Advertisement

The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation

Published:October 23, 2017DOI:https://doi.org/10.1016/j.brachy.2017.09.004

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Brachytherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • 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
        • Van Dongen J.A.
        • Voogd A.C.
        • Fentiman I.S.
        • et al.
        Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial.
        J Natl Cancer Inst. 2000; 92: 1143-1150
        • 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
        • Arndt V.
        • Stegmaier C.
        • Ziegler H.
        • et al.
        Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: A population-based study.
        J Cancer Res Clin Oncol. 2008; 134: 1311-1318
        • Aerts L.
        • Christiaens M.R.
        • Enzlin P.
        • et al.
        Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: A prospective controlled study.
        Breast. 2014; 23: 629-636
        • Sun Y.
        • Kim S.W.
        • Heo C.Y.
        • et al.
        Comparison of quality of life based on surgical technique in patients with breast cancer.
        Jpn J Clin Oncol. 2014; 44: 22-27
        • Fisher B.
        • Bryant J.
        • Dignam J.J.
        • et al.
        Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less.
        J Clin Oncol. 2001; 20: 4141-4149
        • Fyles A.W.
        • McCready D.R.
        • Manchul L.A.
        • et al.
        Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer.
        N Engl J Med. 2004; 351: 963-970
        • Darby S.
        • McGale P.
        • Correa C.
        • et al.
        • Early Breast Cancer Trialists’ Collaborative Group (EBCTG)
        Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data on 10,801 women in 17 randomised trials.
        Lancet. 2011; 378: 1707-1716
        • Morrow M.
        • White J.
        • Moughan J.
        • et al.
        Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma.
        J Clin Oncol. 2001; 19: 2254-2262
        • Voti L.
        • Richardson L.C.
        • Reis I.
        • et al.
        The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida.
        Breast Cancer Res Treat. 2006; 95: 89-95
        • Whelan T.J.
        • Pignol J.P.
        • Levine M.N.
        • et al.
        Long-term results of hypofractionated radiation therapy for breast cancer.
        N Engl J Med. 2010; 362: 513-520
        • Haviland J.S.
        • Owen J.R.
        • Dewar J.A.
        • et al.
        The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomized controlled trials.
        Lancet Oncol. 2013; 14: 1086-1094
        • Smith G.L.
        • Xu Y.
        • Buchholz T.A.
        • et al.
        Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer.
        JAMA. 2012; 307: 1827-1837
        • Presley C.J.
        • Soulos P.R.
        • Herrin J.
        • et al.
        Patterns of use and short-term complications of breast brachytherapy in the national Medicare population from 2008-2009.
        J Clin Oncol. 2012; 30: 4302-4307
      1. American Brachytherapy Society: Breast Brachytherapy Task Group. Breast Brachytherapy. Available at: http://www.americanbrachytherapy.org/guidelines/abs_breast_brachytherapy_taskgroup.pdf. Accessed May 22, 2017.

        • Shah C.
        • Vicini F.
        • Wazer D.E.
        • et al.
        The American Brachytherapy Society consensus statement for accelerated partial breast irradiation.
        Brachytherapy. 2013; 12: 267-277
        • Correa C.
        • Hariss E.E.
        • Leonardi M.C.
        • et al.
        Accelerated partial breast irradiation: Executive summary for the update of an ASTRO evidence-based consensus statement.
        Pract Radiat Oncol. 2017; l7: 73-79
        • Polgar C.
        • Van Limbergen E.
        • Potter R.
        • et al.
        Patient selection for accelerated partial-breast irradiation (APBI) after breast conserving surgery: Recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009).
        Radiother Oncol. 2010; 94: 264-273
      2. The American Society of Breast Surgeons. Consensus Statement for Accelerated Partial Breast Irradiation. Available at: https://www.breastsurgeons.org/statements/PDF_Statements/APBI.pdf. Accessed May 12, 2017.

        • Polgar C.
        • Fodor J.
        • Major T.
        • et al.
        Breast-conserving therapy with partial or whole breast irradiation: Ten-year results of the Budapest randomized trial.
        Radiother Oncol. 2013; 108: 197-202
        • Strnad V.
        • Ott O.J.
        • Hildebrandt G.
        • et al.
        5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: A randomised, phase 3, non-inferiority trial.
        Lancet. 2016; 387: 229-238
        • Polgar C.
        • Ott O.J.
        • Hildebrandt G.
        • et al.
        Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial.
        Lancet Oncol. 2017; 18: 259-268
        • Olivotto I.
        • Whelan T.J.
        • Parpia S.
        • et al.
        Interim cosmetic and toxicity results from RAPID: A randomized trial of accelerated partial breast irradiation using 3D conformal external beam radiation therapy.
        J Clin Oncol. 2013; 31: 4038-4045
        • Julian T.B.
        • Constantino J.P.
        • Vicini F.A.
        • et al.
        Early toxicity results with 3D conformal external beam (CEBT) from the NSABP B-39/RTOG 0413 accelerated partial breast irradiation (APBI) trial.
        J Clin Oncol. 2011; 29: S1011
      3. RTOG 0413 Protocol Information. Available at: https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0413. Accessed May 22, 2017.

        • Rodriguez N.
        • Sanz X.
        • Dengra J.
        • et al.
        Five-year outcomes, cosmesis, and toxicity with 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2013; 87: 1051-1057
        • Livi L.
        • Meattini I.
        • Marrazzo L.
        • et al.
        Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial.
        Eur J Cancer. 2015; 51: 451-463
        • Coles C.
        • Griffin C.L.
        • Kirby A.M.
        • et al.
        Partial breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3 non-inferiority trial.
        Lancet. 2017; 390: 1048-1060
        • Vaidya J.S.
        • Wenz F.
        • Bulsara M.
        • et al.
