Abstract
Purpose
In recent years, results with mature follow-up have been reported for several Phase
III trials randomizing women to receive whole breast irradiation (WBI) versus varying
modalities of partial breast irradiation (PBI). It is important to recognize that
these methods vary in terms of volume of breast tissue treated, dose per fraction,
and duration of therapy. As such, clinical and technical guidelines may vary among
the various PBI techniques.
Methods
Members of the American Brachytherapy Society with expertise in PBI performed an extensive
literature review focusing on the highest quality data available for the numerous
PBI options offered in the modern era. Data were evaluated for strength of evidence
and published outcomes were assessed.
Results
The majority of women enrolled on randomized trials of WBI versus PBI have been age
>45 years with tumor size <3 cm, negative margins, and negative lymph nodes. The panel
also concluded that PBI can be offered to selected women with estrogen receptor negative
and/or Her2 amplified breast cancer, as well as ductal carcinoma in situ, and should
generally be avoided in women with extensive lymphovascular space invasion.
Conclusions
This updated guideline summarizes published clinical trials of PBI methods. The panel
also highlights the role of PBI for women facing special circumstances, such as history
of cosmetic breast augmentation or prior breast irradiation, and discusses promising
novel modalities that are currently under study, such as ultrashort and preoperative
PBI. Updated consensus guidelines are also provided to inform patient selection for
PBI and to characterize the strength of evidence to support varying PBI modalities.
Keywords
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Article info
Publication history
Published online: September 15, 2022
Accepted:
July 6,
2022
Received in revised form:
June 15,
2022
Received:
March 26,
2022
Footnotes
Disclosures: Dr. Anderson reports grant funding from ViewRay paid to her institution and consulting fees from TME Advisory Board. Dr. Arthur reports participation on a data safety monitoring or advisory board for Advanced Radiation Therapy, INC. Dr. Kamrava reports leadership roles with ABS and ADROP BOD. Dr. Khan reports grant funding from Merck, Clovis Oncology and Varian paid to his institution, an honoraria from EXACT Sciences, an oncology drug patent pending, and stock/stock options with Novavax and Xtrava Inc. Dr. Shaitelman reports grants/contracts from Emerson Collective, NIH R21, and Artios Pharma, as well as contracted research agreements with Alpha Tau, Exact Sciences, and TAE Life Sciences. Dr. Scanderbeg reports grants/contracts from the Department of Defense, consulting fees from Merit Medical Inc, payment/honoraria from Varian and Merit Medical Inc, and a leadership role with UC Center for Laboratory Safety. Dr. Shah reports grants/contract with Varian, PreludeDx, and VisionRT, as well as consulting fees from ImpediMed, PreludeDx, Videra Surgical, and Evicore. Dr. Vicini reports receiving consulting fees from ImpediMed and a research advisor role with Prelude. Dr. Wazer reports medical advisory board membership for Advanced Radiation Therapy, Inc. Dr. Yashar reports leadership roles with ASTRO, ABR, and NCCN. Dr. Kuske, Dr. Showalter and Dr. Hannoun-Levi report no relevant disclosures.
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© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
