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:
    • Multi-focality 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 intra-ductal component
    • The absence of lymph node involvement
  • American Society for Radiation Oncology consensus statement (Table 1) considers patients to be “unsuitable” if the following characteristics are met:
    • Age younger than 40 years
    • Presence of a BRCA 1 / 2 deleterious mutation
    • Tumor size greater than 3 cm:
    • Including multiple foci
    • Multi-centricity
    • Positive surgical margins
    • Extensive LVI
    • Lymph node involvement (or not assessed).
  • American Society for Radiation Oncology consensus statement (Table 1) considers patients to be “cautionary” if the 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
      • Pure DCIS
      • ER-positive
      • ER-negative
      • Negative surgical margins (“on ink”)
      • Negative lymph nodes
      • Absence of LVI
  • The Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) consensus statement (Table 3) also classifies patients as “low risk” and good candidates for partial breast irradiation with the following criteria:
    • Age 50 years and older
    • ER-negative (or positive) disease
    • Tumors 3 cm or less
  • The American Society of Breast Surgeons current guidelines (Table 4) include:
    • Age 45 years and older for invasive tumors
    • Age 50 years and older for DCIS
    • Tumor size < 3 cm
    • Negative margins
    • Negative lymph nodes

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.

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