Current status of accelerated partial breast irradiation

Mitsumori, Michihide; Hiraoka, Masahiro

doi:10.1007/s12282-007-0012-1

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…In many cases mammary gland tissue does not remain on the dermal or pectoralis muscle sides of the tumor. The target of irradiation is only the lateral stump [23]. Hence APBI techniques like the Mammosite will not be very applicable in the Asian population, because of potential excessive radiation dose to the skin.…”

Section: Discussionmentioning

confidence: 99%

“…In addition 15% to 30% of patients who undergo lumpectomy do not receive radiation therapy [20-22]. Similarly in Japan radiation therapy is performed in approximately 70% of patients following breast conservation surgery [23]. The under utilization of BCT has been associated with the fact that some women cannot, or will not, commit to the usual 6- 7 week course of adjunct conventional radiation therapy that is part of the BCT package [24].…”

Section: Rationale For Accelerated Partial Breast Irradiation (Apbi)mentioning

confidence: 99%

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Accelerated Partial Breast Irradiation (APBI): A review of available techniques

2010

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Breast conservation therapy (BCT) is the procedure of choice for the management of the early stage breast cancer. However, its utilization has not been maximized because of logistics issues associated with the protracted treatment involved with the radiation treatment. Accelerated Partial Breast Irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1-2 cm margin, rather than the whole breast. Hence because of the small volume of irradiation a higher dose can be delivered in a shorter period of time. There has been growing interest for APBI and various approaches have been developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy and intra-operative radiation therapy (IORT). Balloon-based brachytherapy approaches include Mammosite, Axxent electronic brachytherapy and Contura, Hybrid brachytherapy devices include SAVI and ClearPath. This paper reviews the different techniques, identifying the weaknesses and strength of each approach and proposes a direction for future research and development. It is evident that APBI will play a role in the management of a selected group of early breast cancer. However, the relative role of the different techniques is yet to be clearly identified.

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Section: Discussionmentioning

confidence: 99%

Section: Rationale For Accelerated Partial Breast Irradiation (Apbi)mentioning

confidence: 99%

Accelerated Partial Breast Irradiation (APBI): A review of available techniques

2010

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“…First, ideally, less than 60% of the normal whole breast volume should receive ≥ 50% of the prescribed dose. In this respect, Asian women are at a disadvantage due to their relatively small breasts compared to European and American women, and this might be one of the reasons why APBI has not been actively investigated for them [26]. To satisfy this recommendation, the implementation of computed tomography-based three-dimensional planning would be advantageous.…”

Section: Discussionmentioning

confidence: 99%

Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity

et al. 2010

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BackgroundTo investigate the efficacy and safety of accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) multicatheter interstitial brachytherapy for early-stage breast cancer.MethodsBetween 2002 and 2006, 48 prospectively selected patients with early-stage breast cancer received APBI using multicatheter brachytherapy following breast-conserving surgery. Their median age was 52 years (range 36-78). A median of 34 Gy (range 30-34) in 10 fractions given twice daily within 5 days was delivered to the tumor bed plus a 1-2 cm margin. Most (92%) patients received adjuvant systemic treatments. The median follow-up was 53 months (range 36-95). Actuarial local control rate was estimated from surgery using Kaplan-Meier method.ResultsLocal recurrence occurred in two patients. Both were true recurrence/marginal miss and developed in patients with close (< 0.2 cm) surgical margin after 33 and 40 months. The 5-year actuarial local recurrence rate was 4.6%. No regional or distant relapse and death has occurred to date. Late Grade 1 or 2 late skin and subcutaneous toxicity was seen in 11 (22.9%) and 26 (54.2%) patients, respectively. The volumes receiving 100% and 150% of the prescribed dose were significantly higher in the patients with late subcutaneous toxicity (p = 0.018 and 0.034, respectively). Cosmesis was excellent to good in 89.6%.ConclusionsAPBI using HDR multicatheter brachytherapy yielded local control, toxicity, and cosmesis comparable to those of conventional whole breast irradiation for select early-stage breast cancer. Patients with close resection margins may be ineligible for APBI.

