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01-08-2013 | Breast Oncology

The Evolving Role of Partial Breast Irradiation in Early-Stage Breast Cancer

Authors: Mitchel Barry, MD, Alice Ho, MD, Monica Morrow, MD

Published in: Annals of Surgical Oncology | Issue 8/2013

Abstract

Whole breast irradiation (WBI) over 5–7 weeks has long been considered standard adjuvant treatment after breast-conserving surgery. Recently the concept of irradiating the whole breast has been challenged by accelerated partial breast irradiation (APBI), which exclusively targets the lumpectomy site plus margin. We review the evidence supporting APBI from modern clinical trials, the pros and cons of various APBI techniques, and the controversies regarding the applicability of APBI to specific patient groups.

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

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, 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

Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998;16:441–52.PubMed

EORTC Breast Cancer Cooperative Group, EORTC Radiotherapy Group, Bijker N, Meijnen P, Peterse JL, Bogaerts J, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24:3381–7.PubMedCrossRef

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of the 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.

Malin JL, Schuster MA, Kahn KA, Brook RH. Quality of breast cancer care: what do we know? J Clin Oncol. 2002;20:4381–93.PubMedCrossRef

Morrow M, White J, Moughan J, Owen J, Pajack T, Sylvester J, et al. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol. 2001;19:2254–62.PubMed

Kuerer HM, Julian TB, Strom EA, Lyerly HK, Giuliano AE, Mamounas EP, et al. Accelerated partial breast irradiation after conservative surgery for breast cancer. Ann Surg. 2004;239:338–51.PubMedCrossRef

Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.PubMedCrossRef

10.

Fisher B, Anderson S. Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. National Surgical Adjuvant Breast and Bowel Project. World J Surg. 1994;18:63–9.PubMedCrossRef

11.

Botteri E, Bagnardi V, Rotmensz N, Gentilini O, Disalvatore D, Bazolli B, et al. Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol. 2010;21:723–8.PubMedCrossRef

12.

Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56:979–90.

13.

Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, et al.; European Organization for Research and Treatment of Cancer Radiotherapy and Breast Cancer Groups. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–87.PubMedCrossRef

14.

Polgár C, Fodor J, Major T, Németh G, Lövey K, Orosz Z, et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma—5-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007;69:694–702.PubMedCrossRef

15.

Coles C, Yarnold J; IMPORT Trials Management Group. The IMPORT trials are launched. Clin Oncol (R Coll Radiol). 2006;18:587–90.

16.

Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cacner (TARGIT-A trial): an international, prospective, randomized, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.PubMedCrossRef

17.

Holmes DR, Baum M, Joseph D. The TARGIT trial: targeted intra-operative radiation therapy versus conventional postoperative whole breast radiotherapy after breast conserving surgery for the management of early-stage breast cancer (a trial update). Am J Surg. 2007;194 :507–10.PubMedCrossRef

18.

Intra M, Luini A, Gatti G, Ciocca M, Gentilini OD, Viana AA, et al. Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: a lesson learned by over 1000 procedures. Surgery. 2006;140:467–71.PubMedCrossRef

19.

Pignol JP, Rakovitch E, Keller BM, Sankreacha R, Chartier C. Tolerance and acceptance results of a palladium-103 permanent breast seed implant phase I/II study. Int J Radiat Oncol Biol Phys. 2009;73:1482–8.PubMedCrossRef

20.

Veronesi U, Orecchia R, Luini A, Galimberti V, Zurrida S, Intra M, et al. Intra-operative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast Cancer Res Treat. 2010;124:141–51.PubMedCrossRef

21.

Leonardi MC, Maisonneuve P, Mastropasqua MG, Morra A, Lazzari R, Dell’acqua V, et al. Accelerated partial breast irradiation with intra-operative electrons: using GEC-ESTRO recommendations as guidance for patient selection. Radiother Oncol. 2013;106:21–7.PubMedCrossRef

22.

Antonucci JV, Wallace M, Goldstein MS, Kestin L, Chen P, Benitez P, et al. Differences in patterns of failure in patients treated with accelerated partial breast irradiation versus whole-breast irradiation; a matched pair analysis with 10-year follow up. Int J Radiat Oncol Biol Phys. 2009;74:447–52.PubMedCrossRef

23.

Chen PY, Vicini FA, Benitez P, Kestin LL, Wallace M, Mitchell C, et al. Long-term cosmetic results and toxicity after accelerated partial breast irradiation. Cancer. 2006;106:991–9.PubMedCrossRef

24.

Kuske RR, Winter K, Arthur DW, Bolton J, Rabinovitch R, White J, et al. Phase II trial of brachytherapy alone after lumpectomy for select breast cancer: toxicity analysis of RTOG 95-17. Int J Radiat Oncol Biol Phys. 2006;65:45–51.PubMedCrossRef

25.

