Despite the significant advancement in local and systemic therapies, breast cancer
remains the second leading cause of women cancer deaths (
[1]
). While adjuvant radiation therapy remains an integral part of breast cancer management
(
[2]
), 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 (
- 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.
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.
Lancet. 2011; 378: 1707-1716
[3]
,
[4]
).- 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).
Radiother Oncol. 2010; 94: 264-273
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Article info
Publication history
Published online: September 24, 2022
Accepted:
August 17,
2022
Received:
August 16,
2022
Identification
Copyright
© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
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- The case against IORT in the management of early stage breast cancerBrachytherapyVol. 21Issue 6
- PreviewSince 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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