title: The use of the MammoSite balloon applicator in re-irradiation of the breast.
abstract: OBJECTIVE
  To examine the feasibility of using the MammoSite brachytherapy applicator in the retreatment of the previously irradiated breast.
  
  
  METHODS
  Between March 2004 and March 2007, three patients previously treated with external beam radiotherapy were retreated using the MammoSite brachytherapy device. Two patients were treated for an ipsilateral breast tumor recurrence after breast conservation surgery and postoperative irradiation, whereas the third patient developed an in-field breast cancer likely associated with Hodgkin's disease mantle irradiation 27 years before. The recurrent histology of two was ductal carcinoma in situ ([DCIS] one originally presenting as infiltrating ductal carcinoma [IDC] and the other as DCIS), whereas the Hodgkin's disease patient presented with IDC. All patients received a twice-daily tumor dose of 3400 cGy at 340 cGy/fraction. The mean maximum skin dose was 53.4% (range, 49.5-60.3%) of the prescribed dose.
  
  
  RESULTS
  With a mean followup of 32 months, no patient developed a local recurrence. Cosmesis in all three cases as graded by the National Surgical Adjuvant Breast and Bowel Project, cosmesis criteria was excellent (Grade I) in all cases. Dosimetric calculations demonstrated that the device allows for appropriate local irradiation while sparing the previously irradiated skin of the involved breast as defined by the protocol standard.
  
  
  CONCLUSIONS
  Use of the MammoSite device in the treatment of the previously irradiated breast is feasible and may provide adequate local control as well as acceptable cosmesis in carefully selected patients.
authors.affiliation: Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA. mtrombet@wpahs.org
authors.forename: Mark
authors.initials: M
authors.lastname: Trombetta
authors.forename: Thomas
authors.initials: T
authors.lastname: Julian
authors.forename: Moyed
authors.initials: M
authors.lastname: Miften
authors.forename: Woodrow
authors.initials: W
authors.lastname: McWilliams
authors.forename: Yongbok
authors.initials: Y
authors.lastname: Kim
authors.forename: David
authors.initials: D
authors.lastname: Parda
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D001940:Breast / Q000528:radiation effects; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects; D011881:Radiotherapy, Computer-Assisted; D016896:Treatment Outcome