source: https://doi.org/10.48350/20639 | downloaded: 12.12.2022 22 Strahlenther Onkol 2006 · No. 1 © Urban & Vogel Strahlentherapie und Onkologie Original Article Neoadjuvant Interstitial High-Dose-Rate (HDR) Brachytherapy Combined with Systemic Chemotherapy in Patients with Breast Cancer Sandra J. Roddiger 1 , Christos Kolotas 2 , Ineza Filipowicz 1 , Ralf Kurek 1 , Ralph Paul Kuner 3 , Thomas Martin 4 , Dimos Baltas 1 , Bernd Rogge 1 , Marina Kontova 1 , Gerald Hoffmann 3 , Bettina Pollow 3 , Nikolaos Zamboglou 1 Background and Purpose: This is the first study investigating neoadjuvant interstitial high-dose-rate (HDR) brachytherapy combined with chemotherapy in patients with breast cancer. The goal was to evaluate the type of surgical treatment, histo- pathologic response, side effects, local control, and survival. Patients and Methods: 53 patients, who could not be treated with breast-conserving surgery due to initial tumor size (36/53) or due to an unfavorable breast-tumor ratio (17/53), were analyzed retrospectively. All but one were in an intermediate/high-risk group (St. Gallen criteria). The patients received a neoadjuvant protocol consisting of systemic chemotherapy combined with fractionated HDR brachytherapy (2 × 5 Gy/day, total dose 30 Gy). In cases, where breast-conserving surgery was performed, pa- tients received additional external-beam radiotherapy (EBRT, 1.8 Gy/day, total dose 50.4 Gy). In patients, who underwent mas- tectomy but showed an initial tumor size of T3/T4 and/or more than three infiltrated lymph nodes, EBRT was also performed. Results: In 30/53 patients (56.6%) breast-conserving surgery could be performed. The overall histopathologic response rate was 96.2% with a complete remission in 28.3% of patients. 49/53 patients were evaluable for follow-up. After a median of 58 months (45–72 months), one patient showed a mild fibrosis of the breast tissue, three patients had mild to moderate lymphatic edema of the arm. 6/49 (12.2%) patients died of distant metastases, 4/49 (8.2%) were alive with disease, and 39/49 (79.6%) were free from disease. Local recurrence was observed in only one case (2%) 40 months after primary therapy. After mastectomy, this pa- tient is currently free from disease. Conclusion: The combination of interstitial HDR brachytherapy and chemotherapy is a well-tolerated and effective neoadjuvant treatment in patients with breast cancer. Compared to EBRT, treatment time is short. Postoperative EBRT of the whole breast – if necessary – is still possible after neoadjuvant brachytherapy. Even though the number of patients does not permit definite con- clusions, the results are promising regarding survival and the very low rate of local recurrences. Key Words: Interstitial HDR brachytherapy · Neoadjuvant treatment · Breast cancer Strahlenther Onkol 2006;182:22–9 DOI 10.1007/s00066-006-1454-7 Neoadjuvante interstitielle HDR-Brachytherapie in Kombination mit Chemotherapie bei Patientinnen mit Mammakarzinom Hintergrund und Ziel: Dies ist die erste Studie, welche den neoadjuvanten Einsatz einer Kombination aus interstitieller High- Dose-Rate-(HDR-)Brachytherapie und Chemotherapie bei Patientinnen mit Mammakarzinom untersucht. Ziel war es, die Art des chirurgischen Eingriffs, das histopathologische Ansprechen wie auch Nebenwirkungen, lokale Kontrolle und Überleben zu evalu- ieren. Patienten und Methodik: Es wurden retrospektiv 53 Patientinnen ausgewertet, bei welchen eine primäre brusterhaltende The- rapie nicht möglich war (36/53 wegen initialer Tumorausdehnung, 17/53 wegen ungünstigen Tumor-Brust-Verhältnisses). 52/53 Patientinnen zählten gemäß den St.-Gallen-Kriterien zur Gruppe mit intermediärem bzw. hohem Risiko. Alle erhielten eine neo- adjuvante systemische Chemotherapie, kombiniert mit fraktionierter interstitieller HDR-Brachytherapie (2 × 5 Gy/Tag, Summen- dosis 30 Gy). Nach brusterhaltender Therapie wurde eine perkutane Radiatio der Brust (1,8 Gy/Tag, Summendosis 50,4 Gy) durchgeführt, ebenso bei Patientinnen nach Mastektomie mit initialem Tumorstadium T3/T4 und/oder mehr als drei befallenen Lymphknoten. Received: April 12, 2005; accepted: November 2, 2005 1 Radiation Department, Klinikum Offenbach, Germany, 2 Radiation Department, Kantonsspital Bern, Switzerland, 3 Department of Gynecology and Obstetrics, St. Josefs Hospital, Wiesbaden, Germany, 4 Radiation Department, Klinikum Bremen-Mitte, Germany.