👉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 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.
👉The recent American Brachytherapy Society (Table 2) 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, and the absence of LVI.
👉The Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) consensus statement (Table 3) also classifies patients age 50 years and older, ER-negative (or positive) disease, and tumors 3 cm or less as “low risk” and good candidates for partial breast irradiation.
👉The American Society of Breast Surgeons current guidelines (Table 4) include age 45 years and older for invasive tumors and age 50 years and older for DCIS, tumor size less than 3 cm, negative margins, and negative lymph nodes
| Suitable | Cautionary | Unsuitable | |
| Age | ≥50 years | 40-49 years | <40 years |
| Tumor size | <2 cm | 2.1-3cm | >3 cm |
| Margin width | Negative by >2 mm | Close <2 mm | Positive |
| LVI | Negative | Limited | Positive |
| ER status | Positive | Negative or positive | Either |
| Centricity | Unicentric, unifocal | Unicentric, multifocal | Multricentric |
| Tumor histology | IDC (no ILC) | IDC or ILC | Either |
| DCIS | Allowed ❤ cm | – | – |
| Extensive intraductal component | Not allowed | ❤ cm | – |
| Lymph node status | Negative | Negative | Positive |
| Age ≥50 years |
| Tumor ≤3 cm |
| Invasive or DCIS |
| ER positive or negative |
| Negative margins |
| No LVI |
| Lymph node negative |
| Low risk/suitable | Intermediate risk or possible candidates | High risk or contraindicated | |
| Age | >50 years | >40-50 years | <40 years |
| Histology | Invasive ductal | IDC or ILC | – |
| DCIS | Not allowed | Acceptable | – |
| Size | ❤ cm | ❤ cm | >3 cm |
| Margins | >2 mm | Negative but <2 mm | Positive |
| Centricity | Unicentric | Unicentric | Multicentric |
| Focality | Unifocal | Multifocal within 2 cm | Multifocal >2 cm apart |
| Extensive intraductal component | Not allowed | Not allowed | Positive |
| LVI | Not allowed | Not allowed | Positive |
| ER status | Positive or negative | Positive or negative | – |
| Lymph node status | Negative | N1 after axillary lymph node dissection | Nx or N2 |
| Neoadjuvant chemotherapy | Not allowed | Not allowed | Neoadjuvant chemotherapy given |
| Age ≥45 years for invasibe cancer or age ≥50 years for pure DCIS |
| IDC or DCIS |
| ≤3 cm |
| Negative margins |
| Lymph node negative |
REFERENCES
- The American Society of Breast Surgeons. Consensus statement for accelerated partial breast irradiation. https://www.breastsurgeons.org/new_layout/about/statements/PDF_Statements/APBI.pdf. Updated August 15, 2011. Accessed January 21, 2016.
- Polgár C, Van Limbergen E, Potter R, et al; GEC-ESTRO breast cancer working group. 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.
- Shah C, Vicini F, Wazer DE, Arthur D, Patel RR. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy. 2013;12:267-277.
- 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.
- Rodrigo Arrangoiz MS, MD, FACS cirujano de mama / cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
- Es experto en el manejo del cáncer de mama.
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
Rodrigo Arrangoiz MS, MD, FACS, FSSO 