Feasibility and full-course dosimetry of an intraoperatively placed multichannel brachytherapy catheter for accelerated partial breast irradiation

Bradley J. Stish, Deanna H. Pafundi, Tina J Hieken, Thomas J. Whitaker, Keith M. Furutani, James W Jakub, Judy C Boughey, Amy C Degnim, Luke B. McLemore, Benjamin Mou, Robert Mutter, Sean S Park

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose Determine feasibility and resultant dosimetry of an intraoperatively placed multichannel intracavitary brachytherapy catheter for accelerated partial breast irradiation (APBI). Methods Patients with breast cancer underwent intraoperative brachytherapy catheter placement based on frozen section analysis with immediate postoperative APBI. The planning target volume evaluation (PTVEval) and organs at risk were contoured on daily pretreatment CT scans for each patient, and the original treatment plan was applied to assess full-course dosimetry. Results Of the first 21 patients consented for intraoperative catheter placement, 20 (95%) were able to proceed with treatment as planned. The mean volume of PTVEval receiving 90% of prescription dose (V90%) and mean percentage of prescription dose to 90% of the PTVEval (D90%) on initial planning were 96.7 (±1.1%) and 100.2 (±2.1%), respectively. Full-course dose coverage remained excellent with a mean PTVEval V90% and D90% of 95.0 (±4.4%) and 100.2 (±9.6%), respectively. Mean full-course maximum dose constraints for chest wall and skin were met by 70% and 95% of patients, respectively. Air accumulation >1 cc during treatment increased the risk of a daily fraction with PTVEval coverage below goal (odds ratio, 9.8; p = 0.05), whereas those with applicators <0.5 cm from the chest wall at planning were at risk of exceeding that organ's maximum dose constraint on a daily fraction (odds ratio, 45; p = 0.02). Conclusions Intraoperative catheter placement and early initiation of APBI based on frozen section pathology is feasible, yields acceptable dosimetry, and is an option for completing breast conserving therapy in less than 10 days.

Original languageEnglish (US)
Pages (from-to)796-803
Number of pages8
JournalBrachytherapy
Volume15
Issue number6
DOIs
StatePublished - Nov 1 2016

Fingerprint

Brachytherapy
Breast
Catheters
Organs at Risk
Frozen Sections
Thoracic Wall
Prescriptions
Odds Ratio
Therapeutics
Air
Pathology
Breast Neoplasms
Skin

Keywords

  • Accelerated partial breast irradiation
  • Adaptive replanning
  • Brachytherapy
  • Breast cancer
  • Dosimetry
  • Frozen section pathology

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Feasibility and full-course dosimetry of an intraoperatively placed multichannel brachytherapy catheter for accelerated partial breast irradiation. / Stish, Bradley J.; Pafundi, Deanna H.; Hieken, Tina J; Whitaker, Thomas J.; Furutani, Keith M.; Jakub, James W; Boughey, Judy C; Degnim, Amy C; McLemore, Luke B.; Mou, Benjamin; Mutter, Robert; Park, Sean S.

In: Brachytherapy, Vol. 15, No. 6, 01.11.2016, p. 796-803.

Research output: Contribution to journalArticle

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abstract = "Purpose Determine feasibility and resultant dosimetry of an intraoperatively placed multichannel intracavitary brachytherapy catheter for accelerated partial breast irradiation (APBI). Methods Patients with breast cancer underwent intraoperative brachytherapy catheter placement based on frozen section analysis with immediate postoperative APBI. The planning target volume evaluation (PTVEval) and organs at risk were contoured on daily pretreatment CT scans for each patient, and the original treatment plan was applied to assess full-course dosimetry. Results Of the first 21 patients consented for intraoperative catheter placement, 20 (95{\%}) were able to proceed with treatment as planned. The mean volume of PTVEval receiving 90{\%} of prescription dose (V90{\%}) and mean percentage of prescription dose to 90{\%} of the PTVEval (D90{\%}) on initial planning were 96.7 (±1.1{\%}) and 100.2 (±2.1{\%}), respectively. Full-course dose coverage remained excellent with a mean PTVEval V90{\%} and D90{\%} of 95.0 (±4.4{\%}) and 100.2 (±9.6{\%}), respectively. Mean full-course maximum dose constraints for chest wall and skin were met by 70{\%} and 95{\%} of patients, respectively. Air accumulation >1 cc during treatment increased the risk of a daily fraction with PTVEval coverage below goal (odds ratio, 9.8; p = 0.05), whereas those with applicators <0.5 cm from the chest wall at planning were at risk of exceeding that organ's maximum dose constraint on a daily fraction (odds ratio, 45; p = 0.02). Conclusions Intraoperative catheter placement and early initiation of APBI based on frozen section pathology is feasible, yields acceptable dosimetry, and is an option for completing breast conserving therapy in less than 10 days.",
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author = "Stish, {Bradley J.} and Pafundi, {Deanna H.} and Hieken, {Tina J} and Whitaker, {Thomas J.} and Furutani, {Keith M.} and Jakub, {James W} and Boughey, {Judy C} and Degnim, {Amy C} and McLemore, {Luke B.} and Benjamin Mou and Robert Mutter and Park, {Sean S}",
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T1 - Feasibility and full-course dosimetry of an intraoperatively placed multichannel brachytherapy catheter for accelerated partial breast irradiation

