Partial-Breast Radiation for Early Staged Breast Cancers: Hypothesis, Existing Data, and a Planned Phase III Trial

Author: Beryl McCormick MD 1
View More View Less
  • 1 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York

This review of clinical data from partial-breast treatment studies discusses results from a single institution's experience using brachytherapy catheters, the MammoSite balloon (Proxima Company, Alpharetta, GA), and three-dimensional external beam partial-breast treatment. Rationale, techniques, dose schedules, and available results are presented. Intra-operative single-dose radiation to the lumpectomy site is also reviewed. The National Surgical Adjuvant Breast and Bowel Project (NSABP) and Radiation Therapy Oncology Group (RTOG) cooperative groups are opening a phase III trial to compare partial-breast treatment to the standard 5- to 6-week course of whole-breast radiation. The design of this study is also presented in this review.

If the inline PDF is not rendering correctly, you can download the PDF file here.

Correspondence: Beryl McCormick, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021. E-mail: mccormib@mskcc.org
  • 1

    Levene M, Harris J, Hellman S. Treatment of carcinoma of the breast by radiation therapy. Cancer 1977;39:28402845.

  • 2

    Prosnitz L, Goldenberg I, Packard A. Radiation therapy as initial treatment for early stage cancer of the breast without mastectomy. Cancer 1977;39:917923.

    • Search Google Scholar
    • Export Citation
  • 3

    Ghossein N, Stacey P, Alpert S. Local control of breast cancer with tumorectomy plus radiotherapy or radiotherapy alone. Radiology 1976;121:455459.

    • Search Google Scholar
    • Export Citation
  • 4

    Montague E, Gutierrez A, Barker J. Conservation surgery and irradiation for the treatment of favorable breast cancer. Cancer 1979;43:10581061.

    • Search Google Scholar
    • Export Citation
  • 5

    Clark R, Wilkinson R, Mahoney L. Breast cancer: a 21 year experience with conservative surgery and radiation. Int J Radiat Oncol Biol Phys 1982;8:967975.

    • Search Google Scholar
    • Export Citation
  • 6

    Pierquin B, Baillet F, Wilson F. Radiation therapy in the management of primary breast cancer. Am J Roentgenol 1976;127:654648.

  • 7

    Keynes G. Conservative treatment of cancer of the breast. Br Med J 1937;2:643647.

  • 8

    Baclesse F. Roentgen therapy as the sole method of treatment of cancer of the breast. Am J Roentgenol Radium Ther Nucl Med 1949;62:311319.

    • Search Google Scholar
    • Export Citation
  • 9

    Atkins H, Hayward J, Klugman D. Treatment of early breast cancer: a report after ten years of a clinical trial. Br Med J 1972;2:423429.

  • 10

    Wise L, York Mason A, Ackerman L. Local excision and irradiation: an alternative method for the treatment of early mammary cancer. Ann Surg 1971;174:392399.

    • Search Google Scholar
    • Export Citation
  • 11

    Bonadonna G, Brusamolino F, Valagussa P. Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 1976;294:405410.

    • Search Google Scholar
    • Export Citation
  • 12

    Fisher B, Carbone P, Economou S. L-phenylalanine mustard (L-PAM) in the management of primary breast cancer. N Engl J Med 1975;292:117122.

  • 13

    Fisher B, Anderson S, Bryant J. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:12331241.

    • Search Google Scholar
    • Export Citation
  • 14

    Veronesi U, Cascinelli N, Mariani L. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:12271232.

    • Search Google Scholar
    • Export Citation
  • 15

    Veronesi U, Marubini E, Mariani L. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 2001;12:9971003.

    • Search Google Scholar
    • Export Citation
  • 16

    Fentiman I, Poole C, Tong D. Iridium implant treatment without external radiotherapy for operable breast cancer: A pilot study. Eur J Cancer 1991;27:447450.

