When Should we Offer Partial Breast Irradiation?

• Several guidelines have been published to guide decision making for treating select patients with partial breast irradiation off protocol:
  • The American Society for Radiation Oncology consensus statement (Table 1) considers patients to be “suitable” if the following characteristics are met:
    • Age 50 years and older
    • BRCA 1 / 2 wild-type
    • Tumor size 2 cm or less:
      • Multifocality is allowed:
        • Provided the total size is 2 cm or less
    • ER-positive
    • Invasive ductal (or other favorable) histology
    • Surgical margins 2 mm or greater
    • Absence of lymph-vascular invasion (LVI)
    • Pure ductal carcinoma in situ (DCIS) meeting trial criteria
    • Absence of an extensive intraductal component
    • Absence of lymph node involvement
  • “Unsuitable” characteristics included:
    • Age younger than 40 years
    • Presence of a BRCA 1 / 2 deleterious mutation
    • Tumor size greater than 3 cm (including multiple foci)
    • Multicentricity
    • Positive surgical margins
    • Extensive LVI
    • Lymph node involvement (or not assessed).
  • “Cautionary” characteristics:
    • Fall between suitable and unsuitable.

Table: ASTRO Consensus Guidelines for Accelerated Partial Breast Irradiation

• The recent American Brachytherapy Society (Table) defined acceptable criteria for partial breast irradiation as:
  • Age 50 years and older
  • Size ≤ 3 cm
  • All invasive subtypes and pure DCIS
  • ER-positive or negative
  • Negative surgical margins (“on ink”)
  • Negative lymph nodes
  • Absence of LVI.

Table: American Brachytherapy Society Guidelinesfor Accelerated Partial Breast Irradiation

• The Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) consensus statement (Table) classifies patients into “low risk” and good candidates for partial breast irradiation:
  • Patients age 50 years and older
  • ER-negative (or positive) disease
  • Tumors 3 cm

Table: GEC-ESTRO Guidelines for Accelerated Partial Breast Irradiation

• The American Society of Breast Surgeons current guidelines (Table) include:
  • Age 45 years and older for invasive tumors
  • Age 50 years and older for DCIS
  • Tumor size less than 3 cm
  • Negative margins
  • Negative lymph

Table: American Society of Breast Surgeons Accelerated Partial Breast Irradiation Position Statement

Rodrigo Arrangoiz MS, MD, FACS a surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

• He is an expert in the management of breast cancer.

  • If you have any questions about Partial Breast Irriadation  please fill free to contact Dr. Arrangoiz.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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