Four-Year Efficacy, Cosmesis, and Toxicity Using Three-Dimensional Conformal External Beam Radiation Therapy to Deliver Accelerated Partial Breast Irradiation

Chen, Peter Y.; Wallace, Michelle; Mitchell, Christina; Grills, Inga; Kestin, Larry; Fowler, Ashley; Martinez, Alvaro; Vicini, Frank

doi:10.1016/j.ijrobp.2009.03.012

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Volume 76, Issue 4 , Pages 991-997, 15 March 2010

Four-Year Efficacy, Cosmesis, and Toxicity Using Three-Dimensional Conformal External Beam Radiation Therapy to Deliver Accelerated Partial Breast Irradiation

Peter Y. Chen, M.D.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Michelle Wallace, R.N.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Christina Mitchell, R.N., B.S.N.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Inga Grills, M.D.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Larry Kestin, M.D.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Ashley Fowler
- University of Michigan, Ann Arbor, MI
Alvaro Martinez, M.D.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Frank Vicini, M.D.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
- Reprint requests to: Frank A. Vicini, M.D., Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073. Tel: (248) 551-0243; Fax: (248) 551-3833

Received 21 January 2009; received in revised form 2 March 2009; accepted 5 March 2009. published online 09 June 2009.

Purpose

This prospective study examines the use of three-dimensional conformal external beam radiation therapy (3D-CRT) to deliver accelerated partial breast irradiation (APBI). Four-year data on efficacy, cosmesis, and toxicity are presented.

Methods

Patients with Stage O, I, or II breast cancer with lesions ≤3 cm, negative margins, and negative nodes were eligible. The 3D-CRT delivered was 38.5 Gy in 3.85 Gy/fraction. Ipsilateral breast, ipsilateral nodal, contralateral breast, and distant failure (IBF, INF, CBF, DF) were estimated using the cumulative incidence method. Disease-free, overall, and cancer-specific survival (DFS, OS, CSS) were recorded. The National Cancer Institute Common Terminology Criteria for Adverse Events (version 3) toxicity scale was used to grade acute and late toxicities.

Results

Ninety-four patients are evaluable for efficacy. Median patient age was 62 years with the following characteristics: 68% tumor size <1 cm, 72% invasive ductal histology, 77% estrogen receptor (ER) (+), 88% postmenopausal; 88% no chemotherapy and 44% with no hormone therapy. Median follow-up was 4.2 years (range, 1.3–8.3). Four-year estimates of efficacy were IBF: 1.1% (one local recurrence); INF: 0%; CBF: 1.1%; DF: 3.9%; DFS: 95%; OS: 97%; and CSS: 99%. Four (4%) Grade 3 toxicities (one transient breast pain and three fibrosis) were observed. Cosmesis was rated good/excellent in 89% of patients at 4 years.

Conclusions

Four-year efficacy, cosmesis, and toxicity using 3D-CRT to deliver APBI appear comparable to other experiences with similar follow-up. However, additional patients, further follow-up, and mature Phase III data are needed to evaluate thoroughly the extent of application, limitations, and complete value of this particular form of APBI.

Partial breast irradiation, breast cancer, breast conserving therapy, brachytherapy, three-dimensional conformal irradiation