BACKGROUND: The optimal radiotherapy technique for cardiac sparing in left-sided early breast cancer (EBC) is not clear. In this context, the aim of our dosimetric study was to compare cardiac and lung doses according to the type of radiotherapy - whole breast irradiation (WBI), external partial breast irradiation (PBI), and multicatheter interstitial brachytherapy-accelerated partial breast irradiation (MIB-APBI). The dosimetric results with the WBI and PBI were calculated with and without DIBH. MATERIALS AND METHODS: Dosimetric study of 23 patients treated with WBI, PBI, with and without DIBH, or MIB-APBI. The prescribed dose was 40 Gy in 15 fractions for WBI and PBI and 34 Gy in 10 fractions (bid) for MIB-APBI. Doses to the organs-at-risk (OAR) - heart, left anterior descending coronary artery (LAD), left ventricle (LV), and left lung - were recalculated to the equivalent dose in 2-Gy fractions (EQD2). RESULTS: The addition of DIBH significantly reduced EQD2 doses to all OARs (except for the left lung maximal dose) in WBI and PBI. MHD values were 0.72 Gy for DIBH-WBI, 1.01 Gy for MIB-APBI and 0.24 Gy for DIBH-PBI. There were no significant differences in cardiac doses between WBI with DIBH and PBI without DIBH. DIBH-PBI resulted in significantly lower mean doses to all OARs (except for maximum lung dose) compared to MIB-APBI. Conclusions: These results show that the use of DIBH significantly reduces cardiac doses in patients with left EBC. Partial irradiation techniques (PBI, MIB-APBI) significantly reduced cardiac doses due to the smaller clinical target volume. The best results were obtained with DIBH-PBI.

• Publication type
• Journal Article MeSH

Standardem léčby časných stadií karcinomu prsu je prs šetřící chirurgická léčba, kombinovaná s perioperační léčbou systémovou a pooperační radioterapií. Mastektomie se nadále provádí u pacientek, kterým nelze záchovnou operaci z léčebného či kosmetického hlediska doporučit. Jedná se často o lokálně či regionálně pokročilá onemocnění, kde po mastektomii prakticky vždy následuje adjuvantní radioterapie. S rekonstrukcí prsu po mastektomii se setkáváme stále častěji a tento trend bude dále narůstat i v budoucnosti. S pokroky v medicíně dochází k rozvoji jak chirurgických postupů samotné rekonstrukce, tak i technických možností radioterapie. Otázka správné kombinace a načasování rekonstrukce a adjuvantní radioterapie nadále vyvolává četné otázky, na které se snaží odpovědět následující přehledový článek.

Breast-conserving surgical treatment combined with perioperative systemic therapy and postoperative radiotherapy is the standard treatment for early-stage breast carcinoma. Mastectomy continues to be performed in patients in whom breast-conserving surgery cannot be recommended for therapeutic or cosmetic reasons. They often have locally or regionally advanced disease in which mastectomy is virtually always followed by adjuvant radiotherapy. Breast reconstruction following mastectomy is increasingly encountered, and this trend will continue to grow in the future. With advances in medicine, there has been progress in both the surgical procedures used in reconstruction and the technical aspects of radiotherapy. The issue of correct combination and timing of reconstruction and adjuvant radiotherapy continues to raise numerous questions which the present review article attempts to address.

• MeSH
• Radiotherapy, Adjuvant MeSH
• Radiotherapy Dosage MeSH
• Clinical Decision-Making MeSH
• Humans MeSH
• Mammaplasty * classification   methods   adverse effects   MeSH
• Mastectomy MeSH
• Breast Neoplasms surgery   radiotherapy   MeSH
• Radiotherapy * MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Review MeSH

