to 8% at 12 months; none required intervention. At 12 months, 91% of patients reported an overall QoL score as ≥ 8 out of 10 and patient-reported cosmesis was good or excellent in 95%. All patients are alive without relapse at the last follow-up. Conclusions: 3-fraction ICBB is associated with low rates of early provider and patient reported adverse events and compares favorably with early outcomes of more protracted ICBB regimens

Five-year oncological outcome after a single fraction of accelerated partial breast irradiation in the elderly

“…Other studies reported encouraging results of vAPBI in patients presenting low-risk breast cancer and confirmed the safety and the efficiency of this new approach (Table 3) [6–8, 19–23].…”

Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review

“…Infections were seen in 3% of patients and no grade 2 or greater toxicities were noted. 95 At this time, limited data are available comparing external beam and brachytherapy APBI approaches. Stecklein et al 96 compared 3D-CRT APBI to applicator brachytherapy in a prospective series of 281 patients.…”

The Case for Brachytherapy: Why It Deserves a Renaissance

“…Early data for breast brachytherapy delivered in 1-4 fractions has demonstrated excellent local tumor control and cosmetic outcomes (37,38). The phase II Triumph-T trial showed excellent local tumor control (albeit short median follow up) and breast cosmesis using a 3-fraction breast brachytherapy technique, and a similar 4-fraction regimen had excellent cosmesis with no locoregional recurrences at 6 years (37, 39).…”

“…Early data for breast brachytherapy delivered in 1 to 4 fractions have demonstrated excellent local tumor control and cosmetic outcomes. 37 , 38 The phase 2 Triumph-T trial showed excellent local tumor control (albeit with a short median follow up) and breast cosmesis using a 3-fraction breast brachytherapy technique, and a similar 4-fraction regimen had excellent cosmesis with no locoregional recurrences at 6 years. 37 , 39 Furthermore, in elderly patients, single-fraction regimens have also demonstrated excellent oncologic outcomes, 40 and a recent study comparing PBI with PBI + hormone therapy or hormone therapy alone in women age >70 years with low-risk, hormone-positive, early stage breast cancer demonstrated that PBI was superior when compliance with hormone therapy was poor, 41 and tested compliance interventions have demonstrated no improvement.…”