Vol 27, No 1 (2022)
Research paper
Published online: 2022-01-27

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CyberKnife versus multicatheter interstitial brachytherapy for accelerated partial breast irradiation: a dosimetrical assessment with focus on organs at risk

András Herein12, Gábor Stelczer12, Csilla Pesznyák12, Georgina Fröhlich13, Viktor Smanykó1, Norbert Meszaros14, Csaba Polgár14, Zoltán Takácsi-Nagy14, Tibor Major54
Rep Pract Oncol Radiother 2022;27(1):152-160.

Abstract

Background: The purpose of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation with special focus on dose to organs at risk (OARs).

Materials and methods: Treatment plans of thirty-one patients treated with MIBT were selected and additional CK plans were created on the same CT images. The OARs included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left sided cases. The fractionation was identical (4 x 6.25 Gy). Dose-volume parameters were calculated for both techniques and compared.

Results: The D90 of the PTV for MIBT and CK were similar (102.4% vs. 103.6%, p = 0.0654), but in COIN the MIBT achieved lower value (0.75 vs. 0.91, p < 0.001). Regarding the V100 parameter of non-target breast CK performed slightly better than MIBT (V100: 1.1% vs. 1.6%), but for V90, V50 and V25 MIBT resulted in less dose. Every examined parameter of ipsilateral lung, skin, ribs and contralateral lung was significantly smaller for MIBT than for CK. Protection of the heart was slightly better with MIBT, but only the difference of D2cm3 was statistically significant (17.3% vs. 20.4%, p = 0.0311). There were no significant differences among the dose-volume parameters of the contralateral breast.

Conclusion: The target volume can be properly irradiated by both techniques with high conformity and similar dose to the OARs. MIBT provides more advantageous plans than CK, except for dose conformity and the dosimetry of the heart and contralateral breast. More studies are needed to analyze whether these dosimetrical findings have clinical significance.

