Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence
Introduction
Accelerated partial breast irradiation (APBI) is a treatment option for breast conservation therapy. The National Surgical Adjuvant Breast and Bowel Project and The Radiation Therapy Oncology group are investigating regarding the optimal target volume of whole breast vs. partial breast irradiation in early breast cancer patients. There are several techniques and applicators available for APBI, including multicatheter interstitial brachytherapy, MammoSite device (Cytyc Corp., Marlborough, MA), newer multilumen catheters namely SAVI, Contura, ClearPath, intraoperative irradiation with HAM applicator, intraoperative electron beam therapy, computerized tomography–based three-dimensional external beam, intensity modulated radiation therapy, and proton beam therapy. Multicatheter interstitial brachytherapy has a low recurrence rate and favorable cosmesis [1], [2], [3], but requires significant training and expertise. MammoSite is a single catheter balloon device, which is placed intraoperatively by the open-cavity technique (OCT) or postoperatively by closed-cavity technique. Published pooled multi-institutional results using the MammoSite Radiation System demonstrated favorable local control and cosmesis (4). However, acute skin reactions, infections, seroma formation, telangectasia, breast pain, edema, and pigmentation continue to be reported (4).
Seroma development after MammoSite brachytherapy has incidence rates ranging from 9% to 79% [5], [6], [7]. The incidence of seroma and infection is higher when OCT is used (7). Herein, we examine the incidence of infection, as well as contributing factors for clinically significant seroma (CSS), in postmenopausal patients treated with APBI using the MammoSite Catheter.
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Patients
Fifty-seven patients were included in the analysis; 1 patient was excluded because she expired 4 weeks after her treatment because of causes unrelated to her breast cancer. The patients were eligible for APBI with MammoSite if they were postmenopausal, had either invasive ductal carcinoma or ductal carcinoma in situ, had tumors no larger than 3 cm, had no evidence of nodal metastases or lymphovascular invasion, had margins of 1 mm or greater, had a balloon surface to skin distance of 7 mm or
Results
The tumor was in the upper outer quadrant of the breast in most of the patients. The most common pathologic stage was pT1b N0 and pT1c N0 (Table 1). Overall seroma was identified in 29 of 57 patients (51.7%), and CSS was documented in 18 of 57 patients (31.5%). Four of the 18 (22.2%) patients underwent a biopsy followed by re-excision for an abnormal mammogram. Fifteen of the 18 (83%) patients underwent these procedures at least 6 months (range, 6–36 months) after completion of the treatment.
Discussion
After intraoperative placement of MammoSite for breast brachytherapy, data was collected to report on the incidence of infection and to identify possible risk factors for development of CSS. The rate of seroma formation after intraoperative breast brachytherapy has been reported in the literature in the range of 9–79% [5], [6], [7]. The overall rate of seroma formation in patients in whom OCT was used is reported as 61.1% (8). Evans et al.(6) found a 76.3% overall incidence of seroma and
Conclusions
Meticulous wound care and postoperative antibiotics prevented acute infection. Infection was not a contributing factor for seroma formation in these patients. Placement of the MammoSite catheter by OCT did not increase the risk of CSS development, in breast cancer patients.
References (12)
- et al.
Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for Tis, 1,2 breast cancer
Am J Surg
(2000) - et al.
Persistent seroma after intraoperative placement of MammoSite for accelerated partial breast irradiation: Incidence, pathologic anatomy, and contributing factors
Int J Radiat Oncol Biol Phys
(2006) - et al.
MammoSite accelerated partial breast Irradiation: A single institution outcome analysis with 2 years of follow up
Brachytherapy
(2009) - et al.
Analysis of treatment efficacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial breast irradiation: The William Beaumont Hospital experience
Int J Radiat Oncol Biol Phys
(2007) - et al.
Description and outcomes of insertion techniques of breast brachytherapy balloon catheter in 1403 patients enrolled in the American Society of Breast Surgeon MammoSite breast registry trials
Am J Surg
(2005) - et al.
Limited-field radiation therapy in the management of early-stage breast cancer
J Natl Cancer Inst
(2003)
Cited by (0)
Poster presented at the 2008 World Congress of Brachytherapy, May 4–6, 2008, at Marriott Copley Place, Boston, MA.