title: Multicatheter breast implant during breast conservative surgery: Novel approach to deliver accelerated partial breast irradiation.
abstract: To assess the safety, feasibility, and efficacy of free-hand intraoperative multicatheter breast implant (FHIOMBI) and perioperative high-dose-rate brachytherapy (PHDRBT) in early breast cancer.
  
  
  
  Patients with early breast cancer candidates for breast conservative surgery (BCS) were prospectively enrolled. Patients suitable for accelerated partial breast irradiation (APBI) (low or intermediate risk according GEC-ESTRO criteria) received PHDRBT (3.4 Gy BID × 10 in 5 days). Patients not suitable for APBI (high risk patients according GEC-ESTRO criteria) received PHDRBT boost (3.4 Gy BID × 4 in 2 days) followed by whole breast irradiation.
  
  
  
  From June 2007 to November 2014, 119 patients were treated and 122 FHIOMBI procedures were performed. Median duration of FHIOMBI was 25 minutes. A median of eight catheters (range, 4-14) were used. No severe intraoperative complications were observed. Severe early postoperative complications (bleeding) were documented in 2 patients (1.6%), wound healing complications in 3 (2.4%), and infection (mastitis or abscess) in 2 (1.6%). PHDRBT was delivered as APBI in 88 cases (72.1%) and as a boost in 34 (27.8%). The median clinical target volume T was 40.8 cc (range, 12.3-160.5); median D90 was 3.32 Gy (range, 3.11-3.85); median dose homogeneity index was 0.72 (range, 0.48-0.82). With a median followup of 38.4 months (range, 8.7-98.7) no local, elsewhere, or regional relapses were observed; there was only one distant failure in PHDRBT boost. No major (acute or late) RTOG grade 3 or higher were documented in any of the 119 patients treated with PHDRBT. Cosmetic outcome in APBI patients was excellent or good in (87.0%) and fair or poor in (11.9%) while in boost patients was excellent or good in (76.4%) and fair in (23.5%).
  
  
  
  The FHIOMBI-PHDRBT program does not add complications to conservative surgery. It allows precise selection of APBI patients and offers excellent results in disease control and cosmetics. It also offers logistic advantages because it dramatically shortens the time of local treatment and avoids further invasive procedures.
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain. Electronic address: mcambeiro@unav.es.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cambeiro
authors.affiliation: Department of General Surgery, University of Navarre, Pamplona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martinez-Regueira
authors.affiliation: Department of General Surgery, University of Navarre, Pamplona, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Rodriguez-Spiteri
authors.affiliation: Department of Gynaecology, University of Navarre, Pamplona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Olartecoechea
authors.affiliation: Department of Radiology, University of Navarre, Pamplona, Spain.
authors.forename: Luis Pina
authors.initials: LP
authors.lastname: Insausti
authors.affiliation: Department of Radiology, University of Navarre, Pamplona, Spain.
authors.forename: Arlette
authors.initials: A
authors.lastname: Elizalde
authors.affiliation: Department of Pathology, University of Navarre, Pamplona, Spain.
authors.forename: Miguel Idoate
authors.initials: MI
authors.lastname: Gastearena
authors.affiliation: Department of Pathology, Servicio Riojano de Salud, Logroño, Spain.
authors.forename: Jesús Sola
authors.initials: JS
authors.lastname: Gallego
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Santisteban
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Aramendía
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: José Javier
authors.initials: JJ
authors.lastname: Aristu
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Leire Arbea
authors.initials: LA
authors.lastname: Moreno
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Moreno-Jiménez
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: German
authors.initials: G
authors.lastname: Valtueña
authors.affiliation: Department of Oncology, University of Navarre, Pamplona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Monge
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D057785:Catheters; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000601:surgery; D011446:Prospective Studies; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D011879:Radiotherapy Dosage; D012086:Reoperation; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Accelerated partial breast irradiation; Early breast cancer; Intraoperative procedure; Multicatheter breast implant