title: A Novel Treatment Schedule for Rapid Completion of Surgery and Radiation in Early-Stage Breast Cancer.
abstract: Data support the use of accelerated partial-breast irradiation (APBI) for early-stage breast cancer. We initiated a prospective protocol for intraoperative APBI catheter placement using a multi-lumen strut-based device. We hypothesized that with intraoperative pathology assessment of margins and sentinel nodes, all locoregional treatment (surgery and APBI) could be completed within 10 days with acceptable complication rates and cosmesis.
  
  
  
  Eligible patients included women age 50 years or older with clinical T1 estrogen receptor positive (ER+) sentinel lymph node (SLN)-negative invasive ductal cancer or pure ductal carcinoma in situ. Patients were prospectively registered. Cosmesis was assessed using photographs graded independently by three investigators for patients with photos taken 6 months or longer after treatment.
  
  
  
  From October 2012 to August 2015, we enrolled 123 patients; 110 (90 %) underwent intraoperative catheter placement, whereas 13 did not due to intraoperative pathology findings. 109 APBI patients (99 %) completed their prescribed radiotherapy within 5 days, and all their locoregional therapy within 9 days, whereas one patient with a delayed positive SLN received only boost radiotherapy via catheter followed by conventional whole breast radiation. The 30-day complication rate was 6 %. In 81 patients with at least one-year followup, complications occurred in 14 (17 %) (including infection in five patients and symptomatic seroma in five patients) and correlated with device size (p = 0.05) but not with tumor size or location. The local recurrence rate was 1.8 % (two patients). Scored cosmesis was excellent or good in 88 % and fair in 12 % of patients.
  
  
  
  A protocol for intraoperative strut-based APBI catheter placement using careful patient selection and intraoperative pathology assessment can deliver efficient, effective treatment for early breast cancer.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA. hieken.tina@mayo.edu.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Mutter
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.affiliation: Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Sukov
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Childs
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Corbin
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Furutani
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Whitaker
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sean S
authors.initials: SS
authors.lastname: Park
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D019583:Dose Fractionation, Radiation; D004954:Esthetics; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049291:Seroma / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors