title: The rationale, technique, and feasibility of partial breast irradiation using noninvasive image-guided breast brachytherapy.
abstract: OBJECTIVE
  Noninvasive image-guided breast brachytherapy (NIBB) is a novel approach to deliver accelerated partial breast irradiation (APBI). NIBB is noninvasive, yet maintains a high degree of precision by using breast immobilization and image guidance. This makes NIBB an attractive alternative to existing APBI techniques.
  
  
  METHODS
  Forty patients were enrolled to an institutional review board-approved prospective clinical trial evaluating APBI using NIBB. The NIBB technique is described in detail. Briefly, patients were treated with the breast compressed and immobilized sequentially in two orthogonal axes for each fraction. Radiation was delivered using collimated emissions from a high-dose-rate iridium-192 source via specialized applicators. The prescribed dose was 34.0 Gy in 10 fractions. Feasibility and tolerability of treatment were assessed.
  
  
  RESULTS
  All patients completed protocol treatment. The median age was 68 years. Sixty-three percent of patients had invasive carcinoma, and 37% had ductal carcinoma in situ. All were node negative. Ninety-three percent of patients were postmenopausal. Mean tumor size, tumor bed volume, and breast volume were 1.1 cm, 22.4 cc, and 1591 cc, respectively. NIBB treatment was well tolerated. Median patient-reported discomfort was 1 on a 10-point pain scale. Treatment delivery times were reasonable. The average treatment time per axis was 14 min (5-20 min), and the average time from start of first treatment axis to completion of orthogonal axis was 43 min (30-63 min). Acute skin toxicity was Grade 0, 1, and 2 in 20%, 53%, and 28% of patients, respectively. There were no Grade 3 or greater acute toxicities observed.
  
  
  CONCLUSIONS
  NIBB holds promise as an alternative method to deliver APBI. NIBB is feasible and well tolerated by patients. Further investigation of NIBB to deliver APBI is warranted.
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA. Electronic address: jhepel@lifespan.org.
authors.forename: Jaroslaw T
authors.initials: JT
authors.lastname: Hepel
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Hiatt
authors.affiliation: Department of Radiation Oncology, Watson Clinic, Lakeland, FL.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sha
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Leonard
authors.affiliation: Department of Surgery, Rhode Island Hospital, Brown University, Providence, RI.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Graves
authors.affiliation: Department of Surgery, Rhode Island Hospital, Brown University, Providence, RI.
authors.forename: Doreen L
authors.initials: DL
authors.lastname: Wiggins
authors.affiliation: Department of Radiation Oncology, Tacoma Valley Radiation, Tacoma, WA.
authors.forename: Dean
authors.initials: D
authors.lastname: Mastras
authors.affiliation: Department of Radiation Oncology, Tacoma Valley Radiation, Tacoma, WA.
authors.forename: Ann
authors.initials: A
authors.lastname: Pittier
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA.
authors.forename: David E
authors.initials: DE
authors.lastname: Wazer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008327:Mammography / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000295:instrumentation / Q000379:methods*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
chemical_list: D007496:Iridium Radioisotopes; D019275:Radiopharmaceuticals
keywords: APBI; AccuBoost; Breast cancer; NIBB; Noninvasive image-guided breast brachytherapy; Partial breast irradiation