Accelerated partial irradiation for breast cancer: Systematic review and meta-analysis of 8653 women in eight randomized trials

Local Treatment of Breast Cancer

“…[46][47][48][49] Radiation begins 4 to 6 weeks after surgery or following chemotherapy. The omission of radiation therapy following lumpectomy increases the risk of ipsilateral breast recurrence, and may negatively affect the risk of distant recurrence.…”

“…The omission of radiation therapy following lumpectomy increases the risk of ipsilateral breast recurrence, and may negatively affect the risk of distant recurrence. [46][47][48][49] …”

“…46 Whole breast radiation therapy following a lumpectomy has demonstrated equal mortality rates as mastectomy with fewer long-term side effects. [46][47][48][49] A radiation boost may decrease local recurrence, which may add to the absolute gain in younger patients because of their anticipated longer life span. 25,[46][47][48][49] Women who require daily radiation therapy may have conflicts related to transportation, time, work, children, finances, mobility, or access to care issues, and may eliminate this important component of local therapy.…”

“…46 Studies that examined various types of APBI suggest that larger and more frequent doses of radiation therapy may be superior to whole breast radiation. [46][47][48][49] Lacking are the results of large, prospective, comparative randomized trials to assure that APBI is superior to whole breast radiation, and which type of APBI is superior. [46][47][48][49] Several types of ABPI have been administered and studied in small institutional trials with interstitial high-dose rate, pulsed dose rate, or permanent implants, intracavitary brachytherapy with balloon or hybrid-type luminal devices, and intraoperative radiation.…”

Lessons Learned in Breast-Conserving Therapy

“…46,47 In a meta-analysis, Marta and colleagues concluded that local recurrence rates were higher after APBI than after whole-breast irradiation (hazard ratio ¼ 4.54; 95% CI: 1.78-11.61; P ¼ 0.002). 48 Around 2010, both the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology 49 and ASTRO 50,51 published recommendations on patient selection criteria for APBI, classifying patients into 3 groups: suitable, cautionary, and unsuitable. Recently published 5-year rates of in-breast tumor recurrences in the ELIOT study for the risk groups as defined by ASTRO recommendations were 1.5%, 4.4%, and 8.8%, respectively.…”