title: Partial breast brachytherapy as the primary treatment for breast cancer diagnosed after mantle radiation therapy for Hodgkin's disease.
abstract: OBJECTIVE
  Mastectomy is the most widely accepted treatment for managing breast cancer in patients who have previously received mantle radiation therapy (RT). With accumulating evidence supporting partial breast irradiation, we treated newly diagnosed breast cancer among lymphoma survivors who had history of RT with lumpectomy and breast brachytherapy.
  
  
  METHODS
  Five patients, with history of Hodgkin disease (HD) underwent lumpectomy and sentinel lymphadenectomy +/- axillary dissection followed by low dose rate Ir-192 interstitial brachytherapy. A multicatheter technique was used and all patients received 45 Gy to the target volume over 4 to 5 day time interval. Adjuvant systemic therapy when indicated was administered after completion of brachytherapy.
  
  
  RESULTS
  The median time from the treatment of the HD to the diagnosis of breast cancer was 242 months (range: 68-322 months). The median T-size of the invasive breast cancer is 0.7 cm. The range of follow up after brachytherapy is 5 to 67 months. All 5 patients have an intact breast and are without evidence of relapse. No patients developed an infection. No skin toxicity > or =grade 2 was observed. All patients have an excellent cosmetic result. No excessive fibrosis or necrosis has been observed.
  
  
  CONCLUSIONS
  The preliminary experience using partial breast brachytherapy (PBB) in patients with previous history of mantle RT suggests low complication rates, and acceptable cosmetic results. The excellent local control and freedom from mastectomy for local recurrence warrants further investigation to establish brachytherapy as an acceptable alternative to mastectomy for early stage breast cancer among HD survivors with history of prior RT.
authors.affiliation: Department of Radiation Oncology, Beth Israel Medical Center, New York, NY 10003, USA. mchadha@chpnet.org
authors.forename: Manjeet
authors.initials: M
authors.lastname: Chadha
authors.forename: Harold
authors.initials: H
authors.lastname: Yoon
authors.forename: Sheldon
authors.initials: S
authors.lastname: Feldman
authors.forename: Niral
authors.initials: N
authors.lastname: Shah
authors.forename: Eric
authors.initials: E
authors.lastname: Moore
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
mesh_terms: D000328:Adult; D001918:Brachytherapy; D001943:Breast Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000209:etiology / Q000532:radiotherapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000209:etiology / Q000532:radiotherapy; D005260:Female; D006689:Hodgkin Disease / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000209:etiology / Q000532:radiotherapy*; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult