High-dose-rate brachytherapy for breast cancer: a patient-specific approach – first results

«Radiation and Risk», 2020, vol. 29, No. 4, pp.146-157

DOI: 10.21870/0131-3878-2020-29-4-146-157


Demianovich A.V. – Researcher. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249035. Tel.: +7 (484) 399-13-48; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Sanin D.B. – Sen. Researcher, C. Sc., Biol.
Martynova V.V. – Engineer
Borysheva N.B. – Head of Dep., C. Sc., Phys.-Math.
Aminov G.G. – Physician, C. Sc., Med.
Obukhov A.A. – Sen. Researcher, C. Sc., Med.
Gulidov I.A. – Head of Dep., MD, Prof.
Mardyntsky Yu.S. – Chief Researcher, Corresponding Member of RAS, MD, Prof.
Kiselyova M.V. – Head of Dep., MD, Prof.
Ivanov S.A. – Director, MD, Prof. of RAS. A. Tsyb MRRC.
Kaprin A.D. – Director General, Academician of RAS, MD, Prof. NMRRC.

1 A. Tsyb MRRC – branch of the NMRRC, Obninsk 2 NMRRC, Moscow


The study purpose was to demonstrate developed treatment scheme for breast cancer high-dose-rate brachytherapy with 192Ir and evaluate received radiation exposure. The results of research are discussed in the paper. Thirty patients of median age of 63 years with diagnosed T1N0M0 breast cancer received treatment between August, 2017 and June, 2019 in A. Tsyb MRRC. All patients underwent lumpectomy followed by accelerated partial breast irradiation (APBI) with single radiation dose of 3.4 Gy and total dose of 34 Gy. A patient received two fractions of irradiation daily, the interval between them was no less than 6 hours. The treatment duration was 5 days. The treatment outcomes were assessed in terms of the treatment planning including radiation exposure to the target, healthy tissues and organs-at-risk. The study highlighted that determined dosimetric parameters correspond to those given in the approved treatment protocol and meet the international recommendations. As the result of this research it is shown that treatment plan for each patient should be developed individually. Since the follow-up period is small, further studies will be conducted. This will allow early detection of toxic effects of brachy-therapy and the analysis of living status.

Key words
ionising radiation, interstitial radiation therapy, radiotherapy, high-dose-rate brachytherapy, 192Ir, dosimetric parameters, breast cancer, lumpectomy, organs-at-risk, dose-volume histogram.


1. International Agency for Research on Cancer (IARC) and World Health Organization (WHO). GLOBOCAN 2018: Breast. 2018. Available at: http://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf (Accessed 15.11.2018).

2. Forouzanfar M.H., Foreman K.J., Delossantos A.M., Lozano R., Lopez A.D., Murray C.J.L., Naghavi M. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet, 2011, vol. 378, no. 9801, pp. 1461-1484.

3. The status of cancer care for the population in Russia in 2016. Eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow, NMRRC, 2017. 236 p. (In Russian).

4. Ujmanov V.A., Nechushkin M.I., Gladilina I.A., Parokonnaya A.A. Interstitial radiation therapy for breast cancer as part of the organ-preserving treatment of early stages breast cancer. Vestnik RONTs im. N.N. Blokhina – Journal of N. N. Blokhin Russian Cancer Research Center, 2007, vol. 18, no. 4, pp. 19-27. (In Russian).

5. Harat A., Harat M., Makarewicz R. Whole breast irradiation vs. APBI using multicatheter brachytherapy in early breast cancer - simulation of treatment costs based on phase 3 trial data. J. Contemp. Brachythera-py, 2016, vol. 8, no. 6, pp. 505-511.

6. Strnad V., Major T., Polgár C., Lotter M., Guinot J-L., Gutierrez-Miguelez C., Galalae R., Van Limbergen E., Guix B., Neihoff P., Lossl K., Hannoun-Levi J.-M. ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost – GEC-ESTRO Breast Cancer Working Group practical recommendations. Radiother. Oncol., 2018, vol. 128, no. 3, pp. 411-420.

7. Mayadev J., Benedict S., Kamrava M. Handbook of Image-Guided Brachytherapy. Springer International Publishing, 2017. 622 p.

8. Kinj R., Chand M-E., Gal J., Gautier M., Montagne L., Lam Cham Kee D., Hannoun-Levi J.M. Single fraction of accelerated partial breast irradiation in the elderly: early clinical outcome. Radiat. Oncol., 2018, vol. 13, no. 174. DOI: 10.1186/s13014-018-1119-6.

