Hypofractionated whole breast IMRT with HDR brachytherapy boost in early-stage breast cancer: Long-term results from a single-center

INTRODUCTION/OBJECTIVES

The addition of a boost to the lumpectomy bed after whole-breast (WB) radiotherapy plays a key role in the treatment of patients with breast cancer (BC). The clinical benefits of a boost with high-dose-rate brachytherapy (HDR-BT) after conventional fractionation is supported by a large body of evidence. However, few studies have described its outcomes after a hypofractionated scheme.

MATERIALS AND METHODS

We included all patients treated with adjuvant WB-IMRT in 15 sessions followed by a single-session HDR-BT boost with local anesthesia on an outpatient basis.

RESULTS

Between 2009 and 2017, 638 patients with early-stage BC were treated according to the aforementioned protocol after breast-conserving surgery. Median follow-up was 6 years (4-11). Despite the low incidence of side effects and their slightness, we did identify an impact of breast volume on the risk of acute radiodermatitis, fibrosis, pain and edema. However, we did not identify any relationship between the volume in cubic centimeters of the BT-implant with acute or long-term side effects. 2.2% patients had an actual local relapse, 2.4% a 2nd primary in the same breast and 2.39% were diagnosed with contralateral BC. Event-free survival at 11 years was 85.5% with an overall survival of 95.7%.

CONCLUSION

Adjuvant hypofractionated whole-breast IMRT followed by a single dose HDR-BT boost has a low incidence of acute and chronic toxicity and excellent oncological outcomes. However, it may be worthwhile to intensify self-care protocols and surveillance in women with large breasts who may be at increased risk of side effects.

Detection of furazolidone in human biological fluids by high performance liquid chromatography

Furazolidone has normally been administered as a non-absorbable antimicrobial agent for use in gastrointestinal infections. However, in India and Mexico it has been used successfully for the treatment of typhoid fever. We measured concentrations of furazolidone by high performance liquid chromatography (HPLC) in several biological fluids, after a single oral dose (5 mg/kg). Six healthy adult volunteers and seven children with typhoid fever and ten children with purulent meningitis were studied. In adults the peak serum concentration was less than or equal to 0.84 mg/l and less than or equal to 4.78% of the ingested dose was excreted in the urine. In the children concentrations were similar to those found in volunteers. The cerebrospinal fluid/serum ratio ranged from 1.02 to 5.95 in the meningitis patients. HPLC is a rapid and sensitive method for the quantitation of furazolidone in biological fluids. The minimum detectable concentration was 0.05 mg/l, with a precision of 6% from peak area and an average recovery of 98%.