        Risk-adapted targeted intraoperative radiotherapy versus whole-beast radiotherapy for breast cancer: 5-year results of local control and overall survival from the TARGIT-A randomized trial.
        Lancet. 2014; 383: 603-613
        • Veronesi U.
        • Orecchia R.
        • Maisonneuve P.
        • et al.
        Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): A randomized controlled equivalence trial.
        Lancet Oncol. 2013; 14: 1269-1277
        • Polgar C.
        • Major T.
        • Fodor J.
        • et al.
        Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study.
        Radiother Oncol. 2010; 94: 274-279
        • White J.
        • Winter K.
        • Kuske R.R.
        • et al.
        Long-term outcomes from Study NRG Oncology/RTOG 9517: A phase 2 study of accelerated partial breast irradiation with multicatheter brachytherapy after lumpectomy for early-stage breast cancer.
        Int J Radiat Oncol Biol Phys. 2016; 95: 1460-1465
        • Rabinovitch R.
        • Winter K.
        • Kuske R.
        • et al.
        RTOG 95-17, a Phase II trial to evaluate brachytherapy as the sole method of radiation therapy for Stage I and II breast carcinoma- year-5 toxicity and cosmesis.
        Brachytherapy. 2014; 13: 17-22
        • Shah C.
        • Badiyan S.
        • Ben Wilkinson J.
        • et al.
        Treatment efficacy with accelerated partial breast irradiation (APBI): Final analysis of the American Society of Breast Surgeons MammoSite breast brachytherapy trial.
        Ann Surg Oncol. 2010; 20: 3279-3285
        • Shah C.
        • Khwaja S.
        • Badiyan S.
        • et al.
        Brachytherapy-based partial breast irradiation is associated with low rates of complications and excellent cosmesis.
        Brachytherapy. 2013; 12: 278-284
        • Rabinovitch R.
        • Moughan J.
        • Vicini F.
        • et al.
        Long-term update of NRG Oncology RTOG 0319: A Phase 1 and 2 trial to evaluate 3-dimensional conformal radiation therapy confined to the region of the lumpectomy cavity for Stage I and II breast carcinoma.
        Int J Radiat Oncol Biol Phys. 2016; 96: 1054-1059
        • Chafe S.
        • Moughan J.
        • McCormick B.
        • et al.
        Late toxicity and patient self-assessment of breast appearance and satisfaction on RTOG 0319: A phase 2 trial of 3-dimensional conformal radiation therapy-accelerated partial breast irradiation following lumpectomy for stages I and II breast cancer.
        Int J Radiat Oncol Biol Phys. 2013; 86: 854-859
        • Jagsi R.
        • Ben-David M.A.
        • Moran J.M.
        • et al.
        Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2010; 76: 71-78
        • Liss A.
        • Ben-David M.A.
        • Jagsi R.
        • et al.
        Decline of cosmetic outcomes following accelerated partial breast irradiation using intensity modulated radiation therapy; results of a single-institution prospective clinical trial.
        Int J Radiat Oncol Biol Phys. 2014; 89: 96-102
        • Hattangadi J.A.
        • Powell S.N.
        • Macdonald S.M.
        • et al.
        Accelerated partial breast irradiation with low-dose-rate interstitial implant brachytherapy after wide local excision: 12-year outcomes from a prospective trial.
        Int J Radiat Oncol Biol Phys. 2012; 83: 791-800
        • Strnad V.
        • Hildebrandt G.
        • Potter R.
        • et al.
        Accelerated partial breast irradiation: 5-year results of the German-Austrian multicenter phase II trial using interstitial multicatheter brachytherapy alone after breast-conserving surgery.
        Int J Radiat Oncol Biol Phys. 2011; 80: 17-24
        • Benitez P.R.
        • Keisch M.E.
        • 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
        • Vicini F.A.
        • Keisch M.
        • Shah C.
        • et al.
        Factors associated with optimal long-term cosmetic results in patients treated with accelerated partial breast irradiation using balloon-based brachytherapy.
        Int J Radiat Oncol Biol Phys. 2012; 83: 512-518
        • Cuttino L.W.
        • Arthur D.W.
        • Vicini F.
        • et al.
        Long-term results from the Contura multilumen balloon breast brachytherapy catheter phase 4 registry trial.
        Int J Radiat Oncol Biol Phys. 2014; 90: 1025-1029
        • Baglan K.L.
        • Sharpe M.B.
        • 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
        • Lei R.Y.
        • Leonard C.E.
        • Howell K.T.
        • et al.
        Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT).
        Breast Cancer Res Treat. 2013; 140: 119-133
        • King T.A.
        • Bolton J.S.
        • Kuske R.R.
        • 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
        • Krishnan L.
        • Jewell W.R.
        • Tawfik O.W.
        • et al.
        Breast conservation therapy with tumor bed irradiation alone in a selected group of patients with stage I breast cancer.
        Breast J. 2001; 7: 91-96
        • Arthur D.W.
        • Koo D.
        • Zwicker R.D.
        • et al.
        Partial breast brachytherapy after lumpectomy: Low-dose-rate and high-dose-rate experience.
        Int J Radiat Oncol Biol Phys. 2003; 56: 681-689
        • Perera F.
        • Yu E.
        • Engel J.
        • et al.
        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: 1239-1246
        • Johansson B.
        • Karlsson L.
        • Liljegren G.
        • et al.
        Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1-2 breast cancer: First long time results from a clinical study.
        Radiother Oncol. 2009; 90: 30-35
        • Yoshida K.
        • Nose T.
        • Masuda N.
        • et al.
        Preliminary result of accelerated partial breast irradiation after breast-conserving surgery.
        Breast Cancer. 2009; 16: 105-112
        • Stevens M.J.
        • Cooper S.G.
        • Cross P.
        • et al.
