Introduction
Methods
Patient selection and data analysis
Surgery
Systemic therapy
Interstitial implant technique
Whole breast irradiation
Results
All Disease | |||
---|---|---|---|
APBI | WBI | P value | |
Patients
| 202 | 94 | |
Months Follow-up
| 64.3 | 64.1 | 0.422 |
(Range)
| (2.2-96.6) | (4.4-98.4) | |
Median Age
| 60.0 | 56.9 | 0.087 |
(Range)
| (34.7-84.3) | (33.0-83.2) | |
Race
| < 0.001* | ||
Caucasian
| 169 (83.7%) | 52 (55.3%) | |
Black
| 31 (15.4%) | 42 (44.7%) | |
Other
| 2 (1.0%) | 0 (0%) | |
Anatomy
| |||
Side
| 0.803 | ||
Right
| 97 (48.0%) | 47 (50.0%) | |
Left
| 105 (52.0%) | 47 (50.0%) | |
Quadrant
| |||
UOQ
| 88 (43.6%) | 64 (68.1%) | < 0.001* |
UIQ
| 53 (26.2%) | 17 (18.1%) | |
LIQ
| 29 (14.4%) | 5 (5.3%) | |
LOQ
| 32 (15.8%) | 8 (8.5%) | |
Grade
| 0.207 | ||
DCIS
| 40 (19.8%) | 18 (19.1%) | |
I
| 78 (38.6%) | 25 (26.6%) | |
II
| 55 (27.2%) | 27 (28.7%) | |
III
| 29 (14.4%) | 20 (21.3%) | |
Unknown
| 0 (0%) | 4 (4.3%) | |
Stage
| |||
Tis
| 40 (19.8%) | 18 (19.1%) | |
T1
mic
| 3 (1.5%) | 4 (4.3%) | |
T1
a
| 23 (11.4%) | 7 (7.4%) | |
T1
b
| 67 (33.2%) | 29 (30.9%) | |
T1
c
| 54 (26.7%) | 31 (33.0%) | |
T1
| 147 (72.8%) | 71 (75.5%) | |
T2
| 15 (7.4%) | 5 (5.3%) | |
Histology
| 0.092 | ||
DCIS
| 40 (19.8%) | 18 (19.1%) | |
Invasive Ductal
| 141 (69.8%) | 60 (63.8%) | |
Invasive Lobular
| 8 (4.0%) | 11 (11.7%) | |
Invasive Tubular
| 7 (3.5%) | 1 (1.1%) | |
Invasive Mucinous
| 5 (2.5%) | 2 (2.1%) | |
Invasive Papillary
| 1 (0.5%) | 2 (2.1%) | |
Estrogen Receptor
| 0.464 | ||
ER +
| 167 (82.7%) | 71 (71.6%) | |
ER -
| 26 (12.9%) | 15 (16.0%) | |
ER Unknown
| 9 (4.5%) | 8 (8.5%) | |
Progesterone Receptor
| 0.489 | ||
PR +
| 134 (66.3%) | 56 (59.6%) | |
PR -
| 59 (29.2%) | 30 (31.9%) | |
PR Unknown
| 9 (4.5%) | 8 (8.5%) | |
Her-2/Neu
(Invasive Only)
| 0.350 | ||
Overexpressed
| 14 (6.9%) | 9 (4.5%) | |
Not Overexpressed
| 147 (72.8%) | 62 (66.0%) | |
Unknown
| 41 (20.3%) | 23 (24.5%) | |
Disease Type
| |||
Luminal A
| 128 (63.4%) | 51 (54.3%) | 0.353 |
Luminal B
| 9 (4.5%) | 7 (7.5%) | |
Her-2/Neu
| 5 (2.5%) | 2 (2.1%) | |
Basal
| 16 (7.9%) | 11 (3.7%) | |
DCIS
| 40 (19.8%) | 18 (6.1%) | |
Unable to classify
| 4 (2.0%) | 5 (5.3%) | |
LVSI (Invasive Only)
| 0.591 | ||
Present
| 10 (4.9%) | 6 (8.1%) | |
Absent
| 152 (74.5%) | 70 (91.9%) | |
LCIS
| 0.011* | ||
Present
| 15 (7.4%) | 17 (18.1%) | |
Absent
| 187 (92.6%) | 77 (81.9%) | |
EIC (Invasive Only)
| 0.688 | ||
Present
| 4 (2.5%) | 3 (3.9%) | |
Absent
| 148 (91.4%) | 73 (96.1%) | |
Unknown
| 10 (6.2%) | 0 (0%) | |
Endocrine Therapy
(Invasive Only)
| 0.182 | ||
Given
| 127 (78.4%) | 50 (65.8%) | |
Not Given
| 34 (21.0%) | 21 (27.6%) | |
Unknown
| 1 (0.6%) | 5 (6.6%) | |
Endocrine Therapy
(DCIS Only)
| 0.756 | ||
Given
| 29 (72.5%) | 14 (77.8%) | |
Not Given
| 11 (27.5%) | 4 (22.2%) | |
Unknown
| 0 (0%) | 0 (0%) | |
Cytotoxic Chemotherapy
