Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Correa, Candace R.; Harris, Eleanor; Leonardi, Maria Cristina; Smith, Benjamin D.; Taghian, Alphonse G.; Thompson, Alastair; White, Julia; Harris, Jay R.

doi:10.1016/j.prro.2016.09.007

Cited by 501 publications

(331 citation statements)

References 49 publications

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“…The guidelines updates reflect these NCCN Guidelines Insights (1) age of ≥50 years with invasive ductal carcinoma measuring ≤2 cm (T1 disease) with negative margins by ≥2 mm, no LVSI, hormone receptor-positive, and BRCA-negative, or (2) low to intermediate grade screen-detected ductal carcinoma in situ measuring ≤2.5 cm with negative margins by ≥3 mm. 36 Recent results from a randomized study of APBI using interstitial brachytherapy versus WBRT (50 Gy with 10 Gy boost) after lumpectomy in patients with low-risk disease demonstrated that APBI was not inferior to WBRT with respect to 5-year local control, DFS, and OS. 37 Overall recurrence rates were low in both arms.…”

Section: Nccn Recommendations For Rni After Lumpectomymentioning

confidence: 99%

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Gradishar¹,

Anderson

Balassanian

et al. 2017

J Natl Compr Canc Netw

375

331

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These NCCN Guidelines Insights highlight the important updates/changes to the surgical axillary staging, radiation therapy, and systemic therapy recommendations for hormone receptor-positive disease in the 1.2017 version of the NCCN Guidelines for Breast Cancer. This report summarizes these updates and discusses the rationale behind them. Updates on new drug approvals, not available at press time, can be found in the most recent version of these guidelines at NCCN.org.

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Section: Nccn Recommendations For Rni After Lumpectomymentioning

confidence: 99%

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Gradishar¹,

Anderson

Balassanian

et al. 2017

J Natl Compr Canc Netw

375

331

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“…Fastner: Partial breast irradiation (PBI) either with postoperative hypofractionated external beam RT [37] intraoperative [38, 39] or interstitial techniques [40, 41] seems to be an alternative treatment option if patients could be allocated to “very” low-risk breast cancer subtypes [42-44]. In our own institution, intraoperative RT with electrons has had a long tradition administered as anticipated tumor bed boost since 1998.…”

Section: Question 5: Do You Perform Partial Breast Irradiation? Whichmentioning

confidence: 99%

“…In our own institution, intraoperative RT with electrons has had a long tradition administered as anticipated tumor bed boost since 1998. However, according to international guidelines and recommendations [43, 44], intraoperative RT with electrons as single-shot full-dose treatment (21 Gy at the 90% reference isodose, 23.4 Gy Dmax) is offered exclusively to patients who are classified as “suitable” with unicentric(-focal) Luminal A tumors of sizes <2 cm, negative lymph nodes (cN0 and negative intraoperative frozen section histology for sentinel nodes), ≥50 years of age, clear resection margins, tumor grading G1/2 without neoadjuvant systemic treatment, respectively. Moreover, with lobular histology, preoperative breast MRT is mandatory [45].…”

Section: Question 5: Do You Perform Partial Breast Irradiation? Whichmentioning

confidence: 99%

Challenges in Radiotherapy

et al. 2019

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“…Accelerated partial breast irradiation Accelerated Partial breast radiation (APBI) has emerged as an established adjuvant treatment option following lumpectomy in women with favorable, early stage breast cancer such as those over the age of 50 with small, lymph node negative, hormone receptor positive disease [45][46][47][48]. APBI offers many potential advantages over whole breast irradiation including shortening the course of treatment and reducing normal tissue exposure.…”

Section: Clinical Applications For Pbt In Breast Cancermentioning

confidence: 99%

Proton therapy for breast cancer: progress & pitfalls

Corbin

Mutter

2018

Breast Cancer Management

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Practice points• Proton therapy is under investigation for early stage and locally advanced breast cancer.• Due to unique physical properties, proton therapy reduces the dose to the heart, lungs, skin, muscle, and bone and is therefore hypothesized to reduce side effects from treatment.• Proton therapy may also enable improved target coverage in some breast cancer patients.• Due to its highly conformal nature, proton therapy requires careful attention to target volume delineation and implementation of strategies to mitigate uncertainties in setup and delivery.• Proton therapy for breast cancer is rapidly evolving with improvements in techniques for treatment delivery and optimizing of dose and fractionation schedules.• Research is ongoing to determine whether proton therapy improves treatment outcomes and quality of life compared with conventional photon techniques.As the number of patients cured from breast cancer increases with improvements in multidisciplinary care, emphasis on reducing late toxicities of treatment has increased, in order to improve long-term quality of life. Proton beam therapy (PBT) is a form of radiotherapy that uses particles with unique physical properties that enable treatment delivery with minimal dose deposition beyond the treatment target. Therefore, PBT has emerged as an exciting radiotherapy modality for breast cancer due to the ability to minimize exposure to the heart, lungs, muscle, and bone. Herein, we review the rationale for PBT in breast cancer, potential clinical applications, and the available clinical data supporting its use. We also address some of the technical and logistical challenges and areas of ongoing research that will ultimately establish the role for PBT for breast cancer in the years ahead.First draft submitted: 5 January 2018; Accepted for publication: 13 March 2018; Published online: 13 April 2018Keywords: breast cancer • cardiotoxicity • heart • particle therapy • pencil-beam scanning • proton therapy • radiation therapyBreast cancer accounts for 30% of new cancer diagnoses in women [1]. Although breast cancer remains the second leading cause of cancer death among women, advances in detection and treatment have resulted in improved outcomes, with 5-year expected survival of 90% [1]. Radiation therapy (RT) is indicated in the management of the majority of women with breast cancer [2]. For early stage breast cancer, breast irradiation following lumpectomy is an essential component of breast conserving therapy, lowering the risk of recurrence and improving breast cancer specific survival [3,4]. Recently published clinical trials also support the oncologic value of regional nodal irradiation (RNI) in some women with high risk node negative or axillary nodal metastases [5,6]. In addition, women with locally advanced breast cancer benefit from RT to the chest wall and regional lymph nodes, delivered in the post mastectomy setting [7]. While RT is widely utilized and improves breast cancer treatment outcomes, RT is also associated with late effects including cardi...

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Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Cited by 501 publications

References 49 publications

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Challenges in Radiotherapy

Proton therapy for breast cancer: progress & pitfalls

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