Accelerated Partial Breast Irradiation: Where Do We Stand?

Author:
Frederick M. DirbasStanford Cancer Center and Department of Surgery, Section of Surgical Oncology, Stanford University School of Medicine, Stanford University, Stanford, California

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Volume/Issue:
Volume 7: Issue 2
Online Publication Date:
Feb 2009
DOI:
https://doi.org/10.6004/jnccn.2009.0015
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Accelerated partial breast irradiation (APBI) is a new form of postlumpectomy radiotherapy delivered over 1 to 5 days. Early trials showed high local recurrence rates. More recent single and multiinstitutional studies, as well as a single phase III trial, have shown local control more comparable to whole breast radiotherapy. Patient selection and surgical technique are important variables preparatory to irradiation, which is delivered using 1 of 4 accelerated radiotherapy methods. Phase I/II studies have produced most of the information currently available regarding APBI. Additional phase III studies are underway to determine whether any or all of these accelerated radiotherapy approaches may safely substitute for whole breast radiotherapy in women seeking breast conservation.

Correspondence to: Frederick M. Dirbas, MD, Stanford University, 875 Blake Wilbur Drive, CC2235, Stanford, CA 94305.E-mail: dirbas@stanford.edu
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  • 1

    Fisher B, Anderson S, Bryant J et al.. 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;347:1233–1241.

    • Search Google Scholar
    • Export Citation
  • 2

    Veronesi U, Cascinelli N, Mariani L et al.. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–1232.

    • Search Google Scholar
    • Export Citation
  • 3

    Whelan T, MacKenzie R, Julian J et al.. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst 2002;94:1143–1150.

    • Search Google Scholar
    • Export Citation
  • 4

    Recht A, Silver B, Schnitt S et al.. Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int J Radiat Oncol Biol Phys 1985;11:1271–1276.

    • Search Google Scholar
    • Export Citation
  • 5

    Timmerman R, Bastasch M, Saha D et al.. Optimizing dose and fractionation for stereotactic body radiation therapy. Normal tissue and tumor control effects with large dose per fraction. Front Radiat Ther Oncol 2007;40:352–365.

    • Search Google Scholar
    • Export Citation
  • 6

    Garcia-Barros M, Paris F, Codon-Cardo C et al.. Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science 2003;300:1155–1159.

    • Search Google Scholar
    • Export Citation
  • 7

    Rose C, Recht A. Accelerated partial-breast irradiation (APBI): let’s give it a good test. Int J Radiat Oncol Biol Phys 2003;57:1217–1218.

    • Search Google Scholar
    • Export Citation
  • 8

    Fentiman IS, Poole C, Tong D et al.. Iridium implant treatment without external radiotherapy for operable breast cancer: a pilot study. Eur J Cancer 1991;27:447–450.

    • Search Google Scholar
    • Export Citation
  • 9

    Ribeiro GG, Magee B, Swindell R et al.. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol) 1993;5:278–283.

    • Search Google Scholar
    • Export Citation
  • 10

    Dodwell DJ, Dyker K, Brown J et al.. A randomised study of whole-breast vs tumour-bed irradiation after local excision and axillary dissection for early breast cancer. Clin Oncol (R Coll Radiol) 2005;17:618–622.

    • Search Google Scholar
    • Export Citation
  • 11

    Vicini F, Kini VR, Chen P et al.. Irradiation of the tumor bed alone after lumpectomy in selected patients with early-stage breast cancer treated with breast conserving therapy. J Surg Oncol 1999;70:33–40.

    • Search Google Scholar
    • Export Citation
  • 12

    King TA, Bolton JS, Kuske RR et al.. Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer. Am J Surg 2000;180:299–304.

    • Search Google Scholar
    • Export Citation
  • 13

    Dirbas FM, Jeffrey SS, Goffinet DR. The evolution of accelerated, partial breast irradiation as a potential treatment option for women with newly diagnosed breast cancer considering breast conservation. Cancer Biother Radiopharm 2004;19:673–705.

    • Search Google Scholar
    • Export Citation
  • 14

    Godinez J, Gombos EC, Chikarmane SA et al.. Breast MRI in the evaluation of eligibility for accelerated partial breast irradiation. AJR Am J Roentgenol 2008;191:272–277.

