title: Adjuvant stereotactic permanent seed breast implant: a boost series in view of partial breast irradiation.
abstract: OBJECTIVE
  The aim of this study was to use permanent seed implants in the breast and describe our experience with 15 cases, using iodine seed implants as a tumor bed boost.
  
  
  METHODS
  Breasts were fixed with a thermoplastic sheet, a template bridge applied, the thorax scanned and the images rotated to be perpendicular to the implant axis. Skin, heart, and lung were delineated. A preplan was made, prescribing 50 Gy to the clinical target volume (CTV), consisting in this boost series of nearly a quadrant. Iodine (125) seeds were stereotactically implanted through the template, and results were checked with a postplan computed tomographic (CT) scan.
  
  
  RESULTS
  The breast was immobilized reproducibly. Simulation, scanning, and implant were performed without difficulties. Preplan CTV D90% (the dose delivered to 90% of the CTV) was 66 Gy, and postoperative fluoroscopic or CT scan checks were satisfactory. Pre- and postplan dose-volume histogram showed good organ sparing: mean postplan skin, heart, and lung V30 Gy (the organ volume receiving a dose of 30 Gy) of 2 +/- 2.2 mL, 0.24 +/- 0.34 mL, and 3.5 +/- 5 mL, respectively. No short-term toxicity above Grade 1 was noted, except for transient Grade 3 neuropathy in 1 patient.
  
  
  CONCLUSIONS
  Seeds remained in the right place, as assessed by fluoroscopy, absence of significant pre- to postplan dose-volume histogram change for critical organs, and total irradiated breast volume. The method could be proposed as a boost when high dosimetric selectivity is required (young patients after cardiotoxic chemotherapy for left-sided cancer). This boost series was a preliminary step before testing partial breast irradiation by permanent seed implant in a prospective trial.
authors.affiliation: Department of Radiation Oncology, Liege University Hospital, Liege, Belgium. nicolas.jansen@chu.ulg.ac.be
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jansen
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Deneufbourg
authors.forename: Philippe
authors.initials: P
authors.lastname: Nickers
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control; D011859:Radiography; D013238:Stereotaxic Techniques
chemical_list: D007457:Iodine Radioisotopes