        Accelerated partial breast irradiation using interstitial high dose rate iridium brachytherapy: Early Australian experience and review of the literature.
        Australas Radiol. 2006; 50: 143-151
        • Kaufman S.A.
        • DiPetrillo T.A.
        • Price L.L.
        • et al.
        Long-term outcome and toxicity in a Phase I/II trial using high-dose-rate multicatheter interstitial brachytherapy for T1/2 breast cancer.
        Brachytherapy. 2007; 6: 286-292
        • Patel R.R.
        • Christensen M.E.
        • Hodge C.W.
        • 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
        • Gomez-Iturriaga A.
        • Pina L.
        • Cambeiro M.
        • et al.
        Early breast cancer treated with conservative surgery, adjuvant chemotherapy, and delayed accelerated partial breast irradiation with high-dose-rate brachytherapy.
        Brachytherapy. 2008; 7: 310-315
        • Slampa P.
        • Soumarova R.
        • Ruzickova J.
        • et al.
        Pilot study of sole conformal perioperative interstitial brachyradiotherapy of early stage breast carcinoma using high-dose rate afterloading.
        Neoplasma. 2005; 52: 292-296
        • Shah C.
        • Antonucci J.V.
        • Wilkinson J.B.
        • et al.
        Twelve-year clinical outcomes and patterns of failure with accelerated partial breast irradiation versus whole-breast irradiation: Results of a matched-pair analysis.
        Radiother Oncol. 2011; 100: 210-214
        • Ferraro D.J.
        • Garsa A.A.
        • Dewees T.A.
        • et al.
        Comparison of accelerated partial breast irradiation via multicatheter interstitial brachytherapy versus whole breast irradiation.
        Radiat Oncol. 2012; 7: 53
        • Kamrava M.
        • Kuske R.R.
        • Anderson B.
        • et al.
        Outcomes of breast cancer patients treated with accelerated partial breast irradiation via multicatheter interstitial brachytherapy: The Pooled Interstitial Sites (PROMIS) experience.
        Ann Surg Oncol. 2015; 22: s404-s411
        • Richards G.M.
        • Berson A.M.
        • Rescigno J.
        • et al.
        Acute toxicity of high-dose-rate intracavitary brachytherapy with the MammoSite applicator in patients with early-stage breast cancer.
        Ann Surg Oncol. 2004; 11: 739-746
        • Dowlatshahi K.
        • Snider H.C.
        • Gittleman M.A.
        • et al.
        Early experience with balloon brachytherapy for breast cancer.
        Arch Surg. 2004; 139: 603-607
        • Tsai P.I.
        • Ryan M.
        • Meek K.
        • et al.
        Accelerated partial breast irradiation using the MammoSite device: Early technical experience and short-term clinical follow-up.
        Am Surg. 2006; 72: 929-934
        • Niehoff P.
        • Ballardini B.
        • Polgar C.
        • et al.
        Early European experience with the MammoSite radiation therapy system for partial breast brachytherapy following breast conservation operation in low-risk breast cancer.
        Breast. 2006; 15: 319-325
        • Niehoff P.
        • Polgar C.
        • Ostertag H.
        • et al.
        Clinical experience with the MammoSite radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial.
        Radiother Oncol. 2006; 79: 316-320
        • Chao K.K.
        • Vicini F.A.
        • 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
        • Cuttino L.W.
        • Keisch M.
        • Jenrette J.M.
        • 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
        • Wobb J.L.
        • Shah C.
        • Chen P.Y.
        • et al.
        Brachytherapy-based accelerated partial breast irradiation provides equivalent 10-year outcomes to whole breast irradiation: A matched-pair analysis.
        Am J Clin Oncol. 2016; 39: 468-472
        • Shah C.
        • Wilkinson J.B.
        • Lyden M.
        • et al.
        Comparison of survival and regional failure between accelerated partial breast irradiation and whole breast irradiation.
        Brachytherapy. 2012; 11: 311-315
        • Shah C.
        • Wilkinson J.B.
        • Lyden M.
        • et al.
        Predictors of local recurrence following accelerated partial breast irradiation: A pooled analysis.
        Int J Radiat Oncol Biol Phys. 2012; 82: e825-e830
        • Shah C.
        • Wilkinson J.B.
        • Lanni T.
        • et al.
        Five-year outcomes and toxicities using 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation.
        Clin Breast Cancer. 2013; 13: 206-211
        • Hepel J.T.
        • Tokita M.
        • MacAusland S.G.
        • et al.
        Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2009; 75: 1290-1296
      4. Kuske R, Kamrava M, Chen P, et al. Interstitial multi-catheter brachytherapy for select DCIS with 5 year follow-up: A multi-institutional study PROMIS: Pooled registry of multicatheter interstitial sites. American Society of Breast Surgeons Annual Meeting, May 2014, Las Vegas, Nevada.

        • Shah C.
        • McGee M.
        • Wilkinson J.B.
        • et al.
        Clinical outcomes using accelerated partial breast irradiation in patients with ductal carcinoma in situ.
        Clin Breast Cancer. 2012; 12: 259-263
        • Stull T.S.
        • Goodwin M.
        • Gracely E.J.
        • et al.
        A single-institution review of accelerated partial breast irradiation in patients considered “cautionary” by the American Society for Radiation Oncology.
        Ann Surg Oncol. 2012; 19: 553-559
        • Benitez P.R.
        • Streeter O.
        • Vicini F.
        • et al.
        Preliminary results and evaluation of MammoSite balloon brachytherapy for partial breast irradiation for pure ductal carcinoma in situ: A phase II clinical study.
        Am J Surg. 2006; 192: 427-433
        • Vicini F.
        • Shah C.
        • Wilkinson J.B.
        • et al.
