Elsevier

Brachytherapy

Volume 9, Issue 1, January–March 2010, Pages 76-80
Brachytherapy

Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence

https://doi.org/10.1016/j.brachy.2009.08.010Get rights and content

Abstract

Purpose

To identify possible risk factors for development of clinically significant seroma (CSS) (seroma requiring intervention) and to report on incidence of infection after intraoperative placement of MammoSite for breast brachytherapy.

Methods and Materials

Fifty-eight postmenopausal patients with early stage breast cancer and no nodal metastases, treated with partial breast irradiation using the MammoSite catheter from June 2003 to November 2007 were analyzed retrospectively for CSS predictive factors and incidence of infection. After a lumpectomy, a MammoSite catheter was placed by intraoperative open-cavity technique (OCT). All the patients received wound care and prophylactic antibiotics. A dose of 3400 cGy was prescribed at 1 cm from the surface of the balloon and was delivered at 340 cGy twice daily 6 h apart for 5 days. The patients with seroma who underwent intervention were considered to have CSS. On the basis of the characteristics and symptoms associated with seroma, interventions, such as aspiration, core biopsy, or re-excision of the lumpectomy cavity were performed either to relieve symptoms or to rule out a local recurrence.

Results

Fifty-seven of the 58 patients were eligible for analysis. One patient, who died 4 weeks after treatment from unrelated causes, was excluded from final analysis. All the patients were postmenopausal, with a median age of 71 years (range, 53–88 years). Eighteen of the 57 patients (31.5%) had CSS; 9 of them had re-excision of the lumpectomy cavity. Pathology in all revealed evidence of fat necrosis, chronic inflammatory cells, and fibrosis. There was no evidence of tumor recurrence in any of these patients. Technical and nontechnical parameters were analyzed to determine possible risk factors for CSS, and none were found to be statistically significant. No patient developed acute postprocedural infection.

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 postmenopausal breast cancer patients.

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.

Section snippets

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.

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Poster presented at the 2008 World Congress of Brachytherapy, May 4–6, 2008, at Marriott Copley Place, Boston, MA.

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