Comparison of accelerated partial breast irradiation via multicatheter interstitial brachytherapy versus whole breast radiation

<p>Abstract</p> <p>Background</p> <p>Brachytherapy as adjuvant treatment for early-stage breast cancer has become widely available and offers patients an expedited treatment schedule. Given this, many women are electing to undergo brachytherapy in lieu of standard fractionation radiotherapy. We compare outcomes between patients treated with accelerated partial breast irradiation (APBI) via multicatheter interstitial brachytherapy versus patients who were also eligible for and offered APBI but who chose whole breast radiation (WBI).</p> <p>Methods</p> <p>Patients treated from December 2002 through May 2007 were reviewed. Selection criteria included patients with pTis-T2N0 disease, ≤ 3 cm unifocal tumors, and negative margins who underwent breast conservation surgery. Local control (LC), cause-specific (CSS) and overall survival (OS) were analyzed.</p> <p>Results</p> <p>202 patients were identified in the APBI cohort and 94 patients in the WBI cohort. Median follow-up for both groups exceeded 60 months. LC was 97.0% for the APBI cohort and 96.2% for the WBI cohort at 5 years (ns). Classification by 2010 ASTRO APBI consensus statement categories did not predict worse outcomes.</p> <p>Conclusion</p> <p>APBI via multicatheter interstitial brachytherapy provides similar local failure rates compared to WBI at 5 years for properly selected patients. Excellent results were seen despite the high fraction of younger patients (< 60 years old) and patients with DCIS.</p

Treatment response as predictor for brain metastasis in triple negative breast cancer: A score‐based model

Background Triple negative breast cancer (TNBC) has worse prognosis than other subtypes of breast cancer, and many patients develop brain metastasis (BM). We developed a simple predictive model to stratify the risk of BM in TNBC patients receiving neo‐adjuvant chemotherapy (NAC), surgery, and radiation therapy (RT). Methods Patients with TNBC who received NAC, surgery, and RT were included. Cox proportional hazards method was used to evaluate factors associated with BM. Significant factors predictive for BM on multivariate analysis (MVA) were used to develop a risk score. Patients were divided into three risk groups: low, intermediate, and high. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of the risk group in predicting BM. This predictive model was externally validated. Results A total of 160 patients were included. The median follow‐up was 47.4 months. The median age at diagnosis was 49.9 years. The 2‐year freedom from BM was 90.5%. Persistent lymph node positivity, HR 8.75 (1.76‐43.52, P = 0.01), and lack of downstaging, HR 3.46 (1.03‐11.62, P = 0.04), were significant predictors for BM. The 2‐year rate of BM was 0%, 10.7%, and 30.3% (P < 0.001) in patients belonging to low‐, intermediate‐, and high‐risk groups, respectively. Area under the ROC curve was 0.81 (P < 0.001). This model was externally validated (C‐index = 0.79). Conclusions Lack of downstaging and persistent lymph node positivity after NAC are associated with development of BM in TNBC. This model can be used by the clinicians to stratify patients into the three risk groups to identify those at increased risk of developing BM and potentially impact surveillance strategies