PURPOSE: To quantify mean heart dose (MHD) and doses to the left anterior descending artery (LAD) and left ventricle (LV) in a retrospective series of patients who underwent perioperative accelerated partial breast irradiation with multicatheter interstitial brachytherapy (MIB-APBI). METHODS: Sixty-eight patients with low-risk left breast cancer were treated with MIB-APBI at our institution between 2012 and 2017. Interstitial tubes were inserted during the tumorectomy and sentinel node biopsy and APBI was started 6 days later. The prescribed dose was 34 Gy in 10 fractions (twice a day) to the clinical target volume (CTV). The heart, LAD, and LV were contoured and the distance between each structure and the CTV was measured. The MHD, mean and maximum LAD doses (LAD mean/max), and mean LV doses (LV mean) were calculated and corrected to biologically equivalent doses in 2‑Gy fractionation (EQD2). We also evaluated the impact of the distance between the cardiac structures and the CTV and of the volume receiving the prescribed dose (V100) and high-dose volume (V150) on heart dosimetry. RESULTS: Mean EQD2 for MHD, LAD mean/max, and mean LV were 0.9 ± 0.4 Gy (range 0.3-2.2), 1.6 ± 1.1 Gy (range, 0.4-5.6), 2.6 ± 1.9 Gy (range, 0.7-9.2), and 1.3 ± 0.6 Gy (range, 0.5-3.4), respectively. MHD, LAD mean/max, and LV mean significantly correlated with the distance between the CTV and these structures, but all doses were below the recommended limits (German Society of Radiation Oncology; DEGRO). The MHD and LV mean were significantly dependent on V100. CONCLUSION: Perioperative MIB-APBI resulted in low cardiac doses in our study. This finding provides further support for the value of this technique in well-selected patients with early-stage left breast cancer.

• MeSH
• Brachytherapy methods   MeSH
• Radiotherapy Dosage MeSH
• Middle Aged MeSH
• Humans MeSH
• Breast Neoplasms radiotherapy   MeSH
• Breast radiation effects   MeSH
• Retrospective Studies MeSH
• Heart radiation effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE: To assess the feasibility of high-dose-rate perioperative multicatheter interstitial brachytherapy to deliver accelerated partial breast irradiation (APBI) in selected patients with early breast cancer. METHODS AND MATERIALS: Perioperative multicatheter interstitial brachytherapy for APBI has been used at our department since 2012 for patients with low-risk breast cancer. Interstitial catheters were inserted perioperatively via hollow needles immediately following tumorectomy with sentinel node biopsy. APBI started on Day 6 after surgery. The prescribed dose was 34 Gy (10 fractions of 3.4 Gy bid). Hormonal therapy was prescribed in all cases. RESULTS: Between June 2012 and December 2017, 125 patients were scheduled for APBI. Of these, APBI was not performed in 12 patients (9.6%) due to adverse prognostic factors identified on the definitive biopsy. We observed wound dehiscence in 2/113 cases (1.8%), inflammatory complications requiring antibiotics in 7/113 cases (6.2%), transient Grade I radiodermatitis in 6/113 patients (4.4%), and seroma which resolved spontaneously in 3/113 patients (2.7%). With median followup of 39 months (range 3.3-75.3) no relapses were observed. No late complications in Radiation Therapy Oncology Group Grade 3 or higher were documented. Cosmetic outcome in patients with followup > 2 years was excellent or good in 92%. CONCLUSION: Our preliminary results show that the perioperative multicatheter interstitial high-dose-rate brachytherapy for APBI in selected patients with early breast cancer is feasible. This treatment schedule reduces treatment duration, spares the patients of repeated anesthesia, and enables precise application of the afterloading tubes under direct visual control.

• MeSH
• Brachytherapy adverse effects   methods   MeSH
• Radiotherapy Dosage MeSH
• Catheters MeSH
• Combined Modality Therapy adverse effects   methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local MeSH
• Breast Neoplasms radiotherapy   surgery   MeSH
• Breast pathology   radiation effects   surgery   MeSH
• Mastectomy, Segmental adverse effects   methods   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Feasibility Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Akcelerovaná parciální radioterapie karcinomu prsu (APBI) je metoda, která u vybraných pacientek s časným karcinomem nahrazuje po prs šetřících chirurgických výkonech ozáření celého prsu (WBI) ozářením oblasti lůžka tumoru s bezpečnostním lemem. Výhodou oproti WBI je zkrácení celkové doby léčby a menší objem ozářených zdravých tkání. Pro APBI byla použita řada technik: konformní zevní radioterapie (3D RT), radioterapie s modulovanou intenzitou (IMRT), intraoperační zevní radioterapie elektronovým svazkem, intrabeam, balónová brachyterapie a intersticiální brachyterapie. Nejzralejší data jsou k dispozici pro pooperační intersticiální multikatétrovou brachyterapii (MIB). Perioperační aplikace MIB dále zkracuje celkovou dobu léčby, šetří pacientky od opakované anestézie a umožňuje precizní zavedené brachyterapeutických katétrů pod přímou vizuální kontrolou. Podmínkou APBI je dodržení mezinárodních indikačních kritérií.

