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Outcomes of Node-positive Breast Cancer Patients Treated With Accelerated Partial Breast Irradiation Via Multicatheter Interstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience

Kamrava, Mitchell, MD*; Kuske, Robert, R., MD; Anderson, Bethany, MD; Chen, Peter, MD§; Hayes, John, MD; Quiet, Coral, MD; Wang, Pin-Chieh, PhD*; Veruttipong, Darlene, MPH*; Snyder, Margaret, RN; Demanes, David, J., MD*

American Journal of Clinical Oncology: June 2018 - Volume 41 - Issue 6 - p 538–543
doi: 10.1097/COC.0000000000000334
Original Articles: Breast

Objectives: To report outcomes for breast-conserving therapy using adjuvant accelerated partial breast irradiation (APBI) with interstitial multicatheter brachytherapy in node-positive compared with node-negative patients.

Materials and Methods: From 1992 to 2013, 1351 patients (1369 breast cancers) were treated with breast-conserving surgery and adjuvant APBI using interstitial multicatheter brachytherapy. A total of 907 patients (835 node negative, 59 N1a, and 13 N1mic) had >1 year of data available and nodal status information and are the subject of this analysis. Median age (range) was 59 years old (22 to 90 y). T stage was 90% T1 and ER/PR/Her2 was positive in 87%, 71%, and 7%. Mean number of axillary nodes removed was 12 (SD, 6). Cox multivariate analysis for local/regional control was performed using age, nodal stage, ER/PR/Her2 receptor status, tumor size, grade, margin, and adjuvant chemotherapy/antiestrogen therapy.

Results: The mean (SD) follow-up was 7.5 years (4.6). The 5-year actuarial local control (95% confidence interval) in node-negative versus node-positive patients was 96.3% (94.5-97.5) versus 95.8% (87.6-98.6) (P=0.62). The 5-year actuarial regional control in node-negative versus node-positive patients was 98.5% (97.3-99.2) versus 96.7% (87.4-99.2) (P=0.33). The 5-year actuarial freedom from distant metastasis and cause-specific survival were significantly lower in node-positive versus node-negative patients at 92.3% (82.4-96.7) versus 97.8% (96.3-98.7) (P=0.006) and 91.3% (80.2-96.3) versus 98.7% (97.3-99.3) (P=0.0001). Overall survival was not significantly different. On multivariate analysis age 50 years and below, Her2 positive, positive margin status, and not receiving chemotherapy or antiestrogen therapy were associated with a higher risk of local/regional recurrence.

Conclusions: Patients who have had an axillary lymph node dissection and limited node-positive disease may be candidates for treatment with APBI. Further research is ultimately needed to better define specific criteria for APBI in node-positive patients.

*Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA

Arizona Breast Cancer Specialists, Scottsdale, AZ

Department of Radiation Oncology, University of Wisconsin, Madison, WI

§Department of Radiation Oncology, William Beaumont Hospital Royal Oak, MI

Gamma West Cancer Services, Salt Lake City, UT

Supported by an unrestricted educational grant from Elekta.

The authors declare no conflicts of interest.

Reprints: Mitchell Kamrava, MD, 200 UCLA Medical Plaza Suite B265, Los Angeles, CA 90095. E-mail: mkamrava@mednet.ucla.edu.

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