The surgeon's role in breast brachytherapy.

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Breast-conserving surgery is chosen by many patients, but a significant portion does not complete indicated radiation therapy.
• Reasons for non-adherence include patient/surgeon attitudes and logistical challenges like facility distance.
• Accelerated partial breast irradiation (APBI) is emerging as a more convenient alternative to traditional whole-breast radiation therapy.

Purpose of the Study:

• To provide guidelines for integrating APBI into surgical practice.
• To highlight key considerations for successful APBI programs from a surgeon's viewpoint.
• To present consensus from a best practices symposium on APBI.

Main Methods:

• Review of best practices and guidelines for APBI candidate selection.
• Discussion of surgical techniques, including MammoSite balloon brachytherapy.
• Emphasis on patient selection criteria (age, histology, tumor/breast size) and surgical planning.
• Importance of real-time sonographic guidance and cavity evaluation.
• Consideration of catheter insertion timing and technique.
• Highlighting the necessity of surgeon-radiation oncologist communication.

Main Results:

• APBI, particularly using MammoSite balloon brachytherapy, is a viable option for select early-stage breast cancer patients.
• Successful APBI integration requires careful patient selection, meticulous surgical technique, and effective multidisciplinary communication.
• Guidelines exist for candidate selection and surgical best practices in APBI.

Conclusions:

• APBI can improve adherence to adjuvant radiation therapy for early-stage breast cancer.
• Surgeons play a crucial role in patient selection and the technical aspects of APBI delivery.
• Collaboration between surgical and radiation oncology is essential for optimal APBI outcomes.