title: Updated feasibility and reproducibility results of multi-institutional study of noninvasive breast tumor bed boost.
abstract: To report updated feasibility and reproducibility results for high-dose-rate noninvasive breast brachytherapy (NIBB) for tumor bed boost with whole breast radiation therapy (WBRT) in the setting of expanded patient and treatment facility number.
  
  
  
  Fifteen independent community-based and academic centers reported 518 early-stage breast cancer patients from July 2007 to February 2015 on a privacy-encrypted online data registry. All patients' treatment included lumpectomy followed by combination of WBRT and NIBB. NIBB was completed with commercially available (AccuBoost, Billerica, MA) mammography-based system using high-dose-rate192Ir emissions along orthogonal axes. Harvard scale was used to grade cosmesis.
  
  
  
  Total patient cohort had median followup of 12 months (1-75 months) with subset of 268 having available cosmesis. Greater than 2- and 3-year followup was 29% and 14%, respectively. Entire cohort had 97.4% excellent/good (E/G) breast cosmesis and freedom from recurrence of 97.6% at the final followup. WBRT timing with respect to NIBB delivery demonstrated no statistically significant difference in E/G cosmesis. Achieved E/G cosmesis rate was also not statistically significant (χ2p-value = 0.86) between academic and community institutions with 97.8% vs. 96.6%.
  
  
  
  NIBB represents an alternative method for delivery of breast tumor cavity boost that has shown feasibility in a diverse group of both academic and community-based practices with reproducible early cosmesis and tumor control results. Recommendations are updated noting ideal timing of boost delivery likely to be before or early during WBRT given equal cosmesis and less documented treatment discomfort.
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA. Electronic address: Jessica.moore84@hotmail.com.
authors.forename: Jessica
authors.initials: J
authors.lastname: Schuster
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chipko
authors.affiliation: Schmidt College of Medicine, FAU Lynn Cancer Institute, Boca Raton, FL.
authors.forename: Michael
authors.initials: M
authors.lastname: Kasper
authors.affiliation: Watson Clinic Cancer & Research Center, Lakeland, FL.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sha
authors.affiliation: Oncology Research Department, John B. Amos Cancer Center, Columbus, GA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ciuba
authors.affiliation: Texas Oncology Paris, Paris, TX.
authors.forename: James
authors.initials: J
authors.lastname: Petrikas
authors.affiliation: Cancer Center of Putnam, First Radiation Oncology Group, Palatka, FL.
authors.forename: Anand
authors.initials: A
authors.lastname: Kuruvilla
authors.affiliation: 21st Century Oncology, Inc, FL.
authors.forename: Ravichandra
authors.initials: R
authors.lastname: Sandrapaty
authors.affiliation: Arizona Breast Cancer Specialists, Phoenix, AZ.
authors.forename: Coral
authors.initials: C
authors.lastname: Quiet
authors.affiliation: Memorial Hospital Jacksonville, Jacksonville, FL.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Anderson
authors.affiliation: Eugene M. & Christine E. Lynn Cancer Institute, Boca Raton, FL.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Benda
authors.affiliation: Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Wazer
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Hepel
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Arthur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004954:Esthetics; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012042:Registries; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Breast boost; High dose rate; Noninvasive breast brachytherapy