5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial.

BACKGROUND In a phase 3, randomised, non-inferiority trial, accelerated partial breast irradiation (APBI) for patients with stage 0, I, and IIA breast cancer who underwent breast-conserving treatment was compared with whole-breast irradiation. Here, we present 5-year follow-up results. METHODS We did a phase 3, randomised, non-inferiority trial at 16 hospitals and medical centres in seven European countries. 1184 patients with low-risk invasive and ductal carcinoma in situ treated with breast-conserving surgery were centrally randomised to either whole-breast irradiation or APBI using multicatheter brachytherapy. The primary endpoint was local recurrence. Analysis was done according to treatment received. This trial is registered with ClinicalTrials.gov, number NCT00402519. FINDINGS Between April 20, 2004, and July 30, 2009, 551 patients had whole-breast irradiation with tumour-bed boost and 633 patients received APBI using interstitial multicatheter brachytherapy. At 5-year follow-up, nine patients treated with APBI and five patients receiving whole-breast irradiation had a local recurrence; the cumulative incidence of local recurrence was 1·44% (95% CI 0·51-2·38) with APBI and 0·92% (0·12-1·73) with whole-breast irradiation (difference 0·52%, 95% CI -0·72 to 1·75; p=0·42). No grade 4 late side-effects were reported. The 5-year risk of grade 2-3 late side-effects to the skin was 3·2% with APBI versus 5·7% with whole-breast irradiation (p=0·08), and 5-year risk of grade 2-3 subcutaneous tissue late side-effects was 7·6% versus 6·3% (p=0·53). The risk of severe (grade 3) fibrosis at 5 years was 0·2% with whole-breast irradiation and 0% with APBI (p=0·46). INTERPRETATION The difference between treatments was below the relevance margin of 3 percentage points. Therefore, adjuvant APBI using multicatheter brachytherapy after breast-conserving surgery in patients with early breast cancer is not inferior to adjuvant whole-breast irradiation with respect to 5-year local control, disease-free survival, and overall survival. FUNDING German Cancer Aid.

Na 1 Nachlass Max Horkheimer, 293 - Korrespondenzen u.a. mit Jürgen Habermas (p. V 83, 144-253)

1 Brief von Eugen Ripp an Max Horkheimer, 1952; 24 Briefe zwischen Professor Jürgen Habermas und Max Horkheimer, 1960-1971; 3 Briefe zwischen Notar Häfele und Max Horkheimer, 1950; 7 Briefe zwischen Professor Georg W. F. Hallgarten und Max Horkheimer, 1959; 35 Briefe zwischen Professor Walter Hallstein und Max Horkheimer, 1946-1967; 8 Briefe zwischen der Staatssekretärin Hildegard Hamm-Brücher und Max Horkheimer, 1968-1969;

(Table 3) Concentration of Au, Pd, and Pt in the interstitial waters of ODP Leg 125 samples

Palladium, platinum, and gold were analyzed for 20 interstitial water samples from Leg 125. No Pd or Pt was detected in fluids from serpentinite muds from Conical Seamount in the Mariana forearc, indicating that low-temperature seawater-peridotite interaction does not mobilize these elements into the serpentinizing fluids to levels above 0.10 parts per billion (ppb) in solution. However, Au may be mobilized in high pH solutions. In contrast, fluids from vitric-rich clays on the flanks of the Torishima Seamount in the Izu-Bonin forearc have Pd values of between 4.0 and 11.8 nmol/L, Pt values between 2.3 and 5.0 nmol/L and Au values between 126.9 and 1116.9 pmol/L. The precious metals are mobilized, and possibly adsorbed onto clay mineral surfaces, during diagenesis and burial of the volcanic-rich clays. Desorption during squeezing of the sediments may produce the enhanced precious metal concentrations in the analyzed fluids. The metals are mobilized in the fluids probably as neutral hydroxide, bisulfide, and ammonia complexes. Pt/Pd ratios are between 0.42 and 2.33, which is much lower than many of the potential sources for Pt and Pd but is consistent with the greater solubility of Pd compared with Pt in most natural low-temperature fluids.