title: Long-term outcome with interstitial brachytherapy in the management of patients with early-stage breast cancer treated with breast-conserving therapy.
abstract: OBJECTIVE
  We reviewed our institution's experience with interstitial implant boosts to determine their long-term impact on local control and cosmetic results.
  
  
  METHODS
  Between January 1, 1980 and December 31, 1987, 390 women with 400 cases of Stage I and II breast cancer were managed with breast-conserving therapy (BCT) at William Beaumont Hospital. All patients were treated with an excisional biopsy and 253 (63%) underwent reexcision. Radiation consisted of 45-50 Gy external beam irradiation to the whole breast followed by a boost to the tumor bed to at least 60 Gy using either electrons [108], photons [15], or an interstitial implant [277] with either 192Ir [190] or 125I [87]. Long-term local control and cosmetic outcome were assessed and contrasted between patients boosted with either interstitial implants, electrons, or photons.
  
  
  RESULTS
  With a median follow-up of 81 months, 25 patients have recurred in the treated breast for a 5- and 8-year actuarial rate of local recurrence of 4 and 8%, respectively. There were no statistically significant differences in the 5- or 8-year actuarial rates of local recurrence using either electrons, photons, or an interstitial implant. Greater than 90% of patients obtained a good or excellent cosmetic result, and no statistically significant differences in cosmetic outcome were seen whether electrons, photons, or implants were used.
  
  
  CONCLUSIONS
  We conclude that patients with Stage I and II breast cancer undergoing BCT and judged to be candidates for boosts can be effectively managed with LDR interstitial brachytherapy. Long-term local control and cosmetic outcome are excellent and similar to patients boosted with either electrons or photons.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Vicini
authors.forename: E M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: M D
authors.initials: MD
authors.lastname: Lacerna
authors.forename: C F
authors.initials: CF
authors.lastname: Dmuchowski
authors.forename: D M
authors.initials: DM
authors.lastname: Brown
authors.forename: J
authors.initials: J
authors.lastname: White
authors.forename: P Y
authors.initials: PY
authors.lastname: Chen
authors.forename: G K
authors.initials: GK
authors.lastname: Edmundson
authors.forename: G S
authors.initials: GS
authors.lastname: Gustafson
authors.forename: D H
authors.initials: DH
authors.lastname: Clarke
authors.forename: G S
authors.initials: GS
authors.lastname: Gustafson
authors.forename: R C
authors.initials: RC
authors.lastname: Matter
authors.forename: A A
authors.initials: AA
authors.lastname: Martinez
mesh_terms: D000328:Adult; D001706:Biopsy; D001918:Brachytherapy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D007496:Iridium Radioisotopes