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“…However, compared with studies in European countries and the United States, few studies have evaluated this technique in Asian patients with breast cancer (Mitsumori, & Hiraoka, 2008;Yeo et al, 2010). To our knowledge, this is one of the largest prospective observational studies from Asia, demonstrating the feasibility of BCT using multicatheter brachytherapy and showing acceptable clinical outcomes.…”

Section: Discussionmentioning

confidence: 98%

Individualized Case–Control Study of Accelerated Partial Breast Irradiation by Multicatheter Intertstitial Brachytherapy in Japanese Patients with Breast Cancer

Sato¹,

Mizuno²,

Fuchikami³

et al. 2013

CCO

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AbbreviationsBCS, breast-conserving surgery; WBI, whole-breast irradiation; APBI, accelerated partial breast irradiation; ICC, individualized case-control; CT, computed tomography; MRI, magnetic resonance imaging; IBTR, ipsilateral breast tumor recurrence. AbstractBackground: Breast-conserving surgery (BCS) followed by whole-breast irradiation (WBI) are the standard of care for treating early-stage breast cancer. The efficacy of accelerated partial breast irradiation (APBI) has recently been investigated as an alternative to WBI. Although we previously reported that multicatheter brachytherapy in APBI is feasible in Japanese patients, long-term data of several APBI techniques have not yet been obtained. Here we estimated the long-term efficacy of multicatheter brachytherapy in Japanese patients with breast cancer to validate its use an individualized case-control (ICC) analysis. Method: From October 2008 to March 2013, a total of 184 consequent patients with 188 tumors underwent BCS followed by multicatheter brachytherapy. A total of 120 consecutive patients (mean age, 55.1 years) with 122 tumors (pN0) who had at least 1 year of follow-up were enrolled in this analysis. Before lumpectomy, the insertion of applicators and delivery doses were simulated by computed tomography. After confirming the free margins and negative sentinel node metastases by frozen section analysis, the applicators were inserted. APBI therapy was initiated on the same day of surgery on the basis of the dose distribution analysis, at 32 Gy in 8 fractions over 5-6 days with a 2-cm tumor margin coverage. Regarding our prospective follow-up policy in this observational study, all patients had a predefined schedule including clinical examination every 3-4 months and mammography and breast magnetic resonance imaging (MRI) every 12 months. We performed ICC analysis to estimate the number of patients with ipsilateral breast tumor recurrence (IBTR). The 10-year risk of IBTR for each patient when undergoing with WBI was calculated using the web-based decision-making tool IBTR! and was adjusted during the real-time follow-up period using data obtained from an overview by the Early Breast Cancer Trialists' Collaborative Group. Results: The median follow-up period was 3.1 years (range, 1.1-4.4 years). Most tumors (92.6%) were ≤2 cm in diameter, and 89.4% were estrogen receptor-positive. Hormone therapy was administered in 86.7% and adjuvant chemotherapy in 20.0% patients. If all patients received WBI after BCS, we estimated www.ccsenet.org/cco Cancer and Clinical Oncology Vol. 2, No. 1; 2013 128 IBTR in this group to be 1.1-2.8. Although 1 IBTR was observed, no tumor bed recurrence was recorded. Conclusions: Although this study involved only a small number of patients and short follow-up period, only 1 IBTR case was recorded, which was within the estimated range of local recurrence. Multicatheter brachytherapy using this technique may offer the same rates of local control as WBI in Japanese patients.

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Current status of accelerated partial breast irradiation

Cited by 10 publications

References 39 publications

Accelerated Partial Breast Irradiation (APBI): A review of available techniques

Accelerated Partial Breast Irradiation (APBI): A review of available techniques

Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity

Individualized Case–Control Study of Accelerated Partial Breast Irradiation by Multicatheter Intertstitial Brachytherapy in Japanese Patients with Breast Cancer

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