Comparison of three accelerated partial breast irradiation techniques: Treatment effectiveness based upon biological models

Background and purpose: Accelerated partial breast irradiation (APBI) is being studied in a phase III randomized trial as an alternative to whole breast irradiation (WBI) for early stage breast cancer patients. There are three methods for APBI: multi-catheter brachytherapy (MCT), MammoSite (R) brachytherapy (MST), or 3D conformal (3DCRT). There is a paucity of data comparing among methods. Using a linear-quadratic (LQ) model, we evaluated the anticipated efficacy among the APBI methods for equivalent uniform dose (EUD), Tumor Control Probability (TCP), and Normal Tissue Complication Probability (NTCP). Materials and methods: Treatment plans from five patients treated by each APBI modality were retrospectively selected. Dose-volume-histograms (DVH) for planning target volume (PTV), breast, and lung were generated. The LQ parameters alpha = 0.3 Gy(-1) and alpha/beta = 10 Gy were used for calculations. The values of EUD, TCP, and NTCP were calculated based on DVHs. Results: The average EUD (normalized to 3.4 Gy BID) for the MCT, MST, and 3DCRT APBI was 35, 37.2, and 37.6 Gy. When normalized to 2 Gy fractionation these become, 42.2, 46.4, and 46.9 Gy. Average TCP for MCT, MST, and 3DCRT PBI was 94.8%, 99.1%, and 99.2%. The NTCP values for breast and lung were low for all three methods. Conclusions: The EUD for PTV and TCP were most similar in MST and 3DCRT APBI and were lower in MCT APBI. This questions the equivalence of the three APBI modalities that are currently being evaluated in the NSABP-B39/RTOG 0413 protocol. (C) 2007 Elsevier Ireland Ltd. All rights reserved.