Accelerated Partial Breast Irradiation

by Wazer, David E.; Arthur, Douglas W.; Vicini, Frank A.

• ISBN13: 9783540282020
• ISBN10: 3540282025
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-07-15
• Publisher: Springer Verlag

Summary

Accelerated partial breast irradiation (APBI) is being rapidly introduced into the clinical management of early breast cancer. APBI, in fact, encompasses a number of different techniques and approaches that include brachytherapy, intraoperative, and external beam techniques. There is currently no single source that describes these techniques and their clinical implementation. This text will be a concise handbook designed to assist the clinician in the implementation of APBI. This will include a review of the principles that underlie APBI, a practical and detailed description of each technique for APBI, a review of current clinical results of APBI, and a review of the incidence and management of treatment related complications.

Table of Contents

1 Accelerated Partial Breast Irradiation: History, Rationale, and Controversies	1	(16)
Thomas A. Buchholz and Eric A. Strom
1.1 Introduction	1	(2)
1.2 History of APBI	3	(3)
1.3 Controversies Regarding the Use of APBI	6	(5)
1.3.1 Does APBI Treat an Adequate Volume of Breast Tissue?	7	(2)
1.3.2 Which Patients May Be The Most Appropriate for APBI?	9	(1)
1.3.3 Does APBI Deliver an Adequate Radiation Dose?	10	(1)
1.3.4 Can APBI Increase Rates of Normal Tissue Injury?	11	(1)
1.4 Convenience Benefits of APBI	11	(1)
1.4.1 Will APBI Increase Access to Medical Facilities and Reduce Costs?	11	(1)
1.5 Conclusions	12	(1)
References	13	(4)
2 Who is a Candidate for Accelerated Partial Breast Irradiation?	17	(14)
Douglas W. Arthur, Frank A. Vicini and David E. Wazer
2.1 Introduction	17	(2)
2.2 Pathologic Data	19	(1)
2.3 Anatomic Patterns of In-Breast Failure after Breast-Conserving Treatment	19	(2)
2.4 Proper Selection Criteria	21	(6)
References	27	(4)
3 Pathologic Anatomy of Early-Stage Breast Cancer and its Relevance to Accelerated Partial Breast Irradiation: Defining the Target	31	(10)
Shruti Jolly, Larry L. Kestin, Neal S. Goldstein and Frank A. Vicini
3.1 Determining the Extent of Disease Beyond the Lumpectomy Cavity	31	(5)
3.1.1 Mastectomy Studies	32	(2)
3.1.2 Re-Excision Pathologic Studies	34	(1)
3.1.2.1 Concerns Regarding Re-Excision Analysis	35	(1)
3.1.3 Recurrence Patterns in PBI	35	(1)
3.1.4 Composite Disease Extension	36	(1)
3.2 Impact of Radiation on Elsewhere Failures	36	(1)
3.3 Conclusions	37	(1)
References	38	(3)
4 Physics of Partial Breast Irradiation: Coping with the New Requirements of the NSABP B39/RTOG 0413 Protocol	41	(14)
Gregory K. Edmundson
4.1 Introduction	42	(1)
4.1.1 Imaging	42	(1)
4.1.2 Breast Reference Volume	43	(1)
4.2 Interstitial Multicatheter Technique	43	(3)
4.2.2 Volumes of Interest	43	(1)
4.2.2.1 PTV_EVAL	43	(1)
4.2.2.2 Breast Reference Volume	43	(1)
4.2.3 Appropriateness for Treatment: Evaluation of Dosimetric Parameters	44	(1)
4.2.4 Dose Prescription and Delivery	45	(1)
4.2.5 Treatment Verification	45	(1)
4.3 MammoSite	46	(5)
4.3.1 Volumes of Interest	46	(1)
4.3.1.1 CTV=PTV=PTV_EVAL	46	(1)
4.3.1.2 Volume of Nonconformity	47	(1)
4.3.1.3 Breast Reference Volume	47	(1)
4.3.2 Appropriateness for Treatment	47	(3)
4.3.3 Dose Prescription and Delivery	50	(1)
