Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy

Shane R. Stecklein, Simona F. Shaitelman, Gildy V. Babiera, Isabelle Bedrosian, Dalliah M. Black, Matthew Ballo, Isadora Arzu, Eric A. Strom, Valerie K. Reed, Tomas Dvorak, Benjamin D. Smith, Wendy A. Woodward, Karen E. Hoffman, Pamela J. Schlembach, Steve M. Kirsner, Christopher L. Nelson, Jinzhong Yang, William Guerra, Shiva Dibaj, Elizabeth S. Bloom

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: This study aimed to prospectively characterize toxicity and cosmesis after accelerated partial breast irradiation (APBI) with 3-dimensional conformal radiation therapy (CRT) or single-entry, multilumen, intracavitary brachytherapy. Methods and materials: A total of 281 patients with pTis, pT1N0, or pT2N0 (≤3.0 cm) breast cancer treated with segmental mastectomy were prospectively enrolled from December 2008 through August 2014. APBI was delivered using 3-dimensional CRT (n = 29) or with SAVI (n = 176), Contura (n = 56), or MammoSite (n = 20) brachytherapy catheters. Patients were evaluated at protocol-specified intervals, at which time the radiation oncologist scored cosmetic outcome, toxicities, and recurrence status using a standardized template. Results: The median follow-up time is 41 months. Grade 1 seroma and fibrosis were more common with brachytherapy than with 3-dimensional CRT (50.4% vs 3.4% for seroma; P < .0001 and 66.3% vs 44.8% for fibrosis; P = .02), but grade 1 edema was more common with 3-dimensional CRT than with brachytherapy (17.2% vs 5.6%; P = .04). Grade 2 to 3 pain was more common with 3-dimensional CRT (17.2% vs 5.2%; P = .03). Actuarial 5-year rates of fair or poor radiation oncologist-reported cosmetic outcome were 9% for 3-dimensional CRT and 24% for brachytherapy (P = .13). Brachytherapy was significantly associated with inferior cosmesis on mixed model analysis (P = .003). Significant predictors of reduced risk of adverse cosmetic outcome after brachytherapy were D0.1cc (skin) ≤102%, minimum skin distance >5.1 mm, dose homogeneity index >0.54, and volume of nonconformance ≤0.89 cc. The 5-year ipsilateral breast recurrence was 4.3% for brachytherapy and 4.2% for 3-dimensional CRT APBI patients (P = .95). Conclusions: Brachytherapy APBI is associated with higher rates of grade 1 fibrosis and seroma than 3-dimensional CRT but lower rates of grade 1 edema and grade 2 to 3 pain than 3-dimensional CRT. Rates of radiation oncologist-reported fair or poor cosmetic outcomes are higher with brachytherapy. We identified dosimetric parameters that predict reduced risk of adverse cosmetic outcome after brachytherapy-based APBI. Ipsilateral breast recurrence was equivalent for brachytherapy and 3-dimensional CRT.

Original languageEnglish (US)
Pages (from-to)e4-e13
JournalPractical Radiation Oncology
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Brachytherapy
Cosmetics
Breast
Radiotherapy
Seroma
Recurrence
Fibrosis
Segmental Mastectomy
Edema
Catheters
Breast Neoplasms
Pain

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy. / Stecklein, Shane R.; Shaitelman, Simona F.; Babiera, Gildy V.; Bedrosian, Isabelle; Black, Dalliah M.; Ballo, Matthew; Arzu, Isadora; Strom, Eric A.; Reed, Valerie K.; Dvorak, Tomas; Smith, Benjamin D.; Woodward, Wendy A.; Hoffman, Karen E.; Schlembach, Pamela J.; Kirsner, Steve M.; Nelson, Christopher L.; Yang, Jinzhong; Guerra, William; Dibaj, Shiva; Bloom, Elizabeth S.

In: Practical Radiation Oncology, Vol. 9, No. 1, 01.01.2019, p. e4-e13.