(Invasive Only)
| 0.102 | ||
Given
| 35 (21.6%) | 23 (30.3%) | |
Not Given
| 127 (78.4%) | 49 (64.5%) | |
Unknown
| 0 (0%) | 4 (5.3%) |
DCIS | Invasive | |||||
---|---|---|---|---|---|---|
APBI | WBI | P value | APBI | WBI | P value | |
Patients
| 40 | 18 | 162 | 76 | ||
Months Follow-up
| 69.4 | 72.7 | 0.502 | 62.9 | 62.1 | 0.543 |
(Range)
| (13.7-92.6) | (24.6-87.6) | (2.2-96.6) | (4.4-98.4) | ||
Median Age
| 59.2 | 56.5 | 0.752 | 61.4 | 58.1 | 0.079 |
(Range)
| (40.3-82.4) | (41.4-84.2) | (34.7-84.3) | (33.0-84.7) | ||
Race
| 0.018 | < 0.001 | ||||
Caucasian
| 31 (77.5%) | 10 (55.6%) | 138 (85.2%) | 44 (57.9%) | ||
Black
| 9 (22.5%) | 8 (44.4%) | 22 (13.6%) | 32 (42.1%) | ||
Other
| 0 (0%) | 0 (0%) | 2 (1.2%) | 0 (0.0%) | ||
Anatomy
| ||||||
Side
| 0.776 | 1.000 | ||||
Right
| 17 (42.5%) | 9 (50.0%) | 80 (49.4%) | 38 (50.0%) | ||
Left
| 23 (57.5%) | 9 (50.0%) | 82 (50.6%) | 38 (50.0%) | ||
Quadrant
| 0.049 | < 0.001 | ||||
UOQ
| 18 (45.0%) | 14 (77.8%) | 70 (43.2%) | 50 (65.8%) | ||
UIQ
| 7 (17.5%) | 3 (16.7%) | 46 (28.4%) | 14 (18.4%) | ||
LIQ
| 6 (15.0%) | 1 (5.6%) | 23 (14.2%) | 4 (5.3%) | ||
LOQ
| 9 (22.5%) | 0 (0%) | 23 (14.2%) | 8 (10.5%) | ||
Estrogen Receptor
| 0.548 | 0.256 | ||||
ER +
| 28 (70.0%) | 12 (66.7%) | 139 (85.8%) | 59 (77.6%) | ||
ER -
| 3 (7.5%) | 0 (0%) | 23 (14.2%) | 15 (19.7%) | ||
ER Unknown
| 9 (22.5%) | 6 (33.3%) | 0 (0%) | 2 (2.6%) | ||
Progesterone Receptor
| 0.727 | 0.369 | ||||
PR +
| 21 (52.5%) | 9 (50.0%) | 113 (69.8%) | 49 (64.5%) | ||
PR -
| 10 (25.0%) | 3 (16.7%) | 49 (30.2%) | 27 (35.5%) | ||
PR Unknown
| 9 (22.5%) | 6 (33.3%) | 0 (0%) | 2 (2.6%) | ||
LCIS
| 0.084 | |||||
Present
| 1 (2.5%) | 3 (16.7%) | 14 (8.6%) | 14 (18.4%) | 0.050 | |
Absent
| 39 (97.5%) | 15 (83.3%) | 148 (91.4%) | 62 (81.6%) |
APBI dosimetry
Median | Minimum | Maximum | |
---|---|---|---|
V
100
| 222 | 97.3 | 775 |
V
150
| 43.6 | 19.1 | 190 |
V
200
| 15.6 | 7.01 | 58.2 |
(1-V
150
/V
100
)
| 0.8 | 0.45 | 0.88 |
DHI
| 0.83 | 0.56 | 1.00 |
PTV Volume
| 154.5 | 57.6 | 552 |
PTV Coverage
| 148.5 | 56.2 | 520 |
% PTV Coverage
| 95.7% | 78.5% | 100% |
Cavity Volume
| 18.4 cc | 1.4 cc | 114 cc |
Number of Catheters
| 20 | 10 | 37 |
Recurrence rates and survival analysis
APBI | WBI | P value | |
---|---|---|---|
Overall
| |||
Local Recurrence Rate | 3.04% (5) | 3.82% (3) | 0.721 |
Locoregional Recurrence Rate | 4.25% (7) | 3.82% (3) | 0.902 |
Disease-Free Survival | 94.3% (9) | 93.4% (8) | 0.870 |
Cause Specific Survival | 99.4% (1) | 98.9% (1) | 0.954 |
Overall Survival | 91.9% (15) | 96.7% (3) | 0.113 |
DCIS
| |||
Local Recurrence Rate | 2.56% (1) | 6.25% (1) | 0.573 |
Disease-Free Survival | 97.4% (1) | 93.8% (1) | 0.573 |
Cause Specific Survival | 100% (0) | 100% (0) | - |
Overall Survival | 97.5% (1) | 100% (1) | 0.843 |
Invasive Disease
| |||
Local Recurrence Rate | 3.24% (4) | 3.10% (2) | 0.939 |