4.3.4 Treatment Verification	50	(1)
4.4 3D Conformal External Beam	51	(2)
4.4.1 Contouring	51	(1)
4.4.2 Volumes of Interest	51	(1)
4.4.3 Beam Angles/Treatment Position	52	(1)
4.4.4 Appropriateness for Treatment	52	(1)
4.4.5 Dose Prescription and Delivery	52	(1)
4.4.6 Treatment Verification	53	(1)
4.5 Conclusions	53	(1)
References	53	(2)
5 The Radiobiology of Accelerated Partial Breast Irradiation	55	(14)
Simon N. Powell
5.1 Introduction	55	(2)
5.2 Advantages of Accelerated Therapy	57	(2)
5.3 Volume of Breast Requiring Treatment in APBI	59	(1)
5.4 Dose Homogeneity	60	(1)
5.5 Dose Fractionation Schedules	61	(3)
5.6 Accuracy of Treatment Delivery	64	(1)
5.7 Summary	65	(1)
References	65	(4)
6 Surgical Considerations for Accelerated Partial Breast Irradiation	69	(10)
Henry M. Kuerer
6.1 Introduction	69	(1)
6.2 Volume of Breast Resection	70	(1)
6.3 Brachytherapy	71	(2)
6.3.1 Interstitial Needle-Based Therapy	71	(1)
6.3.2 Intracavitary Balloon-Based Brachytherapy	71	(2)
6.4 Intraoperative Radiation Therapy	73	(2)
6.5 External Beam Delivery of Conformal Radiation Therapy	75	(1)
6.6 APBI for Breast Preservation After Local Recurrence	76	(1)
References	76	(3)
7 The Virginia Commonwealth University (VCU) Technique of Interstitial Brachytherapy	79	(12)
Laurie W. Cuttino and Douglas W. Arthur
7.1 History	79	(2)
7.2 Implantation Technique	81	(4)
7.2.1 Preprocedure Evaluation	81	(1)
7.2.2 Patient Preparation	81	(1)
7.2.3 Catheter Placement	82	(3)
7.3 Dosimetric Guidelines	85	(1)
7.4 Results	86	(2)
7.5 Conclusion	88	(1)
References	88	(3)
8 The William Beaumont Hospital Technique of Interstitial Brachytherapy	91	(14)
Peter Y. Chen and Greg Edmundson
8.1 History	91	(1)
8.2 Physics	92	(1)
8.2.1 LDR Dosimetry	92	(1)
8.2.2 HDR Dosimetry	92	(1)
8.3 Implantation Technique	93	(5)
8.3.1 Open Cavity Technique	94	(1)
8.3.2 Closed Cavity Technique	95	(3)
8.4 Clinical Results	98	(2)
8.5 Future Directions	100	(1)
References	101	(4)
9 Brachytherapy Techniques: the University of Wisconsin/Arizona Approach	105	(24)
Robert R. Kuske
9.1 Introduction: a 14-year Historical Perspective on the Evolution of APBI	105	(3)
9.2 A New Hypothesis and a Potential Paradigm Shift	108	(1)
9.3 The Target Volume	109	(1)
9.4 Irradiating the Target Volume	109	(2)
9.5 Brachytherapy Techniques	111	(13)
9.5.1 Open Freehand Interstitial Catheter Insertion	111	(2)
9.5.2 Ultrasound-Guided Supine Catheter Insertion	113	(3)
9.5.3 Image-Guided Prone Catheter Insertion with a Special Breast Template	116	(3)
9.5.4 CT-Guided Supine Catheter Insertion with a Special Breast Template	119	(3)
9.5.5 Balloon Intracavitary Catheter Insertion	122	(2)
9.6 Judgment: Selecting the Optimal Technique for a Particular Patient	124	(1)
9.7 Summary	125	(1)
References	126	(3)
10 The MammoSite Technique for Accelerated Partial Breast Irradiation	129	(1)
Martin E. Keisch and Frank A. Vicini
10.1 Introduction	129	(2)
10.2 History of the Applicator	131	(1)
10.2.3 MammoSite and the FDA Trial	131	(1)
10.3 Physics of the MammoSite	132	(3)
10.3.1 General	132	(1)
10.3.2 Single Dwell vs. Multiple Dwell	132	(2)
10.3.3 Elliptical MammoSite	134	(1)
10.3.4 Contrast Effect	135	(1)
10.4 Implantation Techniques	135	(1)
10.5 Other Considerations	136	(1)
10.6 Appropriateness for Treatment	137	(1)
10.7 Clinical Results	137	(3)
10.8 Conclusions	140	(1)
References	141	(2)
