Local resection and brachytherapy confined to the lumpectomy site for early breast cancer: A pilot study

• Published in: Journal of surgical oncology Vol. 65; no. 4; pp. 263 - 268
• Main Authors: Perera, Francisco, Engel, Jay, Holliday, Ronald, Scott, Leslie, Girotti, Murray, Girvan, David, Chisela, Frank, Venkatesan, Varagur
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.08.1997
• Subjects: Adult; Aged; Aged, 80 and over; Brachytherapy; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Combined Modality Therapy; fat; Fat Necrosis - etiology; Feasibility Studies; Female; high dose rate; Humans; Mastectomy, Segmental - adverse effects; Middle Aged; necrosis; Pilot Projects; Radiotherapy Dosage
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/(SICI)1096-9098(199708)65:4<263::AID-JSO7>3.0.CO;2-3

Background and Objectives The commonest site of local breast recurrence after breast conservation surgery is the primary tumor bed. We have tested the feasibility of outpatient high dose rate brachytherapy to the primary tumor bed as the only radiation. Our technique relies on the placement of surgical clips to mark the tumor bed. Methods Between March 1992 and January 1996, 39 patients with clinical T1 T2 breast cancer were enrolled in this pilot study. The first 13 patients had intraoperative implantation of the breast. The remaining 26 patients had outpatient postoperative implantation under general anesthesia (2 patients) or local anaesthesia (24 patients). High dose rate brachytherapy was given twice daily at least 6 hours apart for a total dose of 37.2 Gy in 10 fractions over 5–7 days. Results Three patients had mild clinical cellulitis responding to oral antibiotics. One patient had a small sinus in the lumpectomy scar requiring local excision to heal. Four patients developed fat necrosis at the lumpectomy site at 4 (1 patient), 13 (1 patient), and 18 months (2 patients) post radiotherapy. Patient rated satisfaction with treatment was high. At a median followup of 20 months, one infield local recurrence has been salvaged by wider resection and postoperative conventional external beam radiation. Conclusions Except for fat necrosis, which may be associated with this technique, complications have been minimal. Outpatient implantation under local anesthesia is feasible. Longer followup is required to establish the local control rates. J. Surg. Oncol. 1997;65:263–268. © 1997 Wiley‐Liss, Inc.