Accelerated partial breast irradiation

Abstract

BACKGROUND. Breast‐conserving surgery followed by whole‐breast radiotherapy (WBRT) has become the standard treatment for the majority of patients with early breast cancer. Whereas the indications for systemic adjuvant treatment have continuously expanded, there is a tendency to restrict postoperative radiotherapy to accelerated partial breast irradiation (APBI) instead of WBRT. METHODS. The different techniques of APBI are described and their respective advantages or potential drawbacks outlined. Moreover, the results described in the literature are briefly reviewed as a basis for the consensus statements and recommendations of the German Society of Radiation Oncology, the German Society of Senology, and the Working Group for Gynecological Oncology of the German Cancer Society. RESULTS. The methods mainly used for APBI are: interstitial radiotherapy with multicatheter technique, intraoperative radiotherapy (IORT) using either electrons produced by linear accelerators or 50 kV x‐rays (Intrabeam), the balloon‐catheter technique (MammoSite), or 3D conformal external beam radiotherapy. These techniques have marked differences in dose distribution and homogeneity. The published range of local recurrence rates varies between 0% to 37%, the median follow‐up from 8 to 72 months. CONCLUSIONS. To date, follow‐up times mostly do not yet permit a definite judgment concerning the long‐term effectiveness and side effects of APBI. The relevant societies in Germany support randomized clinical studies comparing APBI with WBRT in a well‐defined subset of low‐risk patients. However, the authors expressly discourage the routine use of APBI outside clinical trials. Until definite results show that APBI neither impairs therapeutic outcome nor cosmetic results, WBRT remains the gold standard in the treatment of early breast cancer. Cancer 2007. © 2007 American Cancer Society.

Intraoperative Radiotherapy as Accelerated Partial Breast Irradiation for Early Breast Cancer

“…This is in accordance with formerly [29] and recently [37] published statements of the DEGRO and current German guidelines [1,12,30].…”

“…In addition to whole breast irradiation (WBI), it has yielded excellent long-term results [31,38]. Under the assumption that the majority of in-breast tumor recurrences (IBTR) occur in the originally affected site, accelerated partial breast irradiation (APBI) as the sole treatment modality was initiated in several studies and with different techniques, one of which was IORT first with electrons, later also with conventional x-rays [29].The question whether and for whom the gold standard of WBI may be replaced by APBI -especially IORT -alone has recently been one of the most controversial issues of adjuvant therapy for breast cancer. Two recently published studies by Veronesi et al [36] and Vaidya et al…”

“…In addition to whole breast irradiation (WBI), it has yielded excellent long-term results [31,38]. Under the assumption that the majority of in-breast tumor recurrences (IBTR) occur in the originally affected site, accelerated partial breast irradiation (APBI) as the sole treatment modality was initiated in several studies and with different techniques, one of which was IORT first with electrons, later also with conventional x-rays [29].…”

DEGRO Practical Guidelines for Radiotherapy of Breast Cancer I

“…Statement 24a of the S3 guidelines of the German Cancer Society time, which is appealing especially when radiation resources are limited [35].…”

“…So far, no subgroups have been unequivocally identified for whom risk-adapted use of ABPI can be regarded as a safe alternative to WBRT [35]. Neither the proper treatment volume nor the adequate total dose have been defined.…”