title: Report on the Clinical Outcomes of Permanent Breast Seed Implant for Early-Stage Breast Cancers.
abstract: OBJECTIVE
  Permanent breast seed implant is an accelerated partial breast irradiation technique realizing the insertion of (103)Pd seeds in the seroma after lumpectomy. We report the 5-year efficacy and tolerance for a cohort, pooling patients from 3 clinical trials.
  
  
  METHODS
  The trials accrued postmenopausal patients with infiltrating ductal carcinoma or ductal carcinoma in situ ≤3 cm and clear surgical margins, who were node negative, and had a planning target volume <120 cm(3). The outcomes included overall and disease-free survival and local and contralateral recurrence at 5 years. The true local recurrence rate was compared using 2-tailed paired t tests for estimates calculated using the Tufts University ipsilateral breast tumor recurrence and Memorial Sloan Kettering ductal carcinoma in situ nomograms.
  
  
  RESULTS
  The cohort included 134 patients, and the observed local recurrence rate at a median follow-up period of 63 months was 1.2% ± 1.2%, similar to the estimate for whole breast irradiation (P=.23), significantly better than for surgery alone (relative risk 0.27; P<.001), and significantly lower than contralateral recurrence (relative risk 0.33; P<.001). The 5-year overall survival rate was 97.4% ± 1.9%, and the disease-free survival rate was 96.4% ± 2.1%. At 2 months, 42% of the patients had erythema, 20% induration, and 16% moist desquamation. The rate of mainly grade 1 telangiectasia was 22.4% at 2 years and 24% at 5 years. The rate of asymptomatic induration was 23% at 2 years and 40% at 5 years.
  
  
  CONCLUSIONS
  The 5-year data suggest that permanent breast seed implantation is a safe accelerated partial breast irradiation option after lumpectomy for early-stage breast cancer with a tolerance profile similar to that of whole breast irradiation.
authors.affiliation: Radiation Oncology Department, University of Toronto at Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Radiation Oncology Department, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands. Electronic address: j.p.pignol@erasmusmc.nl.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Pignol
authors.affiliation: Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Caudrelier
authors.affiliation: Department of Radiation Oncology, BC Cancer Agency Center for the Southern Interior, Kelowna, British Columbia, Canada.
authors.forename: Juanita
authors.initials: J
authors.lastname: Crook
authors.affiliation: Radiation Oncology Department, University of Toronto at Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: McCann
authors.affiliation: Radiation Oncology Department, BC Cancer Agency Vancouver Island Centre, Victoria, British Columbia, Canada.
authors.forename: Pauline
authors.initials: P
authors.lastname: Truong
authors.affiliation: Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Helena A
authors.initials: HA
authors.lastname: Verkooijen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary; D049451:Nomograms; D010165:Palladium / Q000627:therapeutic use*; D011868:Radioisotopes / Q000627:therapeutic use*; D049291:Seroma / Q000532:radiotherapy*; D013997:Time Factors
chemical_list: D011868:Radioisotopes; D010165:Palladium