        Should ductal carcinoma-in-situ (DCIS) be removed from the ASTRO consensus panel cautionary group for off-protocol use of accelerated partial breast irradiation (APBI)? A pooled analysis of outcomes for 300 patients with DCIS treated with APBI.
        Ann Surg Oncol. 2013; 12: 91-98
        • McHaffie D.R.
        • Patel R.R.
        • Adkison J.B.
        • et al.
        Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features.
        Int J Radiat Oncol Biol Phys. 2011; 81: 46-51
        • Abbott A.M.
        • Portschy P.R.
        • Lee C.
        • et al.
        Prospective multicenter trial evaluating balloon-catheter partial-breast irradiation for ductal carcinoma in situ.
        Int J Radiat Oncol Biol Phys. 2013; 87: 494-498
        • Zauls A.J.
        • Watkins J.M.
        • Wahlquist A.E.
        • et al.
        Outcomes in women treated with MammoSite brachytherapy or whole breast irradiation stratified by ASTRO accelerated partial breast irradiation consensus statement groups.
        Int J Radiat Oncol Biol Phys. 2012; 82: 21-29
        • Goyal S.
        • Vicini F.
        • Beitsch P.D.
        • et al.
        Ductal carcinoma in situ treated with breast-conserving surgery and accelerated partial breast irradiation comparison of the MammoSite registry trial with intergroup study E5194.
        Cancer. 2011; 117: 1149-1155
        • McCormick B.
        • Winter K.
        • Hudis C.
        • et al.
        RTOG 9804: A prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy and observation.
        J Clin Oncol. 2015; 33: 709-715
        • Ribeiro G.G.
        • Magee B.
        • Swindell R.
        • et al.
        The Christie Hospital breast conservation trial: An update at 8 years from inception.
        Clin Oncol. 1993; 5: 278-283
        • Shah C.
        • Wilkinson J.B.
        • Shaitelman S.
        • et al.
        Clinical outcomes using accelerated partial breast irradiation in patients with invasive lobular carcinoma.
        Int J Radiat Oncol Biol Phys. 2011; 81: e547-e551
        • Shaikh A.Y.
        • LaCombe M.A.
        • Du H.
        • et al.
        Accelerated partial breast irradiation using once-daily fractionation: Analysis of 312 cases with four years median follow-up.
        Radiat Oncol. 2012; 7: 17
        • Cannon D.M.
        • McHaffie D.R.
        • Patel R.R.
        • et al.
        Locoregional recurrence following accelerated partial breast irradiation fore early-stage invasive breast cancer: Significance of estrogen receptor status and other pathological variables.
        Ann Surg Oncol. 2013; 20: 3346-3352
        • Moran M.S.
        • Yang Q.
        • Haffty B.G.
        • et al.
        Yale University experience of early-stage invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) treated with breast conservation treatment (BCT): Analysis of clinical-pathologic features, long-term outcomes, and molecular expression of COX-2, Bcl-2, and p53 as a function of histology.
        Breast J. 2009; 15: 571-578
        • Shah C.
        • Wilkinson J.B.
        • Shaitelman S.
        • et al.
        Impact of lymph node status on clinical outcomes after accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2012; 82: e409-e414
        • Kamrava M.
        • Kuske R.R.
        • Anderson B.
        • et al.
        Outcomes of node-positive breast cancer patients treated with accelerated partial breast irradiation via multicatheter interstitial brachytherapy: The pooled registry of multicatheter interstitial sites (PROMIS) experience.
        Am J Clin Oncol. 2016; ([Epub ahead of print])
        • Beitsch P.
        • Vicini F.
        • Keisch M.
        • et al.
        Five-year outcome of patients classified in the “unsuitable” category using the American Society of Therapeutic Radiology and Oncology (ASTRO) consensus panel guidelines for the application of accelerated partial breast irradiation: An analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial.
        Ann Surg Oncol. 2010; 17: 219-225
        • Wilder R.B.
        • Curcio L.D.
        • Khanijou R.K.
        • et al.
        Preliminary results with accelerated partial breast irradiation in high-risk breast cancer patients.
        Brachytherapy. 2010; 9: 171-177
        • Whelan T.J.
        • Olivotto I.A.
        • Parulekar W.R.
        • et al.
        Regional nodal irradiation in early-stage breast cancer.
        N Engl J Med. 2015; 373: 307-316
        • Donker M.
        • van Tienhoven G.
        • Straver M.E.
        • et al.
        Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicenter, open-label, phase 3 non-inferiority trial.
        Lancet Oncol. 2014; 15: 1303-1310
        • Tendulkar R.D.
        • Rehman S.
        • Shukla M.E.
        • et al.
        Impact of postmastectomy radiation on locoregional recurrence in breast cancer patients with 1-3 positive lymph nodes treated with modern systemic therapy.
        Int J Radiat Oncol Biol Phys. 2012; 83: e577-e581
        • Lowery A.J.
        • Kell M.R.
        • Glynn R.W.
        • et al.
        Locoregional recurrence after breast cancer surgery: A systematic review by receptor phenotype.
        Breast Cancer Res Treat. 2012; 133: 831-841
        • Truong P.T.
        • Sadek B.T.
        • Lesperance M.F.
        • et al.
        Is biological subtype prognostic of locoregional recurrence risk in women with pT1-2N0 breast cancer treated with mastectomy?.
        Int J Radiat Oncol Biol Phys. 2014; 88: 57-64
        • Kuske R.R.
        • Demanes J.
        • Anderson B.M.
        • et al.
        Discrepancies in accelerated partial breast irradiation (APBI) treatment outcomes in younger women when using claims versus a database (PROMIS) with actual recurrence rates.
        Int J Radiat Oncol Biol Phys. 2016; 96: e53-e54
        • Khan A.J.
        • Vicini F.A.
        • Beitsch P.
        • et al.
