Strnad Partial Breast Irradiation using Multicatheter Brachytherapy

1. Auflage 2006
ISBN: 978-3-88603-901-2
Verlag: W. Zuckschwerdt Verlag
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 165 Seiten

In this book a very comprehensive overview is given on the state of the art of interstitial multicatheter APBI by very experienced and prominent representatives of breast brachytherapy. Patient selection criteria, target volume definition from both the pathologist’s and the clinician’s point of view, implant techniques including anaesthesia and patient care, biological and physical aspects, normal-tissue constraints, and also clinical results of APBI studies will be reviewed. Physicians who are interested in interstitial multi-catheter APBI will find this book helpful for the implementation of this treatment technique in their institutions.

Autoren/Hrsg.

Strnad, Vratislav

Inhaltsverzeichnis

1;Contents;6
2;Target volume definition after closed-cavity surgery: clinical considerations;42
3;Contributors;8
4;Introduction;10
5;Patterns of care for breast brachytherapy in Europe;12
5.1;Introduction;12
5.2;The main tumour sites treated with brachytherapy;12
5.3;Breast cancer in Europe;13
6;Partial breast irradiation with multi- catheter brachytherapy: how hazardous is it?;16
6.1;The basic importance of whole breast irradiation ( WBI);16
6.2;How patient selection impacts local control after breast- conserving surgery and whole breast irradiation;17
6.3;Local recurrence after accelerated partial breast irradiation ( APBI) with strict patient selection;19
6.4;Local recurrence after APBI without strict patient selection;20
6.5;Summary;22
7;Patient selection criteria and pathological considerations;24
7.1;Introduction;24
7.2;Evidence-based selection criteria for APBI;24
7.3;Treatment-related prognostic factors Surgical margins and radiation dose;26
7.4;Patient-related and tumour-related predictive factors Patient age;28
7.4.1;Patient age;28
7.4.2;Extensive intraductal component;28
7.4.3;Tumour size;29
7.4.4;Histological grade;29
7.4.5;Invasive lobular carcinoma;30
7.4.6;Ductal carcinoma in situ;30
7.4.7;Hormone receptor status;31
7.4.8;Lymphatic Spread;31
7.4.9;Conclusions;32
8;Pre-brachytherapy imaging procedures;38
8.1;Introduction ;38
8.2;Clinical assessment;38
8.3;Technical methods;38
8.4;Summary;41
9;Target volume definition after closed-cavity surgery: clinical considerations;42
9.1;Introduction;42
9.2;Individual variations of the anatomy of the female breast after breastconserving surgery;42
9.3;Value of the surgical report and the pathological report;44
9.4;Value of the skin scar;46
9.5;Value of sonography;47
9.6;Value of mammography, CT, and MRI;48
9.7;Value of surgical clips;51
9.8;Summary;52
10;Target volume definition after open-cavity surgery: clinical considerations;56
10.1;Basic clinical considerations for target definition in breast radiotherapy;56
10.2;What should be the target volume for partial breast brachytherapy?;56
11;Anaesthesia and patient care;62
11.1;Introduction;62
11.2;Anaesthesia;62
11.3;Positioning of the patient;63
11.4;Instruments;63
11.5;Surgical report;63
11.6;Postoperative monitoring after general anaesthesia;63
11.7;Care of the tubes;64
11.8;Removal of the tubes;65
11.9;Care instruction after multi-catheter brachytherapy of the breast;66
12;Clip-based implant technique using an Integrated Brachytherapy Unit (IBU);68
13;CT-based implant technique after closed-cavity surgery;72
13.1;Introduction;72
13.2;Pre-implantation CT-based simulation of the tumour bed;73
13.3;Implantation procedure;73
13.4;Post-implantation CT and reconstruction of implant geometry;74
13.5;Target volume definition (CTV/PTV) and delineation of organs at risk (OARs);74
13.6;CT-based calculation and optimization of 3D-physical dose distribution;74
14;CT-based implant technique after open-cavity surgery: European policy;80
15;CT-based implant technique after open-cavity surgery: American policy;86
15.1;Introduction;86
15.2;Catheter placement technique;86
15.3;Dose delivery parameters;89
16;Ultrasound-based implant technique;92
16.1;Introduction;92
16.2;Ultrasound-guided multi-catheter implantation;94
16.3;Conclusion;98
17;Physical aspects: dosimetry, planning, and documentation;100
17.1;Introduction;100
17.2;Dose calculation formalism;100
17.3;Treatment planning;101
18;Biological aspects: total dose and fractionation;116
18.1;Introduction;116
18.2;The linear quadratic model;117
18.3;The LQ model in brachytherapy;119
18.4;Pulsed-dose-rate (PDR) brachytherapy;120
18.5;Conclusions;120
19;Normal-tissue constraints;124
19.1;Introduction;124
19.2;Breast fibrosis;124
19.3;Skin teleangiectasia;125
19.4;Fat necrosis;128
19.5;Summary;130
20;Clinical results: European experience;134
20.1;Introduction;134
20.2;Guy’s Hospital studies;134
20.3;Uzsoki Hospital’s cobalt-needle study;136
20.4;Florence series;136
20.5;Royal Devon/Exeter Hospital series;137
20.6;Ninewells Hospital’s study;137
20.7;Örebro series;137
20.8;National Institute of Oncology (Hungary) phase II study;137
20.9;German-Austrian multicentric trial;138
20.10;National Institute of Oncology (Hungary) phase III trial;139
20.11;Summary of European experience;140
21;Clinical results: American experience;142
21.1;Introduction;142
21.2;William Beaumont Hospital;142
21.3;Ochsner Clinic;144
21.4;Tufts-Brown Universities;144
21.5;Radiation Therapy Oncology Group 95-17;145
21.6;Conclusions;145
22;Current randomised trials;148
22.1;Introduction;148
22.2;The European GEC-ESTRO APBI Trial;148
22.3;The North-American NSABP B-39/RTOG 0413 Trial;150
22.4;Comparison of the European GECESTRO APBI Trial and the North- American NSABP B-39/RTOG 0413 Trial;153
22.5;Summary;155
23;Summary;158
24;Index;160

