Twelve-year clinical outcomes and patterns of failure with accelerated partial breast irradiation versus whole-breast irradiation: Results of a matched-pair analysis

Shah, Chirag; Antonucci, J. Vito; Wilkinson, J. Ben; Wallace, Michelle; Ghilezan, M.; Chen, Peter; Lewis, Kenneth T.; Mitchell, C.; Vicini, Frank A.

doi:10.1016/j.radonc.2011.03.011

Cited by 119 publications

(35 citation statements)

References 21 publications

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“…Unfortunately, there are few randomized trials currently available. 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].…”

Section: Discussionmentioning

confidence: 99%

“…A similar trial, the RAPID trial, randomized patients to either WBI or 3D-CRT APBI. Although data on equivalence of APBI and WBI currently comes from trials with shorter follow-up and fewer patients [8][9][10], this technique has become increasingly popular with patients, hospitals, and health care providers. In addition to patient convenience, there is also an underlying assumption that it is less costly [11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Leung¹,

Lock²,

Louie³

et al. 2013

Cureus

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Leung¹,

Lock²,

Louie³

et al. 2013

Cureus

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“…One such technique is accelerated partial breast irradiation (APBI), which covers the area surrounding the lumpectomy cavity with a margin and typically is completed in one week or less [8]. Multiple studies have compared APBI with WBI and have found equivalent rates of local control and thus, APBI has emerged as a viable, safe treatment option for properly selected patients with early stage breast cancer [9,10,11,12,13]. As interest in and the utilization APBI grows, a standardized approach to treatment and workflow is necessary for many groups.…”

Section: Purposementioning

confidence: 99%

Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow

Shah¹,

Wobb²,

Manyam³

et al. 2016

jcb

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Accelerated partial breast irradiation (APBI) represents an evolving technique that is a standard of care option in appropriately selected woman following breast conserving surgery. While multiple techniques now exist to deliver APBI, interstitial brachytherapy represents the technique used in several randomized trials (National Institute of Oncology, GEC-ESTRO). More recently, many centers have adopted applicator-based brachytherapy to deliver APBI due to the technical complexities of interstitial brachytherapy. The purpose of this article is to review methods to evaluate and select patients for APBI, as well as to define potential workflow mechanisms that allow for the safe and effective delivery of APBI. Multiple consensus statements have been developed to guide clinicians on determining appropriate candidates for APBI. However, recent studies have demonstrated that these guidelines fail to stratify patients according to the risk of local recurrence, and updated guidelines are expected in the years to come. Critical elements of workflow to ensure safe and effective delivery of APBI include a multidisciplinary approach and evaluation, optimization of target coverage and adherence to normal tissue guideline constraints, and proper quality assurance methods.J PurposeBreast conserving therapy, consisting of lumpectomy followed by 6 to 7 weeks of whole breast irradiation (WBI), has been shown in multiple randomized trials to produce equivalent clinical outcomes compared to mastectomy, as well as reduced breast cancer mortality when compared to lumpectomy alone [1,2,3,4]. However, the protracted nature of treatment can pose financial and logistical hardships on patients and medical systems [5,6,7]. Therefore, there has been increased interest in developing shorter treatment courses without compromising treatment efficacy, in particular local control. One such technique is accelerated partial breast irradiation (APBI), which covers the area surrounding the lumpectomy cavity with a margin and typically is completed in one week or less [8]. Multiple studies have compared APBI with WBI and have found equivalent rates of local control and thus, APBI has emerged as a viable, safe treatment option for properly selected patients with early stage breast cancer [9,10,11,12,13]. As interest in and the utilization APBI grows, a standardized approach to treatment and workflow is necessary for many groups. The purpose of this review is to provide clinicians with a guide on patient selection and treatment workflow for patients undergoing brachytherapy-based APBI. Discussion Patient selectionSociety-specific guidelines have utilized a combination of data from patients treated with APBI, data from patients treated with WBI including patterns of failure, and expert opinion to define appropriateness criteria for the utilization of APBI off-protocol (Table 1) [14,15,16,17]. The ASTRO consensus statement, published in 2009, is one of the most commonly utilized guidelines and uses clinical and pathologic features that stratify ...

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“…15 Some early results of APBI support the hypothesis that for a selected group of patients, whole breast irradiation is unnecessary. [16][17][18] The recently published results of the targeted intraoperative radiotherapy (TARGIT-A) trial also added strength to this argument. In the TARGIT-A trial, a single fraction of intraoperative radiotherapy restricted to the tumor bed is compared with the conventional WB-EBRT.…”

Section: Introductionmentioning

confidence: 99%

GammaPod—A new device dedicated for stereotactic radiotherapy of breast cancer

Shao

Zhang

et al. 2013

Medical Physics

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Purpose: This paper introduces a new external beam radiotherapy device named GammaPod that is dedicated for stereotactic radiotherapy of breast cancer. Methods:The design goal of the GammaPod as a dedicated system for treating breast cancer is the ability to deliver ablative doses with sharp gradients under stereotactic image guidance. Stereotactic localization of the breast is achieved by a vacuum-assisted breast immobilization cup with built-in stereotactic frame. Highly focused radiation is achieved at the isocenter due to the cross-firing from 36 radiation arcs generated by rotating 36 individual Cobalt-60 beams. The dedicated treatment planning system optimizes an optimal path of the focal spot using an optimization algorithm borrowed from computational geometry such that the target can be covered by 90%-95% of the prescription dose and the doses to surrounding tissues are minimized. The treatment plan is intended to be delivered with continuous motion of the treatment couch. In this paper the authors described in detail the gamma radiation unit, stereotactic localization of the breast, and the treatment planning system of the GammaPod system. Results: A prototype GammaPod system was installed at University of Maryland Medical Center and has gone through a thorough functional, geometric, and dosimetric testing. The mechanical and functional performances of the system all meet the functional specifications. Conclusions: An image-guided breast stereotactic radiotherapy device, named GammaPod, has been developed to deliver highly focused and localized doses to a target in the breast under stereotactic image guidance. It is envisioned that the GammaPod technology has the potential to significantly shorten radiation treatments and even eliminate surgery by ablating the tumor and sterilizing the tumor bed simultaneously.

show abstract

Twelve-year clinical outcomes and patterns of failure with accelerated partial breast irradiation versus whole-breast irradiation: Results of a matched-pair analysis

Cited by 119 publications

References 21 publications

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

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

Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow

GammaPod—A new device dedicated for stereotactic radiotherapy of breast cancer

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