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An Overview of European Clinical Trials of APBI

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In the last two decades, there has been an increasing interest in Europe in treating selected patients with early-stage breast cancer with accelerated partial breast irradiation (APBI) using interstitial or intracavitary (MammoSite) brachytherapy. In this chapter, we give an overview of these European clinical trials of APBI, including their implications for optimal patient selection, target definition, treatment technique, and quality assurance. Finally, we will discuss the development and status of the new European multicentric Phase III APBI trial conducted by the Breast Cancer Working Group of the Groupe Européen de Curiethérapie—European Society for Therapeutic Radiology and Oncology (GEC-ESTRO).

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References

  • Benitez PR, Keisch ME, Vicini F, et al. (2007) Five-year results: the initial clinical trial of Mammosite balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am J Surg 194:456–462

    Article  PubMed  Google Scholar 

  • Chao KK, Vicini FA, Wallace M, et al. (2007) Analysis of treatment effi cacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial-breast irradiation: the William Beaumont Hospital experience. Int J Radiat Oncol Biol Phys 69:32–40

    PubMed  Google Scholar 

  • Chen S, Dickler A, Kirk M, et al. (2007) Patterns of failure after MammoSite brachytherapy partial breast irradiation: a detailed analysis. Int J Radiat Oncol Biol Phys 69:25–31

    PubMed  Google Scholar 

  • Cionini L, Marzano S, Pacini P, et al. (1995) Iridium implant of the surgical bed as the sole radio-therapeutic treatment after conservative surgery for breast cancer (abstract). Radiother Oncol 35 (Suppl.):S1

    Google Scholar 

  • Clark RM, Whelan T, Levine R (1996) Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. J Natl Cancer Inst 88:1659–1654

    Article  PubMed  CAS  Google Scholar 

  • Clarke DH, Vicini F, Jacobs H, et al. (1994) High dose rate brachytherapy for breast cancer. In: Nag S (ed) High dose rate brachytherapy: a textbook. Futura, Armonk, pp 321–329

    Google Scholar 

  • Cuttino LW, Keisch M, Jenrette JM, et al. (2008) Multi-institutional experience using the MammoSite Radiation Therapy System in the treatment of early-stage breast cancer: 2-year results. Int J Radiat Oncol Biol Phys Biol 71:107–114

    Google Scholar 

  • Edmundson GK, Vicini F, Chen P, et al. (2002) Dosimetric characteristics of the MammoSite RTS, a new breast brachytherapy applicator. Int J Radiat Oncol Biol Phys 4:1132–1139

    Google Scholar 

  • Fentiman IS, Poole C, Tong PJ, et al. (1991) Iridium implant treatment without external radiotherapy for operable breast ancer: a pilot study. Eur J Cancer 27:447–450

    Article  PubMed  CAS  Google Scholar 

  • Fentiman IS, Poole C, Tong D, et al. (1996) Inadequacy of iridium implant as a sole radiation treatment for operable breast cancer. Eur J Cancer 32A:608–611

    Article  PubMed  CAS  Google Scholar 

  • Fentiman IS, Deshmane V, Tong D, et al. (2004) Caesium-137 implant as sole radiation therapy for operable breast cancer: a phase II trial. Radiother Oncol 71:281–285

    Article  PubMed  CAS  Google Scholar 

  • Dragun AE, Harper JL, Jenrette JM, et al. (2007) Predictors of cosmetic outcome following MammoSite breast brachytherapy: a single-institution experience of 100 patients with two years of follow-up. Int J Radiat Oncol Biol Phys. 68:354–358

    Google Scholar 

  • Jacobson JA, Danforth DN, Cowan KH (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332:907–911

    Article  PubMed  CAS  Google Scholar 

  • Johansson B, Karlsson L, Liljegren G, et al. (2008) Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1—T2 breast cancer: First long time results from a clinical study. Radiother Oncol 90(1):30–35

    Article  PubMed  Google Scholar 

  • Lövey K, Nemeskéri C, Mayer A. (1994) Analysis of local recurrences developed after conservative surgery of breast cancer (in Hungarian). Magyar Onkológia 38:179–183

    Google Scholar 

  • Lövey K, Fodor J, Major T, et al. (2007) Fat necrosis after partial-breast irradiation with brachyther-apy or electron irradiation versus standard whole-breast radiotherapy: 4-year results of a randomized trial. Int J Radiat Oncol Biol Phys 69:724–731

    PubMed  Google Scholar 

  • Magee B, Swindell R, Harris M, et al. (1996) Prognostic factors for breast recurrence after conservative breast surgery and radiotherapy: results of a randomised trial. RadiotherOncol 39:223–227

    Article  CAS  Google Scholar 

  • Major T, Niehoff P, Kovács G, et al. (2006) Dosimetric comparisons between high dose rate interstitial and MammoSite balloon brachytherapy for breast cancer. Radiother Oncol 79:321–328

    Article  PubMed  Google Scholar 

  • Mayer A, Nemeskéri C (1993) Forms of radiotherapy complementing operations of reduced radi-cality for early cancer of the breast (prospective clinical study) (in Hungarian). Magyar Sebészet 46:65–68

    Google Scholar 

  • Niehoff P, Ballardini B, Polgár C, et al. (2006a) Early European experience with the MammoSite Radiation Therapy System for partial breast brachytherapy following breast conservation operation at low risk breast cancer. Breast 15:319–325

    Article  Google Scholar 

  • Niehoff P, Polgár C, Ostertag H, et al. (2006b) Clinical experience with the MammoSite® Radiation Therapy System for intracavitary brachytherapy of breast cancer: results from an iternational phase II trial. Radiother Oncol 79:316–320