    • Search Google Scholar
    • Export Citation
  • 15

    Horst KC, Ikeda DM, Birdwell RL et al.. Breast magnetic resonance imaging alters patient selection for accelerated, partial breast irradiation. Proceedings of the American Society for Therapeutic Radiology and Oncology 47th Annual Meeting 2005;63(Suppl 1):S4–5.

    • Search Google Scholar
    • Export Citation
  • 16

    Fisher B, Redmond C, Poisson R et al.. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989;320:822–828.

    • Search Google Scholar
    • Export Citation
  • 17

    Veronesi U, Salvadori B, Luini A et al.. Conservative treatment of early breast cancer. Long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy. Ann Surg 1990;211:250–259.

    • Search Google Scholar
    • Export Citation
  • 18

    Patel RR, Christensen ME, Hodge CW et al.. Clinical outcome analysis in “high-risk” versus “low-risk” patients eligible for national surgical adjuvant breast and bowel B-39/radiation therapy oncology group 0413 trial: five-year results. Int J Radiat Oncol Biol Phys 2008;70:970–973.

    • Search Google Scholar
    • Export Citation
  • 19

    Mohideen N, Nigh S, Lobo M et al.. Are patients with triple negative breast cancer appropriately treated with accelerated partial breast irradiation (APBI)? Proceedings of the American Society for Therapeutic Radiology and Oncology 47th Annual Meeting 2008;72(1 Suppl 1):S198.

    • Search Google Scholar
    • Export Citation
  • 20

    Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 2002;184:383–393.

    • Search Google Scholar
    • Export Citation
  • 21

    Zannis V, Beitsch P, Vicini F et al.. Descriptions and outcomes of insertion techniques of a breast brachytherapy balloon catheter in 1403 patients enrolled in the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Am J Surg 2005;190:530–538.

    • Search Google Scholar
    • Export Citation
  • 22

    Vicini FA, Beitsch PD, Quiet CA et al.. First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer 2005;104:1138–1148.

    • Search Google Scholar
    • Export Citation
  • 23

    Benitez PR, Chen PY, Vicini FA et al.. Partial breast irradiation in breast conserving therapy by way of interstitial brachytherapy. Am J Surg 2004;188:355–364.

    • Search Google Scholar
    • Export Citation
  • 24

    Intra M, Luini A, Gatti G et al.. Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: a lesson learned by over 1000 procedures. Surgery 2006;140:467–471.

    • Search Google Scholar
    • Export Citation
  • 25

    Vaidya J, Baum M, Tobias JS et al.. The novel technique of delivering targeted intraoperative radiotherapy (Targit) for early breast cancer. Eur J Surg Oncol 2002;28:447–454.

    • Search Google Scholar
    • Export Citation
  • 26

    NSABP B39/RTOG 0413 Protocol. Available at: http://www.rtog.org/members/protocols/0413/0413.pdf. Accessed January 2, 2009.

  • 27

    Landis DM, Luo W, Song J et al.. Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys 2007;67:1299–1308.

    • Search Google Scholar
    • Export Citation
  • 28

    Dzhugashvili M, Dunant A, Pichenot C et al.. The added value of surgical clips in target volume determination in accelerated partial breast cancer irradiation. Proceedings of the American Society for Therapeutic Radiology and Oncology 47th Annual Meeting 2008;72(1 Suppl 1):S173.

    • Search Google Scholar
    • Export Citation
  • 29

    Hasan Y, Kim L, Martinez A et al.. Image guidance in external beam accelerated partial breast irradiation: comparison of surrogates for the lumpectomy cavity. Int J Radiat Oncol Biol Phys 2008;70:619–625.

    • Search Google Scholar
    • Export Citation
  • 30

    Arthur DW, Winter K, Kuske RR et al.. A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 95-17. Int J Radiat Oncol Biol Phys 2008;72:467–473.

    • Search Google Scholar
    • Export Citation
  • 31

    Kaufman SA, DiPetrillo TA, Price LL et al.. Long-term outcome and toxicity in a Phase I/II trial using high-dose-rate multicatheter interstitial brachytherapy for T1/T2 breast cancer. Brachytherapy 2007;6:286–292.

