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The use of an interstitial boost in the conservative treatment of breast cancer: how to perform it routinely in a radiotherapy department.

Gutiérrez C, Najjari D, Martínez E, Botella S, Eraso A, Pino F, Moreno F, Pera J, Guedea F - J Contemp Brachytherapy (2014)

Bottom Line: Our hospital's results are comparable in terms of local control and cosmesis to those of other authors.This educational article describes our department's boost technique with rigid needles and comments briefly on our results using this technique in a group of consecutively treated patients in our department.A review of the literature and the published results on local control and cosmesis is also described.

View Article: PubMed Central - PubMed

Affiliation: Radiation Oncology Department, Institut Català d'Oncologia, Barcelona, Spain.

ABSTRACT

Purpose: To demonstrate the utility of a boost with interstitial brachytherapy (BT) in breast-conserving therapy (BCT) by doing a thorough review of the literature and describing in detail our technique for delivering this boost.

Material and methods: Our department has been delivering the boost with interstitial BT since 1989, in most cases with rigid needles and a theoretical dosimetry. In the early years, we used low-dose-rate (LDR) with iridium-192 wires. The dose administered was 15 Gy if there were no risk factors for local relapse or 20-25 Gy in the presence of risk factors. The risk factors considered were the presence of a close margin (less than 10 mm) and an extensive intraductal component (more than 25%). After 2002, we switched to high-dose-rate (HDR); using the linear quadratic model we changed the low dose to 3 fractions of 4.5 Gy in the case of no risk factors for local relapse or to 3 fractions of 5 Gy in the presence of risk factors.

Results: In 79 consecutive boost patients treated in our department between 2010 and 2011, with a median follow-up of 46 months, the local control rate was 97.47%. With respect to cosmesis, fibrosis occurred in 17 cases (21.5%) and hyperpigmentation in 26 cases (32.9%). Our hospital's results are comparable in terms of local control and cosmesis to those of other authors.

Conclusions: This educational article describes our department's boost technique with rigid needles and comments briefly on our results using this technique in a group of consecutively treated patients in our department. A review of the literature and the published results on local control and cosmesis is also described.

No MeSH data available.


Related in: MedlinePlus

Projection of the seroma on the skin
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Figure 0002: Projection of the seroma on the skin

Mentions: In the Brachytherapy Unit we have one dedicated operating theatre with an anaesthesiologist. Four or five procedures are performed in one day. Deep sedation is administered for the patient's comfort. Firstly, an US is performed to localize the tumour bed (Fig. 1) and project it on to the skin (Fig. 2); a marker is used to draw it, and then the template is leaned on to the patient's skin to mark the entrance and exit points in order to obtain a good geometric distribution. We try to leave at least 3 cm from the first point to the projection of the planning target volume (PTV). Local anaesthesia (2% Mepivacaine with a little bicarbonate) is injected at the entrance and exit points of every needle (Fig. 3). When doing the implant, the ultrasound is used continuously to find the seroma and check the position of every needle with respect to the seroma and to the skin. In cases without seroma, a CT is performed just before entering the operating theatre to look for the clips. We then try to surround the whole seroma with needles, always starting with the superficial plane. The first plane is inserted between the skin and the superficial part of the seroma (Fig. 4), and the deep plane under the seroma (Fig. 5). The free-hand technique is used for the superficial plane and the template is used to guide the rest of the implant. The distance to the skin and the pectoral muscle is checked with US. In most cases, a 2-plane implant is sufficient. Many other centers start with the deep plane, but using the US we are able to adjust any of the needles as necessary. Some centers use the free-hand technique, others always use a template. Some centers perform a CT before the implant and others use US; our instituion considers all techniques to be adequate, depending on the department experience.


The use of an interstitial boost in the conservative treatment of breast cancer: how to perform it routinely in a radiotherapy department.

Gutiérrez C, Najjari D, Martínez E, Botella S, Eraso A, Pino F, Moreno F, Pera J, Guedea F - J Contemp Brachytherapy (2014)

Projection of the seroma on the skin
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300358&req=5

Figure 0002: Projection of the seroma on the skin
Mentions: In the Brachytherapy Unit we have one dedicated operating theatre with an anaesthesiologist. Four or five procedures are performed in one day. Deep sedation is administered for the patient's comfort. Firstly, an US is performed to localize the tumour bed (Fig. 1) and project it on to the skin (Fig. 2); a marker is used to draw it, and then the template is leaned on to the patient's skin to mark the entrance and exit points in order to obtain a good geometric distribution. We try to leave at least 3 cm from the first point to the projection of the planning target volume (PTV). Local anaesthesia (2% Mepivacaine with a little bicarbonate) is injected at the entrance and exit points of every needle (Fig. 3). When doing the implant, the ultrasound is used continuously to find the seroma and check the position of every needle with respect to the seroma and to the skin. In cases without seroma, a CT is performed just before entering the operating theatre to look for the clips. We then try to surround the whole seroma with needles, always starting with the superficial plane. The first plane is inserted between the skin and the superficial part of the seroma (Fig. 4), and the deep plane under the seroma (Fig. 5). The free-hand technique is used for the superficial plane and the template is used to guide the rest of the implant. The distance to the skin and the pectoral muscle is checked with US. In most cases, a 2-plane implant is sufficient. Many other centers start with the deep plane, but using the US we are able to adjust any of the needles as necessary. Some centers use the free-hand technique, others always use a template. Some centers perform a CT before the implant and others use US; our instituion considers all techniques to be adequate, depending on the department experience.

Bottom Line: Our hospital's results are comparable in terms of local control and cosmesis to those of other authors.This educational article describes our department's boost technique with rigid needles and comments briefly on our results using this technique in a group of consecutively treated patients in our department.A review of the literature and the published results on local control and cosmesis is also described.

View Article: PubMed Central - PubMed

Affiliation: Radiation Oncology Department, Institut Català d'Oncologia, Barcelona, Spain.

ABSTRACT

Purpose: To demonstrate the utility of a boost with interstitial brachytherapy (BT) in breast-conserving therapy (BCT) by doing a thorough review of the literature and describing in detail our technique for delivering this boost.

Material and methods: Our department has been delivering the boost with interstitial BT since 1989, in most cases with rigid needles and a theoretical dosimetry. In the early years, we used low-dose-rate (LDR) with iridium-192 wires. The dose administered was 15 Gy if there were no risk factors for local relapse or 20-25 Gy in the presence of risk factors. The risk factors considered were the presence of a close margin (less than 10 mm) and an extensive intraductal component (more than 25%). After 2002, we switched to high-dose-rate (HDR); using the linear quadratic model we changed the low dose to 3 fractions of 4.5 Gy in the case of no risk factors for local relapse or to 3 fractions of 5 Gy in the presence of risk factors.

Results: In 79 consecutive boost patients treated in our department between 2010 and 2011, with a median follow-up of 46 months, the local control rate was 97.47%. With respect to cosmesis, fibrosis occurred in 17 cases (21.5%) and hyperpigmentation in 26 cases (32.9%). Our hospital's results are comparable in terms of local control and cosmesis to those of other authors.

Conclusions: This educational article describes our department's boost technique with rigid needles and comments briefly on our results using this technique in a group of consecutively treated patients in our department. A review of the literature and the published results on local control and cosmesis is also described.

No MeSH data available.


Related in: MedlinePlus