title: Excellent Long-term Breast Preservation Rate After Accelerated Partial Breast Irradiation Using a Balloon Device.
abstract: Accelerated partial breast irradiation (APBI) using a balloon device has been well tolerated. A recent retrospective population-based study showed an increase in the rate of subsequent mastectomy for patients who undergo APBI compared with whole breast radiation therapy. Our aim was to analyze the long-term results of patients treated with APBI at our institution to determine the salvage mastectomy and locoregional recurrence rates and cosmesis outcomes.
  
  
  
  After institutional review board approval, we conducted a retrospective review of 111 patients treated from June 2003 to October 2014 at our institution for early-stage breast cancer using a balloon device. After lumpectomy and nodal staging, the patients underwent APBI with high-dose rate iridium-192 brachytherapy. A computed tomography-based 3-dimensional plan was created, and a dose of 34 Gy in 10 fractions was given twice daily, 6 hours apart, over 5 days. Follow-up examinations were performed 2 to 3 times annually by either a surgeon and/or a radiation oncologist. Annual mammograms were obtained. The patients included postmenopausal women with node-negative early-stage invasive ductal carcinoma with a tumor size < 3 cm (n = 93) or ductal carcinoma in situ (n = 18). Cosmesis was evaluated using the Harvard criteria, as excellent, good, fair, or poor.
  
  
  
  At a median follow-up period of 66 months (range, 1-139 months) after completing treatment, with a minimum of 5 years of follow-up data for 62 patients (55.9%), the incidence of ipsilateral breast tumor recurrence (IBTR) was 2.7% (n = 3) and the incidence of ipsilateral axilla nodal recurrence was 1.8% (n = 2). The ipsilateral breast preservation rate was 97.3%. The salvage mastectomy rate was 2.7% (n = 3), and the 5-year salvage mastectomy-free rate was 98.7% (95% confidence interval, 91.0%-99.8%). No distant failure developed, and no breast cancer-related deaths occurred. The 5-year overall survival rate was 91.7% (95% confidence interval, 83.2%-96.0%), and the 10-year breast cancer-specific survival rate was 100%. Of the 3 cases of IBTR, 2 were estrogen receptor negative (P = .076). The mean interval to IBTR was 78.7 ± 27.5 months from treatment completion. A significant association was noted between African-American ethnicity and IBTR (P = .0398). Excellent to good cosmesis was observed in 98.1% of the patients. The maximum skin dose (mean value) for patients with excellent, good, and fair cosmesis was 302.2 Gy, 315.4 Gy, and 372.5 Gy (88.9%, 92.7%, and 109.5% of the prescription dose), respectively. The maximum skin dose was < 340 Gy (100% of the prescribed dose) in 69.9% of patients with excellent to good cosmesis.
  
  
  
  The long-term follow-up data of patients receiving APBI with a balloon device showed a low salvage mastectomy rate with durable long-term breast preservation. Excellent local control with good cosmesis was noted in these postmenopausal patients treated with APBI.
authors.affiliation: Department of Radiation Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY. Electronic address: Jum9094@nyp.org.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Mann
authors.affiliation: Department of Radiation Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Osian
authors.affiliation: Department of Radiation Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brandmaier
authors.affiliation: Department of Radiation Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Weisi
authors.initials: W
authors.lastname: Yan
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Kap-Jae
authors.initials: KJ
authors.lastname: Sung
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Beth
authors.initials: B
authors.lastname: Siegel
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Simon
authors.initials: S
authors.lastname: Fink
authors.affiliation: Division of Hematology/Medical Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Barry
authors.initials: B
authors.lastname: Kaplan
authors.affiliation: Division of Hematology/Medical Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Malvin
authors.initials: M
authors.lastname: Fulman
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Guojiao
authors.initials: G
authors.lastname: Wu
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.affiliation: Department of Radiation Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Dattatreyudu
authors.initials: D
authors.lastname: Nori
authors.affiliation: Department of Radiation Oncology, New York-Presbyterian Hospital/Queens, Weill Cornell Medical College, New York, NY.
authors.forename: Akkamma
authors.initials: A
authors.lastname: Ravi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Ballon brachytherapy; Breast brachytherapy; Breast cancer; Contura; MammoSite; Radiotherapy; Whole breast radiation therapy