Single fraction of accelerated partial breast irradiation in the elderly: early clinical outcome.
BACKGROUND
To analyze the clinical outcome of elderly women with early breast cancer who underwent accelerated partial breast irradiation (APBI) based on a post-operative single fraction of multicatheter interstitial high dose-rate brachytherapy (MIB).


METHODS
A single institution retrospective cohort study was performed focusing on elderly patients (≥ 65 years old) presenting a low-risk breast carcinoma treated by lumpectomy plus axillary evaluation followed by MIB. A single fraction of 16 Gy was prescribed on the 100% isodose. Clinical outcome at 3 years was reported based on local relapse free survival (3-y LRFS), specific survival (SS) and overall survival (OS). Acute (< 180 days after APBI) and late toxicity were evaluated. Cosmetic results were clinically evaluated by the physician.


RESULTS
Between January 2012 and August 2015, 48 women (51 lesions) were treated. Median age was 77.7 years (range: 65-92) with a median tumor size of 12 mm (range: 3-32). Five patients (pts) presented an axillary lymph node involvement (4 Nmic, 1 N1). Invasive ductal carcinoma was the most frequent histology type (86.3%). With a median follow-up of 40 months (range: 36-42), no local relapse occurred while 1 pt. developed axillary relapse (2.1%). The 3-y LRFS, SS and OS rates were 100%, 100% and 93.1% respectively. Forty-five acute events were remained. The most frequent acute toxicity was grade (G) 1 hyperpigmentation (26.7%), 3 pts. (6.3%) presented G3 acute toxicity (2 breast hematomas, 1 breast abscess). No ≥ G3 late toxicity was observed while 15 late toxicities occurred (G1: 13 events - 86.7%) mainly breast fibrosis). The rate of excellent cosmetic outcome was 76.4%.


CONCLUSION
We reported promising and encouraging clinical outcome of a post-operative single fraction of MIB ABPI in the elderly. This approach leads to consider a sfAPBI as an attractive alternative to intra-operative radiation therapy while all the patients will be good candidates for APBI in regards to the post-operative pathological report. More mature results (number of patients and follow-up) are needed.
['Kinj|Rémy|R|', 'Chand|Marie-Eve|ME|', 'Gal|Jocelyn|J|', 'Gautier|Mathieu|M|', 'Montagné|Lucile|L|', 'Lam Cham Kee|Daniel|D|', 'Hannoun-Lévi|Jean Michel|JM|']
D000368:Aged D000369:Aged, 80 and over D001918:Brachytherapy D001943:Breast Neoplasms D018270:Carcinoma, Ductal, Breast D005260:Female D005500:Follow-Up Studies D006801:Humans D015412:Mastectomy, Segmental D009364:Neoplasm Recurrence, Local D011446:Prospective Studies D012189:Retrospective Studies D016896:Treatment Outcome
Accelerated partial breast irradiation Elderly Breast cancer Brachytherapy