Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial

Breast-conserving therapy has been established as a standard treatment for women with early-stage breast cancer. Whole-breast irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole-breast irradiation after breast-conserving surgery has become controversial, with some investigators advocating accelerated partial breast irradiation as an alternative. Accelerated partial breast irradiation is delivered over a shorter period and only to a portion of the breast. This review will examine the emerging role of accelerated partial breast irradiation in the treatment of early-stage breast cancer and review the biologic rationale for, techniques of, and limitations of partial breast irradiation following breast-conserving surgery.

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Accelerated Partial-Breast Irradiation Compared With Whole-Breast Irradiation for Early Breast Cancer: Long-Term Results of the Randomized Phase III APBI-IMRT-Florence Trial

Journal of Clinical Oncology ◽

10.1200/jco.20.00650 ◽

2020 ◽

Vol 38 (35) ◽

pp. 4175-4183 ◽

Cited By ~ 1

Author(s):

Icro Meattini ◽

Livia Marrazzo ◽

Calogero Saieva ◽

Isacco Desideri ◽

Vieri Scotti ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Phase Iii ◽

Accelerated Partial Breast Irradiation ◽

Long Term Results ◽

Partial Breast Irradiation ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Once Daily

PURPOSE To report the long-term results of external-beam accelerated partial-breast irradiation (APBI) intensity-modulated radiation therapy (IMRT) Florence phase III trial comparing whole-breast irradiation (WBI) to APBI in early-stage breast cancer. PATIENTS AND METHODS The primary end point was to determine the 5-year difference in ipsilateral breast tumor recurrence (IBTR) between 30 Gy in 5 once-daily fractions (APBI arm) and 50 Gy in 25 fractions with a tumor bed boost (WBI arm) after breast-conserving surgery. RESULTS Five hundred twenty patients, more than 90% of whom had characteristics associated with low recurrence risk, were randomly assigned (WBI, n = 260; APBI, n = 260) between 2005 and 2013. Median follow-up was 10.7 years. The 10-year cumulative incidence of IBTR was 2.5% (n = 6) in the WBI and 3.7% (n = 9) in the APBI arm (hazard ratio [HR], 1.56; 95% CI, 0.55 to 4.37; P = .40). Overall survival at 10 years was 91.9% in both arms (HR, 0.95; 95% CI, 0.50 to 1.79; P = .86). Breast cancer–specific survival at 10 years was 96.7% in the WBI and 97.8% in the APBI arm (HR, 0.65; 95% CI, 0.21 to 1.99; P = .45). The APBI arm showed significantly less acute toxicity ( P = .0001) and late toxicity ( P = .0001) and improved cosmetic outcome as evaluated by both physician ( P = .0001) and patient ( P = .0001). CONCLUSION The 10-year cumulative IBTR incidence in early breast cancer treated with external APBI using IMRT technique in 5 once-daily fractions is low and not different from that after WBI. Acute and late treatment-related toxicity and cosmesis outcomes were significantly in favor of APBI.

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Accelerated Intensity-Modulated External Radiotherapy as a New Technical Approach to Treat the Index Quadrant after Conserving Surgery in Early Breast Cancer: A Preliminary Study

Tumori Journal ◽

10.1177/030089160509100303 ◽

2005 ◽

Vol 91 (3) ◽

pp. 227-232 ◽

Cited By ~ 11

Author(s):

Lorenzo Livi ◽

Fabiola Paiar ◽

Fabrizio Banci Buonamici ◽

Silvia Scoccianti ◽

Elisa Meldolesi ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Breast Conserving Surgery ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

External Radiotherapy ◽

Technical Approach ◽

Skin Changes ◽

Intensity Modulated

Purpose We present a novel technical approach to treat the index quadrant after conserving surgery in patients with early breast cancer and study its clinical feasibility. Methods and material Patients selected for the study, after breast conserving surgery with histologically verified breast carcinoma, signed a full informed consent to intensity-modulated external radiotherapy of the partial breast. Treatment was performed with the 6 MV beam from one of the Elekta Precise LINAC units installed in our Department. The prescribed dose was 30 Gy in 5 fractions in 10 days. Results Acute toxicity was minimal. No skin changes were noted during treatment or during the first 6 months after radiotherapy treatment. Conclusions Accelerated partial breast irradiation using intensity-modulated external radiotherapy is technically feasible. We think the approach will give good results in terms of local control, toxicity and quality of life, at the same time sparing resources for the patient and health care system.

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Accelerated partial breast irradiation with interstitial multicatheter brachytherapy after breast-conserving surgery for low-risk early breast cancer

The Breast ◽

10.1016/j.breast.2020.04.008 ◽

2020 ◽

Vol 52 ◽

pp. 45-49

Author(s):

Nieves G. Rodriguez-Ibarria ◽

Ma Beatriz Pinar ◽

Laura García ◽

M. Auxiliadora Cabezón ◽

Marta Lloret ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Breast Conserving Surgery ◽

Low Risk ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation

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Accelerated Partial Breast Irradiation: A New Strategy for Early-Stage Breast Cancer

Archives of Breast Cancer ◽

10.32768/abc.201963102-112 ◽

2019 ◽

pp. 102-112

Author(s):

Mahdi Aghili ◽

Marzieh Lashkari ◽

Mohammad Babaei ◽

Sepideh Mansouri

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Radiation Therapy ◽

Early Stage ◽

Breast Conserving Therapy ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

Cosmetic Outcomes

Background: Accelerated partial breast irradiation (APBI) is defined as applying high doses of radiation with a shorter interval to the lumpectomy cavity in the setting of breast-conserving therapy for early-stage breast cancer. This treatment strategy is attractive to patients, and its utilization has increased during recent years because of the shorter treatment schedule, better cosmetic outcomes, and acceptable local control rates in selected patients undergoing breast-conserving therapy. Here we provide an overview of various APBI techniques in terms of clinical and cosmetic outcomes, quality of life, and cost of treatment. We also review the current guidelines for selecting suitable breast cancer patients for APBI strategy.Methods: A comprehensive literature search of PubMed between 1996 -2019 that was made was made for case series and randomized studies with at least 2 years of follow-up in term of clinical and cosmetic outcomes, quality of life, and treatment costs. Results: Technological advances have made various APBI modalities, including intracavitary and interstitial brachytherapy, intraoperative radiation therapy, and external-beam radiation therapy, more accessible in the community. Mature data from several randomized and prospective nonrandomized trials have contributed to the development of consensus guidelines for selecting the most appropriate candidates ABPI.Conclusion: APBI represent an attractive treatment option for appropriately selected patients with early breast cancer. Irrespective to various techniques used for APBI it is very important to select the most appropriate patient population according to reliable guidelines for this treatment strategy that could be non-inferiority to whole breast irradiation especially in high-volume radiation centers with long waiting lists and for patients who live far away from the radiotherapy centers.

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