Martin Keisch

Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy.

PURPOSEnWe present the results of the initial clinical testing of the MammoSite balloon breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy.nnnMETHODS AND MATERIALSnSeventy patients were enrolled in a multicenter prospective trial testing the applicator for safety and performance. Fifty-four patients were implanted, and 43 patients were ultimately eligible for and received brachytherapy as the sole radiation modality after lumpectomy. Patients were staged T1N0M0 with negative pathologic margins and age >45 years. A dose of 34 Gy was delivered in 10 fractions over 5 days prescribed to 1 cm from the applicator surface using 192Ir high-dose-rate brachytherapy. A minimum skin-to-balloon surface distance of 5 mm was required for treatment. Device performance, complications, and cosmesis were assessed.nnnRESULTSnComputed tomography imaging post-balloon inflation showed 8, 14, and 21 patients with 5-6 mm, 7-9 mm, and >10 mm of skin spacing, respectively. Two patients were explanted because of inadequate skin spacing and 7 because of suboptimal conformance of the surgical cavity to the applicator balloon. One patient was explanted because of positive nodal status and another because of age. The most common side effects related to device placement included mild erythema, drainage, pain, and echymosis. No severe side effects related to implantation, brachytherapy, or explantation occurred. Side effects related to radiation therapy were generally mild with erythema, pain, and dry desquamation being the most common. At 1 month, 88% of patients were evaluated as having good-to-excellent cosmetic results.nnnCONCLUSIONSnThe MammoSite balloon breast brachytherapy applicator performed well clinically. All eligible patients completed treatment. Side effects were mild to moderate and self-limiting. Skin-balloon surface distance and balloon-cavity conformance were the main factors limiting the initial use of the device.

MammoSite radiation therapy system.

Abstract The MammoSite ® Radiation Therapy System (RTS) has become the most widely used brachytherapy method used in the treatment of breast cancer, due to its ease of use, short learning curve, and requirement of only one interstitial path through the breast skin. The dosimetry is simple, one source position in the middle of the MammoSite ® balloon catheter. The data on long-term complications, however are not available, though developing. Trials for DCIS are being developed, as well as a comparison trial to standard external beam radiation as well as other forms of accelerated partial breast irradiation (APBI).

Applying Innovations in Surgical and Radiation Oncology to Breast Conservation Therapy

Abstract:u2003 A paradigm shift is occurring in the radiotherapeutic management of early breast carcinoma. The current change includes technological advances in radiation therapy delivery to limit toxicity by minimizing patient treatment. These treatments include improved techniques for whole‐breast irradiation, for example, hypofractionation and intensity modulated radiation therapy, and those for irradiating a smaller portion of the breast in a shorter period of time, specifically, accelerated partial breast irradiation. This article also addresses interesting research on delivering radiation therapy intraoperatively and looks ahead toward applications aimed at minimizing the physical, biological, and psychosocial impact of breast conservation therapy.

Accelerated partial breast irradiation: the case for current use

The treatment of early stage breast cancer is evolving from traditional breast conservation techniques, employing conventionally fractionated whole breast irradiation, to techniques in which partial breast irradiation is used in an accelerated fractionation scheme. A growing body of evidence exists, including favorable findings. Additional studies are under way that may ultimately prove equivalence. The logic behind this approach is reviewed, and the currently available data are presented to support the current use of carefully applied partial breast irradiation techniques in appropriately selected and informed patients.

Accelerated partial breast irradiation: a valid choice

Doctor Ross puts forth a series of cogent arguments in favor of careful study of partial breast irradiation prior to its generalized use. (1) The title of Dr. Rosss article-particularly the phrase who will benefit begs a different perspective than the presentation of existing data for or against the use of any given therapy. Instead, the question asks for a more profound view of the role of any healthcare provider within any healthcare system in helping a patient deal with the medical, social, psychological and financial impact of a disease process.