ASTRO Expands Guidelines for Treatment of Breast Cancer with Accelerated Partial Breast Irradiation

According to the American Society for Radiation Oncology (ASTRO) younger patients with early stage breast cancer and individuals with low-risk ductal carcinoma in situ (DCIS) can appropriately be treated with accelerated partial breast irradiation (APBI).

Many women with early-stage breast cancer are already eligible for acceler­ated partial breast irradiation (APBI), which delivers a dose of radiation from within the breast. These carefully selected patients may achieve similar tumor control following shorter, targeted schedules of radiation as they would with weeks of radiation to the whole breast. The benefits of this targeted approach to radia­tion delivery include reduced radia­tion exposure to healthy tissue, bet­ter cosmetic results, and fewer side effects. Additionally, brachytherapy may allow for more treatment op­tions in the event of a future recur­rence or new primary cancer.

The updated ASTRO statement decreases the age from 60 t0 50 as “suitable” for APBI. The expert panel believes that women younger than 40 remain unsuitable for APBI.

The update extended the option of APBI to women with low-risk DCIS, defined as screen-detected disease, low to intermediate nuclear grade, tumor size ?2.5 cm, and negative surgical margins ?3 mm.

Brachytherapy provides a targeted approach to breast cancer treatment. With breast brachytherapy, radiation treats only the portions of the breast around where the tumor was before surgery (generally the lumpectomy cavity, plus one to two centimeters beyond the surgical edge). This minimizes unnecessary radiation to other parts of the body. The rationale behind breast brachytherapy is to intensify treatment to the area most at risk for recurrence, treating just the affected part of the breast to control the cancer, reduce side effects, and improve overall quality of life.

Brachytherapy has a shorter treatment time than traditional radiation. Brachytherapy is a four- or five-day treatment. One week of treatment instead of the traditional six weeks of full-breast radiation allows you to more quickly get back to your work, family, and friends. The shorter duration also benefits women who must travel long distances to the oncologist and those who might have other medical issues.

Breast brachytherapy leads to significantly better cosmetic outcomes.2

Reference:

  1. Correa C, et al “Accelerated partial breast irradiation: Update of an ASTRO evidence-based consensus statement” Pract Radiat Oncol 2016; DOI: 10.1016/j.prro.2016.09.007.
  2. A randomized European trial with more than 10 years of follow-up showed equivalent local control and significantly better cosmetic outcomes for breast brachytherapy.

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