Authors: Marc André Mahé Albert Lisbona JeanFrançois Chatal
Publish Date: 2009/12/05
Volume: 37, Issue: 2, Pages: 201-202
Abstract
After breastconserving surgery the standard treatment for the majority of patients with early breast cancer is adjuvant wholebreast radiotherapy delivering a dose of about 50 Gy and followed by an additional local boost dose of 10–20 Gy applied to the tumour bed Such adjuvant treatment allows reduction in the absolute risk of local recurrence by 19 in patients with negative lymph nodes and 33 in patients with positive lymph nodes Moreover the gain in survival has been shown to be 54 at 15 years 1This treatment irradiates both the clusters of malignant cells located inside or in close proximity to the tumour bed and remote sites in the breast Moreover it can be completed with irradiation of lymph node areas according to the anatomical localization of the tumour and histoprognostic factors such as axillary lymph node involvementThe limitations of this wholebreast radiotherapy include delay exceeding 8 weeks in initiating treatment which may decrease the probability of local control 2 and overall treatment time which is a problem for patients continuing their professional activity for elderly patients and for patients living far from the radiotherapy centre Moreover cosmetic outcomes are not always excellent due to fibrosis and finally transportation costs may have a significant financial impactOver the past few years accelerated partialbreast irradiation has been used as an alternative to wholebreast radiotherapy aiming at shortening overall treatment time and reducing the workload of radiotherapy departments and cost Several techniques have been implemented and are being used for specific indications 3The interstitial multicatheter technique has the longest reported experience exceeding 5 years It is an invasive procedure requiring good clinical experience and consists in inserting some plastic catheters loaded with 192Ir into the tumour bed This technique is flexible which allows adapting the conformation of the irradiated volume to the anatomical characteristics and having a reproducible geometry of the dose distributionIntraoperative radiotherapy using electrons produced in a linear accelerator or 50 kV Xrays is another technique Intrabeam® with a rationale based on the immediate irradiation of the tumour bed after surgical resection of the tumour The intraoperative condition allows delivering a high dose to a limited volume and sparing the surrounding normal tissueAnother technique uses a balloon catheter called MammoSite® filled with 192Ir and inserted into the resection cavity This is a simple method requiring a short learning curve and with a wellstandardized dosimetry but which may not be adapted to specific individual target volumes Moreover this technique may lead to unfavourable cosmetic outcomes
Keywords: