Accelerated Radiotherapy

Accelerated treatment of breast cancer.

Vicini FA, Baglan KL, Kestin LL, Mitchell C, Chen PY, Frazier RC, Edmundson G, Goldstein NS, Benitez P, Huang RR, Martinez A

Departments of Radiation Oncology, Pathology, and Surgery and the Research Institute, William Beaumont Hospital, Royal Oak, MI.

PURPOSE: Radiation therapy (RT) restricted to the tumor bed, by means of an interstitial implant, and lasting 4 to 5 days after lumpectomy was prospectively evaluated in early-stage breast cancer patients treated with breast-conserving therapy (BCT). The goals of the study were to determine whether treatment time can be reduced and whether elective treatment of the entire breast is necessary.

MATERIALS AND METHODS: Between January 1993 and January 2000, 174 cases of early-stage breast cancer were managed with lumpectomy followed by RT restricted to the tumor bed using an interstitial implant. Each brachytherapy patient was matched with one external-beam RT (ERT) patient derived from a reference group of 1,388 patients treated with standard BCT. Patients were matched for age, tumor size, histology, margins of excision, absence of an extensive intraductal component, nodal status, estrogen receptor status, and tamoxifen use.

Median follow-up for both the ERT and brachytherapy groups was 36 months. RESULTS: No statistically significant differences were noted in the 5-year actuarial rates of ipsilateral breast treatment failure or locoregional failure between ERT and brachytherapy patients (1% v 0%, P: =.31 and 2% v 1%, P: =.63, respectively). In addition, there were no statistically significant differences noted in rates of distant metastasis (6% v 3%, P: =.24), disease-free survival (87% v 91%, P: =.55), overall survival (90% v 93%, P: =.66), or cause-specific survival (97% v 99%, P: =.28).

CONCLUSION: Accelerated treatment of breast cancer using an interstitial implant to deliver radiation to the tumor bed alone over 4 to 5 days seems to produce 5-year results equivalent to those achieved with conventional ERT. Extended follow-up will be required to determine the long-term efficacy of this treatment approach. PMID: 11283132, UI: 21179427

J Clin Oncol 2001 Apr 1;19(7):1993-2001

Ann's NOTE: At the recent (4/01) conference of the American Society of Breast Disease, I met the representative from the company that developed this product in the U.S. It can be performed by the radiation oncology department. I had heard about it last year at the Italian American Cancer Foundation meeting. It had been studied in Italy prior to this. There are 57 references at the end of this paper.

The company, Proxima is currently involved in clinical trials. Please see the clinical trials section for more information on the MammoSite radiation therapy system.

Tumor Bed Irradiation:24-48 hours

Journal, The Breast, April, 2001

Targeted Intra-operative RT (TARGIT)

Annals of Oncology, 9/01

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