Accelerated Partial Breast Irradiation (APBI)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Accelerated partial breast irradiation (APBI):
    • Is radiation delivered locally to the resected part of the breast in the setting of lumpectomy
  • The benefits of APBI include:
    • Reduced treatment time and the potential to spare radiation to healthy tissue
  • Evidence to date suggests that survival and local recurrence with APBI is as effective as whole-breast irradiation:
    • However, careful patient selection is key
  • Patients suitable for APBI include:
    • Those ≥ 50 years old
    • Negative margins (by at least 2mm)
    • Tis or T1 tumors
    • Ductal carcinoma in situ (DCIS):
      • Screen detected
      • Low to intermediate nuclear grade
      • ≤ 2.5cm
      • Margins of resection ≥ 3mm
  • APBI is considered cautionary in:
    • Patients 40 to 49 years old if all other criteria for suitability are met
    • Margins < 2mm
    • DCIS ≤ 3 cm and patients ≥ 50 years if patient has no unsuitable factors and at least 1 of these factors:
      • Size 2.1 to 3.0cm, T2 tumors, margins <2 mm, limited / focal lymph-vascular space invasion, ER– tumors, clinically unifocal tumors between 2.1-3.0 cm, invasive lobular histology, pure DCIS ≤3cm if criteria for suitability not fully met and EIC ≤3cm.
  • Patients are deemed unsuitable:
    • If they are below age 40
    • Between the ages of 40 to 49 years and do not meet the criteria for cautionary
    • Positive margins
    • > 3cm of DCIS
  • Current ASTRO guidelines do not recommend low energy IORT off prospective study, and electron IORT only for those patients with suitable risk factors
  • 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.
    • 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(4):987-1001.
Unknown's avatar

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.

Leave a comment