title: Is oncoplastic surgery a contraindication for accelerated partial breast radiation using the interstitial multicatheter brachytherapy method?
abstract: OBJECTIVE
  To evaluate accelerated partial breast irradiation (APBI) in patients after oncoplastic surgery for early breast cancer.
  
  
  METHODS
  A retrospective analysis of 136 breasts of 134 patients, who received breast-conserving oncoplastic surgery for low-risk breast cancer between 2002 and 2010 in the Universities of Vienna and Luebeck followed by adjuvant APBI applying total doses of pulse dose rate of 50.4 Gy or high-dose rate (HDR) of 32 Gy over 4 days. Target volume definition was performed by the use of surgical-free margin data, related to intraoperatively fixed clip positions, pre- and postoperative imaging, and palpation.
  
  
  RESULTS
  At the time of data acquisition, 131 of 134 patients were alive. The median follow-up time was 39 months (range, 4-106 months). After high-dose rate treatment, 3 of 89 patients showed systemic progress after a mean follow-up of 47 months (range, 19-75 months) and 2 patients had a different quadrant in-breast tumor after 27 and 35 months. One patient died 7 months after treatment of unknown causes. After pulse dose rate treatment, 1 of 45 patients had a local recurrence after 42 months and 1 patient died because of another cause after 13 months. We observed mild fibrosis in 27 breasts, telangiectasia in 6, hyperpigmentation in 14 cases, and keloid formation in 1.
  
  
  CONCLUSIONS
  These preliminary results suggest the feasibility of multicatheter APBI after oncoplastic breast-conserving surgery in selected low-risk breast cancer patients; however, special attention to target volume definition is needed. Further prospective investigations with long follow-up are needed to define the real value of the procedure.
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck, Luebeck, Germany.
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Roth
authors.affiliation: Department of Radiotherapy and Radiobiology, Medical University Vienna, Vienna, Austria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Kauer-Dorner
authors.affiliation: Department of Radiotherapy and Radiobiology, Medical University Vienna, Vienna, Austria. Electronic address: alexandra.resch@meduniwien.ac.at.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Resch
authors.affiliation: Department of Surgery, DRK Hospital, Ratzeburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmid
authors.affiliation: Department of Gynecology and Obstetrics, University of Luebeck, Luebeck, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Thill
authors.affiliation: Department of Radiotherapy, City Hospital Cologne, Cologne, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Niehoff
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck, Luebeck, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Melchert
authors.affiliation: Department of Radiotherapy and Radiobiology, Medical University Vienna, Vienna, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berger
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck, Luebeck, Germany.
authors.forename: György
authors.initials: G
authors.lastname: Kovács
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D057785:Catheters; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brachytherapy; Breast cancer; Multicatheter brachytherapy; Oncoplastic surgery; Partial breast irradiation (APBI)