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01-02-2012 | Breast Oncology

A Single-Institution Review of Accelerated Partial Breast Irradiation in Patients Considered “Cautionary” by the American Society for Radiation Oncology

Authors: Tari S. Stull, MD, M. Catherine Goodwin, MD, Edward J. Gracely, PhD, Michael R. Chernick, PhD, Richard J. Carella, MD, Thomas G. Frazier, MD, Andrea V. Barrio, MD

Published in: Annals of Surgical Oncology | Issue 2/2012

Abstract

Background

The American Society for Radiation Oncology (ASTRO) issued a consensus statement in 2009 regarding patient selection for accelerated partial breast irradiation (APBI) following breast-conserving surgery (BCS) for breast cancer (BC). We reviewed our single-institution experience with APBI in patients considered “cautionary” by ASTRO to determine patterns of recurrence.

Methods

An institutional review board-approved, retrospective chart review was conducted from January 2004 to November 2009. We identified 106 “cautionary” patients with 109 BC. All patients were treated with BCS followed by APBI via balloon catheter brachytherapy. “Cautionary” criteria include patients aged 50–59 years, tumor size 2.1–3.0 cm, close margins (<2 mm), focal lymphovascular invasion, estrogen receptor (ER)-negative tumors, invasive lobular carcinoma, or ductal carcinoma in situ (DCIS) ≤ 3 cm. Rates of recurrence at any site were evaluated.

Results

Median follow-up was 3 years. There were 3 IBTR (2.8%) at a median of 3.2 years. The 3-year actuarial IBTR rate was 1.8%. Patients with ER-negative invasive cancers had a higher IBTR rate compared with ER-positive patients (11.8% vs. 2.2%), although this did not reach statistical significance (P = 0.18). There were no IBTR in 46 patients with DCIS. On univariate analysis, there was no association between “cautionary” criteria and risk of local, regional, or distant recurrence.

Conclusions

Patients considered “cautionary” for APBI based on ASTRO guidelines had low rates of IBTR. ER-negative patients trended toward a higher IBTR rate with APBI compared with ER-positive patients. Longer follow-up is needed to establish the safety of APBI in “cautionary” patients.

Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRef

Arriagada R, Le MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Insitut Gustave-Roussy Brest Cancer Group. J Clin Oncol. 1996;14:1558–64.PubMed

Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trail comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRef

Poggi NM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Clinical Trial. Cancer. 2003;98:697–702.PubMedCrossRef

van Donegan JA, Voogd AC, Feniman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for research and Treatment of Cancer 10801 Trial. J Natl Cancer Inst. 2000;92:1143–50.CrossRef

Blichert-Toft M, Rose C, Anderson JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. J Natl Cancer Inst Monogr. 1992;11:19–25.PubMed

Clark RM, McCulloch PB, Levine MN, et al. Randomized clinical trials to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992;84(9):683–9.PubMedCrossRef

Veronesi U, Salvadori B, Luini A, et al. Breast conservation is a safe method in patients with small cancer of the breast: long-term results of three randomized trials on 1973 patients. Eur J Cancer. 1995;31A:1574–9.PubMedCrossRef

Liljegren G, Holmberg L, Bergh J, et al. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol. 1999;17(8):2326–33.PubMed

10.

Forrest AP, Stewart HJ, Everington D, et al. Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group. Lancet. 1996;348(9029):708–13.PubMedCrossRef

11.

Fisher B, Bryant J, Dignam JJ, et al. Tamoxifen, radiation therapy or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol. 2002;20:4141–9.PubMedCrossRef

12.

Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001;12:997-1003.PubMedCrossRef

13.

Pawlik TM, Bucholz TA, Kuerer HM. The biologic rationale for and emerging role of accelerated partial breast irradiation for breast cancer. J Am Coll Surg. 2004;119:479–92.CrossRef

14.

Jeruss JS, Vicini FA, Beitsch PD, et al. Initial outcomes for patients treated on the American Society of Breast Surgeons MammoSite Clinical Trial for ductal carcinoma in situ of the breast. Ann Surg Oncol. 2006;13(7):967–76.PubMedCrossRef

15.

Gage I, Recht A, Gelman R, et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1995;33:245–51.PubMedCrossRef

16.

Fourquet A, Campana F, Zafrani B, et al. Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys. 1990;19:833–42.CrossRef

17.

Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005;366:2087–106.PubMed

18.

Radiation Therapy Oncology Group. NSABP Protocol B-39/RTOG Protocol 0413: a randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer. www.rpc.mdanderson.org/rpc/credentialing/files/B39_Protocol1.pdf.

19.

Smith BD, Arthur DW, Bulcholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society of Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.PubMedCrossRef

20.

Hologic http://www.mammosite.com/physicians/radiation-therapy/about-mammosite.cfm. Accessed January 2011.

21.

Arthur DW, Vicini FA, Kuske RR, Wazer DE, Nag S. Accelerated partial breast irradiation: an updated report from the American Brachytherapy Society. Brachytherapy. 2003;2(2):124–30.PubMedCrossRef

22.

American Society of Breast Surgeons (October 2008). Consensus Statement for Accelerated Partial Breast Irradiation. http://www.breastsurgeons.org/statements/PDF_Statements/APBI_statement_revised_100708.pdf. Accessed January 2011.

23.

Vicini F, Arthur D, Wazer D, Chen P, Mitchell C, Wallace M, Kestin L, Ye H. Limitations of the American Society of Therapeutic Radiology and Oncology Consensus Panel guidelines on the use of accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2009.12.047 (Online December 15, 2009).

24.

Shaitelman SF, Vicini FA, Beitsch P, Haffty B, Keisch M, Lyden M. Five-year outcome of patients classified using the American Society for Radiation Oncology consensus statement guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial. Cancer. 2010;116:4677–85.PubMedCrossRef

25.

Beitsch P, Vicini F, Keisch M, Haffty B, Shaitelman S, Lyden M. Five-year outcome of patients classified in the “unsuitable” category using the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons Mammosite Registry Trial. Ann Surg Oncol. 2010;17:S219–25.CrossRef

26.

Vicini FA, Beitsch P, Quiet C, et al. Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons Mammosite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79:808–17.PubMedCrossRef

27.

McHaffie DR, Patel RR, Adkison JB, Das RK, Geye HM, Cannon GM. Outcomes after accelerated partial breast irradiation in patients with ASTRO Consensus Statement cautionary features. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2010.05.011 (Online May 7, 2010).

28.

Jeruss JS, Kuerer HM, Beitsch PD, Vicini FA, Keisch M. Update on DCIS outcomes from the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Ann Surg Oncol. 2011;18(1):65–71.PubMedCrossRef

29.

Chen YY, DeVries S, Anderson J, et al. Pathologic and biologic response to preoperative endocrine therapy in patients with ER-positive ductal carcinoma in situ. BMC Cancer. doi:10.1186/1471-2407-9-285 (Online August 18, 2009).

Title: A Single-Institution Review of Accelerated Partial Breast Irradiation in Patients Considered “Cautionary” by the American Society for Radiation Oncology
Authors: Tari S. Stull, MD
M. Catherine Goodwin, MD
Edward J. Gracely, PhD
Michael R. Chernick, PhD
Richard J. Carella, MD
Thomas G. Frazier, MD
Andrea V. Barrio, MD
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 2/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-1941-7

Keynote webinar | Spotlight on medication adherence

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A Single-Institution Review of Accelerated Partial Breast Irradiation in Patients Considered “Cautionary” by the American Society for Radiation Oncology

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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