Breast brachytherapy and clinical appendix

Breast brachytherapy delivers partial breast irradiation after breast-conserving surgery. The goal is to reduce local recurrence while minimizing dose to normal tissue. The majority of ipsilateral breast tumor recurrences occur within the index quadrant. It provides options for shorter treatment duration compared to traditional whole breast external beam radiation therapy (5 days vs. 5 weeks). Guidelines from several groups exist with recommendations for selecting appropriate patients. Multiple imaging modalities may be used to identify the lumpectomy cavity and confirm applicator placement. Cross-sectional imaging allows for evaluation of the implant (confirms placement, adjustment, manipulation). HDR or LDR can be utilized to deliver dose: 34 Gy in 10 fractions over 5 days (HDR), 32 Gy in 8 fractions over 4 days (HDR), 10 Gy in 2 fractions over 1-2 days (HDR boost), 45-50 Gy/0.50 Gy per hour (LDR), or 15-20 Gy/0.50 Gy per hour (LDR boost). NSABP B-39/RTOG 0413 will allow for comparison of treatment-related toxicity and cosmesis between accelerated partial breast irradiation and whole breast irradiation (results pending). Good to excellent cosmetic and high treatment-related satisfaction have been reported in many series.