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Partial breast irradiation with interstitial high dose-rate brachytherapy in elderly patients: results of a phase II prospective study

  • Isabella Palumbo1,
  • Alessia Farneti1,
  • Elisabetta Perrucci1,
  • Francesco Barberini2,
  • Antonio Rulli2 and
  • Cynthia Aristei1
BMC Geriatrics20099(Suppl 1):A6

https://doi.org/10.1186/1471-2318-9-S1-A6

Published: 1 April 2009

Aims

To investigate the efficacy, toxicity and cosmetic results of partial breast irradiation (PBI) administered with high-dose-rate brachytherapy (BRT-HDR) in elderly patients (≥65 years) with stage I–II breast cancer.

Materials and methods

Between August 2003 and July 2008, 50 women (median age 65 years; range 65–84; 45 with infiltrating ductal, 1 infiltrating tubular, 1 infiltrating papillary and 3 DCIS) were enrolled in a phase II prospective study. Treatment schedule was 4 Gy twice a day for a total dose of 32 Gy, with a minimum interval of 6 hours between the two daily fraction Therapy was delivered using a microSelectron HDR 192Ir remote afterloading system (Nucletron, The Netherlands). Catheter implantation was performed during surgery or re-excision (in patients with positive or "close" margins) in 7 cases and postoperatively, at a median of 8 weeks (range 4–12) after surgery, in 43 patients. Two patients received adjuvant chemotherapy: CMF for 6 cycles in 1, and epirubicine for 14 weekly administrations in the other one. Adjuvant hormone therapy was prescribed for 39 patients (tamoxifen in 25 and anastrozole in 14).

Results

At a median follow-up of 32 months (range 5–63), acute G1 skin toxicity occurred in 2 cases; late subcutaneous toxicity in 3 (2 G1 and 1 G2); teleangiectasia occurred in 7 patients while fat necrosis occurred in 3 cases. Cosmetic results (evaluated by radiation oncologists and patients) were good to excellent in all cases.

At the last check-up all patients were alive except one, who died of haepatic adenocarcinoma; one patient developed contra-lateral breast cancer, one patient developed kidney oncocitoma, one patient NSCLC and another one squamous cell carcinoma of the vulva.

One patient, 4 years after PBI, developed a tumour in the same breast, but in another quadrant, (pT2a N2aM0, infiltrating ductal G2 ER 40%, PgR 40%, Ki-67 10%, cERb-B2 1+) and was successfully treated with mastectomy and lymph node dissection followed by external beam radiotherapy (chest wall and supraclavicular fossa); one patient developed axillary nodal recurrence and was treated with radiotherapy alone (axillary nodes).

Conclusion

In conclusion, PBI with interstitial HDR brachytherapy is a valid option in the management of selected aged patients with early breast cancer. The technique is feasible, reproducible and associated with very low perioperative and acute toxicity. A longer follow-up in our series will be useful to evaluate the incidence of late toxicity and local relapse.

Authors’ Affiliations

(1)
Section of Radiation Oncology, Department of Surgical Radiological and Odontostomatological Sciences, University of Perugia
(2)
Section of General and Oncological Surgery, Department of Surgical Radiological and Odontostomatological Sciences, University of Perugia

Copyright

© Palumbo et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.

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