Brachytherapy averts capsular contraction.
The zero incidence of capsular contracture among patients in this trial compares quite favorably to the 55% risk of implant hardening with whole breast irradiation (WBI), reported Dr. Robert R. Kuske, who is in private practice in Scottsdale, Ariz.
"The markedly improved cosmetic outcomes and reduced capsular contracture rates, compared with results from WBI, are due to the lack of circumferential dose to the foreign body in the breast, the augmentation implant," Dr. Kuske said.
The accepted treatment for early-stage breast cancer in women with breast implants--skin-sparing mastectomy with axillary dissection and implant exchange followed by WBI--carries a 55% risk of capsular contracture due to the formation of collagenous scar tissue around the implant, Dr. Kuske said. Another treatment option for women with breast implants with early-stage breast cancer is lumpectomy followed by WBI, but this also carries a substantial risk of capsular contracture.
The fact that capsular contracture was not seen in any of the 70 patients in this trial could have important implications for many of the estimated 49,000 women who undergo mammoplasty augmentation each year and who at some point will develop breast cancer, he said.
The need for an effective alternative to WBI is becoming increasingly important because "women who had implants 10, 15, or 20 years ago are growing into the age where they are developing breast cancer," said Dr. Kuske, noting that one-third of his patients have had breast augmentation.
Previous trials have shown excellent overall outcomes and in-breast control rates with multicatheter brachytherapy following lumpectomy in patients with selected early-stage cancers (Int. J. Radiat. Oncol. Biol. Phys. 2008; 72:467-73). The results presented at the RSNA meeting provide the first evidence of brachytherapy's potential as an early-stage treatment alternative for women with saline or silicone breast implants. So far, "early tumor control is 100% [in this group of patients], but obviously more follow-up is necessary," Dr. Kuske said.
Between June 2003 and June 2008, 70 patients (median age 50 years) were treated with multicatheter brachytherapy following lumpectomy in select early-stage cancers. Eligibility criteria were stage I or II breast carcinoma confirmed to be less than 3 cm, and 0-3 positive axillary nodes without extracapsular extension.
A mean of 17 plastic catheters were placed with CT guidance using a template with predrilled holes to map catheter positioning. The catheters rest on the surface of the augmentation, Dr. Kuske noted, but no punctures occurred in any of the patients. The target volume was the lumpectomy cavity plus 2 cm. Treatment was delivered with 34 Gy in 10 fractions twice daily over 5 days with high-dose-rate iridium 192. The end points evaluated were tumor control, complications, and cosmesis.
No breast or nodal recurrence or capsular contracture was noted in any of the patients after a median follow-up time of 26 months (range of 3-60 months). Cosmesis ratings were either excellent (91%) or good (9%) for all patients.
Clinical infections, a concern with multicatheter placement, occurred in four patients, and all were successfully treated with antibiotics. More than half of patients (40) received brachytherapy without antibiotics; 26 patients received antibiotics prophylactically. Other complications included one wound dehiscence, two minor cases of telangiectasia, one pneumothorax, and one persistent seroma.
Dr. Kuske is a consultant for Nucletron.
BY SUSAN BIRK
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|Publication:||Internal Medicine News|
|Date:||Jan 15, 2009|
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