👉A 10-year follow-up study of patients with breast cancer who had been treated with accelerated partial-breast irradiation (APBI) after surgery showed that their rates of disease recurrence were similar to those of patients who had received whole-breast irradiation (WBI), according to data presented by Meattini et al at the 2019 San Antonio Breast Cancer Symposium (Abstract GS4-06).
👉The study results suggest that the less invasive partial-breast procedure may be an acceptable choice for patients with early breast cancer.
👉Many patients diagnosed with early breast cancer undergo lumpectomy followed by a course of radiation.
👉Postoperative radiation still represents a mainstay of adjuvant treatment for breast cancer, able to significantly reduce the local relapse occurrence rate, explained the study’s lead author, Icro Meattini, MD, of the University of Florence, in a statement.
👉In recent years, researchers have sought to determine whether APBI might be as effective as WBI in preventing recurrence.
Study Methods
👉Dr. Meattini’s study examined 10-year follow-up data for women enrolled in the APBI IMRT trial, a randomized phase III trial.
👉The 5-year follow-up from the trial showed no significant difference in tumor recurrence or survival rates.
👉The APBI IMRT trial enrolled 520 women over age 40 who had either stage I or II breast cancer.
👉Between 2005 and 2013, the patients were randomly assigned 1:1 to receive either APBI or WBI.
👉The patients in the APBI arm received a total of 30 Gy of radiation to the tumor bed in five daily fractions, whereas those in the WBI arm received a total of 50 Gy in 25 daily fractions to the whole breast, plus a boost of 10 Gy to the tumor bed in five daily fractions.
👉Both treatment arms were comparable in terms of age, tumor size, tumor type, and adjuvant endocrine treatment, and both achieved a median 10-year follow-up.
👉The majority of the patients had hormone receptor–positive, HER2-negative breast cancer, and most were over age 50.
KEY POINTS
- After 10 years, 3.3% of patients in the APBI group had experienced a recurrence of breast cancer compared to 2.6% in the group that received WBI.
- Overall survival at the 10-year mark was similar between the two groups: 92.7% for the women who had received APBI and 93.3% for the women who received WBI.
- The authors mentioned that APBI may also be less likely to cause cosmetic changes and is less expensive to administer than WBI.
10-Year Follow-up
👉The study showed that after 10 years, 3.3% of patients in the APBI group had experienced a recurrence of breast cancer compared to 2.6% in the group that received WBI.
👉These results were comparable to the 5-year results, in which the group that received APBI had a 2.4% recurrence rate, and the group that received WBI had a 1.2% recurrence rate.
👉Neither difference was statistically significant.
👉Overall survival at the 10-year mark was also very similar between the two groups: 92.7% for the women who had received APBI and 93.3% for the women who received WBI.
👉Breast cancer–specific survival was 97.6% for those who received APBI and 97.5% for those who received WBI.
👉The distant metastasis-free survival rate was 96.9% both for the women who received APBI and for those who received WBI.
👉These results reinforce the initial promising results from the previous study,” said Dr. Meattini.
👉APBI can produce excellent disease control.
👉The study’s chief limitation is its relatively small size.
👉In well-selected cases, there is no difference in patients’ outcomes whether they are treated with APBI or WBI.
👉A once-daily regimen of external APBI might also produce an improved quality of life with less toxicity, and can potentially reduce the overall treatment time.
👉Dr. Meattini added that APBI may also be less likely to cause cosmetic changes and is less expensive to administer than WBI.
👉Partial-breast irradiation is one of the primary examples of effective deescalation of treatment in breast oncology.
👉For many patients, partial-breast irradiation may be an optimal choice that is cost-effective, safe, and efficacious.
Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
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Es experto en el manejo del cáncer de mama.
Es miembro de la American Society of Breast Surgeons:
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 