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Research Article Volume 12 Issue 4
High-dose-rate interstitial brachytherapy in early breast cancer: insights from a cancer center in remote north-eastern India
R Ravichandran, Tarani Mondal, Gopal Datta, Ritesh Tapkire, R Ravi Kannan
Received: August 05, 2025 | Published: August 22, 2025
Citation: Ravichandran R, Mondal T, Datta G, et al. High-dose-rate interstitial brachytherapy in early breast cancer: insights from a cancer center in remote north-eastern India. Int J Radiol Radiat Ther. 2025;12(3):82-85. DOI: 10.15406/ijrrt.2025.12.00427
Abstract
Introduction: The radiotherapy techniques vary for the management of carcinoma breast in different institutions. For reducing recurrence in high-risk patients, there is need for boost radiation dose for the tumor bed. This is aimed at delivering additional 15-20 Gy by high energy electrons or by interstitial implantation. At our center in Northeastern part of India, at Silchar, a MicroSelectron HDR, Brachytherapy (BT) machine, was used for interstitial BT for Breast Conservation Surgery (BCS) patients. Materials and Methods: Between 2017 and 2023, a total of 78 patients completed treatment. A template (M/s Nucletron, Netherlands) supplied with the MicroSelectron HDR unit was used to guide implant needles in parallel as two-plane implants with a treating distance of 1.2 cm. A 10 mm margin on either side of the catheter was kept cold to minimize skin and subcutaneous dose, thereby preserving cosmesis and reducing skin toxicity. Among 73 patients, the prescribed doses to the 100% isodose line were 8.0 Gy × 2 fractions (n = 1), 4.0 Gy × 4 (n = 27), 3.65 Gy × 4 (n = 24), 3.0 Gy × 4 (n = 19), and 3.0 Gy × 3 (n = 2). The regimen of 3.65 Gy × 4 fractions (total 14.6 Gy HDR) is radiobiologically equivalent to 20 Gy with LDR implants. An inter-fraction interval of at least 6 hours was maintained for patients receiving two fractions per day. Following interstitial brachytherapy (IBT), these patients received 40 Gy in 15 fractions (5 fractions per week) on a Theratron 780E cobalt unit, corresponding to an equivalent dose of 46.7 Gy with conventional 2 Gy fractions. The second group, treated with brachytherapy monotherapy, included 5 patients who received total doses of 3.65 Gy × 10 fractions (n = 1), 3.40 Gy × 10 (n = 3), and 5.88 Gy × 10 (n = 1), delivered with inter-fraction intervals >6 hours and two fractions per day. Results: The equivalent external beam radiation therapy (EBRT) dose to the selected breast target volume was calculated. A regimen of 40 Gy in 15 fractions at 2.67 Gy per fraction corresponded to 42.3 Gy at 2 Gy per fraction. The total dose of the combined regimen (Regimen 1) was 58.9 Gy, which lies within 1.5% of the conventional 60 Gy standard. For brachytherapy monotherapy (Regimen 2), the institutional protocol consisted of 3.65 Gy × 10 fractions. The calculated biologically effective dose (BED₁₀) for this schedule was 49.83 Gy, equivalent to 41.5 Gy EBRT delivered at 2 Gy per fraction (5 fractions per week). Patient follow-up demonstrated that clinical outcomes were satisfactory, with no short-term toxicities reported during the observation period. These results suggest that the treatment regimen is both effective and feasible and may be considered for broader implementation in brachytherapy centers.
Keywords: Radiotherapy, HDR interstitial brachytherapy, Breast cancers
©2025 Ravichandran, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.