title: Tumor bed-to-skin distance using accelerated partial-breast irradiation with the strut-adjusted volume implant device.
abstract: OBJECTIVE
  Because of the risk of skin toxicity with single dwell position, single-lumen brachytherapy devices are sometimes contraindicated for tumor cavities 5-7mm from the skin surface. We discuss the use of multicatheter device to treat patients with tumor bed-to-skin distances <7mm.
  
  
  METHODS
  We treated 117 patients with accelerated partial-breast irradiation brachytherapy: 77 single-lumen and 40 multicatheter devices. A subset of 12 patients treated with SAVI(®) had bed-to-skin spacing <7mm. All patients had Tis-2N0 ductal carcinoma with negative margins. A total dose of 34.0Gy in 10 fractions was delivered twice daily. Planning target volume was created using computed tomography-based three-dimensional planning with a 1.0-cm expansion of the lumpectomy cavity. Skin dose was measured dosimetrically, with skin constraints <125% of the prescription. Toxicities were graded, and patients were assessed at various intervals.
  
  
  RESULTS
  Of the patients treated with the multicatheter device, 0% (0/12) had their device pulled. At 2 weeks after treatment, fewer than 50% of the patients had skin toxicities of Grades 1-2, all of which resolved by 6 months. The cosmetic outcome was good to excellent at followup.
  
  
  CONCLUSIONS
  Multicatheter devices permit well-tolerated accelerated partial-breast irradiation in patients with tumor cavities near the skin surface for which the single-lumen device may not be appropriate.
authors: Department of Radiation Oncology, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA. brandon.fisher@drexelmed.edu
authors: Brandon
authors: B
authors: Fisher
authors: Larry
authors: L
authors: Daugherty
authors: Talha
authors: T
authors: Shaikh
authors: Jay
authors: J
authors: Reiff
authors: Dan
authors: D
authors: Perlingiero
authors: Fiori
authors: F
authors: Alite
authors: Luther
authors: L
authors: Brady
authors: Lydia
authors: L
authors: Komarnicky
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy; D044584:Carcinoma, Ductal / Q000532:radiotherapy*; D002404:Catheterization / Q000295:instrumentation*; D005260:Female; D006801:Humans; D011829:Radiation Dosage; D011881:Radiotherapy, Computer-Assisted