Sobreimpresión en fracción única con braquiterapia intersticial de alta tasa en el tratamiento conservador del carcinoma de mama
ABSTRACT IntroducciónEvaluamos la eficacia de la sobreimpresión del lecho quirúrgico con braquiterapia intersticial de alta tasa de dosis, en fracción
única en pacientes con cáncer de mama, tratadas con tratamiento conservador, como alternativa a la sobreimpresión con electrones.
Material y métodosEntre abril de 1999 y diciembre de 2000, hemos realizado un estudio prospectivo sobre 84 pacientes con carcinoma infiltrante
de mama sometidas a cirugía conservadora, con márgenes libres, seguida de radioterapia externa sobre la mama hasta 46 Gy y
una aplicación de braquiterapia con agujas en el lecho quirúrgico, dando 7 Gy al 90% con alta tasa.
ResultadosCon un seguimiento medio de 43 meses, sólo una paciente ha recaído en zona de implante siendo el control local del 98,5% Otra
paciente presentó un segundo tumor en un cuadrante distinto y tres desarrollaron metástasis. La supervivencia a 5 años es
del 98,7%. La toxicidad aguda ha sido mínima, con estética excelente o buena en el 95%.
ConclusionesLa braquiterapia con alta tasa en fracción única, como sobreimpresión en el tratamiento conservador del cáncer de mama, es
bien tolerada, sencilla y rápida, consiguiendo un control local excelente, con buen resultado estético y una mínima toxicidad
IntroductionWe evaluated the effectiveness of interstitial high dose rate brachytherapy as a single fraction boost to the surgical bed
in patients with breast cancer undergoing conservative treatment. The comparison was with the alternative of electron boost.
Materials and methodsBetween April 1999 and December 2000, we conducted a prospective study of 84 patients with infiltrative breast carcinoma treated
with conservative surgery, with free margins. This was followed by external radiotherapy to the breast of up to 46 Gy and
one application of brachytherapy with needles inserted into the surgical bed, and administering 7 Gy to 90% with high dose
ResultsWith a mean follow-up of 43 months, only one patient had therapeutic failure in the implant area, and local control was 98.5%.
Another patient had a 2nd tumour in a different quadrant and 3 developed metastasis. Survival at 5 years was 98.7%. Acute toxicity was minimal, with
excellent or good cosmetic appearance in 95%.
ConclusionsBrachytherapy with high dose rate as single fraction boost in conservative treatment of breast carcinoma is simple, fast,
well tolerated, with excellent local control, good cosmetic appearance, and with minimal late-onset toxicity.
Article: Evolution in brachytherapyClinical and Translational Oncology 03/2006; 8(2):63-5. DOI:10.1007/s12094-006-0158-x · 2.08 Impact Factor
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ABSTRACT: We present the results of a prospective ten-year follow-up study to prove the effectiveness of a single fraction of 192-Ir high-dose-rate (HDR) brachytherapy (BT) as a boost. Between 1999 and 2000, 84 consecutive patients with invasive breast carcinoma, with over 4 mm free margins after conservative surgery, were treated. All cases were stages T1-2, except for one case, a stage T3, 81% pN0, 19% pN1-2. Chemotherapy was used in 47% and hormonal therapy in 87%. Whole breast external beam radiotherapy (46 Gy) was followed 1-2 weeks later by an implant with metallic needles. A 7 Gy single dose of HDR BT to the 90% isodose line was delivered on an outpatient basis. Dosimetry was performed theoretically. This technique is called FAST-boost because the whole treatment is delivered in about two hours. With a median follow-up of 120 months, three patients relapsed in the margin of the implant and two in a different quadrant (5/84, 6%). Actuarial local control at five and ten years was 98.5% and 95.6%. Overall survival was 92.7% and 90.2%, and disease-free survival 90.2% and 79.9%. Cosmetic results were good or excellent in 92.5%. A single-fraction HDR boost with rigid needles (FAST-boost) is a good, quick, simple technique when surgical margins are free.Clinical and Translational Oncology 02/2012; 14(2):109-15. DOI:10.1007/s12094-012-0769-3 · 2.08 Impact Factor
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ABSTRACT: Conservative treatment represents the current therapy for early-stage breast cancer. When risk factors for local relapse exist, a tumour bed boost is required. Retrospectively, we evaluated the prognostic factors influencing local recurrence (LR), overall survival (OS) and disease-free survival (DFS). After conservative treatment, 210 patients received a single-dose HDR brachytherapy (HDRBT) boost between June 1996 and December 2005. Mean age was 57 years; 75% had invasive ductal carcinoma. The most frequent surgery was lumpectomy (55.7%); 39.4% were G3, 18.6% intraductal component >25% and only 22% had negative margins. With a mean follow-up of 85 months, at 5 and 10 years the OS was 93% and 88%, DFS 92% and 89%, and LR 3.6% and 5.3%, respectively. For LR, the risk factors were carcinoma in situ, N+ and involved margins, whereas for metastasis, the risk factors were T2 tumours, stage III, N+ and the presence of local recurrence. HDR-BT boost in one fraction is an effective, simple and safe method for reducing LR. The outpatient setting and shorter treatment duration represent undeniable advantages.Clinical and Translational Oncology 05/2012; 14(5):362-8. DOI:10.1007/s12094-012-0809-z · 2.08 Impact Factor