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Six-Year Results From a Phase I/II Trial for Hypofractionated Accelerated Partial Breast Irradiation Using a 2-Day Dose Schedule

Wilkinson, John B., MD*; Chen, Peter Y., MD; Wallace, Michelle F., BSN, RN, OCN; Shah, Chirag S., MD; Benitez, Pamela R., MD; Martinez, Alvaro A., MD§; Vicini, Frank A., MD§

American Journal of Clinical Oncology: October 2018 - Volume 41 - Issue 10 - p 986–991
doi: 10.1097/COC.0000000000000402
Original Articles: Breast

Background: To report 6-year outcomes from a phase I/II trial using balloon-based brachytherapy to deliver APBI in 2 days.

Methods: A total of 45 patients with early-stage breast cancer received adjuvant APBI in 2 days with high-dose rate (HDR) brachytherapy totaling 2800 cGy in 4 fractions (700 cGy BID) using a balloon-based applicator as part of a prospective phase I/II clinical trial. All patients had negative margins and skin spacing ≥8 mm. We evaluated toxicities (CTCAE v3) as well as ipsilateral breast tumor recurrence (IBTR), regional nodal failure (RNF), distant metastasis, disease-free survival, cause-specific survival, and overall survival.

Results: Median age and tumor size were 66 years old (48 to 83) and 0.8 cm (0.2 to 2.3 cm), respectively. Four percent of patients were N1 (n=2) and 73% were estrogen receptor (ER) positive (n=32). Median follow-up was 6.2 years (2.4 to 8.0 y). Nearly all toxicities at 6 years were grade 1 to 2 except 1 instance of grade 3 telangiectasia (2%). Eleven percent (n=5) of patients had chronic asymptomatic fat necrosis whereas asymptomatic seromas were noted on mammogram in 13% of cases (n=6). Cosmesis at last follow-up was good or excellent in 91% of cases (n=40) and fair in 9% (n=4). Two of the previously reported rib fractures healed with conservative measures. There were no IBTR or RNF (6 y IBTR/RNF rate 0%); however, 2 patients experienced distant metastasis (4% at 6 y). The 6-year actuarial disease-free survival, cause-specific survival, and overall survival were 96%, 100%, and 93%, respectively.

Conclusions: Hypofractionated 2-day APBI using brachytherapy resulted in excellent clinical outcomes with acceptable chronic toxicities.

*Provision Proton Therapy Center, Knoxville, TN

Oakland University William Beaumont School of Medicine, Royal Oak

§Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, MI

Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH

The authors declare no conflicts of interest.

Reprints: John B. Wilkinson, MD, Provision Proton Therapy Center, Knoxville, TN 37909. E-mail:

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