Radiation Techniques with Evidence-Based Guidelines to Support there use with Breast-Conserving Surgery?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Standard fractionation whole-breast irradiation (WBI):
    • Represents a standard radiation technique used following breast-conserving surgery and is part of current evidence-based guidelines
  • Hypofractionated WBI:
    • Has been found to be equivalent to standard fractionation WBI in several randomized trials
    • Updated American Society for Radiation Oncology (ASTRO) guidelines:
      • Recommend its use at any age without any restrictions on prior chemotherapy
      • Any stage can be treated as long as the regional lymph nodes do not require an addition field
      • The dose homogeneity goal is to minimize the breast receiving greater than 105% of the prescription dose
  • Accelerated partial breast irradiation (APBI):
    • Has been found to have comparable rates of local recurrence and toxicity compared with standard / hypofractionated WBI in multiple randomized trials:
      • With current evidence-based guidelines available from ASTRO and the American Brachytherapy Society for off-protocol use
  • Intraoperative radiation therapy (IORT):
    • Has been found to have higher rates of local recurrence in the TARGIT and ELIOT trials compared with standard fractionation WBI, and is not included in commonly utilized evidence-based guidelines at this time
  • References
    • Fisher B, Anderson S, Bryant J, et al. Twenty-year followup of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347(16):1233-1241.
    • Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8(3):145-152
    • Correa C, Harris EE, Leonardi MC, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 2017;7(2):73-79.
    • Shah C, Vicini F, Shaitelman SF, et al. The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation. Brachytherapy.2018;17(1):154-170.
    • Vaidya JS, Wenz F, Bulsara M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 2014(9917);383:603-613.
    • Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14(13):1269-1277.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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