A Concise Review of High Dose Rate (HDR) Brachytherapy (BT) Boost as part of Breast Conserving Treatment (BCT) for Breast Cancer (BC)

Omer Sager*, Murat Beyzadeoglu, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz

University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey

ABSTRACT

Breast cancer (Ca) comprises commonest cancer in female population and is an important causative factor in deaths associated with cancer worldwide. Current multimodality treatment includes resection, radiotherapy, systemic treatment combinations. In the context of adjuvant RT, high level evidence suggests improved treatment results of local control (LC), overall survival (OS) with reduction in breast Ca related mortality in selected patient subgroups. Resection for management typically includes breast conserving surgery (BCS) or mastectomy. Many factors could affect on selection of surgical modality for breast Ca management including patient characteristics and preferences along with contemplated therapeutic results such as LC, OS, and associated toxicity profile. Nevertheless, an increase exists for using conservative surgical resection instead of removal of the whole breast with supporting high level evidence. When the selected surgical modality consists of BCS, adjuvant irradiation is strongly suggested primarily to achive improved LC. Adjuvant irradiation of the breast after BCS may include boost radiotherapy (RT) focused on lumpectomy cavity. This boost therapy may be delivered using several techniques. RT is a critical component of BCT. Whole breast radiotherapy (WBRT) with an additional boost dose focused on lumpectomy cavity is a widely accepted treatment strategy. While benefit of adding boost RT to WBRT has been demonstrated with accumulating evidence from several centers around the globe, there may be concerns about adverse effects associated with irradiation such as induration, fibrosis, telengiectasia and overall cosmesis. In this context, normal tissue sparing techniques are being used in WBRT. BT may offer an excellent method of administering the additional boost dose after WBRT with its inherent advantages of improved conformality and reduced surrounding tissue exposure, which may potentiallty translate into decreased risk of late effects. This has been supported by several comparative studies and experiences from different centers. Clearly, future studies may provide high level evidence. Here in, we provide a concise review of high dose rate (HDR) brachytherapy (BT) boost as part of breast conserving treatment (BCT) for breast Ca.

Keywords:

Breast cancer (Ca), brachytherapy (BT), high dose rate (HDR), boost