Tumor bed boost in breast cancer: Brachytherapy versus electron beam

Sanjoy Roy; Tapas Maji; Prabir Chaudhuri; Debarshi Lahiri; Jaydip Biswas; Devleena

doi:10.4103/0971-5851.125238

Indian Journal of Medical and Paediatric Oncology, Table of Contents

CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2013; 34(04): 257-263
DOI: 10.4103/0971-5851.125238

ORIGINAL ARTICLE

Tumor bed boost in breast cancer: Brachytherapy versus electron beam

Sanjoy Roy

Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India

,

Devleena,

Tapas Maji

Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India

,

Prabir Chaudhuri

Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India

,

Debarshi Lahiri

Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India

,

Jaydip Biswas

Department of Radiotherapy, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India

› Author Affiliations

Abstract

PDF Download

Abstract

Background: The prospective study aimed to evaluate the effectiveness of Electron beam or HDR 192Ir Interstitial Implant used as a boost in breast Conservation cases after completion of EBRT. The two therapeutic modalities were compared in terms of the following parameters; i.e. cosmesis, optimization of tumor bed boost, local control, toxicity, and DFS. Materials and Methods: The EBRT dose used was 50 Gy in 25 fractions over 5 weeks time. Target delineation of boost treatment was done by CT scan or by high resolution USG. EBRT will be immediately followed by local boost at the primary tumor bearing site of breast with 8 to12 MeV electron beam to a dose of 15 Gy in 6 fractions (Arm A) or with HDR 192Ir interstitial brachytherapy to a dose of 15 Gy in 3 fractions at 6 hours apart (Arm B). Results: The excellent cosmesis achieved with electron beam therapy in Arm A was found to be statistically significant (P = 0.025). Local relapse was absent in both the arms. One distant metastasis occurred in Arm A within 10 months of initiation of treatment and one distant metastasis in Arm B came out within 3 months of starting of therapy. Conclusion: The study has shown good cosmetic result with electron boost and 100% local control with both the technique. However if there is a more number of patients with longer period of follow up we could have got the actual picture to verify our results and assess long term survival data.

Keywords

Early stage breast cancers - electron - interstitial

PDF (565 kb)