Research output: Contribution to journalArticle

Stecklein, SR, Shaitelman, SF, Babiera, GV, Bedrosian, I, Black, DM, Ballo, M, Arzu, I, Strom, EA, Reed, VK, Dvorak, T, Smith, BD, Woodward, WA, Hoffman, KE, Schlembach, PJ, Kirsner, SM, Nelson, CL, Yang, J, Guerra, W, Dibaj, S & Bloom, ES 2019, 'Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy', Practical Radiation Oncology, vol. 9, no. 1, pp. e4-e13. https://doi.org/10.1016/j.prro.2018.08.003
Stecklein, Shane R. ; Shaitelman, Simona F. ; Babiera, Gildy V. ; Bedrosian, Isabelle ; Black, Dalliah M. ; Ballo, Matthew ; Arzu, Isadora ; Strom, Eric A. ; Reed, Valerie K. ; Dvorak, Tomas ; Smith, Benjamin D. ; Woodward, Wendy A. ; Hoffman, Karen E. ; Schlembach, Pamela J. ; Kirsner, Steve M. ; Nelson, Christopher L. ; Yang, Jinzhong ; Guerra, William ; Dibaj, Shiva ; Bloom, Elizabeth S. / Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy. In: Practical Radiation Oncology. 2019 ; Vol. 9, No. 1. pp. e4-e13.
@article{4023afcf4bf7457198f3ee250c93658e,
title = "Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy",
abstract = "Purpose: This study aimed to prospectively characterize toxicity and cosmesis after accelerated partial breast irradiation (APBI) with 3-dimensional conformal radiation therapy (CRT) or single-entry, multilumen, intracavitary brachytherapy. Methods and materials: A total of 281 patients with pTis, pT1N0, or pT2N0 (≤3.0 cm) breast cancer treated with segmental mastectomy were prospectively enrolled from December 2008 through August 2014. APBI was delivered using 3-dimensional CRT (n = 29) or with SAVI (n = 176), Contura (n = 56), or MammoSite (n = 20) brachytherapy catheters. Patients were evaluated at protocol-specified intervals, at which time the radiation oncologist scored cosmetic outcome, toxicities, and recurrence status using a standardized template. Results: The median follow-up time is 41 months. Grade 1 seroma and fibrosis were more common with brachytherapy than with 3-dimensional CRT (50.4{\%} vs 3.4{\%} for seroma; P < .0001 and 66.3{\%} vs 44.8{\%} for fibrosis; P = .02), but grade 1 edema was more common with 3-dimensional CRT than with brachytherapy (17.2{\%} vs 5.6{\%}; P = .04). Grade 2 to 3 pain was more common with 3-dimensional CRT (17.2{\%} vs 5.2{\%}; P = .03). Actuarial 5-year rates of fair or poor radiation oncologist-reported cosmetic outcome were 9{\%} for 3-dimensional CRT and 24{\%} for brachytherapy (P = .13). Brachytherapy was significantly associated with inferior cosmesis on mixed model analysis (P = .003). Significant predictors of reduced risk of adverse cosmetic outcome after brachytherapy were D0.1cc (skin) ≤102{\%}, minimum skin distance >5.1 mm, dose homogeneity index >0.54, and volume of nonconformance ≤0.89 cc. The 5-year ipsilateral breast recurrence was 4.3{\%} for brachytherapy and 4.2{\%} for 3-dimensional CRT APBI patients (P = .95). Conclusions: Brachytherapy APBI is associated with higher rates of grade 1 fibrosis and seroma than 3-dimensional CRT but lower rates of grade 1 edema and grade 2 to 3 pain than 3-dimensional CRT. Rates of radiation oncologist-reported fair or poor cosmetic outcomes are higher with brachytherapy. We identified dosimetric parameters that predict reduced risk of adverse cosmetic outcome after brachytherapy-based APBI. Ipsilateral breast recurrence was equivalent for brachytherapy and 3-dimensional CRT.",
author = "Stecklein, {Shane R.} and Shaitelman, {Simona F.} and Babiera, {Gildy V.} and Isabelle Bedrosian and Black, {Dalliah M.} and Matthew Ballo and Isadora Arzu and Strom, {Eric A.} and Reed, {Valerie K.} and Tomas Dvorak and Smith, {Benjamin D.} and Woodward, {Wendy A.} and Hoffman, {Karen E.} and Schlembach, {Pamela J.} and Kirsner, {Steve M.} and Nelson, {Christopher L.} and Jinzhong Yang and William Guerra and Shiva Dibaj and Bloom, {Elizabeth S.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.prro.2018.08.003",
language = "English (US)",
volume = "9",
pages = "e4--e13",
journal = "Practical Radiation Oncology",
issn = "1879-8500",
publisher = "Elsevier BV",
number = "1",

}

TY - JOUR

T1 - Prospective Comparison of Toxicity and Cosmetic Outcome After Accelerated Partial Breast Irradiation With Conformal External Beam Radiotherapy or Single-Entry Multilumen Intracavitary Brachytherapy

AU - Stecklein, Shane R.

AU - Shaitelman, Simona F.

AU - Babiera, Gildy V.

AU - Bedrosian, Isabelle

AU - Black, Dalliah M.

AU - Ballo, Matthew

AU - Arzu, Isadora

AU - Strom, Eric A.

AU - Reed, Valerie K.

AU - Dvorak, Tomas

AU - Smith, Benjamin D.

AU - Woodward, Wendy A.

AU - Hoffman, Karen E.

AU - Schlembach, Pamela J.

AU - Kirsner, Steve M.

AU - Nelson, Christopher L.