11 3D Conformal External Beam Technique	143	(1)
Yasmin Hasan and Frank A. Vicini
11.1 Introduction	143	(1)
11.2 History	144	(3)
11.2.1 Rationale for External Beam APBI	144	(2)
11.2.2 Prospective Randomized Data Comparing APBI and External Beam APBI to Whole-Breast Radiation Therapy	146	(1)
11.3 Physics and Techniques	147	(1)
11.3.1 Prone 3D Conformal APBI	147	(1)
11.3.2 Dose Fractionation Scheme for Postoperative Supine and Prone External Beam APBI	148	(1)
11.4 Clinical Results	148	(9)
11.4.1 Pilot Phase I Dose-Escalation Trial	148	(1)
11.4.2 Phase I/II Trial of Prone 3D Conformal APBI - New York University	149	(3)
11.4.3 The William Beaumont Hospital Experience - 3D Conformal APBI in Supine Position	152	(4)
11.4.4 Ongoing William Beaumont Hospital Experience	156	(1)
11.4.5 RTOG 0319 - Preliminary Results	156	(1)
11.4.6 Massachusetts General Hospital Experience	157	(1)
11.5 Challenges and Limiting Factors in the Application of 3D Conformal APBI	157	(2)
11.6 Future Directions	159	(1)
References	160	(3)
12 Intraoperative Radiotherapy a Precise Approach for Partial Breast Irradiation	163	(1)
Jayant S. Vaidya
12.1 The "New" Thinking that Became the New Dogma	163	(2)
12.2 Intraoperative Radiotherapy: an Elegant Method of Partial Breast Irradiation	165	(1)
12.3 Radiobiology of Intraoperative Radiotherapy	165	(3)
12.4 The Intrabeam Machine and Surgical Technique	168	(3)
12.5 The Novac7 System	171	(1)
12.6 Results of Clinical Trials with the Intrabeam System	172	(1)
12.7 Health Economics	173	(1)
References	174	(5)
13 Quality Assurance for Breast Brachytherapy	179	(1)
Bruce Thomadsen and Rupak Das
13.1 Quality Assurance During the Implantation Process	180	(3)
13.1.1 Interstitial Implants	180	(2)
13.1.1.1 Checking of the Implantation Equipment	180	(1)
13.1.1.2 Verification of the Target	180	(1)
13.1.1.3 Alignment of the Needles	181	(1)
13.1.1.4 Verification after Needle Placement	181	(1)
13.1.2 Intracavitary Insertions	182	(1)
13.1.2.1 Checking the Intracavitary Equipment	182	(1)
13.1.2.2 Verification of Conformance with the Target	183	(1)
13.2 Quality Assurance during Localization and Reconstruction	183	(5)
13.2.1 Interstitial Implants	183	(2)
13.2.1.1 Preparing the Catheters for Imaging	183	(1)
13.2.1.2 Catheter Numbering	184	(1)
13.2.1.3 Checking the Length of Catheters or Catheter Inserts	185	(1)
13.2.2 Intracavitary Insertions	185	(3)
13.2.2.1 Verification of Length	185	(1)
13.2.2.2 Verification of Filled Diameter	185	(2)
13.2.2.3 Appropriateness of Application	187	(1)
13.3 Quality Assurance of the Treatment Plan	188	(5)
13.3.1 Interstitial Implants	188	(4)
13.3.1.1 Target Coverage	188	(1)
13.3.1.2 High-Dose Volume	188	(1)
13.3.1.3 Uniformity Indices	188	(2)
13.3.1.4 Conformality Index	190	(1)
13.3.1.5 Skin Dose	190	(1)
13.3.1.6 Dwell Time vs. Volume	190	(1)
13.3.1.7 Lengths	191	(1)
13.3.2 Intracavitary Insertions	192	(1)
13.3.2.1 Target Coverage	192	(1)
13.3.2.2 Uniformity Indices	192	(1)
13.3.2.3 Skin Dose and Dose to Other Structures	192	(1)
13.3.2.4 Dwell Time vs. Distance	193	(1)
13.3.2.5 Length	193	(1)
13.4 Quality Assurance at the Time of Treatment	193	(2)
13.4.1 Interstitial Implants	193	(1)
13.4.1.1 Program Verification	193	(1)
13.4.1.2 Connection of the Catheters	194	(1)
13.4.2 Intracavitary Insertions	194	(4)
13.4.2.1 Volume Check	195	(1)
