19 Breast Cancer

448 Breast Cancer

Table 18.2: Percentage Excellent(E) and Good (G) cosmetic results after Brachytherapy boost, compared to electron beam boost. Retrospective studies.

Author

N

Fup

EBRT

External beam Boost Dose % E+G

Interstitial Dose % E+G

P

Ray and Fish 1983 (38) Fowble et al. 1986 (11) Olivotto et al. 1989 (32) De le Roche- fordiere et al.1992 (7) Mansfield et al. 1995 (29) Touboul et al. 1995 (48) Perez et al. 1996 (34) Wazer et al. 1997 (61) Hammer et al. 1998 (19) RT ONLY Fourquet et al. 1995 (10) Sarin et al. 1993 (42)

130 2y

45-50 Gy

15-25 Gy variable energy

97% (107pts)

15-25 Gy LDR

74% (23pts)

na

(0.5-5y)

29mos (E) 54mos(Ir)

96%

88%

497 3y

85%

58%%

P<0.03

337 3y

46(+-6)Gy

16 Gy (7-11MeV)

97% (73% E)

20 Gy LDR

95% (79%E)

NS

1070 10y

45 Gy

20 Gy

95%

20Gy

91%

289 3,5y

45Gy(5Gy) 15-20Gy (8-11MeV)

40%

15-20Gy (8-11MeV)

81%

P<0004

(0.3- 11y)

329 2.5-11y

45-50 Gy

15 Gy (9-12MeV) 10-20Gy (9-12MeV) 20 Gy 10-14 Gy no boost

83% (31%E)

62 % (19%E)

P<0.001*

701 5.6y

48-50 Gy

81%

10-20Gy LDR

75%

(4-24y)

517 5y

50 Gy

68% 84 % 87% 70%

20Gy LDR

90%

P=0.001 P=0.01 ns p<0.0001

(1-11 y)

420 5y

50 Gy

10.8 Gy

10 Gy HDR

88%

255 3-7.3 y

57.6 Gy

20 Gy (CO 60)

75% (48%E)

20 Gy LDR

71% (31% E)

P=0.6

EL pts received whole breast RT with cobalt 60, IS pts with 6 MV Linac

Sarin et al. (42) and recent publications by Wazer et al. (61) and Hammer et al. (19) found the cosmetic results after interstitial brachytherapy superior to external boosts with less fibrosis and skin teleangiectases. In the Graz-Linz series, it is interesting to note that the significant decrease in fibrosis (from 29% for electron beam boost to 17% for implants) was consistent with a 3 fold reduction of the treated boost volume (from 70-130 ml in electrons to 21-64 ml). Furthermore, there was as well a significant reduction in radiation teleangiectasia (from 28% for electrons to 9% for implants), leading to good and excellent results in 88% of brachytherapy boost patients and 70% in electron beam boosts ( p<0.001)