    • Search Google Scholar
    • Export Citation
  • 32

    Anderson PJ, Mark R, Neumann T et al.. Interstitial high dose rate (HDR) brachytherapy for early stage breast cancer: five year follow-up of 168 cases using multi-catheter technique. Proceedings of the American Society for Therapeutic Radiology and Oncology 47th Annual Meeting 2008;72(1 Suppl 1):S517.

    • Search Google Scholar
    • Export Citation
  • 33

    Yoshida K, Nose T, Masuda N et al.. Preliminary result of accelerated partial breast irradiation after breast-conserving surgery. Breast Cancer 2008; in press.

    • Search Google Scholar
    • Export Citation
  • 34

    Benitez PR, Keisch ME, Vicini F et al.. Five-year results: the initial clinical trial of MammoSite balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am J Surg 2007;194:456–462.

    • Search Google Scholar
    • Export Citation
  • 35

    Chao KK, Vicini FA, Wallace M et al.. Analysis of treatment efficacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial-breast irradiation: the William Beaumont Hospital experience. Int J Radiat Oncol Biol Phys 2007;69:32–40.

    • Search Google Scholar
    • Export Citation
  • 36

    Cuttino LW, Keisch M, Jenrette JM et al.. Multi-institutional experience using the MammoSite radiation therapy system in the treatment of early-stage breast cancer: 2-year results. Int J Radiat Oncol Biol Phys 2008;71:107–114.

    • Search Google Scholar
    • Export Citation
  • 37

    Vicini F, Beitsch PD, Quiet CA et al.. Three-year analysis of treatment efficacy, cosmesis, and toxicity by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation (APBI). Cancer 2008;112:758–766.

    • Search Google Scholar
    • Export Citation
  • 38

    Haffty BG, Vicini FA, Beitsch P et al.. Timing of chemotherapy after mammosite radiation therapy system breast brachytherapy: analysis of the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial. Int J Radiat Oncol Biol Phys 2008;72:1441–1448.

    • Search Google Scholar
    • Export Citation
  • 39

    Dickler A, Kirk MC, Seif N et al.. A dosimetric comparison of MammoSite high-dose-rate brachytherapy and Xoft Axxent electronic brachytherapy. Brachytherapy 2007;6:164–168.

    • Search Google Scholar
    • Export Citation
  • 40

    MammoSite Web site. Available at: http://www.mammosite.com/breast-lumpectomy/whatis-mammosite.cfm. Accessed December 15, 2008.

  • 41

    Abelson R. Quickly vetted, treatment is offered to patients. The New York Times. October 26, 2008:A1.

  • 42

    Suh WW, Pierce LJ, Vicini FA, Hayman JA et al.. A cost comparison analysis of partial versus whole-breast irradiation after breast-conserving surgery for early-stage breast cancer. Int J Radiat Oncol Biol Phys 2005;62:790–796.

    • Search Google Scholar
    • Export Citation
  • 43

    Nairz O, Deutschmann H, Kopp M et al.. [A dosimetric comparison of IORT techniques in limited-stage breast cancer]. Strahlenther Onkol 2006;182:342–348 [in German].

    • Search Google Scholar
    • Export Citation
  • 44

    Vaidya JS, Baum M, Tobias JS et al.. Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann Oncol 2001;12:1075–1080.

    • Search Google Scholar
    • Export Citation
  • 45

    Gatzemeier W, Orecchia R, Gatti G et al.. [Intraoperative radiotherapy (IORT) in treatment of breast carcinoma—a new therapeutic alternative within the scope of breast-saving therapy? Current status and future prospects. Report of experiences from the European Institute of Oncology (EIO), Mailand]. Strahlenther Onkol 2001;177:330–337 [in German].

    • Search Google Scholar
    • Export Citation
  • 46

    Veronesi U, Orecchia R, Luini A et al.. Full dose intraoperative radiotherapy with electrons (ELIOT) during breast conserving surgery—experience with 1246 cases. Available at: http://www.ecancermedicalscience.com/view-responses.asp?doi=10.3332/eCMS.2008.65. Accessed December 15, 2008.