        Local control, toxicity, and cosmesis in women > 70 years enrolled in the American Society of Breast Surgeons Accelerated Partial Breast Irradiation Registry Trial.
        Int J Radiat Oncol Biol Phys. 2012; 84: 323-330
        • Anderson B.M.
        • Kamrava M.
        • Wang P.C.
        • et al.
        Locoregional recurrence by molecular subtype after multicatheter interstitial accelerated partial breast irradiation. Results from the pooled registry of multicatheter interstitial sites research group.
        Brachytherapy. 2016; 15: 788-795
        • Wilkinson J.B.
        • Shah C.
        • Amin M.
        • et al.
        Outcomes according to breast cancer subtype in patients treated with accelerated partial breast irradiation.
        Clin Breast Cancer. 2017; 17: 55-60
        • Jwa E.
        • Shin K.H.
        • Kim J.Y.
        • et al.
        Locoregional recurrence by tumor biology in breast cancer patients after preoperative chemotherapy and breast conservation treatment.
        Cancer Res Treat. 2016; 48: 1363-1372
        • Tseng Y.D.
        • Uno H.
        • Hughes M.E.
        • et al.
        Biologic subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in large national database.
        Int J Radiat Oncol Biol Phys. 2015; 93: 622-630
        • Pashtan I.M.
        • Recht A.
        • Ancukiewicz M.
        • et al.
        External beam accelerated partial-breast irradiation using 32 Gy in 8 twice-daily fractions: 5-year results of a prospective study.
        Int J Radiat Oncol Biol Phys. 2012; 84: e271-e277
        • Moran M.S.
        • Schnitt S.J.
        • Giuliano A.E.
        • et al.
        Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer.
        J Clin Oncol. 2014; 32: 1507-1515
        • Morrow M.
        • Van Zee K.J.
        • Solin L.J.
        • et al.
        Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ.
        J Clin Oncol. 2016; 34: 4040-4046
        • Houssami N.
        • Macaskill P.
        • Marinovich M.L.
        • et al.
        The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: A meta-analysis.
        Ann Surg Oncol. 2014; 21: 717-730
        • Shah C.
        • Wilkinson J.B.
        • Keisch M.
        • et al.
        Impact of margin status on outcomes following accelerated partial breast irradiation using single-lumen balloon-based brachytherapy.
        Brachytherapy. 2013; 12: 91-98
        • Yeo S.G.
        • Kim J.
        • Kwak G.H.
        • et al.
        Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: Local control and toxicity.
        Radiat Oncol. 2010; 5: 56
        • Polgar C.
        • Major T.
        Current status and perspectives of brachytherapy for breast cancer.
        Int J Clin Oncol. 2009; 14: 7-24
        • Kunkler I.H.
        • Kerr G.R.
        • Thomas J.S.
        • et al.
        Impact of screening and risk factors for local recurrence and survival after conservative surgery and radiotherapy for early breast cancer: Results from a large series with long-term follow-up.
        Int J Radiat Oncol Biol Phys. 2012; 83: 829-838
        • Katz A.M.
        • Strom E.A.
        • Buchholz T.
        • et al.
        The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy.
        Int J Radiat Oncol Biol Phys. 2001; 50: 735-742
        • Jobsen J.
        • van der Palen J.
        • Riemersma S.
        • et al.
        Pattern of ipsilateral breast tumor recurrence after breast-conserving surgery.
        Int J Radiat Oncol Biol Phys. 2014; 89: 1006-1014
        • Jawad M.S.
        • Wilkinson J.B.
        • Shah C.
        • et al.
        Impact of lymphovascular space invasion, extensive intraductal component, and multi-focality following accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2012; 84: s1049
        • Magee B.
        • Swindell R.
        • Harris M.
        • et al.
        Prognostic factors for breast recurrence after conservative breast surgery and radiotherapy: Results from a randomised trial.
        Radiother Oncol. 1996; 39: 223-227
        • Braunstein L.Z.
        • Taghian A.G.
        • Niemierko A.
        • et al.
        Breast-cancer subtype, age, and lymph node status as predictors of local recurrence following breast-conserving therapy.
        Breast Cancer Res Treat. 2017; 161: 173-179
        • Aburabia M.
        • Roses R.E.
        • Kuerer H.M.
        • et al.
        Axillary failure in patients treated with MammoSite accelerated partial breast irradiation.
        Ann Surg Oncol. 2011; 18: 3415-3421
        • Leong C.
        • Boyages J.
        • Jayasinghe U.W.
        • et al.
        Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma.
        Cancer. 2004; 100: 1823-1832
        • Arthur D.W.
        • Vicini F.A.
        • Todor D.A.
        • et al.
        Contura multi-lumen balloon breast brachytherapy catheter: Comparative dosimetric findings of a phase 4 trial.
        Int J Radiat Oncol Biol Phys. 2013; 86: 264-269
        • Shah C.
        • Ghilezan M.
        • Arthur D.
        • et al.
        Initial clinical experience with multilumen brachytherapy catheters for accelerated partial breast irradiation.
        Brachytherapy. 2012; 11: 369-373
        • Yashar C.
        • Attai D.
        • Butler E.
        • et al.
        Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study.
        Brachytherapy. 2016; 15: 780-787
        • Rehman S.
        • Agarwal R.
        • Ochoa L.
        • et al.
        Prospective analysis of toxicity in patients treated with strut-adjusted volume implant for early-stage breast cancer.
        Brachytherapy. 2016; 15: 625-630
        • Bitter S.M.
        • Heffron-Cartwright P.
        • Wennerstrom C.
        • et al.
        WBRT vs. APBI: An interim report of patient satisfaction and outcomes.
        J Contemp Brachytherapy. 2016; 8: 17-22
        • Vicini F.A.
        • Kestin L.L.
        • Goldstein N.S.
