Iridium-192 Afterloading for Boosting the Tumor Bed

Abstract

Interstitial radiotherapy for breast cancer as an alternative to radical mastectomy was first recommended by Janeway in 1917; in 1939 Keynes (Robinson 1986), who was also using radium needles, stated that interstitial radiotherapy for breast cancer was as good as radical mastectomy with less mutilation and less edema of the arm (Robinson 1986). With the introduction of cobalt machines and linear accelerators, interstitial therapy was confined to the delivery of boost doses, especially in France, where a new dosimetry system was developed by Pierquin and Dutreix (1967) using iridium wires in an after-loading technique (Paris system). Many thousands of patients have had breast conservation therapy (BCT) since then, and the results of prospectively randomized trials (Fisher et al. 1985; Veronesi et al. 1983; Sarrazin et al. 1983; van Dongen et al. 1987) as well as the data from retrospective studies (Amalric et al. 1983; Calle et al. 1983; Pierquin 1983; Bartelink et al. 1988; Loper et al. 1987; van Limbergen et al. 1987; Clark et al. 1987) clearly confirm the conclusions of the pioneers in the field: For early breast cancer up to 5 cm in diameter BCT gives results equal to radical mastectomy with respect to survival as well as local control. Local control rates in Ti and T2 breast cancers treated by BCT vary from 91% to 98% at 5 years’, 87% to 92% at 10 years’ (Fisher et al. 1985; Veronesi et al. 1983; Sarrazin et al. 1983; van Dongen et al. 1987; Amalric et al. 1983; Calle et al. 1983; Pierquin 1983; Bartelink et al. 1988; Loper et al. 1987; van Limbergen et al. 1987; Clark et al. 1987), and 80% to 85% at 15 and 20 years’ follow-up (Harris et al. 1984; Kurtz et al. 1987).