title: Breast cancer recurrence after inadvertent malpositioning of a partial breast radiation catheter.
abstract: Accelerated partial breast irradiation (APBI) is an alternative to receiving whole breast radiation in carefully selected patients. Because breast cancer local recurrence rates are low and follow-up has been short-term, the exact cause of recurrences after APBI has been difficult to evaluate. We report the first case of documented radiation balloon catheter malpositioning that resulted in local recurrence. Patients undergo CT imaging of the breast after radiation balloon catheter placement for radiotherapy treatment planning, which evaluates adequate conformance of the balloon to the surrounding breast parenchyma and confirms a >7 mm distance between the balloon surface and the skin surface. Although true local recurrences are rare in appropriately selected partial breast irradiation candidates, inadvertent malpositioning of the radiation treatment catheter can increase the risk. This case is presented to illustrate the importance of comparing CT radiation planning images, with treatment catheter in place, to the original diagnostic breast imaging studies to confirm proper catheter positioning (in addition to measuring balloon to skin distance and conformance) prior to initiating radiotherapy.
authors.affiliation: University of Southern California, Keck School of Medicine, Division of Breast and Soft Tissue Surgery, Los Angeles, CA 90033, USA. stephanie.a.valente@gmail.com
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Valente
authors.forename: Gary M
authors.initials: GM
authors.lastname: Levine
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Guerra
authors.forename: Melvin J
authors.initials: MJ
authors.lastname: Silverstein
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D016896:Treatment Outcome