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Radiation Oncology—
MammoSite Radiation Therapy System

MammoSite HDR Brachytherapy

Conventional radiation therapy course for breast preservation lasts 5-7weeks and entails treatment of the whole breast. Doctors are studying ways to deliver radiation therapy to limited volume of the breast tissue over shorter than conventional period of time.

These techniques called Aceelerated Partial Breast Irradiation (APBI) are available at St. Agnes for a very selected group of patients and are used after a lumpectomy to deliver radiation to the tumor site rather than the entire breast.

MammoSite breast brachytherapy involves placing of a inflateble balloon into the postlumpectomy cavity. Over few days the balloon is being connected to a HDR brachytherapy machine so high doses of radiation can treat the nearby breast tissue.

The St Agnes Cancer Center expects to participate in the upcoming National Cancer Institute sponsored phase III trial comparing accelerated partial breast irradiation with standard whole breast radiation therapy which is expected to begin accrual within the next year.

Doctors at St. Agnes are also investigating MammoSite use for selected patients with Ductal Carcinoma in Situ (DCIS).

To find out whether you are eligible to participate in Accelerated Partial Breast Irradiation Trials contact:

• Department of Radiation Oncology at St. Agnes Cancer Center
• Telephone: (410) 368 2965

Internationally, several institutions have investigated the use of breast brachytherapy as an alternative to whole breast external beam radiation therapy (EBRT) with encouraging results. In well selected patients the single armed studies (phase I & II) report local recurrence rates similar to the recurrence rates documented for patients treated with whole breast EBRT.1-12.

St Agnes Cancer Center was the first and only institution to have the MammoSite registry trial available to the women of the Baltimore area. The ideal study criteria included breast cancer patients pursuing breast preservation with non-lobular tumors < 2 cm in size and > 45 years of age.

The aim of this study was to build upon the existing data suggestive that a 5 day accelerated course of partial breast irradiation (APBI) for selected patients is delivered safely and reproducibly. Patients treated on the study with the 5-day partial breast MammoSite HDR Brachytherapy did not undergo the 5-7 week course of whole breast external beam radiation therapy.

Importantly, these studies describe good/excellent cosmetic outcomes for patients treated with breast brachytherapy. It should be noted that patients enrolled in these studies were carefully selected to minimize the risk of significant residual tumor surrounding the lumpectomy cavity. Appropriate patient selection is essential to successfully treating patients with brachytherapy as an alternative to whole breast radiation therapy.

The largest published partial breast brachytherapy experience is from William Beaumont Hospital.11 From January 1993 through January 2000, 199 patients were treated with low dose rate (60%) and high dose rate (40%) interstitial brachytherapy (not MammoSite). The median follow-up for all patients was 66 months. In order to estimate the expected rate of local recurrence in patients with similar prognostic factors treated with traditional whole breast EBRT, all 199 patients were retrospectively matched to a reference group of 1388 patients treated with standard whole breast radiation therapy at the same institution.

Patients were matched according to age, tumor size, histology, margins of excision, absence of an extensive intraductal component, nodal status, tamoxifen use and follow-up. No statistically significant differences were found between patients treated with brachytherapy or EBRT in the rates of local recurrence or overall survival. The rate of local recurrence in the patients treated with breast brachytherapy was 1.0%.

References

1. Baglan KL, Martinez, AA, Frazier, RC, et al: The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 50: 1003-1011, 2001.
2. Cionini L, Pacini P, Marzano S, et al: Exclusive brachytherapy after conservative surgery in cancer of the breast. Lyon Chir 89: 128, 1993.
3. Clarke DH, Vicini FA, Jacobs H, et al: High dose rate brachytherapy for breast cancer, in Nag S (ed): High Dose Rate Brachytherapy: A Textbook, Armonk, NY, Futura, 1994, 321-329.
4. Keisch Met al. Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 55: 289-293, 2003.
5. King TA, Bolton, JS, Kuske, RR, et al: Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer. Am J Surg 180: 299-304, 2000.
6. Krishnan L, Jewell WR, Tawfik OW, et al: Breast conservation therapy with tumor bed irradiation alone in a selected group of patients with stage i breast cancer. Breast J 7: 91-96, 2001.
7. Kuske RR, Martin B, Hanson W, et al: Quality assurance and reproducibility on RTOG 95-17: A phase II trial of brachytherapy alone for select breast cancers. Presented at Radiological Society of North America 2001 Scientific Assembly and Annual Meeting, Chicago, IL.
8. Perera F, Chisela, F, Engel, J, et al: Method of localization and implantation of the lumpectomy site for high dose rate brachytherapy after conservative surgery for T1 and T2 breast cancer. Int J Radiat Oncol Biol Phys 31: 959-965, 1995.
9. Perera F, Engel, J, Holliday, R, et al: Local resection and brachytherapy confined to the lumpectomy site for early breast cancer: a pilot study. J Surg Oncol 65: 263-267, 1997.
10. Polgar C, Sulyok, Z, Fodor, J, et al: Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: five-year results of a phase I-II study and initial findings of a randomized phase III trial. J Surg Oncol 80: 121-128, 2002.
11. Vicini, F et al. Limited-field radiation therapy in the management of early-stage breast cancer. J Nat Canc Ins 95: 1205-1211, 2003.
12. Wazer DE, Berle, L, Graham, R, et al: Preliminary results of a phase I/II study of HDR brachytherapy alone for T1/T2 breast cancer. Int J Radiat Oncol Biol Phys 53: 889-897, 2002.

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