The Rise and Fall of Accelerated Partial Breast Irradiation via Brachytherapy in a Single Institution

Accelerated partial breast irradiation via brachytherapy (APBI-b) is offered as an alternative to whole breast irradiation (WBI) for selected patients with breast cancer. This study evaluates our clinical experience with APBI-b to identify the reasons for decreased clinical utilization in recent years. We performed an analysis of the prospective database of breast cancer patients treated with APBI-b between 2004 and 2013. During that time, 245 patients received APBI-b, most having stage I (77%) or stage 0 (20%) breast cancer. Since 2004, the number of APBI-b cases per year rose to 49 in 2009, declining thereafter to 14 in 2013 (P < 0.001). The APBI-b case volume dropped in 2010 following the publication of the American Society of Radiation Oncology (ASTRO) consensus guidelines in 2009. After 2009 fewer unsuitable cases received APBI-b (11% vs. 4%,P = 0.1).

The clinical utilization of APBI-b has decreased after the publication of consensus guidelines. A reduction in unsuitable cases treated after 2009 does not explain the global loss of referrals.