Brachytherapy for breast cancer – TRIUMPH-T study

 

TRIUMPH-T study (3-fraction breast brachytherapy) can potentially shorten breast conservation therapy for women

Overview: Recent outcomes of the TRIUMPH-T 2-day breast brachytherapy trial resulted in:

  • Safe delivery of three fraction APBI with either multi-catheter or single-entry devices
  • Similar toxicities to those seen with 10-fraction APBI
  • Tight dosimetric requirements that can be consistently delivered to a large cohort of patients from multiple institutions
  • 88% of patients reporting good to excellent cosmesis
  • Short-term (19-month) local control rates of 99%

It’s well documented that radiation therapy after breast conserving surgery can reduce local recurrence rates by around 75%. Typically women receive whole breast irradiation (WBI) over the course of 5 – 6 weeks, however brachytherapy (either interstitial or intracavitary) can be delivered over a 5 day period and has demonstrated similar outcomes to WBI. A recent prospective, randomized controlled trial comparing WBI to accelerated partial breast irradiation (ABPI) has shown brachytherapy provides similar local tumor control and cosmesis rates (Strnd C, et al).

The next step in brachytherapy treatment was to determine if hypofractionation would allow for similar historical outcomes. The TRIUMPH-T study was initiated to determine if 2 day (3 fraction) APBI for the treatment of early-stage breast cancer would have comparable outcomes to 5 day treatment.  In this study either multi-catheter or single-entry brachytherapy devices were selected for APBI treatment.  The results at 18 months follow up showed that APBI is well tolerated, with similar short-term toxicities as 5 day treatment. To date, one of the 200 patients has had a recurrence.

FAST FACTS:

  • 37% of patients were treated using multi-catheter implants and the remainder were treated using single-entry devices
  • 97% of patients had good/excellent cosmesis, with one patient having poor cosmesis
  • 38% of patients reported a toxicity, similar to historical data reported for 5 day (10-fraction) APBI
  • The majority of the toxicities reported were grade 1 or grade 2 (96%) and included the following: Radiation dermatitis, breast infections, breast pain, breast edema, fat necrosis, seroma formation, deep tissue fibrosis, superficial tissue fibrosis, hyperpigmentation
  • Three patients had grade 3 toxicities of radiation dermatitis (n=1) and non-healing wounds requiring surgical intervention (n=2)
  • At a year and a half follow up, there was one local recurrence out of the 200 patients treated

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