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References

  1. Early Breast Cancer Trialists’ Collaborative Group. Effects of Radiotherapy and Surgery in Early Breast Cancer — An Overview of the Randomized Trials. N Engl J Med. 1995; 333(22): 1444–1456.
  2. Polgár C, Major T. Current status and perspectives of brachytherapy for breast cancer. Int J Clin Oncol. 2009; 14(1): 7–24.
  3. Forster T, Köhler CV, Debus J, et al. Accelerated Partial Breast Irradiation: A New Standard of Care? Breast Care (Basel). 2020; 15(2): 136–147.
  4. Polgár C, Major T, Fodor J, et al. Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol. 2010; 94(3): 274–279.
  5. Polgár C, Fodor J, Major T, et al. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol. 2013; 108(2): 197–202.
  6. Polgár C, Ott O, Hildebrandt G, et al. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2017; 18(2): 259–268.
  7. Strnad V, Ott O, Hildebrandt G, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet. 2016; 387(10015): 229–238.
  8. Ott OJ, Strnad V, Hildebrandt G, et al. Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO). GEC-ESTRO multicenter phase 3-trial: Accelerated partial breast irradiation with interstitial multicatheter brachytherapy versus external beam whole breast irradiation: Early toxicity and patient compliance. Radiother Oncol. 2016; 120(1): 119–123.
  9. Soror T, Kovács G, Seibold N, et al. Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy : Evaluation by a multidisciplinary/multigender committee. Strahlenther Onkol. 2017; 193(5): 367–374.
  10. Schäfer R, Strnad V, Polgár C, et al. Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial. Lancet Oncol. 2018; 19(6): 834–844.
  11. Vicini F, Cecchini R, White J, et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. The Lancet. 2019; 394(10215): 2155–2164.
  12. Polgár C, Van Limbergen E, Pötter R, et al. GEC-ESTRO breast cancer working group. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol. 2010; 94(3): 264–273.
  13. Strnad V, Hannoun-Levi JM, Guinot JL, et al. Working Group Breast Cancer of GEC-ESTRO. Recommendations from GEC ESTRO Breast Cancer Working Group (I): Target definition and target delineation for accelerated or boost Partial Breast Irradiation using multicatheter interstitial brachytherapy after breast conserving closed cavity surgery. Radiother Oncol. 2015; 115(3): 342–348.
  14. Major T, Gutiérrez C, Guix B, et al. Breast Cancer Working Group of GEC-ESTRO. Recommendations from GEC ESTRO Breast Cancer Working Group (II): Target definition and target delineation for accelerated or boost partial breast irradiation using multicatheter interstitial brachytherapy after breast conserving open cavity surgery. Radiother Oncol. 2016; 118(1): 199–204.
  15. Strnad V, Major T, Polgar C, et al. ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost - GEC-ESTRO Breast Cancer Working Group practical recommendations. Radiother Oncol. 2018; 128(3): 411–420.
  16. Strnad V, Krug D, Sedlmayer F, et al. Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO). DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol. 2020; 196(9): 749–763.
  17. Njeh CF, Saunders MW, Langton CM. Accelerated Partial Breast Irradiation (APBI): A review of available techniques. Radiat Oncol. 2010; 5: 90.
  18. Stelczer G, Major T, Mészáros N, et al. External beam accelerated partial breast irradiation: dosimetric assessment of conformal and three different intensity modulated techniques. Radiol Oncol. 2019; 53(1): 123–130.
  19. Xu Q, Chen Y, Grimm J, et al. Dosimetric investigation of accelerated partial breast irradiation (APBI) using CyberKnife. Med Phys. 2012; 39(11): 6621–6628.
  20. Goggin LM, Descovich M, McGuinness C, et al. Dosimetric Comparison Between 3-Dimensional Conformal and Robotic SBRT Treatment Plans for Accelerated Partial Breast Radiotherapy. Technol Cancer Res Treat. 2016; 15(3): 437–445.
  21. Rault E, Lacornerie T, Dang HP, et al. Accelerated partial breast irradiation using robotic radiotherapy: a dosimetric comparison with tomotherapy and three-dimensional conformal radiotherapy. Radiat Oncol. 2016; 11: 29.
  22. Bonfantini F, De Martin E, Giandini T et al. A Dosimetric Comparison between Three Different External Photon Beam Techniques for Accelerated Partial Breast Irradiation.Clin Oncol 2018;3:1501. http://www.clinicsinoncology.com/full-text/cio-v3-id1501.php.
  23. Lee C, Kim W, Kim H, et al. Dosimetric Plan Comparison of Accelerated Partial Breast Irradiation (APBI) Using CyberKnife. Prog Med Phys. 2018; 29(2): 73.
  24. Fan J, Hayes S, Freedman G, et al. Planning the Breast Boost: Dosimetric Comparison of CyberKnife, Photon Mini Tangents, IMRT, and Electron Techniques. Int J Radiat Oncol Biol Phys. 2010; 78(3): S788–S789.
  25. Anbumani S, Palled SR, Prabhakar GS, et al. Accelerated partial breast irradiation using external beam radiotherapy-A feasibility study based on dosimetric analysis. Rep Pract Oncol Radiother. 2012; 17(4): 200–206.
  26. Major T, Stelczer G, Pesznyák C, et al. Multicatheter interstitial brachytherapy versus intensity modulated external beam therapy for accelerated partial breast irradiation: A comparative treatment planning study with respect to dosimetry of organs at risk. Radiother Oncol. 2017; 122(1): 17–23.
  27. Charaghvandi RK, den Hartogh MD, van Ommen AMLN, et al. MRI-guided single fraction ablative radiotherapy for early-stage breast cancer: a brachytherapy versus volumetric modulated arc therapy dosimetry study. Radiother Oncol. 2015; 117(3): 477–482.
  28. Fröhlich G, Mészáros N, Smanykó V, et al. Is stereotactic CyberKnife radiotherapy or multicatheter HDR brachytherapy the better option dosimetrically for accelerated partial breast irradiation? Brachytherapy. 2021; 20(2): 326–331.
  29. Herein A, Stelczer G, Pesznyák C, et al. Multicatheter interstitial brachytherapy versus stereotactic radiotherapy with CyberKnife for accelerated partial breast irradiation: a comparative treatment planning study with respect to dosimetry of organs at risk. Radiol Oncol. 2021; 55(2): 229–239.
  30. Nath R, Anderson LL, Luxton G, et al. Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine. Med Phys. 1995; 22(2): 209–234.
  31. Mészáros N, Smanykó V, Major T, et al. Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife - Technical Considerations and Early Experiences of a Phase II Clinical Study. Pathol Oncol Res. 2020; 26(4): 2307–2313.
  32. Baltas D, Kolotas C, Geramani K, et al. A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy. Int J Radiat Oncol Biol Phys. 1998; 40(2): 515–524.
  33. Bondiau PY, Bahadoran P, Lallement M, et al. Robotic stereotactic radioablation concomitant with neo-adjuvant chemotherapy for breast tumors. Int J Radiat Oncol Biol Phys. 2009; 75(4): 1041–1047.
  34. Vermeulen S, Cotrutz C, Morris A, et al. Accelerated Partial Breast Irradiation: Using the CyberKnife as the Radiation Delivery Platform in the Treatment of Early Breast Cancer. Front Oncol. 2011; 1: 43.
  35. Vermeulen SS, Haas JA. CyberKnife stereotactic body radiotherapy and CyberKnife accelerated partial breast irradiation for the treatment of early breast cancer. Transl Cancer Res. 2014; 3(4): 295–302.
  36. Obayomi-Davies O, Kole TP, Oppong B, et al. Stereotactic Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Rationale, Feasibility, and Early Experience Using the CyberKnife Radiosurgery Delivery Platform. Front Oncol. 2016; 6: 129.
  37. Lozza L, Fariselli L, Sandri M, et al. Partial breast irradiation with CyberKnife after breast conserving surgery: a pilot study in early breast cancer. Radiat Oncol. 2018; 13(1): 49.
  38. Weed DW, Edmundson GK, Vicini FA, et al. Accelerated partial breast irradiation: a dosimetric comparison of three different techniques. Brachytherapy. 2005; 4(2): 121–129.



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