title: High-dose-rate brachytherapy boost effect on local tumor control in young women with breast cancer.
abstract: OBJECTIVE
  To evaluate the local control rate and complications of a single fraction of high-dose-rate brachytherapy (HDR BT) boost in women aged 45 yeas and younger after breast-conserving therapy.
  
  
  METHODS
  Between 1999 and 2007, 167 patients between the ages of 26 and 45 years old (72 were 40 years old or younger), with stages T1 to T2 invasive breast cancer with disease-free margin status of at least 5 mm after breast-conserving surgery received 46 to 50 Gy whole-breast irradiation plus a 7-Gy HDR-BT boost ("fast boost"). An axillary dissection was performed in 72.5% of the patients and sentinel lymph node biopsy in 27.5%. A supraclavicular area was irradiated in 19% of the patients. Chemotherapy was used in 86% of the patients and hormone treatment in 77%. Clinical nodes were present in 18% and pathological nodes in 29%. The pathological stage was pT0: 5%, pTis: 3%, pT1: 69% and pT2: 23%. Intraductal component was present in 40% and 28% were G3.
  
  
  RESULTS
  At a median follow-up of 92 months, 9 patients relapsed on the margin of the implant, and 1 patient in another quadrant, resulting in a 10-year local relapse rate of 4.3% and a breast relapse rate of 4.9%, with breast preservation in 93.4%; no case of mastectomy due to poor cosmesis arose. Actuarial 5- and 10-year disease-free, cause-specific, and overall survival rates were 87.9% and 85.8%, and 92.1% and 88.4%, and 92.1% and 87.3%, respectively. In a univariate analysis, triple-negative cases and negative hormone receptors did worse, but in a multivariate analysis, only the last factor was significant for local and breast control. Asymptomatic fibrosis G2 was recorded in 3 cases, and there were no other late complications. Cosmetic results were good to excellent in 97% of cases.
  
  
  CONCLUSIONS
  A single dose of 7 Gy using the fast-boost technique is well tolerated, with a low rate of late complications and improved local tumor control in women aged 45 and younger, compared to published data. This approach is recommended in breast-preserving treatment.
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain. Electronic address: jguinot@fivo.org.
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Guinot
authors.affiliation: Health Services Research Unit, Center for Public Health Research, Valencia, Spain.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Baixauli-Perez
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Soler
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Tortajada
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Santos
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mut
authors.affiliation: Department of Pathology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gozalbo
authors.affiliation: Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
authors.forename: Leoncio
authors.initials: L
authors.lastname: Arribas
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001365:Axilla; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D015996:Survival Rate; D013997:Time Factors; D064726:Triple Negative Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery