Irradiación parcial acelerada de mama con braquiterapia de alta tasa de dosis con 18 gy.

RESUMEN: OBJETIVOS: evaluar la factibilidad así como los resultados de toxicidad aguda, crónica y objetivos oncológicos en pacientes candidatas a recibir irradiación parcial acelerada de mama con braquiterapia multicatéter de alta tasa de dosis con 18 Gy. MATERIAL Y MÉTODOS: entre septiembre de 2014 y marzo de 2016 tratamos a 20 pacientes con carcinoma infiltrante de bajo riesgo o carcinoma intraductal con braquiterapia de alta tasa de dosis con una fracción única de 18 Gy. RESULTADOS: la mediana de edad fue de 63,5 años (rango de 51-79). Objetivamos toxicidad aguda en 7 pacientes en forma de molestias locales autolimitadas y hematoma en cuatro de las pacientes. Con una mediana de seguimiento fue de 25 meses (22-42 meses) la toxicidad crónica objetivada fue de una paciente con fibrosis g2 y dos pacientes con necrosis grasa (g1: 1 y g2: 1). La supervivencia global y el control local fueron del 100%. La supervivencia libre de enfermedad y el control regional fueron del 95%. La cosmesis fue catalogada como excelente/buena en el 80% (80%) de las pacientes y regular en 4 (20%). CONCLUSIONES: este es el primer trabajo en el que se demuestra la factibilidad y la toxicidad aguda y crónica con una mediana de seguimiento de 25 meses. El protocolo es viable y conveniente. Sin embargo, es necesario un mayor seguimiento para contrastar los datos de toxicidad crónica y objetivos oncológicos.ABSTRACT: Purpose: To evaluate the feasibility of acute and chronic toxicity in patients suitable for accelerated partial breast irradiation (APBI) in a single 18 Gy fraction with multicatheter high-dose-rate (HDR) brachytherapy, as well as cosmetic and oncological outcomes. Material and methods: Between September 2014 and March 2016, twenty consecutive patients with low-risk invasive and ductal carcinoma in situ were treated with interstitial multicatheter HDR brachytherapy in a single 18 Gy fraction. Results: Median age was 63.5 years (range, 51-79). Acute toxicity was observed in seven patients, while the pain during following days and hematoma were seen in four patients. With a median follow-up of 25 months (range, 20-40), late toxicity was found in two patients with fat necrosis (g1:1 and g2:1) and fibrosis g2 in another patient. The overall survival (OS) and locoregional control (LC) was 100%. Disease-free survival (DFS) and distant control was 95%. Good to excellent cosmetic outcomes were noted in 80% of patients and fair in 4 patients (20%). Conclusions: This is the first report in the medical literature that focuses on feasibility and acute and chronic toxicity, with a median follow-up of 24 months. The protocol is viable and convenient. However, a longer follow-up is needed to know chronic toxicity and oncologic outcomes

Comparison of Conventional vs. Oncoplastic Breast-Conserving Surgery in a Breast Unit with Oncoplastic Training

Purpose: Oncoplastic Breast Conserving Surgery (OBCS) has been tested in oncological terms demonstrating that it is as effective as Standard Lumpectomy (SL) nowadays; Patients-Reported Outcomes (PRO) have become a relevant way to assess breast cancer treatment. The aim of this work was to compare OBCS with SL using a PRO measurement, BREAST-Q Breast Conserving Therapy (BCT) module. Methods: One hundred and sixty-five patients with early primary breast cancer treated with BCT were questioned using BREAST-Q Version 2.0 BCT Module, postoperative scales, in Spanish, after radiotherapy treatment was administered. The patients filled in the questionnaire in a paper-andpencil format at our breast unit. The sample size was estimated to observe differences of 7 points in the satisfaction with breast domain (postoperative scale) between both approaches. This difference is slightly higher than 10% of the median of satisfaction with breast domain reported in published studies. An analysis was done to compare statistics. Results: SL was used in 108 patients and OBCS in 57. Patients treated with OCBS had a larger radiological lesion than patients treated with SL (median 20 mm vs. 15 mm) corresponding with a higher pathological tumor (17 mm vs. 13 mm). The time from the radiotherapy end date to when the questionnaire was filled in was longer in those patients treated with OBCS (mean 8 vs. 15.5 months). No significant statistical differences were found in the BREAST-Q postoperative domain scores between both approaches. Conclusion: The quality of life and the satisfaction with the oncoplastic breast conserving approach or the standard lumpectomy evaluated by the BREAST-Q were similar in our breast unit