Accelerated Partial Breast Irradiation (eBook)

Contents 5
Contributors 15
Accelerated Partial Breast Irradiation: History, Rationale, and Controversies 19
1.1 Introduction 19
1.2 History of APBI 22
1.3 Controversies Regarding the Use of APBI 25
1.4 Conclusions 31
References 32
Who Is a Candidate for APBI? 36
2.1 Introduction 36
2.2 Pathologic Data 38
2.3 Anatomic Patterns of In-Breast Failure After Breast-Conserving Treatment 39
2.4 Proper Selection Criteria 40
References 47
Pathologic Anatomy of Early-Stage Breast Cancer and Its Relevance to APBI: Defining the Target 52
3.1 Determining the Extent of Disease Beyond the Lumpectomy Cavity 52
3.2 Impact of Radiation on Local Recurrences 58
3.3 Conclusions 60
References 60
The Radiobiology of Accelerated Partial Breast Irradiation 63
4.1 General Radiobiology Principles 64
4.2 The Radiobiology of Breast Cancer 65
4.3 Intraoperative APBI 66
4.4 External-Beam APBI 67
4.5 Interstitial Implant APBI 68
4.6 Conclusion 70
References 71
Surgical Considerations in Partial Breast Irradiation 74
5.1 Introduction 74
5.2 Patient Selection 75
5.3 Tumor Location 75
5.4 Cavity Shape and Size 78
5.5 Technical Considerations 82
5.6 Impact of Oncoplastic Techniques on the Use of APBI 86
References 87
Physics of Accelerated Partial Breast Irradiation 88
6.1 Introduction 88
6.2 Interstitial Brachytherapy 89
6.3 Intracavitary Volume Implants 94
6.4 External Beam 110
References 114
Quality Assurance for Accelerated Partial Breast Irradiation 116
7.1 Quality Management for Breast Brachytherapy 116
7.2 Quality Management for External-Beam Partial Breast Irradiation 135
References 138
Overview of North American Trials 140
8.1 Introduction 140
8.2 Patient Selection 141
8.3 Interstitial Technique 142
8.4 Tufts/Brown/Rhode Island 146
8.5 MammoSite Balloon 150
8.6 External-Beam APBI 157
8.7 Conclusion 161
References 162
An Overview of European Clinical Trials of APBI 165
9.1 Introduction 165
9.2 Early European APBI Trials 165
9.3 Contemporary European APBI Trials 170
9.4 European MammoSite Brachytherapy Trials 177
9.5 European (GEC–ESTRO) Multicentric Randomized APBI Trial 181
9.6 Summary and Future Directions 183
References 184
The Phase III Trials: Obtaining Definitive Answers 187
10.1 Patient Selection and Study Eligibility 193
10.2 Target Delineation 194
10.3 Technique and Dosimetry 198
10.4 Quality Assurance 199
10.5 Conclusion 200
References 200
The Virginia Commonwealth University Technique of Interstitial Brachytherapy 202
11.1 History 202
11.2 Implantation Technique 204
11.3 Dosimetric Guidelines 210
11.4 Results 212
11.5 Conclusion 213
References 214
Accelerated Partial Breast Irradiation: The William Beaumont Hospital Technique of Interstitial Brachytherapy 216
12.1 History 216
12.2 Physics 217
12.3 Implantation Technique 218
12.4 Clinical Results 225
12.5 Future Directions 228
References 229
Brachytherapy Techniques: The Arizona Approach 232
13.1 Introduction: A 17-Year Historical Perspective on the Evolution of Accelerated Partial Breast Irradiation 232
13.2 A New Hypothesis and a Potential Paradigm Shift 235
13.3 The Target Volume 236
13.4 Irradiating the Target Volume 237
13.5 Brachytherapy Techniques 238
13.6 Judgment: Selecting the Optimal Technique for a Particular Patient 255
13.7 Summary 257
References 258
The MammoSite Technique for Accelerated Partial Breast Irradiation 260
14.1 History of the Applicator 260
14.2 MammoSite and the FDA Trial 261
14.3 Physics of the MammoSite 263
14.4 Single Dwell vs. Multidwell 264
14.5 Elliptical MammoSite 266
14.6 Contrast Effect 266
14.7 Implantation Techniques 266
14.8 Other Considerations 268
14.9 Appropriateness for Treatment 269
14.10 Clinical Results 271