    Article  Google Scholar 

  • Niehoff P, Polgár C, Kovács G (2006c) In regard to Belkacémi and Vicini: High-dose brachyther-apy using the MammoSite applicator “…Give me your hand, and let the subject see, to make them know”. Radiother Oncol 82:355–356

    Article  Google Scholar 

  • Ott OJ, Pötter R, Hammer J, et al. (2004) Accelerated partial breast irradiation with Iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German—Austrian multicenter trial. Strahlenther Onkol 180:642–649

    Article  PubMed  Google Scholar 

  • Ott OJ, Schulz-Wendtland R, Uter W, et al. (2005) Fat necrosis after breast conserving surgery and interstitial brachytherapy and/or external beam irradiation in women with breast cancer. Strahlenther Onkol 181:638–644

    Article  PubMed  Google Scholar 

  • Ott OJ, Hildebrandt G, Pötter R, et al. (2007) Accelerated partial breast irradiation with multi-catheter brachytherapy: Local control, side effects and cosmetic outcome for 274 patients. Results of the German–Austrian multi-centre trial. Radiother Oncol 82:281–286

    Article  PubMed  Google Scholar 

  • Pass H, Vicini FA, Kestin LL, et al. (2004) Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast-conserving therapy at a single institution. Cancer 101:713–720

    Article  PubMed  Google Scholar 

  • Polgár C, Sulyok Z, Fodor J, et al. (2002) Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: Five-year results of a phase I–II study and initial fi ndings of a randomized phase III trial. J Surg Oncol 80:121–128

    Article  PubMed  Google Scholar 

  • Polgár C, Major T, Fodor J, et al. (2004a) HDR brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast conserving surgery: seven-year results of a comparative study. Int J Radiat Oncol Biol Phys 60:1173–1181

    Google Scholar 

  • Polgár C, Major T, Strnad V, et al. (2004b) What can we conclude from the results of an out-of-date breast-brachytherapy study? (Letter). Int J Radiat Oncol Biol Phys 60:342–343

    Article  Google Scholar 

  • Polgár C, Strnad V, Major T (2005) Brachytherapy for partial breast irradiation: the European experience. Semin Radiat Oncol 15:116–122

    Article  PubMed  Google Scholar 

  • Polgár C, Fodor J, Major T, et al. (2007) 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 69:694–702

    PubMed  Google Scholar 

  • Polgár C, Major T, Lövey K, et al. (2008) Hungarian experience on partial breast irradiation versus whole breast irradiation: 12-year results of a phase II trial and updated results of a randomized study (abstract). Brachytherapy 7:91–92

    Article  Google Scholar 

  • Póti Z, Nemeskéri C, Fekésházy A, et al. (2004) Partial breast irradiation with interstitial 60Co brachytherapy results in frequent grade 3 or 4 toxicity: evidence based on a 12-year follow-up of 70 patients. Int J Radiat Oncol Biol Phys 58:1022–1033

    PubMed  Google Scholar 

  • Ribeiro GG, Magee B, Swindell R, et al. (1993) The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol 5:278–283

    Article  CAS  Google Scholar 

  • Samuel LM, Dewar JA, Preece PE, et al. (1999) A pilot study of radical radiotherapy using a perioperative implant following wide local excision for carcinoma of the breast. Breast 8:95–97

    Article  Google Scholar 

  • Strnad V, Ott OJ, Pötter R, et al. (2004) Interstitial brachytherapy alone after breast conserving surgery: interim results of a German–Austrian multicenter phase II trial. Brachytherapy 3:115–119

    Article  PubMed  Google Scholar 

  • Turreson I (1990) Individual variation and dose dependency in the progression rate of skin telangi-ectasia. Int J Radiat Oncol Biol Phys 19:1569–1574

    Google Scholar 

  • Van Dongen JA, Bartelink H, Fentiman IS (1992) Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 Trial. J Natl Cancer Inst Monogr 11:15–18

    PubMed  Google Scholar 

  • Van Limbergen E, van den Bogaert W, van der Schueren E et al. (1987) Tumor excision and radiotherapy as primary treatment of breast cancer. Analysis of patient and treatment parameters and local control. Radiother Oncol 8:1–9

    Article  PubMed  Google Scholar 

  • Van Limbergen E, Rijnders A, van der Schueren E et al. (1989) Cosmetic evaluation of breast conserving treatment for mammary cancer. II. A quantitative analysis of the infl uence of radiation dose, fractionation schedules and surgical treatment techniques on cosmetic results after tumor excision and radiotherapy. Radiother Oncol 16:253–267

    Article  PubMed  Google Scholar 

  • Van Limbergen E, Briot E, Drijkoningen M (1990) The source—skin distance measuring bridge: a method to avoid radiation teleangiectasia in the skin after interstitial therapy for breast cancer. Int J Radiat Oncol Biol Phys 18:1239–1244

    PubMed  Google Scholar 

  • Vicini FA, Arthur DW, Edmundson G (2004) In regard to Póti et al. (letter). Int J Radiat Oncol Biol Phys 60:345

    Article  PubMed  Google Scholar 

  • Vicini FA, Beitsch PD, Quiet CA, et al. (2008) Three-year analysis of treatment effi cacy, cosmesis, and toxicity by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation (APBI). Cancer 112:758–766

    Article  PubMed  Google Scholar 

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Correspondence to Csaba Polgár .

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Polgár, C. et al. (2009). An Overview of European Clinical Trials of APBI. In: Wazer, D.E., Arthur, D.W., Vicini, F.A. (eds) Accelerated Partial Breast Irradiation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88006-6_9

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  • DOI: https://doi.org/10.1007/978-3-540-88006-6_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-88005-9

  • Online ISBN: 978-3-540-88006-6

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