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Five Fraction External Beam Partial Breast Irradiation: A User's Guide.

Shauna R Campbell1, Chirag S Shah1, Sarah M C Sittenfeld2

  • 1Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic.

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|December 23, 2022
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Summary
This summary is machine-generated.

External beam partial breast irradiation (PBI) is safe and effective for early-stage breast cancer. This guide helps implement evidence-based PBI, improving patient selection and workflow for this underutilized treatment.

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Area of Science:

  • Radiation Oncology
  • Breast Cancer Treatment
  • Evidence-Based Medicine

Background:

  • Mature follow-up from randomized trials confirms the safety and efficacy of external beam partial breast irradiation (PBI) for selected early-stage breast cancer patients.
  • Despite robust evidence, external beam PBI is currently underutilized in clinical practice.
  • This highlights a need for practical guidance to facilitate wider adoption.

Purpose of the Study:

  • To provide a user guide for implementing evidence-based external beam partial breast irradiation (PBI).
  • To outline optimal patient selection criteria for PBI.
  • To detail the recommended workflow and address potential challenges in PBI delivery.

Main Methods:

  • Review of current guidelines for PBI suitability and patient selection.
  • Discussion of surgical considerations, including optimal timing post-surgery (3-5 weeks).
  • Detailed description of treatment technique, simulation, contouring, and planning, including target volume expansions (0.5-1.0 cm) and organ-at-risk dose constraints.

Main Results:

  • Prospective data supports a regimen of 30 Gy in 5 fractions using intensity-modulated radiation therapy (IMRT) for PBI.
  • Achievable organ-at-risk dose constraints include heart V3Gy ≤10% and contralateral breast Dmax ≤1 Gy.
  • Specific recommendations for clinical target volume and planning target volume expansions are provided.

Conclusions:

  • Five-fraction external beam PBI is a highly effective treatment with minimal toxicity for early-stage breast cancer patients post-breast-conserving surgery.
  • Intensity-modulated radiation therapy (IMRT) techniques allow for significant normal tissue sparing.
  • Feasibility of implementation is high at most radiation oncology centers due to standard linear accelerator use.