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Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features
Derek R McHaffie1, Rakesh R Patel, Jarrod B Adkison
1Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
International Journal of Radiation Oncology, Biology, Physics
|August 25, 2010
Summary
Women with specific breast cancer features treated with accelerated partial breast irradiation (APBI) had few local recurrences. This suggests APBI is a safe option for select patients with cautionary factors.
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Accelerated partial breast irradiation (APBI) is an alternative to whole-breast irradiation for early-stage breast cancer.
- The American Society for Radiation Oncology (ASTRO) established cautionary criteria for APBI suitability.
- Evaluating outcomes in patients with these cautionary features is crucial for treatment guidelines.
Purpose of the Study:
- To assess the outcomes of women with ASTRO consensus statement cautionary features who underwent brachytherapy-based APBI.
- To identify patient subgroups within the cautionary criteria who may still benefit from APBI.
Main Methods:
- Retrospective review of 322 patients treated with high-dose-rate (HDR) APBI between 2001 and 2006.
- Identification of 136 patients meeting ASTRO cautionary criteria, with 38 having multiple factors.
- Treatment involved multicatheter or Mammosite balloon brachytherapy delivering 32-34 Gy in 8-10 fractions.
Main Results:
- A 5-year actuarial ipsilateral breast tumor recurrence (IBTR) rate of 4.8% was observed in the cautionary group.
- Disease-free survival was 89.6%, cause-specific survival 97.6%, and overall survival 95.3%.
- No IBTRs occurred in patients with ductal carcinoma in situ (DCIS), and patients with Stage I/II invasive cancer cautioned for age alone had 0% IBTR compared to 12.7% for those cautioned by histopathology (p=0.018).
Conclusions:
- Few local recurrences were observed in patients with ASTRO cautionary features treated with APBI.
- Women with DCIS and younger patients (50-59) with Stage I/II disease meeting cautionary criteria appear to have a low risk of IBTR.
- Careful patient selection is essential, particularly for those with tumor-related cautionary features, to optimize APBI outcomes.