13.4.2.2 Source Going to Correct Location	195	(1)
13.5 Post-Treatment Verification	195	(1)
References	195	(2)
14 New and Novel Treatment Delivery Techniques for Accelerated Partial Breast Irradiation	197	(1)
Mark J. Rivard, Alphonse G. Taghian and David E. Wazer
14.1 APBI: Established, New, and Novel Approaches	197	(1)
14.2 Teletherapy	198	(3)
14.2.1 Proton Teletherapy for APBI	199	(2)
14.3 Brachytherapy	201	(3)
14.3.1 Seeds Containing Radionuclides	202	(1)
14.3.2 Microbrachytherapy	202	(1)
14.3.3 Electronic Brachytherapy	203	(1)
14.4 Summary	204	(1)
References	205	(2)
15 Overview of North American Trials	207	(1)
Rakesh R. Patel
15.1 Introduction	207	(1)
15.2 Patient Selection	208	(1)
15.3 Interstitial Technique	209	(8)
15.3.1 The Ochsner Clinic	211	(3)
15.3.2 William Beaumont Hospital	214	(1)
15.3.3 University of Wisconsin	214	(1)
15.3.4 Virginia Commonwealth University	215	(1)
15.3.5 Tufts/Brown/Rhode Island	215	(1)
15.3.6 University of Kansas	216	(1)
15.3.7 Massachusetts General Hospital	216	(1)
15.3.8 RTOG 95-17	217	(1)
15.4 MammoSite Balloon	217	(3)
15.4.1 FDA Study	218	(1)
15.4.2 Tufts/New England Medical Center	219	(1)
15.4.3 Arizona	220	(1)
15.4.4 St. Vincent's	220	(1)
15.4.5 Rush University	220	(1)
15.5 External Beam APBI	220	(3)
15.5.1 William Beaumont Hospital	222	(1)
15.5.2 New York University	222	(1)
15.5.3 RTOG 0319	223	(1)
15.6 Conclusion	223	(1)
References	224	(3)
16 An Overview of European Clinical Trials of Accelerated Partial Breast Irradiation	227	(1)
Csaba Polgár, Tibor Major, Vratislav Strnad, Peter Niehoff, Oliver J. Ott and György Kovács
16.1 Introduction	227	(2)
16.2 Early European APBI Trials	229	(3)
16.2.1 Christie Hospital External Beam APBI Trial	229	(1)
16.2.2 Uzsoki Hospital Cobalt-Needle Study	229	(2)
16.2.3 Guy's Hospital Studies	231	(1)
16.2.4 Florence Series	231	(1)
16.2.5 Royal Devon and Exeter Hospital Series	232	(1)
16.3 Contemporary European APBI Trials	232	(6)
16.3.1 Ninewells Hospital Study	232	(1)
16.3.2 Orebro Series	232	(2)
16.3.3 National Institute of Oncology (Hungary) Studies	234	(2)
16.3.4 German-Austrian Multicentric Trial	236	(2)
16.4 European MammoSite Brachytherapy Trials	238	(3)
16.5 European (GEC-ESTRO) Multicentric Randomized APBI Trial	241	(1)
16.6 Summary and Future Directions	242	(1)
References	243	(4)
17 Normal Tissue Toxicity after Accelerated Partial Breast Irradiation	247	(1)
David E. Wazer
17.1 Introduction	247	(1)
17.2 Terminology, Techniques, and Radiation Biology	248	(2)
17.3 Interstitial Brachytherapy	250	(5)
17.3.1 Toxicity Reports from Selected Single- and Multi-Institutional Studies	250	(2)
17.3.2 LDR versus HDR	252	(2)
17.3.3 Is there an Adverse Interaction between Interstitial Brachytherapy and Chemotherapy?	254	(1)
17.3.4 Toxicity Avoidance Guidelines	254	(1)
17.4 MammoSite Brachytherapy	255	(3)
17.4.1 Toxicity Avoidance Guidelines	258	(1)
17.5 3D Conformal External Beam APBI	258	(1)
17.5.1 Toxicity Avoidance Guidelines	259	(1)
17.6 Intraoperative APBI	259	(1)
17.7 Conclusion	259	(1)
References	260	(3)
18 Future Directions: Phase III Cooperative Group Trials	263	(1)
Joseph R. Kelley and Douglas W. Arthur
18.1 Introduction	263	(3)
18.2 Patient Selection/Study Eligibility	266	(1)
18.3 Target Delineation	267	(2)
18.4 Technique and Dosimetry	269	(2)
18.5 Quality Assurance	271	(1)
18.6 Conclusion	271	(1)
References	272