AU - Stish, Bradley J.

AU - Pafundi, Deanna H.

AU - Hieken, Tina J

AU - Whitaker, Thomas J.

AU - Furutani, Keith M.

AU - Jakub, James W

AU - Boughey, Judy C

AU - Degnim, Amy C

AU - McLemore, Luke B.

AU - Mou, Benjamin

AU - Mutter, Robert

AU - Park, Sean S

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N2 - Purpose Determine feasibility and resultant dosimetry of an intraoperatively placed multichannel intracavitary brachytherapy catheter for accelerated partial breast irradiation (APBI). Methods Patients with breast cancer underwent intraoperative brachytherapy catheter placement based on frozen section analysis with immediate postoperative APBI. The planning target volume evaluation (PTVEval) and organs at risk were contoured on daily pretreatment CT scans for each patient, and the original treatment plan was applied to assess full-course dosimetry. Results Of the first 21 patients consented for intraoperative catheter placement, 20 (95%) were able to proceed with treatment as planned. The mean volume of PTVEval receiving 90% of prescription dose (V90%) and mean percentage of prescription dose to 90% of the PTVEval (D90%) on initial planning were 96.7 (±1.1%) and 100.2 (±2.1%), respectively. Full-course dose coverage remained excellent with a mean PTVEval V90% and D90% of 95.0 (±4.4%) and 100.2 (±9.6%), respectively. Mean full-course maximum dose constraints for chest wall and skin were met by 70% and 95% of patients, respectively. Air accumulation >1 cc during treatment increased the risk of a daily fraction with PTVEval coverage below goal (odds ratio, 9.8; p = 0.05), whereas those with applicators <0.5 cm from the chest wall at planning were at risk of exceeding that organ's maximum dose constraint on a daily fraction (odds ratio, 45; p = 0.02). Conclusions Intraoperative catheter placement and early initiation of APBI based on frozen section pathology is feasible, yields acceptable dosimetry, and is an option for completing breast conserving therapy in less than 10 days.

AB - Purpose Determine feasibility and resultant dosimetry of an intraoperatively placed multichannel intracavitary brachytherapy catheter for accelerated partial breast irradiation (APBI). Methods Patients with breast cancer underwent intraoperative brachytherapy catheter placement based on frozen section analysis with immediate postoperative APBI. The planning target volume evaluation (PTVEval) and organs at risk were contoured on daily pretreatment CT scans for each patient, and the original treatment plan was applied to assess full-course dosimetry. Results Of the first 21 patients consented for intraoperative catheter placement, 20 (95%) were able to proceed with treatment as planned. The mean volume of PTVEval receiving 90% of prescription dose (V90%) and mean percentage of prescription dose to 90% of the PTVEval (D90%) on initial planning were 96.7 (±1.1%) and 100.2 (±2.1%), respectively. Full-course dose coverage remained excellent with a mean PTVEval V90% and D90% of 95.0 (±4.4%) and 100.2 (±9.6%), respectively. Mean full-course maximum dose constraints for chest wall and skin were met by 70% and 95% of patients, respectively. Air accumulation >1 cc during treatment increased the risk of a daily fraction with PTVEval coverage below goal (odds ratio, 9.8; p = 0.05), whereas those with applicators <0.5 cm from the chest wall at planning were at risk of exceeding that organ's maximum dose constraint on a daily fraction (odds ratio, 45; p = 0.02). Conclusions Intraoperative catheter placement and early initiation of APBI based on frozen section pathology is feasible, yields acceptable dosimetry, and is an option for completing breast conserving therapy in less than 10 days.

KW - Accelerated partial breast irradiation

KW - Adaptive replanning

KW - Brachytherapy

KW - Breast cancer

KW - Dosimetry

KW - Frozen section pathology

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