Locoregional Recurrence Rate | 4.80% (6) | 3.10% (2) | 0.669 |
Disease-Free Survival | 93.8% (8) | 94.1% (4) | 0.920 |
Cause Specific Survival | 99.3% (1) | 98.6% (1) | 0.968 |
Overall Survival | 90.4% (14) | 95.6% (3) | 0.093 |
Age at Diagnosis | APBI Class | T stage | Histology | Grade | Biomarker Pattern | Adjuvant Treatment | Radiation Modality | Time to Death (months) | Cause of Death |
---|---|---|---|---|---|---|---|---|---|
77.5 | cautionary | 2 | ductal | II | +/+/- | R + E | APBI | 43.76 | CAD*, Anoxic Brain Injury after V Fib episode |
35.6 | unsuitable | 2 | ductal | III | -/-/+ | R | APBI | 60.35 | Recreational Drug Overdose |
45.4 | unsuitable | 2 | ductal | II | +/+/- | R + C + E | APBI | 74.68 | Breast Cancer |
81.8 | acceptable | 1a | ductal | II | +/+/- | R | APBI | 2.83 | Stroke/Fall |
57.4 | cautionary | 1a | ductal | I | +/+/- | R | APBI | 8.25 | Cirrhosis* with Hepatocellular Cancer |
51.6 | cautionary | 1a | ductal | III | +/-/- | R + E | APBI | 35.91 | Colon Cancer* |
66.5 | cautionary | 1a | ductal | III | -/-/- | R | APBI | 41.95 | Myelodysplastic Syndrome |
34.7 | unsuitable | 1b | tubular | I | +/+/- | R | APBI | 2.96 | Urosepsis |
79.1 | acceptable | 1b | ductal | II | +/+/- | R + E | APBI | 16.33 | CAD*, MI |
80.2 | acceptable | 1b | ductal | I | +/+/- | R | APBI | 32.20 | COPD* |
72.3 | acceptable | 1b | ductal | I | +/+/- | R + E | APBI | 33.71 | High Grade Sarcoma* |
70.7 | cautionary | 1b | ductal | III | -/-/- | R | APBI | 46.29 | Breast Cancer |
50.2 | cautionary | 1c | ductal | III | -/-/- | R + C | APBI | 5.95 | Chemotherapy Toxicity |
58.6 | cautionary | 1c | ductal | III | -/-/- | R | APBI | 13.50 | Ovarian Cancer* |
66.1 | acceptable | 1c | ductal | II | +/+/- | R + E | APBI | 56.48 | Melanoma |
68.8 | acceptable | 1c | ductal | II | +/+/- | R + E | APBI | 58.48 | CHF/COPD* |
66.8 | acceptable | 1c | ductal | I | +/+/- | R + E | APBI | 80.89 | Stroke |
49.1 | unsuitable | Is | DCIS | II | +/+/- | R | APBI | 13.70 | Polycystic Kidney Disease* |
67.1 | cautionary | Is | DCIS | III | -/-/+ | R | APBI | 74.35 | Pneumonia (Restrictive Lung Disease*) |
70.93 | acceptable | 1b | ductal | I | +/+/- | R + E | WBI | 14.78 | M. avium infection (Chronic bronchiectasis*) |
68.55 | cautionary | 1b | ductal | III | +/+/- | R | WBI | 22.01 | Breast cancer |
68.76 | acceptable | 1c | mucinous | II | +/+/- | R + E | WBI | 23.10 | Parkinson's Disease |
48.83 | unsuitable | is | DCIS | II | +/-/- | R + E | WBI | 67.02 | CAD*, MI |
Age at Diagnosis | Menopause Status | ASTRO Category | Size | Histology | Grade | Biomarker Pattern | Node Biopsy | Adjuvant Treatment | Radiation Modality | Initial Failure | Failure (months) | Salvage Treatment | Current Status |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
