title: Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy.
abstract: OBJECTIVE
  To evaluate clinical outcome after accelerated partial breast irradiation (APBI) in the elderly after high-dose-rate interstitial multi-catheter brachytherapy (HIBT).
  
  
  METHODS
  Between 2005 and 2013, 70 patients underwent APBI using HIBT. Catheter implant was performed intra or post-operatively (referred patients) after lumpectomy and axillary sentinel lymph node dissection. Once the pathological results confirmed the indication of APBI, planification CT-scan was performed to deliver 34 Gy/10f/5d or 32 Gy/8f/4d. Dose-volume adaptation was manually achieved (graphical optimization). Dosimetric results and clinical outcome were retrospectively analyzed. Physician cosmetic evaluation was reported.
  
  
  RESULTS
  With a median follow-up of 60.9 months [4.6 - 90.1], median age was 80.7 years [62 - 93.1]. Regarding APBI ASTRO criteria, 61.4%, 18.6% and 20% were classified as suitable, cautionary and non-suitable respectively. Axillary sentinel lymph node dissection was performed in 94.3%; 8 pts (11.5%) presented an axillary involvement. A median dose of 34 Gy [32 - 35] in 8 to 10 fractions was delivered. Median CTV was 75.2 cc [16.9 - 210], median D90 EQD2 was 43.3 Gy [35 - 72.6] and median DHI was 0.54 [0.19 - 0.74]. One patient experienced ipsilateral recurrence (5-year local free recurrence rate: 97.6%. Five-year specific and overall survival rates were 97.9% and 93.2% respectively. Thirty-four patients (48%) presented 47 late complications classified grade 1 (80.8%) and grade 2 (19.2%) with no grade ≥ 3. Cosmetic results were considered excellent/good for 67 pts (95.7%).
  
  
  CONCLUSIONS
  APBI using HIBT and respecting strict rules of implantation and planification, represents a smart alternative between no post-operative irradiation and whole breast irradiation delivered over 6 consecutive weeks.
authors.forename: Caroline
authors.initials: C
authors.lastname: Genebes
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Chand
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Gal
authors.forename: Mathieu
authors.initials: M
authors.lastname: Gautier
authors.forename: Ines
authors.initials: I
authors.lastname: Raoust
authors.forename: Tarik
authors.initials: T
authors.lastname: Ihrai
authors.forename: Adel
authors.initials: A
authors.lastname: Courdi
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Ferrero
authors.forename: Isabelle
authors.initials: I
authors.lastname: Peyrottes
authors.affiliation: Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 33, avenue de Valombrose, Nice 06189, France. jean-michel.hannoun-levi@nice.unicancer.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Hannoun-Levi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D018275:Carcinoma, Lobular / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate; D013997:Time Factors