title: Timing of Chemotherapy after MammoSite radiation therapy system breast brachytherapy: analysis of the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial.
abstract: OBJECTIVE
  To evaluate cosmetic outcome and radiation recall in the American Society of Breast Surgeons registry trial, as a function of the interval between accelerated partial breast irradiation (APBI) and initiation of chemotherapy (CTX).
  
  
  METHODS
  A total of 1440 patients at 97 institutions participated in this trial. After lumpectomy for early-stage breast cancer, patients received APBI (34 Gy in 10 fractions) with MammoSite RTS brachytherapy. A total of 148 patients received CTX within 90 days of APBI. Cosmetic outcome was evaluated at each follow-up visit and dichotomized as excellent/good or fair/poor.
  
  
  RESULTS
  Chemotherapy was initiated at a mean of 3.9 weeks after the final MammoSite procedure and was administered </=3 weeks after APBI in 54 patients (36%) and >3 weeks after APBI in 94 patients (64%). The early and delayed groups were well balanced with respect to multiple factors that may impact on cosmetic outcome. There was a superior cosmetic outcome in those receiving chemotherapy >3 weeks after APBI (excellent/good in 72.2% at </=3 weeks vs. excellent/good in 93.8% at >3 weeks; p = 0.01). Radiation recall in those receiving CTX at </=3 weeks was 9 of 50 (18%), compared with 6 of 81(7.4%) in those receiving chemotherapy at >3 weeks (p = 0.09).
  
  
  CONCLUSIONS
  The majority of patients receiving CTX after APBI have excellent/good cosmetic outcomes, with a low rate of radiation recall. Chemotherapy initiated >3 weeks after the final MammoSite procedure seems to be associated with a better cosmetic outcome and lower rate of radiation recall. An excellent/good cosmetic outcome in patients receiving CTX after 3 weeks was similar to the cosmetic outcome of the overall patient population who did not receive CTX.
authors.affiliation: Department of Radiation Oncology, The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
authors.forename: Peter
authors.initials: P
authors.lastname: Beitsch
authors.forename: Coral
authors.initials: C
authors.lastname: Quiet
authors.forename: Angela
authors.initials: A
authors.lastname: Keleher
authors.forename: Delia
authors.initials: D
authors.lastname: Garcia
authors.forename: Howard
authors.initials: H
authors.lastname: Snider
authors.forename: Mark
authors.initials: M
authors.lastname: Gittleman
authors.forename: Victor
authors.initials: V
authors.lastname: Zannis
authors.forename: Henry
authors.initials: H
authors.lastname: Kuerer
authors.forename: Eric
authors.initials: E
authors.lastname: Whitacre
authors.forename: Pat
authors.initials: P
authors.lastname: Whitworth
authors.forename: Richard
authors.initials: R
authors.lastname: Fine
authors.forename: Martin
authors.initials: M
authors.lastname: Keisch
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D019651:Plastic Surgery Procedures; D012042:Registries; D012955:Societies, Medical; D013518:Surgery, Plastic; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents