GEC-ESTRO multicenter phase 3-trial: Accelerated partial breast irradiation with interstitial multicatheter brachytherapy versus external beam whole breast irradiation: Early toxicity and patient compliance

Background and purpose To compare early side effects and patient compliance of accelerated partial breast irradiation (APBI) with multicatheter brachytherapy to external beam whole breast irradiation (WBI) in a low-risk group of patients with breast cancer. Material and methods Between April 2004 and July 2009, 1328 patients with UICC stage 0–IIA breast cancer were randomized to receive WBI with 50 Gy and a boost of 10 Gy or APBI with either 32.0 Gy/8 fractions, or 30.1 Gy/7 fractions (HDR-brachytherapy), or 50 Gy/0.60–0.80 Gy per pulse (PDR-brachytherapy). This report focuses on early side-effects and patient compliance observed in 1186 analyzable patients. ClinicalTrials.gov identifier: NCT00402519. Results Patient compliance was excellent in both arms. Both WBI and APBI were well tolerated with moderate early side-effects. No grade 4 toxicity had been observed. Grade 3 side effects were exclusively seen for early skin toxicity (radiation dermatitis) with 7% vs. 0.2% (p < 0.0001), and breast infection with 0% vs. 0.2% (p = n.s.) for patients treated with WBI and APBI. The incidence of grades 1–2 early side effects for WBI and APBI was 86% vs. 21% (p < 0.0001) for skin toxicity, 2% vs. 20% (p < 0.0001) for mild hematoma, and 2% vs. 5% (p = 0.01) for mild breast infection rates, respectively. No differences had been found regarding grades 1–2 early breast pain (26% vs. 29%, p = 0.23). Conclusions APBI with interstitial multicatheter brachytherapy was tolerated very well and dramatically reduced early skin toxicity in comparison to standard WBI.