American Brachytherapy Society Task Group Report: Long-term control and toxicity with brachytherapy for localized breast cancer

PURPOSE: There has been significant controversy regarding the equivalency of accelerated partial breast irradiation to whole-breast irradiation. With the recent publication of a large, randomized trial comparing these two treatment modalities, an update on the current state of knowledge of brachytherapy-based accelerated partial breast irradiation, with respect to local control and toxicities, would be useful to practitioners and patients. METHODS AND MATERIALS: A systematic literature review was conducted examining articles published between January 2000 and April 2016 on the topics "brachytherapy" and "breast." A total of 67 articles met inclusion criteria, providing outcomes on local tumor control and/or toxicity for breast brachytherapy. RESULTS: Reported 5-year local failure rates were 1.4-6.1% for multicatheter interstitial brachytherapy (MB) and 0-5.7% for single-entry brachytherapy catheters when delivered to patients with standard selection criteria. Toxicity profiles are acceptable, with cosmetic outcomes comparable to whole-breast irradiation. The reported rates of infection were 0-12%. Symptomatic fat necrosis was found in 0-12% and 0-3.2% of patients treated with MIB and single-entry brachytherapy catheters, respectively. Late Grade telangiectasias and fibrosis were reported in 0-8% and 0-9.1% of patients treated with MIB, respectively. These side effects were less common with single-entry brachytherapy catheters (0-2.0% and 0%, respectively). CONCLUSIONS: Breast brachytherapy is a treatment technique that provides acceptable rates of local control in select patients, as demonstrated by Level I evidence. The side effect profile of this treatment is well documented and should be shared with patients when considering this treatment modality. (C) 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.