title: Improvements in critical dosimetric endpoints using the Contura multilumen balloon breast brachytherapy catheter to deliver accelerated partial breast irradiation: preliminary dosimetric findings of a phase iv trial.
abstract: OBJECTIVE
  Dosimetric findings in patients treated with the Contura multilumen balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) on a multi-institutional Phase IV registry trial are presented.
  
  
  METHODS
  Computed tomography-based three-dimensional planning with dose optimization was performed. For the trial, new ideal dosimetric goals included (1) ≥95% of the prescribed dose (PD) covering ≥90% of the target volume, (2) a maximum skin dose ≤125% of the PD, (3) maximum rib dose ≤145% of the PD, and (4) the V150 ≤50 cc and V200 ≤10 cc. The ability to concurrently achieve these dosimetric goals using the Contura MLB was analyzed.
  
  
  RESULTS
  144 cases were available for review. Using the MLB, all dosimetric criteria were met in 76% of cases. Evaluating dosimetric criteria individually, 92% and 89% of cases met skin and rib dose criteria, respectively. In 93% of cases, ideal target volume coverage goals were met, and in 99%, dose homogeneity criteria (V150 and V200) were satisfied. When skin thickness was ≥5 mm to <7 mm, the median skin dose was limited to 120.1% of the PD, and when skin thickness was <5 mm, the median skin dose was 124.2%. When rib distance was <5 mm, median rib dose was reduced to 136.5% of the PD. When skin thickness was <7 mm and distance to rib was <5 mm, median skin and rib doses were jointly limited to 120.6% and 142.1% of the PD, respectively.
  
  
  CONCLUSIONS
  The Contura MLB catheter provided the means of achieving the imposed higher standard of dosimetric goals in the majority of clinical scenarios encountered.
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23298-0058, USA. darthur@mcvh-vcu.edu
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Arthur
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
authors.forename: Dorin A
authors.initials: DA
authors.lastname: Todor
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Julian
authors.forename: Maureen R
authors.initials: MR
authors.lastname: Lyden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D057785:Catheters; D004867:Equipment Design; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012272:Ribs / Q000528:radiation effects; D012867:Skin / Q000033:anatomy & histology / Q000528:radiation effects; D047368:Tumor Burden