Leseproben

CT-based implant technique after open-cavity surgery: American policy (p. 77)
D.W.Arthur,F.A.Vicini
Introduction
The goal of accelerated partial breast irradiation (APBI) is to deliver the prescribed dose to a specified partial breast target over an accelerated time period of 5 days.The success of APBI depends greatly on the ability to identify the treatment target and having a reliable, reproducible treatment technique that allows control of dose delivery. Several methods of achieving this goal have been developed. Each of these treatment techniques has its own set of advantages and disadvantages. In the United States, there are now three dominant treatment approaches used to deliver APBI, including multi-catheter interstitial brachytherapy,MammoSiteTM balloon brachytherapy, and 3D-conformal external beam radiotherapy [1]. Despite the acceptance of these newer techniques, it must be emphasized that all of the data on which the concept of APBI draws its support has been generated using multi-catheter interstitial brachytherapy, and studies reporting more than 5 years of follow-up represent only multi-catheter brachytherapy experiences.

It also should be highlighted that multi-catheter brachytherapy is a versatile, adaptable technique that can be applied in virtually every patient eligible for APBI. Additionally, with the addition of image guidance, the challenge of catheter placement has been greatly improved and become less dependent on operator experience. This can not be stated for the newer techniques as the success of both the MammoSiteTM balloon catheter and the externalbeam- based 3D-conformal approaches is greatly dependent on the size, shape, and location of the lumpectomy cavity in relationship to the size of the affected breast.This chapter will present the catheter placement techniques utilized in America with multi-catheter brachytherapy. Image-guided catheter placement techniques and the more prominent single-institutional studies will be highlighted.

Catheter placement technique

In the early 1990’s,America began its investigation of APBI. At that time, multi-catheter brachytherapy had been well established and used for several prior decades as a surgical-bed boosting technique following open cavity surgery and whole breast radiotherapy [2]. By that time, institutions had greatly shifted away from the use of breast brachytherapy as a method of boosting since electrons were widely available, but the implant techniques were known and intermittently applied. In the early investigation of breast brachytherapy as the sole method of adjuvant radiotherapy, these established techniques were easily implemented. The original techniques focused on the construction of an implant where catheters were placed to provide the opportunity to deliver the prescription dose in as homogeneous a fashion as possible. Intercatheter and intraplanar distances were defined but the quality of each individual implant remained heavily dependent on the experience of the brachytherapist performing the procedure [3, 4].

Location of the target after open cavity surgery was originally based on the lumpectomy scar, physical exam, and mammogram.This was recognized as an inaccurate method of target localization and as the investigation of APBI continued to progress it became clear that, for APBI to be successful and have the potential to be widely used, the addition of image guidance to aid catheter placement was needed.