    • Search Google Scholar
    • Export Citation
  • 47

    Arcangeli G. IOERT vs. EBRT in breast cancer: update of an ongoing multicenter study. Presented at the 5th International Conference of Intraoperative Radiation Therapy; June 10–13, 2008; Madrid, Spain.

    • Search Google Scholar
    • Export Citation
  • 48

    Sacchini V, Beal K, Goldberg J et al.. Study of quadrant high-dose intraoperative radiation therapy for early-stage breast cancer. Br J Surg 2008;95:1105–1110.

    • Search Google Scholar
    • Export Citation
  • 49

    Dirbas F, Horst K. Intraoperative radiotherapy following lumpectomy for breast cancer. Semin Breast Dis 2007;10:26–33.

  • 50

    Ollila DW, Klauber-DeMore N, Tesche LJ et al.. Feasibility of breast preserving therapy with single fraction in situ radiotherapy delivered intraoperatively. Ann Surg Oncol 2007;14:660–669.

    • Search Google Scholar
    • Export Citation
  • 51

    Baglan KL, Sharpe MB, Jaffray D et al.. Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT). Int J Radiat Oncol Biol Phys 2003;55:302–311.

    • Search Google Scholar
    • Export Citation
  • 52

    Vicini FA, Chen P, Wallace M et al.. Interim cosmetic results and toxicity using 3D conformal external beam radiotherapy to deliver accelerated partial breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2007;69:1124–1130.

    • Search Google Scholar
    • Export Citation
  • 53

    Vicini FA, Winter K, Straube W et al.. Initial efficacy results of RTOG 0319: three dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/II breast carcinoma. Proceedings of the American Society for Therapeutic Radiology and Oncology 47th Annual Meeting 2008;72(1 Suppl 1):S3.

    • Search Google Scholar
    • Export Citation
  • 54

    Formenti SC, Truong MT, Goldberg JD et al.. Prone accelerated partial breast irradiation after breast-conserving surgery: preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 2004;60:493–504.

    • Search Google Scholar
    • Export Citation
  • 55

    Polgar C, Fodor J, Major T et al.. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma—5-year results of a randomized trial. Int J Radiat Oncol Biol Phys 2007;69:694–702.

    • Search Google Scholar
    • Export Citation
  • 56

    Polgar C, Strnad V, Major T. Brachytherapy for partial breast irradiation: the European experience. Semin Radiat Oncol 2005;15:116–122.

  • 57

    Holmes DR, Baum M, Joseph D. The TARGIT trial: targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update). Am J Surg 2007;194:507–510.

    • Search Google Scholar
    • Export Citation
  • 58

    Orecchia R. Milan-ELIOT randomized trial. in ISIORT 2008. Presented at the 5th International Conference of Intraoperative Radiation Therapy; June 10–13, 2008; Madrid, Spain.

    • Search Google Scholar
    • Export Citation
  • 59

    Clinicaltrials.gov. RAPID: Randomized Trial of Accelerated Partial Breast Irradiation. Available at: http://clinicaltrials.gov/ct2/show/NCT00282035?recr=open&cond=%22Cosmetics%22&rank=9. Accessed December 16, 2008.

    • Search Google Scholar
    • Export Citation
  • 60

    Current Controlled Trials. Randomised trial testing Intensity Modulated radiotherapy and Partial Organ RadioTherapy following breast conservation surgery for early breast cancer. Available at: http://www.controlled-trials.com/ISRCTN12852634/. Accessed December 15, 2008.

    • Search Google Scholar
    • Export Citation
Copyright:
Copyright © 2009 by the National Comprehensive Cancer Network 2009
Page Numbers:
11
Article Category:
Research Article
Received:
10 Nov 2008
Accepted:
18 Dec 2008
Print Publication Date:
01 Feb 2009
Online Publication Date:
Feb 2009
Keywords:
Accelerated partial breast irradiation; APBI; breast cancer; brachytherapy; IORT; 3D conformal radiotherapy; clinical trials
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