LOCAL RESECTION AND BRACHYTHERAPY CONFINED TO THE LUMPECTOMY SITE FOREARLY BREAST-CANCER - A PILOT-STUDY

Background and Objectives: The commonest site of local breast recurren ce after breast conservation surgery is the primary tumor bed. We have tested the feasibility of outpatient high dose rate brachytherapy to the primary tumor bed as the only radiation. Our technique relies on t he placement of surgical clips to mark the tumor bed. Methods: Between March 1992 and January 1996, 39 patients with clinical T1 T2 breast c ancer were enrolled in this pilot study. The first 13 patients had int raoperative implantation of the breast. The remaining 26 patients had outpatient postoperative implantation under general anesthesia (2 pati ents) or local anaesthesia (24 patients). High dose rate brachytherapy was given twice daily at least 6 hours apart for a total dose of 37.2 Gy in 10 fractions over 5-7 days. Results: Three patients had mild cl inical cellulitis responding to oral antibiotics. One patient had a sm all sinus in the lumpectomy scar requiring local excision to heal. Fou r patients developed fat necrosis at the lumpectomy site at 4 (1 patie nt), 13 (1 patient), and 18 months (2 patients) post radiotherapy. Pat ient rated satisfaction with treatment was high. At a median followup of 20 months, one infield local recurrence has been salvaged by wider resection and postoperative conventional external beam radiation. Conc lusions: Except for fat necrosis, which may be associated with this te chnique, complications have been minimal. Outpatient implantation unde r local anesthesia is feasible. Longer followup is required to establi sh the local control rates. (C) 1997 Wiley-Liss, Inc.