Postlumpectomy Focal Brachytherapy for Simultaneous Treatment of Surgical Cavity and Draining Lymph Nodes

• Published in: International journal of radiation oncology, biology, physics Vol. 79; no. 3; pp. 948 - 955
• Main Authors: Hrycushko, Brian A., Li, Shihong, Shi, Chengyu, Goins, Beth, Liu, Yaxi, Phillips, William T., Otto, Pamela M., Bao, Ande
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier
• Subjects: Animals; Axilla; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; Biological and medical sciences; BODY; BRACHYTHERAPY; Brachytherapy - methods; Breast cancer; Breast Neoplasms - radiotherapy; CAVITIES; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSTIC TECHNIQUES; DISEASES; DOSES; ELECTRON CAPTURE RADIOISOTOPES; Feasibility Studies; Female; Focal brachytherapy; GLANDS; Gynecology. Andrology. Obstetrics; HEAVY NUCLEI; Hematology, Oncology and Palliative Medicine; HOURS LIVING RADIOISOTOPES; Humans; INTERNAL CONVERSION RADIOISOTOPES; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; KERNELS; LIPIDS; Liposome; LIPOSOMES; Lymph node; LYMPH NODES; Lymph Nodes - radiation effects; Lymphatic Irradiation - methods; LYMPHATIC SYSTEM; Mammary gland diseases; MAMMARY GLANDS; Mastectomy, Segmental; Medical sciences; MEDICINE; MINUTES LIVING RADIOISOTOPES; Nanoparticles; NANOSTRUCTURES; Neoplasm, Residual; NEOPLASMS; NUCLEAR MEDICINE; NUCLEI; ODD-ODD NUCLEI; ORGANIC COMPOUNDS; ORGANS; PARTICLES; POINT KERNELS; RADIATION DOSES; RADIOISOTOPE SCANNING; RADIOISOTOPES; Radioisotopes - administration & dosage; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; Radionuclide; RADIOTHERAPY; Radiotherapy Dosage; Rhenium - administration & dosage; RHENIUM 186; RHENIUM 188; RHENIUM ISOTOPES; SCINTISCANNING; SURGERY; THERAPY; Tumors; YEARS LIVING RADIOISOTOPES; Liposome; Radionuclide; Breast cancer; Lymph node; Focal brachytherapy; Breast disease; Malignant tumor; Radiotherapy; Mammary gland diseases; Treatment; Surgery; Curietherapy; Cancer
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.05.062

The primary objective was to investigate a novel focal brachytherapy technique using lipid nanoparticle (liposome)–carried β-emitting radionuclides (rhenium-186 [ 186Re]/rhenium-188 [ 188Re]) to simultaneously treat the postlumpectomy surgical cavity and draining lymph nodes. Cumulative activity distributions in the lumpectomy cavity and lymph nodes were extrapolated from small animal imaging and human lymphoscintigraphy data. Absorbed dose calculations were performed for lumpectomy cavities with spherical and ellipsoidal shapes and lymph nodes within human subjects by use of the dose point kernel convolution method. Dose calculations showed that therapeutic dose levels within the lumpectomy cavity wall can cover 2- and 5-mm depths for 186Re and 188Re liposomes, respectively. The absorbed doses at 1 cm sharply decreased to only 1.3% to 3.7% of the doses at 2 mm for 186Re liposomes and 5 mm for 188Re liposomes. Concurrently, the draining sentinel lymph nodes would receive a high focal therapeutic absorbed dose, whereas the average dose to 1 cm of surrounding tissue received less than 1% of that within the nodes. Focal brachytherapy by use of 186Re/ 188Re liposomes was theoretically shown to be capable of simultaneously treating the lumpectomy cavity wall and draining sentinel lymph nodes with high absorbed doses while significantly lowering dose to surrounding healthy tissue. In turn, this allows for dose escalation to regions of higher probability of containing residual tumor cells after lumpectomy while reducing normal tissue complications.