Table 10.
Cosmesis and complications after APBI with interstitial brachytherapy [29]
| Institution | Technique | Number of patients | Follow-up | Cosmesis and complications |
|---|---|---|---|---|
| The William Beaumont Hospital, USA [49, 80–82] | HDR 32-34 Gy/8-10 fr/4-5 days LDR 50 Gy, 96 hours | 199 | 5.7 years (LR), 6.4 years (cosmesis) | 7% acute infection, 4% late infection, 11% fat necrosis at ≥ 5 yearsa, good/excellent cosmesisb in > 90% |
| Ochsner Clinic, USA [83] | HDR 32-34 Gy/8-10 fr/ 4-5 days LDR 45 Gy, 4 days | 50 | 6.3 years | cosmesis scored at median 20 months: 22% grade I/II compl., 8% grade III compl., 75% had an excellent/ good cosmesisa, all based ona |
| Ochsner Clinic, USA [84] | HDR 32-34 Gy/8-10 fr/4-5 days LDR 45 Gy, 4 days | 99 | 2.7 years | late grade III tox. 18% (LDR) and 4% (HDR), no late grade IV tox., all based ona |
| London Regional Cancer Center, Ontario [85] | HDR 37.2 Gy/10 fr/5 days | 39 | 7.6 years | median overall cosmetics score 89%, 13% had fat necrosisa, all based ona |
| Tufts New England [44, 86–88] | HDR 34 Gy/10 fr/5 days | 75 | 6.1 years | cosmesisa, excellent/good/fair-poor: 67%/24%/9% at last follow-up, late skin tox.c grad. 1/2/3 77%, 19%, 4%, late subcutaneous tox. grad. 1/2/3/4 55%, 15%, 12%, 18% |
| Tufts New England [89] | LDR 50, 55, and 60 Gy | 48 | 1.9 years | very good/excellent cosmesis 91.8%, 12.5% perioperative complications, 25% had fibrosis, 8% moderate to severe fibrosis, based ona |
| Tufts New England [90] | HDR 34 Gy/10 fr/5 days | 32 | 7 years | 18% had fat necrosis > 5 years, 35.7% moderate to severe subcutaneous fibrosis > 5 years, 89% excellent cosmesis at 5 years, toxicity based onc, fibrosis > 5 years |
| University of Kansas [91] | LDR 20-25 Gy | 24 | 3.9 years | cosmesis good to excellent in 100%, no late complications, based ona |
| Guys Hospital, London [92, 93] | LDR 55 Gy, 5 days | 27 | 6 years | cosmesis good to excellent in 83%, no fibrosis, based ona |
| Guys Hospital, London [94] | LDR 45 Gy, 4 days | 49 | 6.3 years | abnormal breast in 58%, based ona |
| National Institue of Oncology, Hungary [95, 96] | HDR 30.3-36.4 Gy/7 fr/4 days | 45 | 6.8 years | cosmesis excellent/good in 84.4%, fat necrosis 20%, ≥ grade 2 late radiation reaction 26.7%, based onb |
| National Institue of Oncology, Hungary [55, 97] | HDR 36.4 Gy/7 fr/4 days (n = 88) or ERBT 50 Gy/25 fr (n = 40) | 126 | 5.5 years | excellent to good in 81.2% (HDR) and 70% (electrons), based onb, 4-year actuarial fat necrosis 36.5% (HDR) and 17.7% (electrons), based on institutional scheme |
| Erlangen, Germany [57, 98–100] | HDR (36%) 32 Gy/8 fr/5 days; PDR (64%) 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour/5 days | 274 | 2.7 years | cosmesis excellent to good in 94%, acute toxicity in 6.6%, fat necrosis 4.7%, breast tissue fibrosis in 19.3% and telangiec-tasia in 12.8%, scoring based onb,c,d |
Number of patients refers to patients diagnosed with invasive cancer
a
Cosmesis scored according to institutional guidelines
b
Cosmesis scored according to Harvard criteria [101]
c
Skin and subcutaneous toxicity scored according to Radiation Therapy Oncology Group (RTOG)/Eastern Cooperative Oncology Group system [102]
d
Acute and late side effects based on LENT SOMA [103]