Skip to main content

Advertisement

SpringerLink
Log in

Timing of Infectious Complications Following Breast-Conserving Therapy with Catheter-Based Accelerated Partial Breast Irradiation

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Accelerated partial breast irradiation (APBI) has been used as an alternative to whole-breast irradiation as part of breast-conserving therapy. Indications and outcomes are topics of ongoing investigation. Previous publications have focused on early postoperative infections and reported low rates of delayed infection. We investigated the pattern of infection after catheter-based APBI at our institution.

Methods

Patients who underwent single-entry catheter-based APBI were identified from an institutional prospective registry including data regarding comorbidities and outcomes. Time of infection was calculated from the date of definitive catheter insertion and classified as early (≤30 days) or delayed.

Results

A total of 91 breast cancer patients were treated with APBI and enrolled in the registry from 2009 to 2011. The median follow-up was 484 days. Breast infection occurred in 13 (14.3 %), with 3 (3.3 %) occurring within 30 days of catheter placement and 10 (11.0 %) in a delayed fashion. Four patients required hospital admission, five underwent percutaneous aspiration, and one underwent incision and drainage. Eight were treated as outpatients with oral antibiotics alone.

Conclusions

Consistent with other reports, we found an overall infection rate of 14.3 % with single-entry catheter-based APBI. There were substantially fewer infections in the early postoperative period than reported elsewhere, but there were more delayed infections. The intensive follow-up in our study likely identified late infections that may not have otherwise been recognized. Vigilance for infectious complications must continue beyond the immediate treatment period in patients undergoing catheter-based APBI. These infections can range in severity but typically can be managed in an outpatient setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg. 2009;209:269–77.

    Article  PubMed  Google Scholar 

  2. Calvo FA, Meirino RM, Orecchia R. Intraoperative radiation therapy part 2. Clinical results. Crit Rev Oncol Hematol. 2006;59:116–27.

    Article  PubMed  Google Scholar 

  3. Polgar C, Fodor J, Major T, et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma: 5-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007;69:694–702.

    Article  PubMed  Google Scholar 

  4. Polgar C, Major T, Fodor J, et al. Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol. 2010;94:274–9.

    Article  PubMed  Google Scholar 

  5. Vaidya JS, Baum M, Tobias JS, et al. Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery. Int J Radiat Oncol Biol Phys. 2011;81:1091–7.

    Article  PubMed  Google Scholar 

  6. Livi L, Buonamici FB, Simontacchi G, et al. Accelerated partial breast irradiation with IMRT: new technical approach and interim analysis of acute toxicity in a phase III randomized clinical trial. Int J Radiat Oncol Biol Phys. 2010;77:509–15.

    Article  PubMed  Google Scholar 

  7. Olivotto IA, Whelan TJ, Parpia S, et al. Interim toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation (APBI) using 3D conformal external beam radiation (3D CRT). Int J Radiat Oncol Biol Phys. 2013;85:21–2.

    Google Scholar 

  8. Orecchia R. ELIOT Trials in Milan: Results. Presented at the World Congress of Brachytherapy, Barcelona, Spain, 2012.

  9. Chen PY, Vicini FA, Benitez P, et al. Long-term cosmetic results and toxicity after accelerated partial-breast irradiation: a method of radiation delivery by interstitial brachytherapy for the treatment of early-stage breast carcinoma. Cancer. 2006;106:991–9.

    Article  PubMed  Google Scholar 

  10. Vicini FA, Beitsch PD, Quiet CA, et al. First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer. 2005;104:1138–48.

    Article  PubMed  Google Scholar 

  11. Cuttino LW, Keisch M, Jenrette JM, et al. Multi-institutional experience using the MammoSite radiation therapy system in the treatment of early-stage breast cancer: 2-year results. Int J Radiat Oncol Biol Phys. 2008;71:107–14.

    Article  PubMed  Google Scholar 

  12. Chao KK, Vicini FA, Wallace M, 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;69:32–40.

    Article  PubMed  Google Scholar 

  13. Richards GM, Berson AM, Rescigno J, et al. Acute toxicity of high-dose-rate intracavitary brachytherapy with the MammoSite applicator in patients with early-stage breast cancer. Ann Surg Oncol. 2004;11:739–46.

    Article  PubMed  Google Scholar 

  14. Bunn F, Jones DJ, Bell-Syer S. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev. 2012;1:CD005360.

    PubMed  Google Scholar 

  15. Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–9.

    Article  CAS  PubMed  Google Scholar 

  16. Keidan RD, Hoffman JP, Weese JL, et al. Delayed breast abscesses after lumpectomy and radiation therapy. Am Surg. 1990;56:440–4.

    CAS  PubMed  Google Scholar 

  17. Kuske R, Zannis V. Spacer balloons prior to partial breast irradiation: helpful or hurtful? Ann Surg Oncol. 2011;18:1807–8.

    Article  PubMed  Google Scholar 

  18. Zannis V, Beitsch P, Vicini F, et al. Descriptions and outcomes of insertion techniques of a breast brachytherapy balloon catheter in 1403 patients enrolled in the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Am J Surg. 2005;190:530–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Supported in part by A Cancer Center Support Grant (NCI Grant P30 CA016672).

Disclosure

None.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alex B. Haynes MD, MPH, Isabelle Bedrosian MD, Henry M. Kuerer MD, PhD, Rosa F. Hwang MD, Abigail S. Caudle MD, Kelly K. Hunt MD & Gildy V. Babiera MD

  2. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Elizabeth S. Bloom MD, Welela Tereffe MD & Simona F. Shaitelman MD

  3. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mark F. Munsell MS

  4. Department of Infectious Disease, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Roy F. Chemaly MD, MPH

  5. Department of Infection Control, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Linda S. Graviss MT, CIC

Authors
  1. Alex B. Haynes MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth S. Bloom MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabelle Bedrosian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henry M. Kuerer MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rosa F. Hwang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark F. Munsell MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roy F. Chemaly MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Linda S. Graviss MT, CIC
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Abigail S. Caudle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kelly K. Hunt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Welela Tereffe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Simona F. Shaitelman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gildy V. Babiera MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gildy V. Babiera MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haynes, A.B., Bloom, E.S., Bedrosian, I. et al. Timing of Infectious Complications Following Breast-Conserving Therapy with Catheter-Based Accelerated Partial Breast Irradiation. Ann Surg Oncol 21, 2512–2516 (2014). https://doi.org/10.1245/s10434-014-3528-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3528-6

Keywords

Search

Navigation