Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion

Abstract

Introduction. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. Material and Method. A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results. Seven papers fulfilled the eligibility criteria. The number of evaluated patients was 405 and the median age was 77.7 years. The disease-free survival (DFS) range was 96.1%–100%, the grade 3-4 toxicity range was 0%–6.6%, the cancer-specific survival (CSS) range was 97.9%–100%, and the overall survival (OS) range was 87%–100%. All studies reported excellent/good cosmetic results in a range of 74% to 99%. Conclusion. Accelerated partial breast irradiation (APBI) results in a safe and effective substitute for the adjuvant external beam radiotherapy in selected elderly early-stage breast cancer patients. Based on the relatively low toxicity, APBI should be advised in selected patients with life expectancies larger than 5–10 years.

Association of the 12-Gene Breast DCIS Score® Assay With Local Recurrence in Patients With Ductal Carcinoma In Situ Treated on Accelerated Partial Breast Radiotherapy Protocols

“…While the number of recurrence events is small, there is a strong association between the DCIS Score result and recurrence risk that is not apparent when assessing risk with the traditional clinicopathologic factors. In the group with a DCIS Recurrence Score of ≥39 there were a total of 5 recurrences at a median of 2.9 years and 2 of these were in the group with scores ≥55 at a median of 1.8 years (26). There was only one recurrence with a score of <39 which occurred at 4.5 years.…”

Dosimetric comparison between interstitial brachytherapy and volumetric-modulated arc therapy for tumor bed boost in breast cancer

“…Therefore, there is significantly less dose to contralateral breast, ipsilateral lung, contralateral lung, ribs, and skin with interstitial brachytherapy, which could be advantageous in terms of toxicity comparing to VMAT, especially in elderly patients, given the possibility of implantation during surgery and thereby reducing overall duration of treatment [31,32]. Although, the present study is the first one to compare the dosimetric differences between interstitial brachytherapy and VMAT for tumor bed boost, it has several limitations.…”

Accelerated partial breast irradiation in the elderly: 8-year oncological outcomes and prognostic factors

“…Many techniques of APBI have been developed: HIBT, external breast RT, and intraoperative RT. HIBT is one of the first APBI technique used and has the longest followup (31,32). The two last trials which reported the comparison between external partial breast RT to WBI confirmed the noninferiority of the APBI technique in the RAPID trial, (but with a significant deleterious impact in terms of cosmetic outcomes) (33,34) but not in the NSABP B-39/ RTOG 0413 trial (35).…”