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Acute Toxicity of High-Dose-Rate Intracavitary Brachytherapy With the MammoSite Applicator in Patients With Early-Stage Breast Cancer

From the Departments of Radiation Oncology (GMR, AMB, JR, SS) and Surgical Oncology (BS, DA, SB), St. Vincent’s Comprehensive Cancer Center, New York, New York; the Department of Surgery (VS, CM), St. Vincent’s Hospital-Manhattan, New York, New York; and New York Medical College (AMB, JR, SS, BS, DA, SB, VS, CM), Valhalla, New York.

Correspondence: Address correspondence and reprint requests to: Anthony M. Berson, MD, Department of Radiation Oncology, St. Vincent’s Comprehensive Cancer Center, 325 W. 15th St., New York, NY 10011; Fax: 212-367-1742; E-mail: aberson{at}salick.com

Background: Intracavitary brachytherapy with the MammoSite applicator as the sole radiation treatment in breast-conserving therapy is an option for women with early-stage breast cancer; we evaluated the acute toxicities associated with this treatment method.

Methods: Thirty-one patients with 32 stage I or II breast carcinomas underwent breast-conserving therapy, which included lumpectomy with negative margins, sentinel node biopsy, or axillary dissection, followed by brachytherapy with the MammoSite applicator. Acute radiation skin complications were graded on the day of radiotherapy completion and at weeks 2, 4, 6, and 12 after radiation treatment. Cosmesis was graded on the Harvard Scale at all follow-ups.

Results: The median follow-up was 11 months (range, 4–15 months). Twenty-seven of the 31 patients were treated with the device as the sole method of radiotherapy. No acute toxicities occurred during the 5 days of treatment. Nineteen patients (68%) had no to mild acute skin reactions, and 25% developed bright erythema and patchy moist desquamation. Two patients (7%) developed confluent moist desquamation within the first 4 weeks (grade 3); this healed by week 12. All skin reactions were localized to the area overlying the balloon. Sixteen percent (5 of 32) of all breasts with implants developed infection. Cosmesis was good to excellent in 86% of cases.

Conclusions: Most acute skin toxicities were mild. Our infection rate was higher than in prior studies that used interstitial brachytherapy. Cosmesis was good to excellent in most patients. Breast brachytherapy with the MammoSite catheter was well tolerated; further investigations of breast brachytherapy with this system are warranted.

Key Words: Brachytherapy • Breast cancer • Breast-conserving therapy • Lumpectomy • Radiation

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