Skip to main content

Advertisement

Log in

Locoregional Recurrence Following Accelerated Partial Breast Irradiation for Early-Stage Invasive Breast Cancer: Significance of Estrogen Receptor Status and Other Pathological Variables

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Understanding risk factors for locoregional recurrence (LRR) after accelerated partial breast irradiation (APBI) can help to guide patient selection for treatment with APBI. Published findings to date have not been consistent. More data are needed as these risk factors continue to be defined.

Methods

A total of 277 women with early-stage invasive breast cancer underwent lumpectomy and were treated adjuvantly at our institution with APBI using high-dose rate brachytherapy. APBI was delivered using multicatheter interstitial brachytherapy (91 %) or single-entry catheter brachytherapy (9 %) to a dose of 32–34 Gy in 8–10 twice daily fractions. Failure patterns and risk factors for recurrence were analyzed.

Results

With a median follow-up of 61 months, the 5-year locoregional control rate was 94.4 %. Negative estrogen receptor (ER) status was strongly associated with LRR on multivariate analysis (p < 0.005). Lobular histology, the presence of an extensive intraductal component, and lymphovascular invasion also were significant but to a lesser degree than ER-negative status. Patients with multiple risk factors were at highest risk for LRR. Age was not significantly associated with increased risk for LRR.

Conclusions

The presence of specific pathological features, particularly ER negative status, was associated with increased risk of LRR in this cohort of women treated with APBI. Further investigation is warranted to determine whether patients with adverse pathological risk factors are at higher risk of LRR after APBI than after conventional whole breast irradiation (WBI), as these same features also may place women at risk for LRR after WBI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pawlik TM, Buchholz TA, Kuerer HM. The biologic rationale for and emerging role of accelerated partial breast irradiation for breast cancer. J Am Coll Surg. 2004;199(3):479–92.

    Article  PubMed  Google Scholar 

  2. Abbott AM, Habermann EB, Tuttle TM. Trends in the use of implantable accelerated partial breast irradiation therapy for early stage breast cancer in the United States. Cancer. 2011;117(15):3305–10.

    Article  PubMed  Google Scholar 

  3. Husain ZA, Mahmood U, Hanlon A, et al. Accelerated partial breast irradiation via brachytherapy: a patterns-of-care analysis with ASTRO consensus statement groupings. Brachytherapy. 2011;10(6):479–85.

    Article  PubMed  Google Scholar 

  4. Smith GL, Xu Y, Buchholz TA, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA. 2012;307(17):1827–37.

    Article  PubMed  CAS  Google Scholar 

  5. Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56(5):979–90.

    Article  PubMed  CAS  Google Scholar 

  6. Polgar C, Fodor J, Major T, et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma–5-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007;69(3):694–702.

    Article  PubMed  Google Scholar 

  7. Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376(9735):91–102.

    Article  PubMed  Google Scholar 

  8. Bartelink H, Bourgier C, Elkhuizen P. Has partial breast irradiation by IORT or brachytherapy been prematurely introduced into the clinic? Radiother Oncol. 2012;104(2):139–42.

    Article  PubMed  Google Scholar 

  9. Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74(4):987–1001.

    Article  PubMed  Google Scholar 

  10. Polgar C, Van Limbergen E, Potter R, et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol. 2010;94(3):264–73.

    Article  PubMed  Google Scholar 

  11. Vicini F, Arthur D, Wazer D, et al. Limitations of the American Society of Therapeutic Radiology and Oncology Consensus Panel guidelines on the use of accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79(4):977–84.

    Article  PubMed  Google Scholar 

  12. Zauls AJ, Watkins JM, Wahlquist AE, et al. Outcomes in women treated with MammoSite brachytherapy or whole breast irradiation stratified by ASTRO Accelerated Partial Breast Irradiation Consensus Statement Groups. Int J Radiat Oncol Biol Phys. Oct 15 2010.

  13. McHaffie DR, Patel RR, Adkison JB, Das RK, Geye HM, Cannon GM. Outcomes after accelerated partial breast irradiation in patients with ASTRO Consensus Statement Cautionary Features. Int J Radiat Oncol Biol Phys. 2011;81(1):46–51.

    Article  PubMed  Google Scholar 

  14. Vicini F, Beitsch P, Quiet C, et al. Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79(3):808–17.

    Article  PubMed  Google Scholar 

  15. Wilkinson JB, Reid RE, Shaitelman SF, et al. Outcomes of breast cancer patients with triple negative receptor status treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;81(3):e159–64.

    Article  PubMed  Google Scholar 

  16. Ribeiro GG, Magee B, Swindell R, Harris M, Banerjee SS. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5(5):278–83.

    Article  PubMed  CAS  Google Scholar 

  17. Shah C, Wilkinson JB, Shaitelman S, et al. Clinical outcomes using accelerated partial breast irradiation in patients with invasive lobular carcinoma. Int J Radiat Oncol Biol Phys. 2011;81(4):e547–51.

    Article  PubMed  Google Scholar 

  18. Das RK, Patel R, Shah H, Odau H, Kuske RR. 3D CT-based high-dose-rate breast brachytherapy implants: treatment planning and quality assurance. Int J Radiat Oncol Biol Phys. 2004;59(4):1224–8.

    Article  PubMed  Google Scholar 

  19. Jones HA, Antonini N, Hart AA, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27(30):4939–47.

    Article  PubMed  Google Scholar 

  20. Ferraro DJ, Garsa AA, Dewees TA, et al. Comparison of accelerated partial breast irradiation via multicatheter interstitial brachytherapy versus whole breast radiation. Radiat Oncol. 2012;7(1):53.

    Article  PubMed  Google Scholar 

  21. Hattangadi-Gluth JA, Wo JY, Nguyen PL, et al. Basal subtype of invasive breast cancer is associated with a higher risk of true recurrence after conventional breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2012;82(3):1185–91.

    Article  PubMed  Google Scholar 

  22. Wilder RB, Curcio LD, Khanijou RK, et al. Results with accelerated partial breast irradiation in terms of estrogen receptor, progesterone receptor, and human growth factor receptor 2 status. Int J Radiat Oncol Biol Phys. 2010;78(3):799–803.

    Article  PubMed  Google Scholar 

  23. Strnad V, Hildebrandt G, Potter R, et al. Accelerated partial breast irradiation: 5-year results of the German-Austrian multicenter phase II trial using interstitial multicatheter brachytherapy alone after breast-conserving surgery. Int J Radiat Oncol Biol Phys. 2011;80(1):17–24.

    Article  PubMed  Google Scholar 

  24. Stull TS, Catherine Goodwin M, Gracely EJ, et al. A single-institution review of accelerated partial breast irradiation in patients considered “cautionary” by the American Society for Radiation Oncology. Ann Surg Oncol. 2012;19(2):553–9.

    Article  PubMed  Google Scholar 

Download references

Funding Support

Supported in part by a grant from Nucletron.

Disclosures

Rakesh R. Patel, M.D., has served on the advisory board of BrachySolutions, Inc., and has received consulting fees from Nucletron as an invited speaker and Cianna Medical as part of a speakers bureau. Other conflicts of interest: none.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Donald M. Cannon MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cannon, D.M., McHaffie, D.R., Patel, R.R. et al. Locoregional Recurrence Following Accelerated Partial Breast Irradiation for Early-Stage Invasive Breast Cancer: Significance of Estrogen Receptor Status and Other Pathological Variables. Ann Surg Oncol 20, 3446–3452 (2013). https://doi.org/10.1245/s10434-013-3015-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3015-5

Keywords

Navigation