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Partial Breast Irradiation using Multicatheter Brachytherapy

Partial Breast Irradiation using Multicatheter Brachytherapy

von: Vratislav Strnad, Oliver J. Ott (eds.)

W. Zuckschwerdt Verlag, 2006

ISBN: 9783886039012 , 165 Seiten

Format: PDF, OL

Kopierschutz: DRM

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Partial Breast Irradiation using Multicatheter Brachytherapy


 

Contents

6

Target volume definition after closed-cavity surgery: clinical considerations

42

Contributors

8

Introduction

10

Patterns of care for breast brachytherapy in Europe

12

Introduction

12

The main tumour sites treated with brachytherapy

12

Breast cancer in Europe

13

Partial breast irradiation with multi- catheter brachytherapy: how hazardous is it?

16

The basic importance of whole breast irradiation ( WBI)

16

How patient selection impacts local control after breast- conserving surgery and whole breast irradiation

17

Local recurrence after accelerated partial breast irradiation ( APBI) with strict patient selection

19

Local recurrence after APBI without strict patient selection

20

Summary

22

Patient selection criteria and pathological considerations

24

Introduction

24

Evidence-based selection criteria for APBI

24

Treatment-related prognostic factors Surgical margins and radiation dose

26

Patient-related and tumour-related predictive factors Patient age

28

Patient age

28

Extensive intraductal component

28

Tumour size

29

Histological grade

29

Invasive lobular carcinoma

30

Ductal carcinoma in situ

30

Hormone receptor status

31

Lymphatic Spread

31

Conclusions

32

Pre-brachytherapy imaging procedures

38

Introduction

38

Clinical assessment

38

Technical methods

38

Summary

41

Target volume definition after closed-cavity surgery: clinical considerations

42

Introduction

42

Individual variations of the anatomy of the female breast after breastconserving surgery

42

Value of the surgical report and the pathological report

44

Value of the skin scar

46

Value of sonography

47

Value of mammography, CT, and MRI

48

Value of surgical clips

51

Summary

52

Target volume definition after open-cavity surgery: clinical considerations

56

Basic clinical considerations for target definition in breast radiotherapy

56

What should be the target volume for partial breast brachytherapy?

56

Anaesthesia and patient care

62

Introduction

62

Anaesthesia

62

Positioning of the patient

63

Instruments

63

Surgical report

63

Postoperative monitoring after general anaesthesia

63

Care of the tubes

64

Removal of the tubes

65

Care instruction after multi-catheter brachytherapy of the breast

66

Clip-based implant technique using an Integrated Brachytherapy Unit (IBU)

68

CT-based implant technique after closed-cavity surgery

72

Introduction

72

Pre-implantation CT-based simulation of the tumour bed

73

Implantation procedure

73

Post-implantation CT and reconstruction of implant geometry

74

Target volume definition (CTV/PTV) and delineation of organs at risk (OARs)

74

CT-based calculation and optimization of 3D-physical dose distribution

74

CT-based implant technique after open-cavity surgery: European policy

80

CT-based implant technique after open-cavity surgery: American policy

86

Introduction

86

Catheter placement technique

86

Dose delivery parameters

89

Ultrasound-based implant technique

92

Introduction

92

Ultrasound-guided multi-catheter implantation

94

Conclusion

98

Physical aspects: dosimetry, planning, and documentation

100

Introduction

100

Dose calculation formalism

100

Treatment planning

101

Biological aspects: total dose and fractionation

116

Introduction

116

The linear quadratic model

117

The LQ model in brachytherapy

119

Pulsed-dose-rate (PDR) brachytherapy

120

Conclusions

120

Normal-tissue constraints

124

Introduction

124

Breast fibrosis

124

Skin teleangiectasia

125

Fat necrosis

128

Summary

130

Clinical results: European experience

134

Introduction

134

Guy’s Hospital studies

134

Uzsoki Hospital’s cobalt-needle study

136

Florence series

136

Royal Devon/Exeter Hospital series

137

Ninewells Hospital’s study

137

Örebro series

137

National Institute of Oncology (Hungary) phase II study

137

German-Austrian multicentric trial

138

National Institute of Oncology (Hungary) phase III trial

139

Summary of European experience

140

Clinical results: American experience

142

Introduction

142

William Beaumont Hospital

142

Ochsner Clinic

144

Tufts-Brown Universities

144

Radiation Therapy Oncology Group 95-17

145

Conclusions

145

Current randomised trials

148

Introduction

148

The European GEC-ESTRO APBI Trial

148

The North-American NSABP B-39/RTOG 0413 Trial

150

Comparison of the European GECESTRO APBI Trial and the North- American NSABP B-39/RTOG 0413 Trial

153

Summary

155

Summary

158

Index

160