Guidelines for Partial Breast Irradiation

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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 (ASTRO) consensus statement (Table) considers patients to be:
    • Suitable if the following characteristics are met:
      • Age greater than 50 years
      • BRCA 1 / BRCA 2 wild-type
      • Tumor size less than 2 cm:
        • Multifocality is allowed:
          • Provided the total size is less than 2 cm
      • ER positive
      • Invasive ductal (or other favorable) histology
      • Surgical margins greater than 2 mm
      • Absence of lymphovascular 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 less than 40 years
      • Presence of a BRCA1 / BRCA 2 deleterious mutation
      • Tumor size > 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:
    • Defined acceptable criteria for partial breast irradiation as:
      • Age greater than 45 years
      • Tumor size ≤ 3 cm
      • All invasive subtypes and pure DCIS
      • ER + / –
      • Negative surgical margins (“on ink”)
      • Negative lymph nodes
      • The absence of LVI
  • The Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) consensus statement also classifies patients:
    • As good candidates for partial breast irradiation
      • Greater than 50 years
      • ER– (or +) disease
      • Tumors less than 3 cm as “low risk”
  • The American Society of Breast Surgeons current guidelines include:
    • Age greater than 45 years for invasive tumors
    • Age greater 50 years for DCIS
    • IDC or DCIS tumor size less than 3 cm
    • Negative margins
    • Negative lymph nodes
  • References
    • 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.
    • 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(3):264-273.
    • Consensus statement for accelerated partial breast irradiation. American Society of Breast Surgeons website. https://www.breastsurgeons.org/docs/statements/Consensus-Statement-for-Accelerated-Partial-Breast-Irradiation.pdf. Accessed August 22, 2019.
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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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