Interstitial multi-catheter breast brachytherapy: Technical aspects and experience feedback in a comprehensive cancer center |
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| Affiliation: | 1. Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vand?uvre-lès-Nancy, France;2. Faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Forêt de Haye, 54505 Vand?uvre-lès-Nancy, France;3. Biostatistic unit, institut de cancérologie de Lorraine, 54519 Vand?uvre-lès-Nancy, France;1. Département de radiothérapie oncologie, groupement hospitalier Lyon Sud, Hospices civils de Lyon, Pierre-Bénite, France;2. Université Claude-Bernard Lyon 1, Lyon, France;3. Département de radiologie, groupement hospitalier Lyon Nord, Hospices civils de Lyon, Lyon, France;4. Département d’hépatologie, groupement hospitalier Lyon Nord, Hospices civils de Lyon, Lyon, France;1. AP–HP, hôpital universitaire Pitié-Salpêtrière, service d’oncologie radiothérapie, 47–83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;2. Université de Paris, institut Cochin, Inserm, CNRS, 22, rue Méchain, 75014 Paris, France;3. AP–HP, hôpital universitaire Pitié-Salpêtrière, service d’oncologie médicale, 47–83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;1. Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal;2. Cancer Epidemiology Group, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal;1. Département de radiothérapie, Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, CS 30 519, 54511 Vand?uvre-lès-Nancy, France;2. Département de biostatistiques, Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54511 Vand?uvre-lès-Nancy, France;3. Département de radiothérapie, centre Henri-Becquerel, 76000 Rouen, France;1. Department of radiation oncology, centre François-Baclesse, Caen, France;2. Department of surgery, centre François-Baclesse, Caen, France;3. CAC, Nantes, France;4. ISC, Avignon, France;5. CHE, Nice, France;6. CJP, Clermont-Ferrand, France;7. AP–HP, Pitié-Salpêtrière, Paris, France;8. CHU, Amiens, France;9. CHU, Lyon, France;10. CHU, Bordeaux, France;11. Institut Lorraine, Nancy, France;12. CHU HEGP, Paris, France;13. Oncopole, Toulouse, France;14. CPS, Strasbourg, France;15. CHU Tenon, Paris, France;p. CHU, Tours, France;q. COL, Lille, France;r. CJB, Le Mans, France;s. CLB, Lyon, France;t. CHU, Brest, France;u. Institut Godinot, Reims, France;v. CHU, Besançon Montbéliard, France;w. CHB, Rouen, France;x. CHU, Grenoble, France;y. CGFL, Dijon, France;z. CHU, Marseille, France;11. Department of ENT surgery, CHU Caen, Caen, France;12. Unicaen, Normandie Université, Caen, France;13. GORTEC, France;1. Radiation Oncology Department, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France;2. LaTIM, INSERM, UMR 1101, University of Brest, 29200, Brest, France |
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| Abstract: | PurposeTo focus on technical aspects of the implementation of interstitial high dose rate brachytherapy, with a step-by-step approach.Materials and methodsPatients were selected during multidisciplinary tumor boards, according to inclusion criteria adapted from GEC-ESTRO guidelines. A CT scan was performed a few days before implantation. On pre-implant CT, using surgical scar and clips, surgical and pathological reports, and preoperative images, we delineated the tumor bed to be included in the Clinical Target Volume (CTV), according to GEC ESTRO Recommendations. A 3D virtual implant simulation of the best catheter positions was performed in order to cover the target volume. Implantation was then carried out under local anaesthetic using 3D projections of the catheter inlets and outlets. Dosimetry was performed on post-implantation CT scan. A dose of 34 Gy was delivered in 10 fractions. Acute and late side effects, and local control were evaluated 2 and 8 months after treatment.ResultsBetween July 2017 and January 2020, 20 patients were treated with accelerated partial breast irradiation. Dose constraints regarding target volume coverage, overdose, dose homogeneity, conformation index and organs at risk were met in 94.7%, 100%, 63.2%, 0% and 89.5% of the treatment plans, respectively. Grade 1-2 acute adverse events were observed in 21% of patients, with no grade 3-4 events.ConclusionThe first dosimetric results and early clinical tolerance and efficacy achieved by the implementation of breast interstitial multicatheter brachytherapy in routine clinical practice are very encouraging, and confirm the interest of extending this practice. |
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| Keywords: | Breast Brachytherapy Interstitial Technical Sein Curiethérapie Interstitielle Techniques |
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