Breast conserving surgery and accelerated partial breast irradiation using the MammoSite system: initial clinical experience.
OBJECTIVE
Balloon catheter-based accelerated partial breast irradiation (APBI) may result in desirable short-term outcomes in patients undergoing breast conserving surgery.


METHODS
Prospective consecutive case series.


METHODS
Tertiary multidisciplinary referral center.


METHODS
Forty selected patients with invasive breast carcinoma undergoing breast conserving surgery and MammoSite device placement.


METHODS
Breast conserving surgery, sentinel and/or axillary node dissection, placement of the new balloon catheter applicator (MammoSite device), and APBI.


METHODS
Infection, early and late seroma, device explantation, time to initiating APBI, acute toxic effects on the skin, and cosmesis using the Harvard Scale.


RESULTS
Thirty-nine patients underwent MammoSite device placement at the time of lumpectomy; 1 patient underwent percutaneous device placement after lumpectomy. Nineteen patients (49%) had drainage catheters placed in the breast cavity at the time of lumpectomy. Wound infection developed in 3 patients (8%). Five devices (12%) were explanted because of unfavorable final pathological findings or infection. The mean time to the start of APBI in patients who did not undergo simultaneous drain placement was 7.2 days (range, 5-12 days), compared with 5.1 days (range, 3-8 days) in patients who did (P = .008). With a mean follow-up of 13.3 months (range, 2-28 months), patients completing APBI had limited toxic effects on the skin, with excellent or good cosmetic results in 39 patients (97%).


CONCLUSIONS
Use of the MammoSite system in APBI has favorable short-term outcomes. Infection and radiation treatment delay are common and may warrant use of perioperative antibiotics and drain placement, respectively. A small number of patients who have device placement at the time of lumpectomy will require explantation because of unfavorable final pathological findings. Short-term outcomes of MammoSite brachytherapy support further studies comparing APBI with standard whole breast irradiation in patients undergoing breast conserving surgery.
DiFronzo
L Andrew
LA
Departments of Surgical Oncology and Radiation Oncology, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA 90027, USA. andrew.L.difronzo@kp.org
Tsai
Peter I
PI
Hwang
Julie M
JM
Lee
John J
JJ
Ryoo
Monica C
MC
Rahimian
Javad
J
Tome
Michael
M
Takasugi
Jan K
JK
Haigh
Philip I
PI
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D011878:Radiotherapy; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome