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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

Final picture of the rigid implant with the metallic bridge and the template
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Figure 0006: Final picture of the rigid implant with the metallic bridge and the template

Mentions: The needles are not usually substituted for plastic tubes. Great care is taken to leave at least 1 cm between the superficial plane and the skin to avoid late toxicity in the form of telangiectasia. Metallic buttons are used to avoid longitudinal needle movement, and a metallic bridge is used to secure the needles (Figs. 6 and 7). In most cases, a theoretical dosimetry is done without CT scan. As the needles are metallic, we just measure the distance from the tip and the end of the needle to the PTV, and also the distance to the skin for every needle. We also check with US that there is more than 1 cm between the superficial plane and the skin.


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)

Final picture of the rigid implant with the metallic bridge and the template
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0006: Final picture of the rigid implant with the metallic bridge and the template
Mentions: The needles are not usually substituted for plastic tubes. Great care is taken to leave at least 1 cm between the superficial plane and the skin to avoid late toxicity in the form of telangiectasia. Metallic buttons are used to avoid longitudinal needle movement, and a metallic bridge is used to secure the needles (Figs. 6 and 7). In most cases, a theoretical dosimetry is done without CT scan. As the needles are metallic, we just measure the distance from the tip and the end of the needle to the PTV, and also the distance to the skin for every needle. We also check with US that there is more than 1 cm between the superficial plane and the skin.

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