GEC-ESTRO APBI classification as a decision-making tool for the management of 2nd ipsilateral breast tumor event

  • Lucile Montagne
  • Jocelyn Gal
  • Marie-Eve Chand
  • Renaud Schiappa
  • Alexander T. Falk
  • Rémy Kinj
  • Mathieu Gauthier
  • Jean-Michel Hannoun-LeviEmail author
Clinical trial



Second ipsilateral breast tumor event (2ndIBTE) occurring after primary radio-surgical treatment can be treated by either salvage mastectomy or 2nd conservative treatment (2ndCT) including an accelerated partial breast re-irradiation (APBrI). We analyzed the impact of the GEC-ESTRO APBI classification (GAC) on the oncological outcome after APBrI.

Materials and methods

Between 2000 and 2016, 159 patients (pts) underwent a 2ndCT. After lumpectomy, APBrI was performed using either low-dose (30–55 Gy reference isodose) or high-dose rate brachytherapy (28–34 Gy). Oncological outcome including 3rdIBTE, regional (RFS) or metastasis-free survival (MFS), specific (SS) and overall survival (OS) was analyzed according to GAC. Univariate (UVA) and multivariate analyses (MVA) were conducted to identify significant prognostic factors for 3rdIBTE.


With a median follow-up of 71 months (range 62–85 months), 60 pts (42%), 61 pts (42.7%) and 22 pts (15.4%) were classified as low-risk (LR), intermediate-risk (IR) and high-risk (HR), respectively. For the whole cohort, 6-year 3rdIBTE-free survival, RFS, MFS, SS and OS rates were 97.4, 96.4, 90.3, 92.9 and 91.2%, respectively. Six-year 3rdIBTE-free survival rates for LR, IR and HR were 100, 95.8 and 92.9%, respectively (p = 0.003), while no significant differences were found between the three GAC groups for RFS, MFS, SS. In UVA, lympho-vascular invasion (p = 0.009), positive margins (p = 0.0001) and GAC high-risk group (p = 0.001) were considered as significant prognostic factors for 3rdIBTE, while, in MVA, high-risk group (p = 0.009) was the only prognostic factor.


In case of 2ndIBTE, GAC could be used as a decision helping tool to discuss conservative or radical treatment options. Patient information remains crucial in order to accurately define the salvage therapy modalities.


Breast cancer Local recurrence Salvage treatment Partial breast irradiation Brachytherapy Treatment decision 


Compliance with ethical standards

Conflict of interest

JMHL is consultant for BEBIG Company. The other co-authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Antoine Lacassagne Cancer Center ethics committee.