        Defining the clinical target volume for patients with early-stage breast cancer treated with lumpectomy and accelerated partial breast irradiation: A pathologic analysis.
        Int J Radiat Oncol Biol Phys. 2004; 60: 722-730
        • Ott O.J.
        • Strnad V.
        • Stillkrieg W.
        • et al.
        Accelerated partial breast irradiation with external beam radiotherapy: First results of the German phase 2 trial.
        Strahlenther Onkol. 2017; 193: 55-61
        • Horst K.C.
        • Fasola C.
        • Ikeda D.
        • et al.
        Five-year results of a prospective clinical trial investigating accelerated partial breast irradiation using 3D conformal radiotherapy after lumpectomy for early stage breast cancer.
        Breast. 2016; 28: 178-183
        • Mozsa E.
        • Meszaros N.
        • Major T.
        • et al.
        Accelerated partial breast irradiation with external beam three-dimensional conformal radiotherapy. Five-year results of a prospective phase II clinical study.
        Strahlenther Onkol. 2014; 190: 444-450
        • Formenti S.C.
        • Hsu H.
        • Fenton-Kerimian M.
        • et al.
        Prone accelerated partial breast irradiation after breast-conserving surgery: Five-year results of 100 patients.
        Int J Radiat Oncol Biol Phys. 2012; 84: 606-611
        • Vera R.
        • Trombetta M.
        • Mukhopadhyay N.D.
        • et al.
        Long-term cosmesis and toxicity following 3-dimensional conformal radiation therapy in the delivery of accelerated partial breast irradiation.
        Pract Radiat Oncol. 2014; 4: 147-152
        • Shateilman S.F.
        • Kim L.H.
        • Grills I.S.
        • et al.
        Predictors of long-term toxicity using three-dimensional conformal external beam radiotherapy to deliver accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2011; 81: 788-794
        • Leonard K.L.
        • Hepel J.T.
        • Hiatt J.R.
        • et al.
        The effect of dose-volume parameters and interfraction interval on cosmetic outcome and toxicity after 3-dimensional conformal accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2013; 85: 623-629
        • Mellon E.A.
        • Sreeraman R.
        • Gebhardt B.J.
        • et al.
        Impact of radiation treatment parameters and adjuvant systemic therapy on cosmetic outcomes after accelerated partial breast irradiation using 3-dimensional conformal radiation therapy technique.
        Pract Radiat Oncol. 2014; 4: e159-e166
        • Shah C.
        • Lanni T.B.
        • Saini H.
        • et al.
        Cost-efficacy of accelerated partial-breast irradiation compared with whole breast irradiation.
        Breast Cancer Res Treat. 2013; 138: 127-135
        • Shah C.
        • Lanni T.
        • Wilkinson J.B.
        • et al.
        Cost-effectiveness of 3-dimensional conformal radiotherapy and applicator-based brachytherapy in the delivery of accelerated partial breast irradiation.
        Am J Clin Oncol. 2014; 37: 172-176
        • Reeder R.
        • Carter D.L.
        • Howell K.
        • et al.
        Predictors of clinical outcomes after accelerated partial breast intensity-modulated radiotherapy.
        Int J Radiat Oncol Biol Phys. 2009; 74: 92-97
        • Lewin A.A.
        • Derhagopian R.
        • Saigal K.
        • et al.
        Accelerated partial breast irradiation is safe and effective using intensity-modulated radiation therapy in selected early-stage breast cancer.
        Int J Radiat Oncol Biol Phys. 2012; 82: 2104-2110
        • Shah C.
        • Ward M.
        • Tendulkar R.
        • et al.
        Evaluating the cost efficacy of image guided partial breast irradiation compared to hypofractionated whole breast irradiation. Varian Research Symposium.
        Illiniois in May, Chicago2017
        • Kozak K.R.
        • Smith B.L.
        • Adams J.
        • et al.
        Accelerated partial-breast irradiation using proton beams: Initial clinical experience.
        Int J Radiat Oncol Biol Phys. 2006; 66: 691-698
        • Galland-Girdet S.
        • Pasthan I.
        • MacDonald S.M.
        • et al.
        Long-term cosmetic outcomes and toxicity of proton beam therapy compared with photon-based 3-dimensional conformal accelerated partial breast irradiation: A phase 1 trial.
        Int J Radiat Oncol Biol Phys. 2014; 90: 493-500
        • Bush D.A.
        • Do S.
        • Lum S.
        • et al.
        Partial breast radiation therapy with proton beam: 5-year results with cosmetic outcomes.
        Int J Radiat Oncol Biol Phys. 2014; 90: 501-505
        • Chang J.H.
        • Lee N.K.
        • Kim J.Y.
        • et al.
        Phase II trial of proton beam accelerated partial breast irradiation in breast cancer.
        Radiother Oncol. 2013; 108: 209-214
        • Strom E.A.
        • Ovalle V.
        Initial clinical experience using protons for accelerated partial-breast irradiation: Longer-term results.
        Int J Radiat Oncol Biol Phys. 2014; 90: 506-508
        • Ovalle V.
        • Strom E.A.
        • Godby J.
        • et al.
        Proton partial-breast irradiation for early-stage breast cancer: Is it really so costly?.
        Int J Radiat Oncol Biol Phys. 2016; 95: 49-51
        • Shah C.
        • Harris E.E.
        • Holmes D.
        • et al.
        Chapter 51: Partial breast irradiation: Accelerated and intraoperative.
        in: Bland K. Copeland E. Klimberg V.S. The Breast. 5th ed. Elsevier, New York2017
        • Khan A.J.
        • Arthur D.W.
        • Vicini F.A.
        On the road to intraoperative radiotherapy: More proceed with caution signs.
        Oncology. 2013; 27: 113-114
        • Shah C.
        • Khan A.J.
        • Arthur D.
        • et al.
