Breast Cancer

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TU_3_3347 - Multi-institutional Registry Study of Accelerated Partial Breast Irradiation (APBI) Using Non-invasive Image-guided Breast Brachytherapy (NIBB)

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Multi-institutional Registry Study of Accelerated Partial Breast Irradiation (APBI) Using Non-invasive Image-guided Breast Brachytherapy (NIBB)
J. T. Hepel1,2, M. Listo3, K. L. Leonard4, J. Scharfen5, C. M. Yashar6, J. P. Einck7, S. J. Sha Jr8, D. G. Mastras9, R. K. Benda10, T. A. DiPetrillo1, and D. E. Wazer4; 1Radiation Oncology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 2Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 3New Jersey Medical School, Newark, NJ, 4Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, 5Rhode Island Hospital, Providence, RI, 6University of California San Diego, San Diego, CA, 7Department of Radiation Medicine, University of California, San Diego, La Jolla, CA, 8Central Florida Cancer Institute, Davenport, FL, 9Tacoma/Valley Radiation Oncology, Tacoma, WA, 10Lynn Cancer Institute, Boca Raton, FL

Purpose/Objective(s): The NIBB technique is a novel non-invasive but targeted method of delivering partial breast irradiation. We established a multi-institutional registry to evaluate feasibility, safety, and efficacy of this technique across various practice settings.

Materials/Methods: All centers employing the NIBB technique were invited to participate. Patients treated with NIBB APBI were registered on a privacy-encrypted online data registry. Patient demographics, tumor characteristics, and treatment parameters were recorded. Outcomes data for acute toxicity, late toxicity, cosmetic outcome, and ipsilateral breast tumor control were collected. Toxicity and cosmetic outcome were graded based on the Common Terminology Criteria for Adverse Events v3.0 and Harvard Scale, respectively.

Results: 154 patients with a mean age of 68 years (range: 50-92 years) underwent APBI using NIBB. The mean tumor size was 1.1 cm (range: 0.1 – 3 cm). Histology was IDC in 64%, DCIS in 21%, and ILC in 3%. 92% were ER positive and 3% were HER2-neu positive. All patients were lymph node negative. Margins were <0.1 mm, 0.1-1.9 mm, and ≥ 2 mm, in 9%, 21%, and 64%, respectively. Treatment doses were 34Gy in 10fx, 36Gy in 10fx, and 28.5Gy in 5fx in 55%, 11%, and 27% of patients, respectively. 12% were treated BID. Mean breast separation with compression was 6.4 cm (3.0 – 9.4 cm). Acute radiation dermatitis was grade 0-1 in 124 patients (81%), grade 2 in 28 patients (18%), and grade 3 in 2 patients (1%). 124 patients were evaluable for late toxicity and cosmetic outcome. Grade 3 late toxicity was observed in 1 patient (<1%) with fat necrosis. Grade 2 toxicity was seen in 6% of patients with 1 hyperpigmentation, 5 telangiectasia, 2 fibrosis, and 1 breast pain. Cosmetic outcome at last follow up was Excellent, Good, and Fair/Poor in 69%, 31%, and 1%. At a median follow up of 18 months (1 - 72 months), ipsilateral breast tumor control was 98%.

Conclusion: APBI delivered using NIBB is well tolerated with a low rate of significant acute toxicity. Late toxicity and cosmetic outcome are also favorable. Longer follow up is needed to confirm late end points.

Author Disclosure: J.T. Hepel: Medical Director; ACRO Accreditation. M. Listo: None. K.L. Leonard: None. J. Scharfen: None. C.M. Yashar: Partner; Kaiser Permanente. Advisory Board; Cianna Medical, MicroChips. Travel Expenses; MicroChips. Board Member; American College of Radiation Oncology. Cancer Committee Chairman; University of California San Diego. President; American Brachytherapy Society. Chair, CEP; Univeristy of California San Diego. Chair of Committee; University of California San Diego. Vice Chief of Staff; University of California San Diego. J.P. Einck: Independent Contractor; American College of Radiation Oncology. Board Member; Cure Cervical Cancer. oRG. R.K. Benda: None. T.A. DiPetrillo: Patent/License Fees/Copyright; Thomas DiPetrillo. D.E. Wazer: Consultant; Advanced Radiation Therapy, Inc. Stock; Advanced Radiation Therapy, Inc, Cancer Care International. LLC. Partnership; PointSource Technologies, LLC. Patent/License Fees/Copyright; PointSource Technologies, LLC.

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