Table 5.
Comparison of the current available APBI techniques (adapted from Sarin [135]), MIB = multicatheter Interstitial brachytherapy, IORT = intraoperative radiation therapy, RCT = randomized Clinical trials, OAR organ at risk
| MIB | Balloon based brachytherapy | Hybrid based brachytherapy | External beam | IORT | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Mammosite | Axxent Electronic | Contura | SAVI | ClearPath | Photons | Electrons | Protons | electrons | Photons | ||
| Prescription point | 1.5 - 2 cm | 1 cm | 1 cm | 1 cm | 1 cm | 1 cm | 1.5 - 2 cm | 1.5 - 2 cm | 1.5-2 cm | 10- 30 mm | 2 mm |
| Coverage of target volume | Variable | Good | Good | Good | Good | Good | Best | Good | Best | Good | Good |
| Dose Homogeneity | Fair | Fair | Fair | Fair | Fair | Fair | Best | Fair | Best | Fair | Fair |
| Sparing of OAR | Good | Good | Better | Better | Better | Better | Least | Varies | Good | Good | Best |
| Skin Dose | Least | Variable | variable | variable | variable | variable | Least | maximum | Least | Least | Least |
| Expertise required | High | Average | Average | Average | Average | Average | Average | Least | High | Very High | High |
| Suitability for various tumor size, location and shape | Not suitable if inadequate tissue or near axilla | Not suitable for large/irregular cavities or at the periphery | Not suitable Large cavities | Not suitable Large cavities | Not suitable Large cavities | Not suitable Large cavities | May not be suitable for small breast | Not suited for deep seated cavities in large breast | Superficial tumor | Not suitable for tumors near brachial plexus/axilla or skin | Not suitable for large irregular cavities or at the periphery of breast |
| Potential for wide spread use | Fair | Very good | Very good | Very good | Very good | Very good | Very good | Very good | Limited | limited | fair |
| Clinical outcome data | 11 years case studies | 5 years case studies | None | Limited | Limited | None | 4.5 years case studies | 8 years case studies | Limited | 4 years Case studies | 4 years RCT |
| Main drawback | High expertise required and QA | Stringent QA is required Cavity, shape and size |
Cavity shape and size | Cavity shape and size | Treatment planning complex | Treatment planning complex | Setup and breathing errors | High skin Dose | Expensive and 2nd neutrons | Pathology not available | Pathology not available |