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The case for risk-stratified IORT for early breast cancer

  • Tamer Refaat
    Affiliations
    Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
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  • Sebastien E. Gros
    Affiliations
    Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
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  • William Small Jr
    Correspondence
    Corresponding author. Department of Radiation Oncology, Director, Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Avenue, Maywood, Il, 60153.
    Affiliations
    Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
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Published:September 24, 2022DOI:https://doi.org/10.1016/j.brachy.2022.08.007
      Despite the significant advancement in local and systemic therapies, breast cancer remains the second leading cause of women cancer deaths (
      • Siegel RL
      • Miller KD
      • Jemal A.
      Cancer statistics, 2020.
      ). While adjuvant radiation therapy remains an integral part of breast cancer management (
      • Darby S
      • McGale P
      • et al.
      Early Breast Cancer Trialists' Collaborative Group (EBCTCG)
      Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials.
      ), de-escalation strategies are increasingly being investigated. Radiation therapy de-escalation approaches entails fewer treatment days (hypofractionation), smaller target volume (partial breast irradiation -PBI-), or both (accelerated partial breast irradiation -APBI-). More than ten thousand women were enrolled in already reported clinical trials comparing PBI to whole breast radiation therapy (WBRT). PBI can be delivered with different modalities including brachytherapy (BT), external beam radiation therapy, (EBRT), or Intra-operative radiation therapy (IORT). Both American Society of Radiation Oncology (ASTRO) and European Society of Radiation Oncology (ESTRO) published consensus guidelines for APBI (
      • Smith BD
      • Arthur DW
      • Buchholz TA
      • et al.
      Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO).
      ,
      • Polgár C
      • Van Limbergen E
      • Pötter R
      • et al.
      Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009).
      ).
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      Linked Article

      • The case against IORT in the management of early stage breast cancer
        BrachytherapyVol. 21Issue 6
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          Since the development of breast conserving therapy (BCT) that incorporated standard fractionation whole breast irradiation (WBI) delivered daily over 5–7 weeks, there has been a concerted effort to shorten the duration of adjuvant radiation therapy as a way to improve convenience and compliance, reduce costs, and potentially reduce toxicities. Over the past decade, an unprecedent shift in breast radiation techniques and regimens has led to the emergence of shorter courses of WBI (5–15 fractions) as well as partial breast approaches which also reduce treatment duration to 1–3 weeks.
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