Download Consensus Statement for Accelerated Partial Breast Irradiation

Consensus Statement for Accelerated Partial Breast Irradiation
Accelerated partial breast irradiation (APBI) is a technique in which the portion of the breast at the
highest risk of recurrence (the tissue surrounding the lumpectomy cavity) receives a shortened course of
high-dose radiation therapy. Several techniques can deliver this therapy, including multiple catheters
placed through the breast; a balloon catheter or a multicatheter single-insertion device placed into the
lumpectomy cavity; localized 3-D conformal external beam radiation; bead or seed implants; single-dose
intraoperative treatment; as well as others. Several single-institution, nonrandomized studies using the
interstitial multicatheter technique in properly selected patients have shown low local recurrence rates that
are comparable to standard whole-breast external beam radiation therapy. In addition, several papers
have been published on MammoSite intracavitary brachytherapy with up to 6 years of follow-up that also
show low local-recurrence rates (<5%) comparable to standard whole-breast irradiation with
good/excellent cosmesis in ~90% of patients.
Based on the available data, The American Society of Breast Surgeons acknowledges the following:
1. Patients should be carefully selected for APBI and properly informed of the benefits and risks of this
type of radiation treatment. The American Society of Breast Surgeons recommends the following
selection criteria when considering patients for treatment with APBI, as a sole form of radiation therapy
in lieu of whole breast irradiation:
• Age 45 years old or older for invasive cancer and age 50 years or older for DCIS
• Invasive carcinoma or ductal carcinoma in situ
• Total tumor size (invasive and DCIS) less than or equal to 3 cm in size
• Negative microscopic surgical margins of excision
• Sentinel lymph node negative
2. Surgeons, radiation oncologists and physicists who will be utilizing the various APBI techniques
should be adequately trained to allow for optimum radiation therapy planning and treatment, including
proper 3-D treatment planning.
3. Multilumen catheter devices or multicatheter interstitial techniques may provide more flexibility in
treatment planning for thin skin-to-lumpectomy cavity distances or devices that abut the pectoralis muscle
to avoid high skin and chest wall doses.
4. All patients should be monitored regularly to identify adverse events as well as local recurrences.
5. The published data for APBI supports the recommendations summarized above. Continuous, longterm, outcomes-based monitoring of APBI is desirable. The American Society of Breast Surgeons
maintains an ongoing MammosSite® Registry (registration completed in 2004), collecting data on 1440
patients treated via the MammosSite balloon catheter technique. As is the case with all cancer treatments,
participation in multi-institutional clinical studies, including NSABP/RTOG B39, or in single-site
protocols, or in the context of data-gathering registries, is desirable, if available.
6. These recommendations are intended as a guide to treat patients but individual treatment decisions
could allow treatment outside of the parameters listed above with appropriate discussion with the patient.
For more information on the recent San Antonio Breast Cancer Symposium data, please see the Society’s
press release from December 8, 2011 available at:
https://www.breastsurgeons.org/news/article.php?id=122
References
1.
Swanson TA,Vicini FA. Overview of accelerated partial breast irradiation. Curr Oncol
Rep.2008;10:54-60.
2.
Arthur DW, Vicini FA. Accelerated partial breast irradiation as a part of breast conservation
therapy. J Clin Oncol. 2005;23:1726-1735.
3.
Antonucci JV, Wallace M, Goldstein NS, et al. Differences in patterns of failure in patients treated
with accelerated partial breast irradiation versus whole-breast irradiation: a matched-pair analysis
with 10-year follow-up. Int J Radiat Oncol Biol Phys. 2009;74:447-452.
4.
Keisch M, Vicini F, Kuske RR, et al. Initial clinical experience with the MammoSite breast
brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving
therapy. Int J Radiat Oncol Biol Phys. 2003;55:289-293.
5.
Zannis V, Beitsch P, Vicini F, et al. Descriptions and outcomes of insertion techniques of a breast
brachytherapy balloon catheter in 1403 patients enrolled in the American Society of Breast
Surgeons MammoSite breast brachytherapy registry trial. Am J Surg. 2005;190:530-538.
6.
Benitez PR, Keisch ME, 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.
7.
Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus
statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol
Phys. 2009;74:987-1001.
8.
Vicini FA, Beitsch PD, Quiet CA, et al. Five-year analysis of treatment efficacy and cosmesis by
the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in
patients treated with accelerated partial breast irradiation (APBI). Int J Rad Oncol Biol Phys.
2011;79:808-817.
9.
Beitsch P, Vicini F, Keisch M, Haffty B, Shaitelman S. Lyden, M. Five-year outcome in patients
classified in the "unsuitable" category using the American Society of Therapeutic Radiology and
Oncology (ASTRO) Consensus Panel (CP) guidelines for the application of accelerated partial
breast irradiation (APBI): an analysis of patients treated on the American Society of Breast
Surgeons (ASBrS) MammoSite® Registry trial. Ann Surg Oncol. 2010;17(suppl 3):219-225.
10.
Jeruss JS, Kuerer HM, Beitsch PD, Vicini FA , Keisch M. Update on DCIS outcomes from the
American Society of Breast Surgeons Accelerated Partial Breast Irradiation Registry Trial. Ann
Surg Oncol. 2011;18:65–71.
11.
Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast
radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, noninferiority phase 3 trial Lancet. 2010:376:91-102.
Revised, August 15, 2011
Board of Directors
The American Society of Breast Surgeons