        Intraoperative radiation therapy: Not ready for prime time.
        Ann Surg Oncol. 2014; 21: 351-353
        • Shah C.
        • Wobb J.
        • Khan A.
        Intraoperative radiation therapy: Still not ready for prime time.
        Ann Surg Oncol. 2016; 23: 1796-1798
        • Cuzick J.
        Radiotherapy for breast cancer, the TARGIT-A trial.
        Lancet. 2014; 383: 1716
        • Valente S.A.
        • Tendulkar R.D.
        • Cherian S.
        • et al.
        TARGIT-R (retrospective): North American experience with intraoperative radiation therapy using low-kilovoltage x-rays for breast cancer.
        Ann Surg Oncol. 2016; 23: 2809-2815
        • Veronesi U.
        • Orecchia R.
        • Luini A.
        • et al.
        Intraoperative radiotherapy during breast conserving surgery: A study on 1,822 cases treated with electrons.
        Breast Cancer Res Treat. 2010; 124: 141-151
        • Leonardi M.C.
        • Maisonneuve P.
        • Mastropasqua M.G.
        • et al.
        How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology.
        Int J Radiat Oncol Biol Phys. 2012; 83: 806-813
        • Hughes K.S.
        • Schnaper L.A.
        • Bellon J.R.
        • et al.
        Lumpectomy plus tamoxifen with or without irradiation on women age 70 years or older with early breast cancer: Long-term follow-up of CALGB 9343.
        J Clin Oncol. 2013; 31: 2382-2387
        • Kunkler I.H.
        • Williams L.J.
        • Jack W.J.
        • et al.
        Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): A randomised controlled trial.
        Lancet Oncol. 2015; 16: 266-273
        • Hepel J.
        • Wazer D.E.
        A flawed study should define a new standard of care.
        Int J Radiat Oncol Biol Phys. 2015; 91: 255-257
        • Vaidya J.S.
        • Bulsara M.
        • Wenz F.
        • et al.
        Pride, prejudice, or science. Attitudes towards the results of the TARGIT-A trial of targeted intraoperative radiation therapy for breast cancer.
        Int J Radiat Oncol Phys. 2015; 92: 491-497
        • Small Jr., W.
        • Thomas T.O.
        • Alvarado M.
        • et al.
        Commentary on “accelerated partial breast irradiation consensus statement: Update of an ASTRO evidence-based consensus statement”.
        Pract Radiat Oncol. 2017; 7: e159-e163
        • Alvarado M.D.
        • Mohan A.J.
        • Esserman L.J.
        • et al.
        Cost-effectiveness analysis of intraoperative radiation therapy for early-stage breast cancer.
        Ann Surg Oncol. 2013; 20: 2873-2880
        • Shah C.
        • Badiyan S.
        • Khwaja S.
        • et al.
        Evaluating radiotherapy options in breast cancer: Does intraoperative radiotherapy represent the most cost-efficacious option?.
        Clin Breast Cancer. 2014; 14: 141-146
        • Vaidya J.S.
        • Baum M.
        • Tobias J.
        • et al.
        Long-term results of targeted intraoperative radiotherapy (TARGIT) boost during breast-conserving surgery.
        Int J Radiat Oncol Biol Phys. 2011; 81: 1091-1097
        • Fastner G.
        • Sedlmayer F.
        • Mertz F.
        • et al.
        IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: Long term results of an ISIORT pooled analysis.
        Radiother Oncol. 2013; 108: 279-286
        • Blank E.
        • Kraus-Tiefenbacher U.
        • Weizel G.
        • et al.
        Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays.
        Ann Surg Oncol. 2010; 17: 352-358
        • Fastner G.
        • Reitsamer R.
        • Ziegler I.
        • et al.
        IOERT as anticipated tumor bed boost during breast-conserving surgery after neoadjuvant chemotherapy in locally advanced breast cancer-results of a case series after 5-year follow-up.
        Int J Cancer. 2015; 136: 1193-1201
        • Forouzannia A.
        • Harness J.K.
        • Carpenter M.M.
        • et al.
        Intraoperative electron radiotherapy boost as a component of adjuvant radiation for breast cancer in the community setting.
        Ann Surg. 2012; 78: 1071-1074
        • Wong W.W.
        • Pockaj B.A.
        • Vora S.A.
        • et al.
        Six-year outcome of a prospective study evaluating tumor bed boost with intra-operative electron irradiation followed by whole-breast irradiation for early-stage breast cancer.
        Breast J. 2014; 20: 125-130
        • Epstein M.
        • Silverstein M.
        • Lin K.
        • et al.
        Acute and chronic complications in breast cancer patients treated with intraoperative radiation therapy.
        Ann Surg Oncol. 2016; 23: 3304-3309
        • Epstein M.S.
        • Silversten M.J.
        • Lin K.
        • et al.
        Acute and chronic complications in patients with ductal carcinoma in situ treated with intraoperative radiation therapy.
        Breast J. 2016; 22: 630-636
        • Bartelink H.
        • Horiot J.C.
        • Poortmans P.M.
        • et al.
        Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial.
        J Clin Oncol. 2007; 25: 3259-3265
        • Guinot J.L.
        • Tortajada M.I.
        • Carrascosa M.
        • et al.
        Ten-year results of a phase II study with single fraction of high-dose-rate brachytherapy (FAST-boost) after whole breast irradiation in invasive breast carcinoma.
        Clin Transl Oncol. 2012; 14: 109-115
        • Schroeder T.M.
        • Liem B.
        • Sampath S.
        • et al.
        Early breast cancer with positive margins: Excellent local control with an upfront brachytherapy boost.
        Breast Cancer Res Treat. 2012; 134: 719-725
        • Pan Q.
        • Calitschi E.
        • Otmezguine Y.
        • et al.