Lawenda BD, Taqhian AG, Kachnic LA, Hamdi H, Smith BL, Gadd MA, et al. Dose–volume analysis of radiotherapy for T1N0 invasive breast cancer treated by local excision and partial breast irradiation by low-dose-rate interstitial implant. Int J Radiat Oncol Biol Phys. 2003;56:671–80.PubMedCrossRef

26.

Stewart AJ, Khan AJ, Devlin PM. Partial breast irradiation: a review of techniques and indications. Br J Radiol. 2010;83:369–78.PubMedCrossRef

27.

Nelson JC, Beitsch PD, Vicini FA, Quiet CA, Garcia D, Snider HC, et al. Four-year clinical update from the American Society of Breast Surgeons MammoSite brachytherapy trial. Am J Surg. 2009;198:83–91.PubMedCrossRef

28.

Goyal S, Khan AJ, Vicini F, Beitsch PD, Lyden M, Keisch M, et al. Factors associated with optimal cosmetic results at 36 months in patients treated with accelerated partial irradiation (APBI) on the American Society of Breast Surgeons (ASBr S) MammoXite Breast Brachytherapy Registry Trial. Ann Surg Oncol. 2009;16:2450–8.PubMedCrossRef

29.

Formenti SC, Truong MT, Goldberg JD, Mukhi V, Rosenstein B, Roses D, et al. Prone accelerated partial breast irradiation after breast-conserving surgery: preliminary clinical results and dose–volume histogram analysis. Int J Radiat Oncol Biol Phys. 2004;60:493–504.PubMedCrossRef

30.

Jagsi R, Ben-David MA, Moran JM, Marsh RB, Griffith KA, Hayman JA, et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:71–8.PubMedCrossRef

31.

Shaitelman SF, Kim LH, Grills IS, Chen PY, Ye H, Kestin LL, et al. Predictors of long-term toxicity using three-dimensional conformal external beam radiotherapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;81:788–94.PubMedCrossRef

32.

Whelan TJ, Olivotto I, Parpia S, Berrang T, Kim DH, Kong I, et al. Ontario Clinical Oncology Group. Interim toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation (APBI) using 3D conformal external beam radiation therapy (3D CRT). ASTRO 2012, plenary session presentation.

33.

Ribeiro GG, Magee B, Swindell R, Harris M, Banerjee SS. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol. 1993;5:278–83.CrossRef

34.

Vicini F, Winter K, Straube W, Wong J, Pass H, Rabinovitch R, et al. A phase I/II trial to evaluate three-dimensional conformal radiation therapy confined to the region of the lumpectomy cavity for stage I/II breast carcinoma: initial report of feasibility and reproducibility of Radiation Therapy Oncology Group (RTOG) study 0319. Int J Radiat Oncol Biol Phys. 2005;63:1531–7.PubMedCrossRef

35.

Vicini F, Winter K, Wong J, Pass H, Rabinovitch R, Chafe S, et al. Initial efficacy results of RTOG 0319: three-dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/II breast carcinoma. Int J Radiat Oncol Biol Phys. 2010;77:1120–7.PubMedCrossRef

36.

Chen PY, Wallace M, Mitchell C, Grills I, Kestin L, Fowler A, et al. Four-year efficacy, cosmesis, and toxicity using three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:991–7.PubMedCrossRef

37.

Wernicke AG, Gidea-Addeo D, Magnolfi C, Fenton-Kerimian M, Goldberg J, Formenti SC, et al. External beam partial breast irradiation following breast-conserving surgery: preliminary results of cosmetic outcome of NYU 00-23. Int J Radiat Oncol Biol Phys. 2006;66:S32A.CrossRef

38.

Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.PubMedCrossRef

39.

Polgar C, Van Limbergen E, Potter R, Kovacs G, Polo A, Lyczek J, et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery; recommendations of the Groupe Europeen de Curietherapie—European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) Breast Cancer Working Group based on clinical evidence (2009). Radiother Oncol. 2010;94:264–73.PubMedCrossRef

40.

Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351:971–7.PubMedCrossRef

41.

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

42.

Anderson SJ, Wapnir I, Dignam JJ, Fisher B, Mamounas EP, Jeong JH, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27:2466–73.PubMedCrossRef

43.

Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426–32.PubMed

Title: The Evolving Role of Partial Breast Irradiation in Early-Stage Breast Cancer
Authors: Mitchel Barry, MD
Alice Ho, MD
Monica Morrow, MD
Publication date: 01-08-2013
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 8/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-2923-8

At a glance: The STEP trials

Springer Medicine

The Evolving Role of Partial Breast Irradiation in Early-Stage Breast Cancer

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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