Current status and perspectives of brachytherapy for breast cancer

Before the era of breast-conserving therapy, brachytherapy implants were used to treat large inoperable breast tumors. In later years, interstitial brachytherapy with rigid needles or multiple flexible catheters has been used to deliver an additional (boost) dose to the tumor bed after breast-conserving surgery and whole-breast irradiation. Reexcision followed by reirradiation using interstitial breast implants has also been implemented as an alternative to mastectomy to treat ipsilateral breast local recurrence after previous breast-conserving therapy. In the past two decades, the new concept of accelerated partial breast irradiation opened a new perspective for breast brachytherapy. The first technique utilized in early accelerated partial breast irradiation studies was multicatheter interstitial brachytherapy. Beyond classical interstitial brachytherapy, recently, new intracavitary applicators have been developed in the United States to decrease the existing barriers against the widespread use of multicatheter brachytherapy. Furthermore, interstitial low-dose-rate seed implants have also been implemented as an alternative for stepping-source multicatheter brachytherapy. In this article, we give an overview of the past achievements, current status, and future perspectives of breast brachytherapy.