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
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Article Info
Publication History
Published online: October 23, 2017
Accepted:
September 18,
2017
Received in revised form:
September 11,
2017
Received:
August 4,
2017
Footnotes
Conflict of interest: Chirag Shah is a consultant at ImpediMed Inc. and receives research grant from Varian Medical Systems and Vision RT. Robert Kuske owns stock with Cianna Medical. Martin Keisch is a consultant at Hologic. David Wazer is a member of medical advisory board of Advanced Radiation Therapy Inc.
Identification
Copyright
© 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