AU - Yang, Jinzhong

AU - Guerra, William

AU - Dibaj, Shiva

AU - Bloom, Elizabeth S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: This study aimed to prospectively characterize toxicity and cosmesis after accelerated partial breast irradiation (APBI) with 3-dimensional conformal radiation therapy (CRT) or single-entry, multilumen, intracavitary brachytherapy. Methods and materials: A total of 281 patients with pTis, pT1N0, or pT2N0 (≤3.0 cm) breast cancer treated with segmental mastectomy were prospectively enrolled from December 2008 through August 2014. APBI was delivered using 3-dimensional CRT (n = 29) or with SAVI (n = 176), Contura (n = 56), or MammoSite (n = 20) brachytherapy catheters. Patients were evaluated at protocol-specified intervals, at which time the radiation oncologist scored cosmetic outcome, toxicities, and recurrence status using a standardized template. Results: The median follow-up time is 41 months. Grade 1 seroma and fibrosis were more common with brachytherapy than with 3-dimensional CRT (50.4% vs 3.4% for seroma; P < .0001 and 66.3% vs 44.8% for fibrosis; P = .02), but grade 1 edema was more common with 3-dimensional CRT than with brachytherapy (17.2% vs 5.6%; P = .04). Grade 2 to 3 pain was more common with 3-dimensional CRT (17.2% vs 5.2%; P = .03). Actuarial 5-year rates of fair or poor radiation oncologist-reported cosmetic outcome were 9% for 3-dimensional CRT and 24% for brachytherapy (P = .13). Brachytherapy was significantly associated with inferior cosmesis on mixed model analysis (P = .003). Significant predictors of reduced risk of adverse cosmetic outcome after brachytherapy were D0.1cc (skin) ≤102%, minimum skin distance >5.1 mm, dose homogeneity index >0.54, and volume of nonconformance ≤0.89 cc. The 5-year ipsilateral breast recurrence was 4.3% for brachytherapy and 4.2% for 3-dimensional CRT APBI patients (P = .95). Conclusions: Brachytherapy APBI is associated with higher rates of grade 1 fibrosis and seroma than 3-dimensional CRT but lower rates of grade 1 edema and grade 2 to 3 pain than 3-dimensional CRT. Rates of radiation oncologist-reported fair or poor cosmetic outcomes are higher with brachytherapy. We identified dosimetric parameters that predict reduced risk of adverse cosmetic outcome after brachytherapy-based APBI. Ipsilateral breast recurrence was equivalent for brachytherapy and 3-dimensional CRT.

AB - Purpose: This study aimed to prospectively characterize toxicity and cosmesis after accelerated partial breast irradiation (APBI) with 3-dimensional conformal radiation therapy (CRT) or single-entry, multilumen, intracavitary brachytherapy. Methods and materials: A total of 281 patients with pTis, pT1N0, or pT2N0 (≤3.0 cm) breast cancer treated with segmental mastectomy were prospectively enrolled from December 2008 through August 2014. APBI was delivered using 3-dimensional CRT (n = 29) or with SAVI (n = 176), Contura (n = 56), or MammoSite (n = 20) brachytherapy catheters. Patients were evaluated at protocol-specified intervals, at which time the radiation oncologist scored cosmetic outcome, toxicities, and recurrence status using a standardized template. Results: The median follow-up time is 41 months. Grade 1 seroma and fibrosis were more common with brachytherapy than with 3-dimensional CRT (50.4% vs 3.4% for seroma; P < .0001 and 66.3% vs 44.8% for fibrosis; P = .02), but grade 1 edema was more common with 3-dimensional CRT than with brachytherapy (17.2% vs 5.6%; P = .04). Grade 2 to 3 pain was more common with 3-dimensional CRT (17.2% vs 5.2%; P = .03). Actuarial 5-year rates of fair or poor radiation oncologist-reported cosmetic outcome were 9% for 3-dimensional CRT and 24% for brachytherapy (P = .13). Brachytherapy was significantly associated with inferior cosmesis on mixed model analysis (P = .003). Significant predictors of reduced risk of adverse cosmetic outcome after brachytherapy were D0.1cc (skin) ≤102%, minimum skin distance >5.1 mm, dose homogeneity index >0.54, and volume of nonconformance ≤0.89 cc. The 5-year ipsilateral breast recurrence was 4.3% for brachytherapy and 4.2% for 3-dimensional CRT APBI patients (P = .95). Conclusions: Brachytherapy APBI is associated with higher rates of grade 1 fibrosis and seroma than 3-dimensional CRT but lower rates of grade 1 edema and grade 2 to 3 pain than 3-dimensional CRT. Rates of radiation oncologist-reported fair or poor cosmetic outcomes are higher with brachytherapy. We identified dosimetric parameters that predict reduced risk of adverse cosmetic outcome after brachytherapy-based APBI. Ipsilateral breast recurrence was equivalent for brachytherapy and 3-dimensional CRT.

UR - http://www.scopus.com/inward/record.url?scp=85054501762&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054501762&partnerID=8YFLogxK

U2 - 10.1016/j.prro.2018.08.003

DO - 10.1016/j.prro.2018.08.003

M3 - Article

VL - 9

SP - e4-e13

JO - Practical Radiation Oncology

JF - Practical Radiation Oncology

SN - 1879-8500

IS - 1

ER -