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Every four local failures avoided, one death avoided at 15 years.
Local recurrence is related to dose and young age.
In young age, even with a boost, local recurrence goes up with F.U.
If bed tumor is bad defined, larger volumes are required.
Doses between 7-10 Gy HDR in a single dose are useful.
In women aged ≤ 45 HDR boost improves local control.
With positive/close margins, a high dose boost reduces local failure.
A higher biological effect of HDR can explain this improved result.
The boost dose has to be tailored to the risk factors
low risk............ no boost is mandatory (APBI)
medium risk..... 10-16 Gy or 1 x 7-8Gy (Fast-boost)
high risk........... ≥16Gy or 1 x 8-10Gy or 3 x 4.7Gy
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