title: Long-term cosmetic results and toxicity after accelerated partial-breast irradiation: a method of radiation delivery by interstitial brachytherapy for the treatment of early-stage breast carcinoma.
abstract: BACKGROUND
  The objective of this study was to assess the cosmesis and toxicities in patients with early-stage breast carcinoma who received treatment with accelerated partial breast irradiation (APBI) using interstitial brachytherapy.
  
  
  METHODS
  From April 1993 to December 2001, 199 patients with Stage I-II breast carcinoma received breast-conserving therapy with APBI to the tumor bed alone through a low-dose-rate (LDR) or high-dose-rate (HDR) implant. A template guide was used. The LDR dose was 50 Gray (Gy) over 96 hours; the outpatient HDR implant delivered 32 Gy in 8-Gy or 34 Gy in 10-Gy twice-daily fractions. Cosmesis (Harvard criteria) and toxicities (Radiation Therapy Oncology Group guidelines) were assessed at < or = 6 months, 2 years, and 5 years.
  
  
  RESULTS
  The median follow up was 6.4 years. Breast pain, edema, erythema, and hyperpigmentation all diminished over time. Breast fibrosis and hypopigmentation increased until the 2-year mark and then stabilized. Fat necrosis and telangiectasia increased over time, with a fat necrosis rate of 11% at 5 years. Nearly all telangiectasias (34% at 5 yrs) were Grade 1 (< 2 mm). The remaining toxicities were Grade 1 at all follow-up intervals. Infections (11%) occurred predominantly within the first month after treatment. Good-to-excellent cosmetic outcomes were noted in 95-99% of patients over time; cosmetic results stabilized at 2 years with excellent results increased out to 5 years.
  
  
  CONCLUSIONS
  APBI with interstitial brachytherapy resulted in mild chronic toxicities, the majority of which diminished or reached a plateau over time. Long-term cosmesis was good to excellent in 95-99% of patients and stabilized at 2 years.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. pchen@beaumont.edu
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Chen
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
authors.forename: Pamela
authors.initials: P
authors.lastname: Benitez
authors.forename: Larry L
authors.initials: LL
authors.lastname: Kestin
authors.forename: Michelle
authors.initials: M
authors.lastname: Wallace
authors.forename: Christina
authors.initials: C
authors.lastname: Mitchell
authors.forename: Jane
authors.initials: J
authors.lastname: Pettinga
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Martinez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D004487:Edema / Q000209:etiology; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections; D008875:Middle Aged; D009336:Necrosis; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology; D011832:Radiation Injuries; D012880:Skin Pigmentation