61.7 | Post | cautionary | 1.00 | DCIS | II | +/-/? | No | R + E | APBI | Local - E | 20.3 | MRM + C + E | NED |
62.1 | Post | acceptable | 0.30 | IDC | I | +/+/- | Yes | R + E | APBI | Local - T | 45.3 | MRM + C | NED |
66.8 | Post | acceptable | 1.00 | IDC | II | +/+/- | Yes | R + E | APBI | Local - E | 59.6 | SM | NED |
69.3 | Post | acceptable | 2.00 | IDC | II | +/-/- | Yes | R + E | APBI | Local - E | 38.2 | PM + C + WBI + E | NED |
59.5 | Post | cautionary | 2.00 | IDC | II | +/-/- | Yes | R + E + C | APBI | Local - E | 47.1 | MRM + C + E | NED |
68.2 | Post | cautionary | 0.90 | IDC | III | -/-/- | Yes | R | WBI | Local - E | 49.5 | MRM | NED |
57.0 | Post | cautionary | 1.50 | IDC | III | -/-/- | Yes | R + C | WBI | Local - T | 5.2 | SM | NED |
56.5 | Post | cautionary | 0.90 | DCIS | III | +/+/? | No | R | WBI | Local - T | 49.3 | SM | NED |
62.3 | Post | acceptable | 0.60 | IDC | II | +/+/- | Yes | R + E | WBI | Local - E | 97.5 | MRM + E | NED |
45.4 | Pre | unsuitable | 3.00 | IDC | II | +/+/- | Yes | R + E + C | APBI | Regional | 55.0 | SR + C | Expired |
53.6 | Post | cautionary | 3.00 | IDC | II | +/+/- | Yes | R + E | APBI | Regional | 17.1 | SR + C + R | NED |
70.7 | Post | cautionary | 0.80 | IDC | III | -/-/- | Yes | R | APBI | Metastatic | 32.4 | C + H | Expired |
68.6 | Post | cautionary | 1.00 | IDC | III | +/+/- | Yes | R | WBI | Metastatic | 13.2 | - | Expired |
71.1 | Post | cautionary | 2.10 | IDC | III | -/-/+ | Yes | R + C | APBI | Metastatic | 45.4 | C + R | Under Treatment |
56.5 | Post | cautionary | 2.90 | IDC | III | +/+/+ | Yes | R + C + E | APBI | Metastatic | 60.8 | R | Under Treatment |
58.1 | Post | cautionary | 1.50 | IDC | II | +/-/- | Yes | R | WBI | Metastatic | 46.1 | C | Under Treatment |
Classification by ASTRO consensus guidelines
Criteria | Suitable | Cautionary | Unsuitable |
---|---|---|---|
Age
| ≥ 60 | 50-59 | < 50 |
Tumor Size
| ≤ 2 cm | 2-3 cm | > 3 cm |
T Stage
| T1 | Tis and T2 | T3-T4 |
Nodal biopsy
| Yes | - | No |
Margins
| Negative (≥ 2 mm) | Close (< 2 mm) | Positive |
Histology
| Invasive ductal or other favorable subtypes | Invasive Lobular | - |
Pure DCIS
| No | ≤ 3 cm | > 3 cm |
ER Receptor
| Positive | Negative | - |
LVSI*
| No | Limited/Focal |
Extensive
|
EIC*
| No | ≤ 3 cm |
> 3 cm
|
Overall (%) | Age at Diagnosis | Tumor Size | T Stage | ER Status | Histology | DCIS | EIC | LVSI | Nodal Assessment | |
---|---|---|---|---|---|---|---|---|---|---|
APBI
| ||||||||||
Acceptable
| 58 (28.7) | 101 | 147 | 147 | 167 | 194 | 162 | 158 | 152 | 156 |
Cautionary
| 104 (51.5) | 64 | 15 | 55 | 35 | 8 | 40 | 4 | 10 | 0 |
Unsuitable
| 40 (19.8) | 37 | 0 | 0 | 0 | 0 | 0 | - | - | 6 |
WBI
| ||||||||||
Acceptable
| 16 (17.0) | 41 | 71 | 71 | 71 | 83 | 76 | 73 | 70 | 67 |
Cautionary
| 47 (50.0) | 30 | 5 | 23 | 23 | 11 | 18 | 3 | 6 | 0 |
Unsuitable
| 31 (33.0) | 23 | 0 | 0 | 0 | 0 | 0 | - | - | 9 |