  1. 1.
    Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2015) Reprint of: cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 51:1201–1202CrossRefGoogle Scholar
  2. 2.
    Bleyer A, Welch HG (2013) Effect of three decades of screening mammography on breast-cancer incidence: editorial comment. Obstet Gynecol Surv 68:440–442CrossRefGoogle Scholar
  3. 3.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefGoogle Scholar
  4. 4.
    Kurtz JM, Amalric R, Brandone H et al (1988) Results of wide excision for mammary recurrence after breast-conserving therapy. Cancer 61:1969–1972CrossRefGoogle Scholar
  5. 5.
    Maulard C, Housset M, Brunel P et al (1995) Use of perioperative or split-course interstitial brachytherapy techniques for salvage irradiation of isolated local recurrences after conservative management of breast cancer. Am J Clin Oncol 18:348–352CrossRefGoogle Scholar
  6. 6.
    Hannoun-Levi JM, Resch A, Gal J et al (2013) Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO Breast Cancer Working Group. Radiother Oncol 108:226–231CrossRefGoogle Scholar
  7. 7.
    Lee CNH, Pignone MP, Deal AM et al (2018) Accuracy of predictions of patients with breast cancer of future well-being after immediate breast reconstruction. JAMA Surg. Google Scholar
  8. 8.
    Polgár C, Van Limbergen E, Pötter R et al (2010) Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group. Radiother Oncol 94:264–273CrossRefGoogle Scholar
  9. 9.
    Smith BD, Arthur DW, Buchholz TA et al (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 74:987–1001CrossRefGoogle Scholar
  10. 10.
    Correa C, Harris EE, Leonardi MC et al (2017) Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol 7:73–79CrossRefGoogle Scholar
  11. 11.
    Hannoun-Levi JM, Castelli J, Plesu A et al (2011) Second conservative treatment for ipsilateral breast cancer recurrence using high-dose rate interstitial brachytherapy: preliminary clinical results and evaluation of patient satisfaction. Brachytherapy 10:171–177CrossRefGoogle Scholar
  12. 12.
    Chassagne D, Dutreix A, Ash D et al (1997) Introduction. J Int Comm Radiat Units Meas os30:1. Google Scholar
  13. 13.
    Gahbauer R, Landberg T, Chavaudra J et al (2004) References. J ICRU 4:95–100Google Scholar
  14. 14.
    Harris JR, Levene MB, Svensson G, Hellman S (1979) Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 5:257–261CrossRefGoogle Scholar
  15. 15.
    Hannoun-Levi J-M, Ihrai T, Courdi A (2013) Local treatment options for ipsilateral breast tumour recurrence. Cancer Treat Rev 39:737–741CrossRefGoogle Scholar
  16. 16.
    Trombetta M, Hannoun-Levi JM (2017) Treatment of second ipsilateral breast tumor event: a need for a new type of evidence for avoiding mastectomy. Eur J Surg Oncol 43:849–850CrossRefGoogle Scholar
  17. 17.
    Guix B, Lejárcegui JA, Tello JI et al (2010) Exeresis and brachytherapy as salvage treatment for local recurrence after conservative treatment for breast cancer: results of a ten-year pilot study. Int J Radiat Oncol Biol Phys 78:804–810CrossRefGoogle Scholar
  18. 18.
    Trombetta M, Hall M, Julian TB (2014) Long-term followup of breast preservation by re-excision and balloon brachytherapy after ipsilateral breast tumor recurrence. Brachytherapy 13:488–492CrossRefGoogle Scholar
  19. 19.
    Kraus-Tiefenbacher U, Bauer L, Scheda A et al (2007) Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer 7:1–7CrossRefGoogle Scholar
  20. 20.
    Thangarajah F, Heilmann J, Malter W et al (2018) Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy. Breast Cancer Res Treat 168:739–744CrossRefGoogle Scholar
  21. 21.
    Chin C, Jadeja P, Taback B et al (2017) Evaluation of partial breast reirradiation with intraoperative radiotherapy after prior thoracic radiation: a single-institution report of outcomes and toxicity. Front Oncol 7:1–6CrossRefGoogle Scholar
  22. 22.
    Blandino G, Guenzi M, Belgioia L et al (2017) Adjuvant intraoperative radiotherapy for selected breast cancers in previously irradiated women: evidence for excellent feasibility and favorable outcomes. Reports Pract Oncol Radiother 22:277–283CrossRefGoogle Scholar
  23. 23.
    Strnad V, Ott OJ, Hildebrandt G et al (2016) 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in situ carcinoma of the female breast: a ran. Lancet 387:229–238CrossRefGoogle Scholar
  24. 24.
    Lee CNH, Deal AM, Huh R et al (2017) Quality of patient decisions about breast reconstruction after mastectomy. JAMA Surg 152:741–748CrossRefGoogle Scholar
  25. 25.
    Wang L, Hong BY, Kennedy SA et al (2018) Predictors of unemployment after breast cancer surgery: a systematic review and meta-analysis of observational studies. J Clin Oncol 36:1868–1879CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyAntoine Lacassagne Cancer Center & University of Cote d’AzurNice CedexFrance
  2. 2.Biostatistic UnitAntoine Lacassagne Cancer Center & University of Cote d’AzurNiceFrance

Personalised recommendations