Breast-conservative surgery with close or positive margins: can the breast be preserved with high-dose-rate brachytherapy boost?
OBJECTIVE
To evaluate the likelihood of preserving the breast in women who show close or positive margins after conservative surgery for early breast carcinoma.


METHODS
Since 1996, 125 women with less than 5 mm or positive margins and positive separate cavity margin sampling were entered in a prospective trial with high-dose radiotherapy. A standard dose of 50 Gy to the whole breast was followed by a high-dose-rate brachytherapy application delivering 3 fractions of 4.4 Gy in 24 hours. The median follow-up was 84 months.


RESULTS
There were only seven local recurrences, with an actuarial local control rate of 95.8% at 5 years and 91.1% at 9 years. Actuarial overall and cause-specific survival rates were 92.6% and 95% at 5 years and 86.7% and 90.4% at 9 years, respectively. Late fibrosis was the most common complication, in 30% of patients, with good or excellent cosmetic results in 77%. The final result was that 95.2% of breasts were preserved.


CONCLUSIONS
Close or positive-margin breast cancer can be well managed with a high-dose boost in a wide tumor bed by means of high-dose-rate brachytherapy. This technique can avoid mastectomy or poor cosmetic resection, with minimal risk of local or general failure.
Guinot
Jose Luis
JL
Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain. jguinot@fivo.org
Roldan
Susana
S
Maroñas
María
M
Tortajada
Isabel
I
Carrascosa
Maria
M
Chust
Maria Luisa
ML
Estornell
Marian
M
Mengual
Jose Luis
JL
Arribas
Leoncio
L
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D001940:Breast; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018365:Neoplasm, Residual; D011446:Prospective Studies; D015996:Survival Rate