Accelerated partial breast irradiation (APBI) is a method substituting whole breast irradiation (WBI) in selected patients with early breast cancer after breast sparing surgery. The advantage in comparison with WBI is shortening of treatment duration and less volume of irradiated healthy tissues. Several techniques were used for APBI: conformal external beam radiotherapy (3D EBRT), intensity modulated radiotherapy (IMRT), intraoperative irradiation with electron beam, intrabeam, balloon brachytherapy, interstitial brachytherapy. The most mature data exist for postoperative multicatheter interstitial brachytherapy (MIB). Perioperative application of MIB reduces further the treatment duration, spares the patients of repeated anesthesia and enables precise application of brachytherapy catheters under direct visual control. The condition of APBI is adherence to international indication criteria.

• MeSH
• Brachytherapy methods   MeSH
• Humans MeSH
• Breast Neoplasms * surgery   pathology   radiotherapy   MeSH
• Radiotherapy methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Female MeSH

• Publication type
• Meeting Abstract MeSH

• Publication type
• Meeting Abstract MeSH

Díky mamárnímu screeningu je dnes karcinom prsu zachycován ve stále časnějším stadiu. Z toho vyplývá, že i chirurgové jsou stále častěji postaveni před úkol řešit operačně tumory prsu, které jsou klinicky nehmatné. Při těchto operacích jsou odkázáni zcela na přesné označení lokalizace tumoru pomocí navigace (kovový vodič, pigmenty). Ve sdělení je popsán postup rutinně používaný na pracovišti autorů, je zde poukázáno na některá úskalí, která s sebou praxe přináší. Aby byly výsledky léčby co nejlepší, je nutná kvalitní spolupráce radiodiagnostika, chirurga (mamárního onkochirurga), klinického a radiačního onkologa, patologa a lékaře z oddělení nukleární medicíny. Tato úzká mezioborová spolupráce se zpětnou vazbou je nezbytnou podmínkou pro optimální výsledky léčby i u pacientů s časnými stadii maligních onemocnění prsu.

Breast cancer is nowadays captured still in earlier stages through screening mammography. Consequently, even surgeons are increasingly faced with the task to solve nonpalpable breast tumors surgically. Performed operations are dependent entirely on the precise identification of tumor localization with help of navigation (metal wire, pigments). The review describes the procedure routinely used by authors, it points out some difficulties, which occur in clinical practice. High quality cooperation between radiologist, surgeon (breast cancer surgeon), clinical and radiation oncologist, pathologist and physician of the department of nuclear medicine is needed for the best treatment results. This close interdisciplinary cooperation with feedback is necessary requirement for the optimal treatment outcomes in patients with early stages of malignant breast cancer.

• MeSH
• Algorithms MeSH
• Surgical Procedures, Operative * methods   MeSH
• Humans MeSH
• Interdisciplinary Communication MeSH
• Breast Neoplasms * diagnosis   surgery   MeSH
• Policy MeSH
• Radiography MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Humans MeSH
• Female MeSH

• MeSH
• Brachytherapy MeSH
• Humans MeSH
• Breast Neoplasms surgery   radiotherapy   MeSH
• Check Tag
• Humans MeSH
• Female MeSH

• MeSH
• Medical Errors * prevention & control   adverse effects   MeSH
• Humans MeSH
• Breast Neoplasms * diagnosis   surgery   radiography   MeSH
• Intraoperative Care MeSH
• Preoperative Care MeSH
• Radiography MeSH
• Reoperation MeSH
• Mastectomy, Segmental * methods   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Female MeSH