References

References
1 Halsted WS. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to January, 1894. Bull Johns Hopkins Hosp 1894;4:297.
2 McWhirter R. Simple mastectomy and radiotherapy in the treatment of breast cancer. Br J Radiol 1955;28:128-39.
3 Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665-73.
4 Kaae S, Johansen H. Does simple mastectomy followed by irradiation offer survival comparable to radical procedures? Int J Radiat Oncol Biol Phys 1977;2:1163-6.
5 Keynes G. Conservative treatment of cancer of the breast. Br Med J 1937;2:643-6663.
6 Amalric R, Santamaria F, Robert F. Conservation therapy of operable breast cancer: Results of 5, 10, and 15 years in 2216 consecutive cases. In: Harris HR, Hellman S, Silen W, editors. Conservative Management of Breast Cancer: New Surgical and Radiotherapeutic Techniques. Philadelphia: JB Lippincott; 1983. p. 15-21.
7 Calle R, Vilcoq JR, Zafrani B, Vielh P, Fourquet A. Local control and survival of breast cancer treated by limited surgery followed by irradiation. Int J Radiat Oncol Biol Phys 1986;12:873-8.
8 Peters MV. Wedge resection with or without radiation in early breast cancer. Int J Radiat Oncol Biol Phys 1977;2:1151-6.
9 Vilcoq JR, Calle R, Stacey P, Ghossein NA. The outcome of treatment by tumorectomy and radiotherapy of patients with operable breast cancer. Int J Radiat Oncol Biol Phys 1981;7:1327-32.
10 Lazovich D, Solomon CC, Thomas DB, Moe RE, White E. Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma. Cancer 1999;86:628-37.
11 Morris AD, Morris RD, Wilson JF, White J, Steinberg S, Okunieff P, et al. Breast-conserving therapy vs mastectomy in early-stage breast cancer: A meta-analysis of 10-year survival. Cancer J Sci Am 1997;3:6-12.
12 Bellon JR, Come SE, Gelman RS. Sequencing of chemotherapy and radiation therapy for patients with early stage breast cancer; updated results of a prospective randomized trial. Int J Radiat Oncol Biol Phys 2001;51 Suppl 1;2.
13 Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 1998;16:2672-85.
14 Pierce LJ, Lew D, Hutchins L. Patterns of recurrence by sequence of chemotherapy and radiotherapy in early stage breast cancer. Int J Radiat Oncol Biol Phys 2003;57 Suppl 1;S127.
15 Gianni L, Valagussa P, Zambetti M, Moliterni A, Capri G, Bonadonna G. Adjuvant and neoadjuvant treatment of breast cancer. Semin Oncol 2001;28:13-29.
16 Early Breast Cancer Trialists′ Meeting at Oxford, September, 2000 Meta-analyses of adjuvant therapies for women with early breast cancer: The Early Breast Cancer Trialists′ Collaborative Group overview. Annals of Oncology 2006;17(Supplement 10):x59-x62.
17 Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997;337:949-55.
18 Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 1999;353:1641-8.
19 Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-41.
20 Recht A, Silver B, Schnitt S, Connolly J, Hellman S, Harris JR. Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int J Radiat Oncol Biol Phys 1985;11:1271-6.
21 Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JC, Jager JJ, et al. Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer 2003;39:932-44.
22 Nandakumar A, Anantha N, Venugopal TC, Sankaranarayanan R, Thimmasetty K, Dhar M. Survival in breast cancer: A population-based study in Bangalore, India. Int J Cancer 1995;60:593-6.
23 Clarke D, Martinez A, Cox RS. Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int J Radiat Oncol Biol Phys 1983;9:1807-13.
24 Ray GR, Fish VJ. Biopsy and definitive radiation therapy in Stage I and II adenocarcinoma of the female breast: Analysis of cosmesis and the role of electron beam supplementation. Int J Radiat Oncol Biol Phys 1983;9:813-8.
25 Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 1979;5:257-61.
26 Van Limbergen E, Rijnders A, van der Schueren E, Lerut T, Christiaens R. Cosmetic evaluation of breast conserving treatment for mammary cancer. 2. A quantitative analysis of the influence of radiation dose, fractionation schedules and surgical treatment techniques on cosmetic results. Radiother Oncol 1989;16:253-67.
27 Solin LJ, Chu JC, Larsen R, Fowble B, Galvin JM, Goodman RL. Determination of depth for electron breast boosts. Int J Radiat Oncol Biol Phys 1987;13:1915-9.
28 Triedman S, Boyages J, Silver B. A comparison of local control and cosmetic outcome in patients boosted with electrons or implant in the conservative management of early breast cancer. In: Proceedings of the 17 th International Congress of Radiation Oncology, Paris; July 1989. p. 48.
29 Gerard JP, Montbarbon JF, Chassard JL, Romestaing P, Ardiet JM, Delaroche G, et al. Conservative treatment of early carcinoma of the breast: Significance of axillary dissection and iridium implant. Radiother Oncol 1985;3:17-22.
30 Trotti A, Byhardt R, Stetz J, Gwede C, Corn B, Fu K, et al. Common toxicity criteria: Version 2.0. An improved reference for grading the acute effects of cancer treatment: Impact on radiotherapy. Int J Radiat Oncol Biol Phys 2000;47:13-47.
31 Hammer J, Track C, Seewald DH. Ir- 92 HDR boost feasibility and cosmetic outcome of a fractionated outpatient delivery scheme. Radiother Oncol 2000;32.
32 Manning MA, Arthur DW, Schmidt-Ullrich RK, Arnfield MR, Amir C, Zwicker RD. Interstitial high-dose-rate brachytherapy boost: The feasibility and cosmetic outcome of a fractionated outpatient delivery scheme. Int J Radiat Oncol Biol Phys 2000;48:1301-6.
33 Fisher B, Wickerham DL, Deutsch M, Anderson S, Redmond C, Fisher ER. Breast tumor recurrence following lumpectomy with and without breast irradiation: An overview of recent NSABP findings. Semin Surg Oncol 1992;8:153-60.
34 Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 1985;56:979-90.
35 Holland R, Veilling SH, Mravunac M. Histological multifocality of early stage breast cancer. Cancer 1985;56:979-90.
36 Holland R, Conolly J, Gelman R. Nature and extent of residual cancer in the breast related to intraductal component in the primary tumor. Int J Radiat Oncol Biol Phys 1988;15:182-3.
37 Vanlimbergen E. Evidence of dose response relationship for local control after BCS and RT. GEC ESTRO. 2001. p. 47-57.
38 EORTC-Trial 22881/10882 - The influence of boost technique on local control in BCS - Radiotherapy and Oncology. 2004. p. 72.
39 Nag S, Kuske RR, Vicini FA, Arthur DW, Zwicker RD. Brachytherapy in the treatment of breast cancer. Oncology (Williston Park) 2001;15:195-202, 205.
40 Polgar C, Orosz Z, Fodor J. The effect of HDRBT and electron boost on local control and side effects after BCS. Radiother Oncol 2001;60.
41 Krishnan L, Jewell WR, Krishnan EC, Cherian R, Lin F. Breast cancer with extensive intraductal component: Treatment with immediate interstitial boost irradiation. Radiology 1992;183:273-6.
42 Fodor J, Major T, Polgár C, Tóth J, Németh G. The impact of radiotherapy on the incidence and time of occurrence of local recurrence in early-stage breast cancer after breast conserving therapy. Neoplasma 2000;47:181-6.
43 Frazier RC, Kestin LL, Kini V, Martinez AA, Chen PY, Baglan KL, et al. Impact of boost technique on outcome in early-stage breast cancer patients treated with breast-conserving therapy. Am J Clin Oncol 2001;24:26-32.
44 Pezner RD. Cosmetic breast fibrosis: It′s the local boost! Int J Radiat Oncol Biol Phys 1994;30:1251-2.