    • Search Google Scholar
    • Export Citation
  • 17

    Fentiman I, Poole C, Tong D. Inadequacy of iridium implant as sole radiation treatment for operable breast cancer. Eur J Cancer 1996;32A:608611.

    • Search Google Scholar
    • Export Citation
  • 18

    Morrow M, White J, Moughan J. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J of Clin Oncol 2001;19:22542262.

    • Search Google Scholar
    • Export Citation
  • 19

    King T, Bolton J, Kuske R. Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for Tis, 1, 2 breast cancer. Am J Surg 2000;180:299304.

    • Search Google Scholar
    • Export Citation
  • 20

    Vicini F, Kestin L, Chen P. Limited-field radiation therapy in the management of early-stage breast cancer. J Natl Cancer Inst 2003;95:12051211.

    • Search Google Scholar
    • Export Citation
  • 21

    Kuske R, Winter K, Arthur D. A phase II trial of brachytherapy alone following lumpectomy for stage I or II breast cancer: Initial outcomes of RTOG 9517. 40th Annual Meeting Proceedings: American Society of Clinical Oncology; 2004 June 5-8; New Orleans, Louisiana.

    • Search Google Scholar
    • Export Citation
  • 22

    Vicini F, Winter K, Straube W. A phase I/II trial to evaluate three dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/II breast carcinoma: initial report of feasibility and reproducibility of Radiation Therapy Oncology Group (RTOG) study 0319. Int J Radiat Oncol Biol Phys 2005 (in press).

    • Search Google Scholar
    • Export Citation
  • 23

    Keisch M, Vicini F, Scroggins T. Thirty month results with the MammoSite breast brachytherapy applicator: cosmesis, toxicity and local control in partial-breast irradiation (Abstr). Int J Radiat Oncol Biol Phys 2004;60(suppl):1026.

    • Search Google Scholar
    • Export Citation
  • 24

    Vicini F, Remouchamps V, Wallace M. Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2003;57:12471253.

    • Search Google Scholar
    • Export Citation
  • 25

    Baglan K, Sharpe M, Jaffray D. Accelerated partial-breast irradiation using 3D conformal radiation therapy (3D-CRT). Int J Radiat Oncol Biol Phys 2003;55:302311.

    • Search Google Scholar
    • Export Citation
  • 26

    Formenti S, Truong M, Goldberg J. Prone accelerated partial-breast irradiation after breast-conserving surgery: Preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 2004;60:493504.

    • Search Google Scholar
    • Export Citation
  • 27

    Veronesi U, Orecchia R, Luini A. A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer 2001;37:21782183.

    • Search Google Scholar
    • Export Citation
  • 28

    Tobias J, Vaidya J, Keshtgar M. Reducing radiotherapy dose in early breast cancer: the concept of conformal intraoperative brachytherapy. Br J Radiol 2004;77:279284.

    • Search Google Scholar
    • Export Citation
  • 29

    Veronesi U, Giovanna G, Luini A. Intraoperative radiation therapy for breast cancer: technical notes. Breast J 2003;9:106112.

  • 30

    Rosenstein B, Lymberis SC, Formenti SC. Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol 2003;60:13931404.

  • 31

    Perera F, Yu E, Engel J. Patterns of breast recurrence in a pilot study of brachytherapy confined to the lumpectomy site for early breast cancer with six years' minimum follow-up. Int J Radiat Oncol Biol Phys 2003;57: 12391246.

    • Search Google Scholar
    • Export Citation
  • 32

    Arthur DW, Koo D, Zwicker RD. Partial-breast brachytherapy after lumpectomy: low-dose-rate and high-dose-rate experience. Int J Radiat Oncol Biol Phys 2003;56:681689.

    • Search Google Scholar
    • Export Citation
  • 33

    Polgar C, Sulyok Z, Fodor J. Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: five-year results of a phase I/II study and initial findings of a randomized phase III trial. J Surg Oncol 2002;80:121129.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 75 42 2
PDF Downloads 48 32 3
EPUB Downloads 0 0 0