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Brachytherapy Boost to Stage I-II Breast Tumour Beds Indicated as Treatment of Choice: Presented at ESTRO

By Adrian Burton
Special to DG News

PRAGUE, CZECH REPUBLIC -- September 20, 2002 -- Boosting the radiation dose to the tumour bed by brachytherapy has been demonstrated to be an excellent treatment in patients who have undergone breast conserving therapy for stage I and II breast cancer.

Data collected over 20 years for 992 patients show an actuarial survival rate of 99 percent with this treatment modality, according to Dr. Benjamín Guix, Head of the Fundación Imor at the Medical Institute for Radiation Oncology, in Barcelona, Spain.

"The figures clearly show that this is an excellent way of treating stage I or II breast cancer," said Dr. Guix, speaking here today at the 21^st annual meeting of the European Society for Therapeutic and Radiation Oncology (ESTRO).

Long term data were collected on 524 patients with stage I and 468 with stage II breast carcinoma between December 1981 and March 2001.

All patients received conservative breast surgery and external beam radiation (EBR) at a dose of 50.4 Gy in 28 fractions for 5.5 weeks. They also received either a boost of low dose brachytherapy (LDR n=637) or of high dose brachytherapy (n=355) two to three weeks after EBR.

Breast tumour characteristics were comparable in all patients. LDR doses were 20 Gy for tumours with no intraductal carcinoma and margins < 1 cm; 25 Gy when tumours had an intraductal component and margins of 0.5-1.0 cm; and 30 Gy for extensive carcinoma or margins <0.5 cm.

HDR doses were calculated to be approximately the same as in LDR early effects. Total HDR dose for all types of patients was between 18 and 20 Gy.

Patients were followed for a minimum of one year and a mean of five years All completed treatment and none were lost to follow-up. Twenty-four regional occurrences occurred, there were 57 cases of distant metastases and 20 deaths.

The actuarial results as provided by Kaplan-Meier analysis at 20 years showed 97.6 percent achieved breast control, 96.7 percent achieved locoregional control, 90.4 percent had disease-free survival. Survival rate was close to 99 percent.

Only 22 patients had changes in skin pigmentation and 12 had telangiectasias. Cosmetic results were good in 92.4 percent of patients. Only 2 percent developed breast fibrosis.

"These results compare very favourably to the results we see when patients receive no brachytherapy boost. In these patients we might expect a death rate of some 15 to 20 percent. There are very few complications with this technique and very few local recurrences, especially if HDR brachytherapy is provided," said Dr. Guix. "We might consider it the treatment of choice."

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