Intraoperative high-dose-rate brachytherapy - A novel technique in the surgical management of axillary recurrence

Treating recurrent disease in the axilla is a challenging and complex clinical problem. Several reports in the literature suggest better outcomes with the combination of both surgery and radiation therapy than either modality alone. However, the available options for re-treatment are limited by the extent of disease at relapse, and the prior therapy that the patient has already received. The choice of re-irradiation using conventional external beam therapy is generally limited because of the risk of exceeding the radiation tolerance of the brachial plexus. In lieu of our concerns regarding excessive morbidity from re-irradiation with external radiation therapy when treating an axillary relapse, we applied intraoperative high-dose-rate brachytherapy (HDR-IORT) at the time of surgical resection ± a modest dose of postoperative external beam radiation therapy. In this paper, we describe the feasibility of HDR-IORT technique in three patients presenting with recurrent disease in the axilla.