Chirag Shah1, Frank Vicini2, Simona F Shaitelman3, Jaroslaw Hepel4, Martin Keisch5, Douglas Arthur6, Atif J Khan7, Robert Kuske8, Rakesh Patel9, David E Wazer4. 1. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH. Electronic address: csshah27@hotmail.com. 2. 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI. 3. Department of Radiation Oncology, The University of MD Anderson Cancer Center, Houston, TX. 4. Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Brown University, Providence, RI. 5. Cancer Healthcare Associates, Miami, FL. 6. Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA. 7. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. 8. Arizona Breast Cancer Specialists, Scottsdale, AZ. 9. Department of Radiation Oncology, Sutter Health, Los Gatos, CA.
Abstract
PURPOSE: Adjuvant radiation after breast-conserving surgery remains the standard-of-care treatment for patients with ductal carcinoma in situ and early-stage invasive breast cancer. Multiple alternatives to standard whole-breast irradiation exist including accelerated partial-breast irradiation (APBI). Therefore, the purpose of this APBI guideline is to provide updated data for clinicians as well as recommendations regarding appropriate patient selection and techniques to deliver APBI. METHODS: Members of the American Brachytherapy Society with expertise in breast cancer and breast brachytherapy in particular created an updated guideline for appropriate patient selection based on an extensive literature search and clinical experience. In addition, data were evaluated with respect to APBI techniques and recommendations presented. RESULTS: Appropriate candidates for APBI include patients aged 45 years or older, all invasive histologies and ductal carcinoma in situ, tumors 3 cm or less, node negative, estrogen receptor positive/negative, no lymphovascular space invasion, and negative margins. With respect to techniques, the strongest evidence is for interstitial brachytherapy and intensity-modulated radiation therapy APBI with moderate evidence to support applicator brachytherapy or three-dimensional conformal radiotherapy APBI. Intraoperative radiation therapy and electronic brachytherapy should not be offered regardless of technique outside of clinical trial. CONCLUSIONS: The updated guidelines presented offer clinicians with a summary of data supporting APBI and guidelines for the appropriate and safe utilization of the technique.
PURPOSE: Adjuvant radiation after breast-conserving surgery remains the standard-of-care treatment for patients with ductal carcinoma in situ and early-stage invasive breast cancer. Multiple alternatives to standard whole-breast irradiation exist including accelerated partial-breast irradiation (APBI). Therefore, the purpose of this APBI guideline is to provide updated data for clinicians as well as recommendations regarding appropriate patient selection and techniques to deliver APBI. METHODS: Members of the American Brachytherapy Society with expertise in breast cancer and breast brachytherapy in particular created an updated guideline for appropriate patient selection based on an extensive literature search and clinical experience. In addition, data were evaluated with respect to APBI techniques and recommendations presented. RESULTS: Appropriate candidates for APBI include patients aged 45 years or older, all invasive histologies and ductal carcinoma in situ, tumors 3 cm or less, node negative, estrogen receptor positive/negative, no lymphovascular space invasion, and negative margins. With respect to techniques, the strongest evidence is for interstitial brachytherapy and intensity-modulated radiation therapy APBI with moderate evidence to support applicator brachytherapy or three-dimensional conformal radiotherapy APBI. Intraoperative radiation therapy and electronic brachytherapy should not be offered regardless of technique outside of clinical trial. CONCLUSIONS: The updated guidelines presented offer clinicians with a summary of data supporting APBI and guidelines for the appropriate and safe utilization of the technique.
Authors: Chirag Shah; Martin Keisch; Atif Khan; Douglas Arthur; David Wazer; Frank Vicini Journal: Ann Surg Oncol Date: 2021-01-13 Impact factor: 5.344
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