Ten-Year Results of Accelerated Partial-Breast Irradiation with Interstitial Multicatheter Brachytherapy after Breast-Conserving Surgery for Low-Risk Early Breast Cancer.

Patients with an early carcinoma of the breast are commonly treated by breast-conserving surgery (BCS) and postoperative radiotherapy. Partial-breast irradiation has gained acceptance in the last few years. Between December 2008 and December 2017, 182 low-risk breast cancer patients treated by BCS in the four university hospitals of the province of Las Palmas and treated with APBI using interstitial multicatheter brachytherapy were included in this study. After a mean follow-up for survivors of 10 years, the treatment was shown to be safe, as no severe acute/late toxicity (grade ≥ 3) was observed. The 10-year IBTR was 1.7% (95%CI: 0.7-2.7%), and the cause-specific survival was 94.9% (95%CI: 93.2-96.6%). We suggest that multicatheter brachytherapy after BCS is safe and effective in early breast cancer patients.

Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer.

PURPOSE: To study those factors that influence the occurrence of surgical complications and local relapse in patients intervened for breast cancer and receiving intraoperative radiotherapy. METHODS: Observational study on patients intervened for breast cancer with conservative surgery and intraoperative radiotherapy with low-voltage X-ray energy source (INTRABEAM), from 2015 to 2017 with 24 months minimum follow-up. Variables possibly associated to the occurrence of postoperative complications were analyzed with the Student t-test and the Fisher exact test; P < 0.05 considered significant. Subsequently, the construction of multiple multivariate analysis models began, thus building a logistic regression analysis using the IBM SPSS Statistics ver. 23 software. Local relapse was described. RESULTS: The study included 102 patients, mean age of 61.2 years; mean global size of tumor, 12.2 mm. Complications occurred in 29.4%. Fibrosis was the most frequently observed complication, followed by postoperative seroma. Using a 45 mm or larger applicator were significantly associated with the occurrence of complications. Tumor size 2 cm or larger and reintervention showed borderline significant association. Only one case of local relapse was observed. CONCLUSION: Certain factors may increase the risk of complication after the use of intraoperative radiotherapy. Using external complementary radiotherapy does not seem to increase the rate of complications. Select patients and the involvement of a multidisciplinary team are essential for achieving good results.

Accelerated partial breast irradiation with interstitial multicatheter brachytherapy after breast-conserving surgery for low-risk early breast cancer.

Patients with low-risk invasive ductal carcinoma treated with breast-conserving surgery (BCS) were included in a multicatheter brachytherapy APBI protocol. The primary endpoint was ipsilateral breast recurrence. Between December 2008-December 2017, 186 low-risk breast cancer patients were treated with APBI using interstitial multicatheter brachytherapy and followed prospectively. At 5-years of follow-up, cumulative local recurrence (LR) and cause-specific survival was 1.1% (95% CI 0.3-1.9) and 98.3% (95% CI 97.3-99.3%) respectively. No grade 3 adverse effects were observed. Postoperative APBI using multicatheter brachytherapy after BCS in early breast cancer patients have excellent rates of local control and survival, without significant toxicity.

Adjuvant radiotherapy for low-risk early breast cancer in elderly women: evidence from randomized trials.

Breast cancer is the most common cancer pathology in women in the Western world. The median age at diagnosis is 60 years and in the coming decades it is estimated that the number of elderly women affected reaches an important percentage. This aging of the cancer population, associated with its inherent comorbidities and aggravated by the lack of consensus about the most appropriate treatment, make it difficult to administer an effective postoperative treatment in elderly women with a low-risk profile. An exhaustive geriatric evaluation is a sine qua non condition to opt for a specific type of treatment. To date, several options are available such as endocrine therapy (ET) alone, moderate/high hypofractionation and various accelerated partial breast irradiation (APBI) techniques. In this article, we provide information about each of them.

Inverse radiotherapy planning in reconstructive surgery for breast cancer.