9. Shah C., Vicini F., Shaitelman S.F., Hepel J., Keisch M., Arthur D., Khan A.J., Kuske R., Patel R., Wazer D.E. The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation. Brachytherapy, 2018, vol. 17, no. 1, pp. 154-170.

10. Khan A.J., Vicini F.A., Brown S., Haffty B.G., Kearney T., Dale R., Lyden M., Arthur D. Dosimetric feasibil-ity and acute toxicity in a prospective trial of ultrashort-course accelerated partial breast irradiation (APBI) using a multi-lumen balloon brachytherapy device. Ann. Surg. Oncol., 2013, vol. 20, no. 4, pp. 1295-1301.

11. Owen J.R., Ashton A., Bliss J.M., Homewood J., Harper C., Hanson J., Haviland J., Bentzen S.M., Yar-nold J.R. Effect of radiotherapy fraction size on tumor control in patients with early-stage breast cancer after local tumor excision: long-term results of a randomised trial. Lancet Oncol., 2006, vol. 7, no. 6, pp. 467-471.

12. Nose T., Otani Y., Asahi S., Tsukiyama I., Dokiya T., Saeki T., Fukuda I., Sekine H., Shikama N., Kuma-zaki Y., Takahashi T., Yoshida K., Kotsuma T., Masuda N., Yoden E., Nakashima K., Matsumura T., Nakagawa S., Tachiiri S., Moriguchi Y., Itami J., Oguchi M.A. Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: clinical results with a median follow-up of 26 months. Breast Cancer, 2016, vol. 23, no. 6, pp. 861-868.

13. Ahmad S., Johnson D., Hiatt J.R., Still D.T., Furhang E.E., Marsden D., Kearly F., Bernard D.A., Holt R.W. Comparison of tumor and normal tissue dose for accelerated partial breast irradiation using an electronic brachytherapy eBx source and an Iridium‐192 source. J. Appl. Clin. Med. Phys., 2010, vol. 11, no. 4, pp. 155-161.

14. Sinnatamby M., Nagarajan V., Sathyanarayana R.K., Karunanidhi G., Singhavajala V. Study of the dosimetric differences between 192Ir and 60Co sources of high dose rate brachytherapy for breast interstitial implant. Rep. Pract. Oncol. Radiother., 2016, vol. 21, no. 5, pp. 453-459.

15. Oshaghi M., Sadeghi M., Mahdavi S.R. A comparison of skin dose delivered with MammoSite and multi-catheter breast brachytherapy. J. Biomed. Phys. Eng., 2013, vol. 6, no. 2, pp. 200-207.

16. Lasota J., Kabacińska R., Makarewicz R. Dose estimation for different skin models in interstitial breast brachytherapy. J. Contemp. Brachytherapy., 2014, vol. 6, no. 2, pp. 200-207.

17. Yoshida K., Otani Y., Nose T., Yoden E., Asahi S., Tsukiyama I., Dokiya T., Saeki T., Fukuda I., Sekine H., Kumazaki Y., Takahashi T., Kotsuma T., Masuda N., Nakashima K., Matsumura T., Nakagawa S., Tachiiri S., Moriguchi Y., Itami J., Oguchi M. Case report of a dose-volume histogram analysis of rib frac-ture after accelerated partial breast irradiation: interim analysis of a Japanese prospective multi-institutional feasibility study. J. Contemp. Brachytherapy, 2018, vol. 10, no. 3, pp. 274-278.

18. Smith G.L., Xu Y., Buchholz T.A., Giordano S.H., Jiang J., Shih Y.C., Smith B.D. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA Oncol., 2012, vol. 307, no. 17, pp. 1827-1837.

19. Huo J., Giordano S.H., Smith B.D., Shaitelman S.F, Smith G.L. Contemporary toxicity profile of breast brachytherapy versus external beam radiation after lumpectomy for breast cancer. Int. J. Radiat. Oncol. Biol. Phys., 2016, vol. 94, no. 2, pp. 709-718.

20. Zharova E.P., Stepanenko V.F., Kiseleva M.V., Bogacheva V.V., Aminov G.G., Kolyzhenkov T.V., Petukhov A.D., Zharikova I.A., Demyanovich A.V., Borysheva N.B., Ivanov S.A., Kaprin A.D. In vivo dosimetry with luminescent microdosimeters in 192Ir brachytherapy of breast cancer: development of technology and clinical testing. Radiatsiya i risk – Radiation and Risk, 2020, vol. 29, no. 2, pp. 67-77. (In Russian).

Full-text article (in Russian)