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Expanding Breast Cancer Treatment Options for Women with Early Stage Breast Cancer: Accelerated Partial Breast Irradiation Rachel Richards, MS, APRN, Nurse Practitioner & Breast Health Navigator, Comprehensive Breast Health Center, Lahey Clinic North Shore, 2011 Nursing Research Fellow Background For several decades, whole-breast irradiation (WBI) has been used as the standard of care to reduce the risk of in-breast recurrence following breast conserving surgery (lumpectomy) for early stage breast cancer. Treatment is given utilizing external beam radiation, 5 days/week, for up to 7 weeks. This treatment schedule can be problematic for working women, elderly patients and those who live a great distance from a treatment facility (Yeo, Kim, Kwak, Kim, Park, Kim et al., 2010). CT Scan of balloon catheter in breast APBI vs. WBI: Treatment field highlighted in red Over the past several years, Accelerated Partial Breast Irradiation (APBI) has gained interest as an alternative to traditional WBI. APBI has several benefits, including decreased overall treatment time (5 days) and a decrease in the radiation delivered to healthy tissue and adjacent organs (Njeh, Saunders & Langton, 2010). Review of the Literature To date, clinical trials have shown similar overall survival and disease free survival with APBI versus WBI at up to 10 years of follow-up. The research also reports good to excellent cosmetic results with APBI. However, experts caution that more research is needed as long-term safety and efficacy of APBI is unknown (Smith, Arthur, Buchholz, Haffty, Hahn, Hardenbergh, et al., 2009). How is APBI performed? It Takes a Team There are several techniques that are used for APBI, including multi-catheter brachytherapy, balloon catheter brachytherapy and localized external beam delivery (Wadasadawala, Sarin, Budrukkar, Jalali, Munshi & Badwe, 2009). Lahey utilizes both the localized external beam and more recently introduced balloon catheter brachytherapy, which involves: Placing a small balloon catheter into the lumpectomy cavity. A radioactive source (seed) is positioned into the balloon through access ports in the catheter for each treatment and then removed. Treatments are delivered twice a day (6 hours apart) for five days, at which time the balloon is deflated and removed. Who is a candidate for APBI? Patients should be carefully selected for APBI and properly informed of the benefits and risks of this type of radiation treatment. The following table summarizes the consensus statements for eligibility from the American Society of Breast Surgeons and the American Society for Radiation Oncology (ASTRO). American Society of Breast Surgeons ASTRO “Suitable” ASTRO “Cautionary” Age > 45y > 60y 50-59y Histology IDC* or DCIS** IDC*, Mucinous, Tubular, Colloid ILC***, pure DCIS** < 3cm Total Tumor Size < 3cm < 2cm 2.1-3.0cm Surgical Margins Negative microscopic Negative by 2mm Close (< 2mm) Sentinel Lymph Node Negative Negative Negative *IDC: Invasive Ductal Carcinoma **DCIS: Ductal Carcinoma In Situ ***ILC: Invasive Lobular Carcinoma Administration Breast Imaging Nursing Breast Surgery Radiation Oncology Breast Health Navigator Visiting Nurse Association Pathology Ambulatory Surgery/ PACU APBI at Lahey Clinic Lahey’s dedication and commitment to offer patients the most advanced options for diagnosis and treatment of breast cancer is exemplified by the expansion of the APBI Program to include the technique of balloon catheter brachytherapy. Lahey’s first brachytherapy patient successfully completed her treatment in February 2011. In March 2011, four more women successfully completed adjuvant radiation treatments with APBI. Program evaluation is on-going. The program has utilized exit interviews with patients to gain insight into patient perspectives and experiences. Additionally, the team continues to meet to discuss past experiences and determine ways to enhance the program design, patient satisfaction and outcomes.