        Long term results of exclusive radiotherapy and brachytherapy of breast cancer.
        Cancer Radiother. 2012; 16: 674-680
        • Kuske R.R.
        Chapter 24: Breast conservation therapy without capsular contracture in augmented women using interstitial brachytherapy.
        in: Arthur D.A.W. Vicini F.A. Wazer D.E. Short Course Breast Radiotherapy: A comprehensive review of hypofractionation, partial breast, and intra-operative irradiation. 1st ed. Springer, New York2016: 373-386
        • Kuske R.
        Breast conservation therapy without capsular contracture in young augmented women using interstitial brachytherapy.
        J Contemp Brachytherapy. 2014; 6: 231-235
        • Bloom E.S.
        • Kirsner S.
        • Mason B.E.
        • et al.
        Accelerated partial breast irradiation using strut-adjusted volume implant single-entry hybrid catheter in brachytherapy for breast cancer in the setting of breast augmentation.
        Brachytherapy. 2011; 10: 178-183
        • Akhtari M.
        • Pino R.
        • Scarboro S.B.
        • et al.
        Dosimetric considerations and early clinical experience of accelerated partial breast irradiation using multi-lumen applicators in the setting of breast augmentation.
        J Contemp Brachytherapy. 2015; 7: 423-429
        • Akhtari M.
        • Nitsch P.L.
        • Bass B.L.
        • et al.
        Long-term outcome of accelerated partial breast irradiation using a multilumen balloon applicator in a patient with existing breast implants.
        Brachytherapy. 2015; 14: 289-292
        • Leonard C.E.
        • Johnson T.
        • Tallhamer M.
        • et al.
        Accelerated partial breast intensity-modulated radiotherapy in women who have prior breast augmentation.
        Clin Breast Cancer. 2011; 11: 184-190
        • Lei R.Y.
        • Leonard C.Y.
        • Howell K.T.
        • et al.
        External beam accelerated partial breast irradiation yields favorable outcomes in patients with prior breast augmentation.
        Front Oncol. 2014; 4: 154
        • Hepel J.T.
        • Hiatt J.R.
        • Sha S.
        • et al.
        The rationale, technique, and feasibility of partial breast irradiation using noninvasive image-guided breast brachytherapy.
        Brachytherapy. 2014; 13: 493-501
        • Sioshansi S.
        • Rivard M.J.
        • Hiatt J.R.
        • et al.
        Dose modeling of noninvasive image-guided breast brachytherapy in comparison to electron beam boost and three-dimensional conformal accelerated partial breast irradiation.
        Int J Radiat Oncol Biol Phys. 2011; 80: 410-416
        • Hamid S.
        • Rocchio K.
        • Arthur D.
        • et al.
        A multi-institutional study of feasibility, implementation, and early clinical results with noninvasive breast brachytherapy for tumor bed boost.
        Int J Radiat Oncol Biol Phys. 2012; 83: 1374-1380
        • Schuster J.
        • Chipko C.
        • Kasper M.
        • et al.
        Updated feasibility and reproducibility results of a multi-institutional study of noninvasive breast tumor bed boost.
        Brachytherapy. 2016; 15: 804-811
        • Leonard K.L.
        • Hepel J.T.
        • Styczynski J.R.
        • et al.
        Breast boost using noninvasive image-guided breast brachytherapy vs. external beam: A 2:1 matched-pair analysis.
        Clin Breast Cancer. 2013; 13: 455-459
        • Leonard K.L.
        • Rivard M.J.
        • Wazer D.E.
        • et al.
        Prescription dose evaluation for APBI with noninvasive image-guided breast brachytherapy using equivalent uniform dose.
        Brachytherapy. 2015; 14: 496-501
        • Hepel J.T.
        • Leonard K.L.
        • Sha S.
        • et al.
        Non-invasive image-guided breast brachytherapy (NIBB) to deliver accelerated partial breast irradiation (APBI): Analysis of acute toxicity and early outcomes.
        Int J Radiat Oncol Biol Phys. 2014; 90: S136
        • Wilkinson J.B.
        • Martinez A.A.
        • Chen P.Y.
        • et al.
        Four-year results using balloon-based brachytherapy to deliver accelerated partial breast irradiation with a 2-day dose fractionation schedule.
        Brachytherapy. 2012; 11: 97-104
        • Khan A.J.
        • Vicini F.A.
        • Brown S.
        • et al.
        Dosimetric feasibility and acute toxicity in a prospective trial of ultrashort-course accelerated partial breast irradiation (APBI) using a multi-lumen balloon brachytherapy device.
        Ann Surg Oncol. 2013; 20: 1295-1301
      5. Accelerated Partial Breast Radiation Therapy Using High-Dose Rate Brachytherapy in Treating Patients with Early Stage Breast Cancer After Surgery (TRIUMPH-T). Available at: https://clinicaltrials.gov/ct2/show/NCT02526498. Accessed May 22, 2017.

        • Showalter S.L.
        • Petroni G.
        • Trifletti D.M.
        • et al.
        A novel form of breast intraoperative radiation therapy with CT-guided high-dose rate brachytherapy: Results of a prospective Phase I clinical trial.
        Int J Radiat Oncol Biol Phys. 2016; 96: 46-54
        • Rahimi A.
        • Thomas K.
        • Spangler A.
        • et al.
        Preliminary results of a Phase I dose escalation trial for early-stage breast cancer using 5-fraction stereotactic body radiation therapy for partial-breast irradiation.
        Int J Radiat Oncol Biol Phys. 2017; 98: 196-205
        • Horton J.K.
        • Blitzblau R.C.
        • Yoo S.
        • et al.
        Preoperative single-fraction partial breast radiation therapy. A novel Phase 1, dose-escalation protocol with radiation response biomarkers.
        Int J Radiat Oncol Biol Phys. 2015; 92: 846-855