Accelerated Partial Breast Irradiation Consensus Statement from the American Society for Radiation Oncology (ASTRO)

Cost-minimization analysis: should partial breast irradiation be utilized over whole breast irradiation assuming equivalent clinical outcomes?

“…Shah, et al [9] concluded from a 12-year follow-up that APBI produced equivalent outcomes to WBI, including regional recurrence, disease-free survival, cause-specific survival, local recurrence, and overall survival. The ASTRO 2009 consensus statement discussed the possibility of an increase in the risk of IBTR, as well as an increased risk of toxicity, including local fibrosis or poor cosmesis, with APBI treatment [5]. If PBI had higher toxicities, this would possibly incur more costs due to an increase in follow-ups necessary to deal with these problems.…”

“…In addition, with the stratification of patients into the three groups, "suitable", "cautionary", and "unsuitable", not all patients may be candidates for APBI. Presently, only the "suitable" group should be treated with APBI outside of a clinical trial, and the "cautionary" group requires caution and concern before being treated with APBI due to limited data [5]. However, APBI is widely utilized already without definitive evidence of equivalent efficacy and safety compared to WBI from phase III randomized clinical trials.…”

“…The ASTRO Consensus Statement indicated that selection outside of a clinical trial include all patients that are "candidates for breast-conserving (no prior radiotherapy, no history of collagen vascular diseases, and not pregnant)". In addition, the committee indicated a 'suitable' group for APBI with criteria, such as age greater than or equal to 60, tumour, T1 stage, margins at least 2 mm, unicentric, no extensive intraductal component (EIC), and no nodal involvement [5]. WBI is given in 50 Gray (Gy) (2.0Gy/fraction) taking place over five weeks, while EB-PBI is given in 38.5Gy in 3.85Gy fractions BID for five days in accordance with the NSABP B-39/RTOG 0413 trial [14].…”

“…The American Society for Radiation Oncology (ASTRO) consensus statement discussed APBI's increase in the risk of ipsilateral breast tumor recurrence (IBTR) associated with an increased risk for distant metastasis and death, as well as an increased risk of toxicity, including local fibrosis or poor cosmesis [5]. However, a recent study by Ferraro, et al showed no significant difference between APBI and WBI for local recurrence rate, disease-free survival, cause specific survival, and overall survival at five years [6].…”

“…This type of cost comparison is based on the presumption that EB-PBI and WBI produce equivalent clinical outcomes, and, in accordance with the consensus statement from ASTRO, that PBI can be acceptable as an alternative outside of a clinical trial in appropriate patient groups [5]. The objective of this study is to determine if EB-PBI or WBI incurs the least cost.…”