A Novel Delivery of Accelerated Partial Breast Irradiation Using Intraoperative Brachytherapy Device Placement and Completion of Breast Conservation Therapy Within 10 Days

Whole-breast irradiation, as part of breast-conservation therapy (BCT), has well-established results, good cosmesis, and low toxicity. Results from the BCT trials suggest that the risk for ipsilateral breast cancer recurrence resides within close proximity to the original tumor site. This leads investigators to consider the role of an accelerated and more tumor bed–focused course of radiotherapy. Accelerated partial-breast irradiation (APBI) involves treating a limited volume of breast tissue, with dose of irradiation per fraction increased and the treatment time course decreased. Four currently available methods of APBI are interstitial brachytherapy, intracavitary brachytherapy, intraoperative radiotherapy, and three-dimensional conformal external-beam radiotherapy. Patient selection is critical. This review article presents some preliminary clinical observations and limitations that suggest a potential role for APBI as a more user-friendly mode for delivering radiotherapy after lumpectomy for early breast cancer.

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Decisional preferences and satisfaction with short-course radiation for breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.193 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 193-193

Author(s):

Matthew Culbert ◽

Gregory Bidermann ◽

Audrey S. Wallace

Keyword(s):

Decision Making ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Second Primary ◽

Treatment Choices ◽

Short Course ◽

Patient Reported ◽

Decisional Satisfaction

193 Background: Limited literature exists regarding preferences and decisional satisfaction for women who choose accelerated partial breast irradiation (APBI) in lieu of 6-7 weeks of radiation. This analysis provides long-term patient reported outcomes in women treated with APBI at one institution. Methods: Records of women treated primarily with balloon-based APBI (2005-2013) were reviewed after IRB approval. Women with recurrent disease or poor prognosis second primary cancer were excluded. Assessment of decisional factors important to the patient, as well as satisfaction and regret with treatment choices (Decisional Regret and Satisfaction Scales) were captured via mail or telephone. Results: In 141 women who met inclusion criteria, 83 participated. Median age at diagnosis was 62 years (SD = 9), and median time from RT to survey completion was 102 months (SD = 8). Histology was pre-invasive, (25%), invasive (52%), and combined invasive/pre-invasive (23%). The majority had estrogen/progesterone receptor positive disease. Factors that were important in decision making included convenience, physician recommendation, financial considerations, novelty of treatment, desire to avoid mastectomy, and recovery time. The majority (48%) reported convenience to be the single most important factor. Provider recommendation was the primary factor in decision making for 20% of women. Most women agreed that their choice was the right decision (96%) and most felt adequately informed (90%). The majority (92% and 90% respectively) of women agreed that their decision was consistent with their personal values and was the best decision for them personally. Decisional satisfaction was high (95%). Overall satisfaction with treatment choices was high: 84% and 10% reported being totally and somewhat satisfied respectively. The majority (90%) of women stated they would make the same treatment choice again. Conclusions: Decisional satisfaction remains high almost a decade after completion of short course radiation. Practitioners should consider patient values and preferences as part of shared decision making when determining type and duration of radiation as part of breast conservation therapy.

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The Radiologist’s Role in a Breast Multidisciplinary Tumor Board

Journal of Breast Imaging ◽

10.1093/jbi/wbaa030 ◽

2020 ◽

Vol 2 (4) ◽

pp. 372-381

Author(s):

Steven J Rockoff ◽

Meghan R Flanagan ◽

Janice N Kim ◽

Kalyan Banda ◽

Kristine E Calhoun ◽

...

Keyword(s):

Breast Conservation ◽

Staging System ◽

Breast Conservation Therapy ◽

Cancer Staging ◽

Response To Treatment ◽

Accelerated Partial Breast Irradiation ◽

Tumor Board ◽

Partial Breast Irradiation ◽

Tumor Boards ◽

Multidisciplinary Tumor Board

Abstract Breast multidisciplinary tumor boards (MTBs) play an important role in determining treatment. This article serves as a guide for the radiologist participating in a breast MTB, as the information presented at MTB can significantly influence treatment plans and dictate future steps for further patient work-up. Multidisciplinary tumor board preparation involves a careful review of the patient’s history while gathering all relevant imaging studies, and reinterpreting them when appropriate. Presented images should be carefully selected, annotated, and displayed clearly before providing final recommendations for localization and incompletely assessed findings. Anatomic staging factors from the AJCC Breast Cancer Staging System, such as tumor size and degree of suspected skin involvement, should be described. In addition, there are many other types of information that the treatment specialists want to know. The surgeon is interested in anatomic information that will help them decide whether breast conservation therapy is feasible or if local structures, such as the nipple, can be spared. The radiation oncologist may need to know whether accelerated partial breast irradiation is feasible or if postmastectomy radiation therapy is indicated. The medical oncologist is looking for factors that may provide an indication for neoadjuvant therapy and ensuring there is a reliable follow-up method for evaluating the response to treatment, such as comparative MRI. Additionally, all specialists need to know the extent of suspected nodal involvement. By clearly and comprehensively presenting this information to the rest of the MTB team, the radiologist provides a vital contribution that guides treatment and ensures adherence to clinical guidelines.

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Implications of short-term follow-up tomosynthesis mammography on downstream workup after breast conservation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.311 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 311-311

Author(s):

Kevin Weinberger ◽

Brittany Colosimo ◽

Shaakir Hasan ◽

Steven Gresswell ◽

Sidney Anderson ◽

...

Keyword(s):

Ductal Carcinoma ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Screening Mammography ◽

Post Treatment ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Time Interval ◽

Breast Cancer Patients

311 Background: We previously reported that premature (less than 6 months) follow-up screening mammography after radiotherapy in breast conservation therapy was associated with an increased rate of unnecessary downstream workup. We now present the results of a similar study conducted with follow-up tomosynthesis mammogram (TS). Methods: Between the years 2015-2017, 143 consecutive breast cancer patients between ages 33 – 82 were treated with lumpectomy and adjuvant radiotherapy with follow-up TS and reviewed in this IRB-approved study. Cases were stratified by time interval until the first post-radiation TS, and secondarily by radiation technique: conventional fractionation (n = 84), hypofractionation (n = 59), boost (n = 116), no boost (n = 27), and accelerated partial breast irradiation (n = 10). The primary endpoint was the rate of further imaging/workup following TS, correlated with clinical, treatment, and post-treatment timing related variables using multivariable binomial regression analysis. Results: The patient cohort included the following clinical characteristics: 6 patients with ductal carcinoma in-situ (the remaining demonstrated either invasive ductal or invasive lobular histology), Ninety-seven patients had stage T1 lesions, 34 had T2, and 4 had T3/T4 lesions. Eighteen patients were node+, 95 ER+/ Her2-, 13 were triple negative, and 13 triple positive. No patients had clinical suspicion of recurrence before their first follow-up TS. Conclusions: Unlike with post-treatment screening two-dimensional mammography, there was no association with post-treatment tomosynthesis timing and downstream workup. Further study should be considered to confirm these preliminary findings.

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