American Brachytherapy Society consensus report for accelerated partial breast irradiation using interstitial multicatheter brachytherapy

Jaroslaw T. Hepel, Douglas Arthur, Simona Shaitelman, C. Polgár, Dorin Todor, Imran Zoberi, Mitchell Kamrava, T. Major, Catheryn Yashar, David E. Wazer

Research output: Contribution to journalReview article

19 Citations (Scopus)

Abstract

Purpose To develop a consensus report for the quality practice of accelerated partial breast irradiation (APBI) using interstitial multicatheter brachytherapy (IMB). Methods and Materials The American Brachytherapy Society Board appointed an expert panel with clinical and research experience with breast brachytherapy to provide guidance for the current practice of IMB. This report is based on a comprehensive literature review with emphasis on randomized data and expertise of the panel. Results Randomized trials have demonstrated equivalent efficacy of APBI using IMB compared with whole breast irradiation for select patients with early-stage breast cancer. Several techniques for placement of interstitial catheters are described, and importance of three-dimensional planning with appropriate optimization is reviewed. Optimal target definition is outlined. Commonly used dosing schemas include 50 Gy delivered in pulses of 0.6–0.8 Gy/h using pulsed-dose-rate technique and 34 Gy in 10 fractions, 32 Gy in eight fractions, or 30 Gy in seven fractions using high-dose-rate technique. Potential toxicities and strategies for toxicity avoidance are described in detail. Dosimetric constraints include limiting whole breast volume that receives ≥50% of prescription dose to <60%, skin dose to ≤100% of prescription dose (≤60–70% preferred), chest wall dose to ≤125% of prescription dose, Dose Homogeneity Index to >0.75 (>0.85 preferred), V150 < 45 cc, and V200 < 14 cc. Using an optimal implant technique coupled with optimal planning and appropriate dose constraints, a low rate of toxicity and a good-to-excellent cosmetic outcome of ≥90% is expected. Conclusions IMB is an effective technique to deliver APBI for appropriately selected women with early-stage breast cancer. This consensus report has been created to assist clinicians in the appropriate practice of APBI using IMB.

Original languageEnglish
Pages (from-to)919-928
Number of pages10
JournalBrachytherapy
Volume16
Issue number5
DOIs
Publication statusPublished - Sep 1 2017

Keywords

  • Accelerated partial breast irradiation
  • Breast brachytherapy
  • Breast cancer
  • Interstitial multicatheter brachytherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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