14.11 Conclusions 274
References 274
Permanent Breast Seed Implants 276
15.1 Introduction 276
15.2 PBSI Challenges and Solutions 277
15.3 PBSI Preimplant Planning 281
15.4 PBSI Procedure 284
15.5 Results 285
15.6 Discussion and Conclusion 286
References 287
3D Conformal External-Beam Technique 290
16.1 History 292
16.2 Physics and Techniques 294
16.3 Clinical Results 297
16.4 Challenges and Limiting Factors in the Application of 3D Conformal APBI 307
16.5 Future Directions 309
References 311
External-Beam Partial Breast Irradiation: The New York University Prone Technique 314
17.1 External-Beam Partial Breast Irradiation 314
17.2 Selection of a Dose Fractionation Scheme for Postoperative Prone EB-PBI 314
17.3 Rationale for Patient Selection Criteria for Postoperative Prone EB-PBI 315
17.4 Rationale for Prone Patient Positioning 317
17.5 Phase I Trial Using the Prone Position (University of Southern California) 319
17.6 Results of the Subsequent Phase I/II Protocol NYU 00-23 (New York University) 319
17.7 Preliminary Results of PBI Using Cone-Beam Imaging: NYU Protocol 07-582 320
17.8 Conclusions 324
References 324
APBI 3D Conformal External Beam: The MGH Technique 327
18.1 Introduction 327
18.2 MGH External-Beam Technique in APBI 328
18.3 Position Verification 331
18.4 Initial Results of the MGH Protocol 333
18.5 External-Beam APBI Dosimetric Comparison 334
18.6 APBI with Protons 334
18.7 Conclusions 337
References 337
APBI with 50 kV Photons: Targeted Intraoperative Radiotherapy (TARGIT) 339
19.1 Individualizing Local Treatment for Breast Cancer 339
19.2 Radiotherapy Has a Dual Benefit: On the Seed and On the Soil! 341
19.3 Radiobiology of Intraoperative Radiotherapy 343
19.4 Intraoperative Radiotherapy: An Elegant Method of Partial Breast Irradiation 346
19.5 The Intrabeam Machine and Surgical Technique 347
19.6 Results of Clinical Trials with the Intrabeam System 349
19.7 Health Economics 351
References 352
APBI Intraoperative Technique with Electrons 357
20.1 Introduction 357
20.2 Rationale for the Use of IOERT in Breast Cancer 358
20.3 Radiobiology 359
20.4 Radiation Technique 361
20.5 ELIOT After Quadrantectomy 363
20.6 EIO Experience 368
20.7 21 Gy as Sole Treatment at Santa Chiara Hospital 371
20.8 The Experience at the University of North Carolina 372
20.9 IORT as a Boost 372
20.10 ELIOT After Nipple-Sparing Mastectomy 374
References 375
Intraoperative Radiation Therapy During Breast-Conserving Surgery the Memorial Sloan–Kettering Cancer Center Technique
21.1 Background 379
21.2 Patient Selection 382
21.3 Technique 382
21.4 The Milan Electron Beam IORT Technique 382
21.5 The MSKCC High Dose Rate Remote Afterloading IORT Technique 383
21.6 Patient Management 385
21.7 Cosmetic Results 386
21.8 Clinical Results 387
21.9 Complications 387
21.10 Discussion 387
References 388
Normal Tissue Toxicity After Accelerated Partial Breast Irradiation 389
22.1 Terminology, Techniques, and Radiation Biology 390
22.2 Interstitial Brachytherapy: Toxicity Reports from Select Single - and Multi-institutional Studies 392
22.3 Intracavity Brachytherapy 397
22.4 3D Conformal External-Beam APBI 403
22.5 Intraoperative APBI 404
22.6 Conclusion 405
References 405
Emerging Technologies Part I: New Brachytherapy Catheter Systems 408
23.1 Introduction 408
23.2 Background: Multicatheter Interstitial Brachytherapy 409
23.3 Background: MammoSite Balloon Brachytherapy 410
23.4 Hybrid Intracavitary Devices 411
23.5 Conclusion 417
References 418
Emerging Technologies Part II: Novel Sources and Delivery Systems 420
24.1 Introduction 420
24.2 Electronic Brachytherapy 421
24.3 AccuBoost 430
24.4 Alternative Radionuclides 439
24.5 Conclusion 440
References 440
Index 442