BACKGROUND: Post-mastectomy radiotherapy reduces the risk of local-regional relapse and distant disease, and increases global survival in women with axillary involvement. With the new reconstruction techniques and increasing use of directed external radiotherapy, immediate reconstruction can be performed with good cosmetic results and low complication rates. MATERIALS AND METHODS: Observational study with consecutive sampling conducted in patients undergoing reconstructive surgery for breast cancer, between 2010 and 2016, with a 12-months minimum follow-up period. A group of patients radiated after receiving an expander (RT-Expander) were compared with a control group of non-radiated patients (Non-RT), who had been treated with the same surgical technique. We compare general complications, reconstruction failure, aesthetic results and satisfaction degree with software IBM® SPSS® Statistics v. 21 and BREAST-Q scores. RESULTS: Reconstruction failure was observed in 15.6% of patients in a similar proportion in both groups. External radiotherapy was not an independent significant factor influencing the occurrence of general complications, capsular contracture grade ≥3 or reconstruction failure. The Kaplan-Meyer curve showed no differences in reconstruction survival between groups. Aesthetic results were excellent-very good in 78.1% of patients. Absence of a contralateral procedure for symmetrization, occurrence of general complications, occurrence of capsular contracture grade ≥3 and reconstruction failure were significantly associated to fair-poor cosmetic results. The satisfaction degree of operated patients was similar in both groups. CONCLUSIONS: The evolution of external radiotherapy towards more directed techniques, which modulate the dose administered to the mammary tissue and adjacent structures, allowed us to make immediate reconstruction a reality for most patients, with complication rates, cosmetic results and satisfaction degrees similar to those of non-radiated patients.

Radioterapia intraoperatoria de la mama con Intrabeam®: experiencia inicial en nuestro centro / Intraoperative radiotherapy of the breast with Intrabeam®: initial experience at our center

Objetivo. La intraoperative radiotherapy (IORT, «radioterapia intraoperatoria») en pacientes seleccionadas con cáncer de mama permite un tratamiento corto y preciso durante la cirugía conservadora sobre el lecho tumoral in situ. Presentamos nuestra experiencia inicial de IORT con dispositivo Intrabeam®. Pacientes y métodos. Se seleccionaron inicialmente 120 pacientes con cáncer de mama para IORT con Intrabeam® según protocolo TARGIT-A, desde enero de 2013 hasta febrero de 2015. Las indicaciones fueron: candidatas a cirugía conservadora, mayores de 45 años, diagnóstico histológico de carcinoma ductal infiltrante≤3cm hormonodependiente y axila clínica, ecográfica e histológicamente negativa. Resultados. De las pacientes seleccionadas, 34 (28%) no recibieron IORT debido al tamaño de la cavidad quirúrgica (28 casos) o problemas técnicos (6 casos). Finalmente, 86 pacientes (72%) recibieron IORT. La edad media fue de 64 años (DE±8,4). En 22 pacientes (26%) fue preciso administrar radioterapia externa a toda la mama. Trece pacientes (15%) tuvieron complicaciones: 3 casos de seroma que precisaron de más de 3 punciones para resolución (4%), 6 casos de absceso-mastitis (7%), 2 casos de hematoma (2%) y 2 casos de dehiscencia parcial de la herida quirúrgica (2%). No hubo toxicidad grave (grado iii-iv). El resultado estético fue bueno o muy bueno en el 87% de las pacientes (75). Conclusión. La IORT con Intrabeam® es una alternativa segura y bien tolerada frente a la radioterapia externa en pacientes seleccionadas, con un buen resultado estético a corto plazo (AU)

Objective. Intraoperative radiotherapy (IORT) in selected patients with breast cancer allows a short and precise treatment on the tumor bed in situ during conservative surgery. We present our initial experience of IORT with the Intrabeam® device. Patients and methods. From January 2013 to February 2015, 120 patients with breast cancer were pre-selected for IORT with Intrabeam® according to the TARGIT-A protocol. The indications were as follows: candidates for conservative surgery, age older than 45 years, a histological diagnosis of hormone-dependent infiltrating ductal carcinoma≤3cm and absence of axillary involvement on physical, ultrasound and histological examination. Results. Among the selected patients, 34 (28%) did not receive IORT due to the size of the surgical cavity (28 patients) or technical problems (6 patients). Finally, 86 patients (72%) received IORT. The average age was 64 years (SD±8.4). In 22 patients (26%), it was necessary to administer external beam radiotherapy to the whole breast. Thirteen patients (15%) had complications: 3 cases of seroma requiring more than 3 attempts for resolution (4%), 6 cases of abscess-mastitis (7%), 2 cases of hematoma (2%) and 2 cases of partial dehiscence of the surgical wound (2%). There was no severe toxicity (grade iii-iv). The aesthetic result was good or very good in 87% of the patients (n=75). Conclusion. IORT with Intrabeam® is a safe and well tolerated alternative versus external radiotherapy in selected patients and provides a good short-term aesthetic result (AU)