A dosimetric analysis comparing electron beam with the MammoSite brachytherapy applicator for intact breast boost

Mono-institutional Italian Experience with a Double-lumen Balloon-brachytherapy Device for Early Breast Cancer: Results at a 5-year Minimum follow-up

Aims and Background

To report the 5-year minimum follow-up in low-risk breast cancer patients treated with a double-lumen balloon-brachytherapy device in one mono-institutional Italian experience. Local control data and cosmetic outcomes were collected and analyzed.

Methods

Between October 2004 and December 2007, we treated 30 early stage breast cancer patients who underwent conservative surgery followed by adjuvant accelerated partial breast irradiation with a double-lumen balloon-brachytherapy system. Eligibility criteria for the protocol were based on the indications of the American Brachytherapy Society and the American Society of Breast Surgeons. The device was placed inside the lumpectomy cavity during surgery by open technique in all the patients. Computed tomography images and standard X-ray were used for treatment planning. The total irradiation dose was 34 Gy in 10 fractions of 3.4 Gy (twice daily) over 5 days to the lumpectomy cavity.

Results

Median follow-up was 80.5 months (range, 60–98). No patient developed local recurrence or distant metastasis. At the end of treatment, there was evidence of a symptomatic seroma in 83% of the total patients, with a yearly decreasing trend. However, the incidence of mild and moderate fibrosis progressively increased. Seventy seven percent of the patients were satisfied with their cosmetic results.

Conclusions

Our findings reinforce the hypothesis that an accelerated double-lumen balloon-breast brachytherapy catheter in selected low-risk patients is safe, and a favorable cosmetic outcome can be achieved.

Treatment techniques to reduce cardiac irradiation for breast cancer patients treated with breast-conserving surgery and radiation therapy: a review

Thousands of women diagnosed with breast cancer each year receive breast-conserving surgery followed by adjuvant radiation therapy. For women with left-sided breast cancer, there is risk of potential cardiotoxicity from the radiation therapy. As data have become available to quantify the risk of cardiotoxicity from radiation, strategies have also developed to reduce the dose of radiation to the heart without compromising radiation dose to the breast. Several broad categories of techniques to reduce cardiac radiation doses include breath hold techniques, prone positioning, intensity-modulated radiation therapy, and accelerated partial breast irradiation, as well as many small techniques to improve traditional three-dimensional conformal radiation therapy. This review summarizes the published scientific literature on the various techniques to decrease cardiac irradiation in women treated to the left breast for breast cancer after breast-conserving surgery.

Evaluation of clinical benefits achievable by using different optimization algorithms during real-time prostate brachytherapy

BACKGROUND AND PURPOSE

High dose rate (HDR) brachytherapy is a clinically used procedure in prostate cancer treatment. The purpose of this study was to present the influence of using different optimization algorithms in 3D-CBRT planning on the treatment plan quality.

MATERIALS AND METHODS

Treatment plans were calculated for 15 patients--three plans for each patient using: geometrical optimization (GO), inverse optimization (IO) and blind inverse optimization (BIO). For each patient, PTV and OAR volumes, number of needles and geometry of the implant were set equal. Differences between dose distributions were tracked using: D90, V100, V200, Dmax (for prostate); D10, Dmax (for urethra); D10, V100, Dmax (for rectum).

RESULTS

The analysis of mean values of D90 and V100 in the prostate showed that inverse algorithms gave the best results (mean D90 was 12.1% for BIO and 9.3% for IO better than for GO, mean V100 was 8.2% for BIO and 6.3% for IO better than for GO). From a clinical point of view, GO diminished the doses in the PTV and urethra in all analyzed parameters. The lowest mean doses in the rectum were achieved for plans optimized with IO and BIO (mean D10: 61.2% for GO, 58.1% for IO, 58.0% for BIO; mean Dmax: 92.8% for GO, 85.1% for IO, 83.6% for BIO).

CONCLUSIONS

Application of the blind inverse optimization (BIO) algorithm led to clinically best dose parameters for PTV and the rectum. Use of geometrical optimization (GO) led to smaller doses in the urethra, which was however associated with a certain dose decrease also in PTV.