Accelerated Partial Breast Irradiation

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Accelerated partial breast irradiation includes multiple techniques, including:
    • Interstitial brachytherapy
    • Applicator brachytherapy
    • External beam radiation therapy
  • The Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) trial:
    • Randomized 1,184 patients with low-risk invasive carcinoma or ductal carcinoma in situ (DCIS) treated with breast-conserving surgery to either whole-breast irradiation (WBI) or APBI using multicatheter brachytherapy
    • The cumulative incidence of local recurrence at 5 years was 1.44% with APBI and 0.92% with WBI
  • The Florence trial:
    • Randomized 520 patients to either WBI or APBI with intensity-modulated radiation therapy
    • With a mean followup of 5 years
    • The rate of local recurrence was 1.5% in both arms
  • Similarly, long-term outcomes from the American Society of Breast Surgeons’ Mammosite Registry:
    • Found that 5-year rates were less than 4%
  • An older randomized trial from Hungary:
    • Using interstitial APBI and electrons had a 5-year local recurrence rate of 4.7%
  • Current ASTRO APBI guidelines:
    • Suitable:
      • Any patient > 50 years, with T1 (margins at least 2 mm) or Tis (if screen-detected, < 2.5cm, low-intermediate grade, margins > 3 mm)
    • Cautionary:
      • 40‒49 years old or > 50 years old with at least one pathological higher risk factor
    • Unsuitable:
      • Less than 40 years old, positive margins, tumor > 3 cm, and N+
  • American Brachytherapy Society guidelines:
    • Consider candidates appropriate if age > 45, invasive or DCIS, tumors < 3 cm, N0, ER+ or ER–, no lymph-vascular space invasion, and negative margins
  • References
    • Livi L, Meattini I, Marrazzo L, et al. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51(4):451-463.
    • Polgár C, Fodor J, Major T, Sulyok Z, Kásler M. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol. 2013;108(3):197-202.
    • Shah C, Badiyan S, Ben Wilkinson J, et al. Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Ann Surg Oncol.2013;20(10):3279-3285.
    • Strnad V, Ott OJ, Hildebrandt G, et al; Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO). 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet. 2016;16(10015);387:229-238.
    • 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.
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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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