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. 2020 Dec;12(6):521-532.
doi: 10.5114/jcb.2020.101684. Epub 2020 Dec 16.

Minimally invasive tumor bed implant (MITBI) and peri-operative high-dose-rate brachytherapy (PHDRBT) for accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost) in breast-conserving surgery for ductal carcinoma in situ

Marta Gimeno Morales  1 , Fernando Martinez-Regueira  2 , Natalia Rodriguez-Spiteri  2 , Begoña Olartecoechea  2 , Isabel Rubio  2 , Antonio Esgueva  2 , Luis Pina  3 , Arlette Elizalde  3 , Carolina Sobrido Sampedro  3 , Miguel Angel Idoate  4 , Marta Abengozar  4 , Luis Ramos  1 , Felipe Calvo Manuel  1 , Rafael Martínez-Monge  1 , Mauricio Cambeiro  1
Affiliations

Minimally invasive tumor bed implant (MITBI) and peri-operative high-dose-rate brachytherapy (PHDRBT) for accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost) in breast-conserving surgery for ductal carcinoma in situ

Marta Gimeno Morales et al. J Contemp Brachytherapy. 2020 Dec.

Abstract

Purpose: To evaluate our institutional experience of minimally invasive tumor bed implantation (MITBI) during breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) to deliver peri-operative high-dose-rate brachytherapy (PHDRBT) as accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost).

Material and methods: Patients older than 40, with clinical and radiological unifocal DCIS < 3 cm were considered potential candidates for accelerated partial breast irradiation (APBI) and were implanted during BCS using MITBI-technique. Patients who in final pathology reports showed free margins and no other microscopic tumor foci, received AMBI with PHDRBT (3.4 Gy BID in 5 days). Patients with adverse features received A-PHDRBT-boost with post-operative external beam radiotherapy (EBRT).

Results: Forty-one patients were implanted, and 36 were treated and analyzed. According to final pathology, 24 (67%) patients were suitable for AMBI and 12 (33%) were qualified for A-PHDRBT-boost. Reoperation rate for those with clear margins was 16.6% (6/36); this rate increased to 33% (4/12) for G3 histology, and 66% (4/6) were rescued using AMBI. Early complications were documented in 5 patients (14%). With a median follow-up of 97 (range, 42-138) months, 5-year rates of local, elsewhere, locoregional, and distant control were all 97.2%. 5-year ipsilateral breast tumor recurrence rates (IBTR) were 5.6% (2/36), 8.3% (2/24) for AMBI, and 0% (0/12) for A-PHDRBT-boost patients. Both instances of IBTR were confirmed G3 tumors in pre-operative biopsies; no IBTR was documented in G1-2 tumors. Cosmetic outcomes were excellent/good in 96% of AMBI vs. 67% in A-PHDRBT-boost (p = 0.034).

Conclusions: The MITBI-PHDRBT program allows selection of patients with excellent prognoses (G1-2 DCIS with negative margins and no multifocality), for whom AMBI could be a good alternative with low recurrence rate, decrease of unnecessary radiation, treatment logistics improvement, and over-treatment reduction. Patients whose pre-operative biopsy showed G3 tumor, presents with inferior local control and more risk of reoperation due to positive margins.

Keywords: DCIS; high-dose-rate brachytherapy; partial breast irradiation.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Minimally invasive tumor breast implant (MITBI). A) Tumor on surgical specimen, B) measurement tumor to margin, C) two of four titanium clips marking the projection of the tumor on superior wall of the surgical bed, D) tumor bed (yellow line) inside surgical bed (orange point line). Tumor bed include clips’ zone and 1-2 cm surrounding of breast tissue encompassed by the catheters
Fig. 2
Fig. 2
Ipsilateral breast tumor recurrence (IBTR) incidence in accelerated minimal breast irradiation (AMBI) group
Fig. 3
Fig. 3
Disease-free survival in the accelerated minimal breast irradiation (AMBI) group and biopsy grades
See this image and copyright information in PMC

References

    1. Wapnir IL, Dignam JJ, Fisher B et al. . Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011; 103: 478-488. - PMC - PubMed
    1. Elshof LE, Schaapveld M, Schmidt MK et al. . Subsequent risk of ipsilateral and contralateral invasive breast cancer after treatment for ductal carcinoma in situ: incidence and the effect of radiotherapy in a population-based cohort of 10,090 women. Breast Cancer Res Treat 2016; 159: 553-563. - PMC - PubMed
    1. Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol 2009; 27: 1615-1620. - PubMed
    1. Morrow M, Van Zee KJ, Solin LJ et al. . Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. J Clin Oncol 2016; 34: 4040-4046. - PMC - PubMed
    1. Rath MG, Uhlmann L, Heil J et al. . Predictors of residual tumor in breast-conserving therapy. Ann Surg Oncol 2015; 22: 451-458. - PubMed