Annals of Surgical Oncology

, Volume 17, Supplement 3, pp 219–225 | Cite as

Five-year Outcome of Patients Classified in the “Unsuitable” Category Using the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel Guidelines for the Application of Accelerated Partial Breast Irradiation: An Analysis of Patients Treated on the American Society of Breast Surgeons MammoSite® Registry Trial

  • Peter Beitsch
  • Frank Vicini
  • Martin Keisch
  • Bruce Haffty
  • Simona Shaitelman
  • Maureen Lyden
American Society of Breast Surgeons



We applied the ASTRO Consensus Panel (CP) guidelines for the application of accelerated partial breast irradiation (APBI) to patients treated with this technique on the ASBS MammoSite® registry trial to determine potential differences in outcome of patients classified in the “unsuitable” category.


Of 1,449 cases treated with APBI on the registry trial, 176 fit the criteria for the unsuitable category: 130 cases were <50 years of age, 13 had positive margins, 38 had positive nodes, 6 had tumors >3 cm, and 9 had an EIC >3 cm. Rates of ipsilateral breast tumor recurrence (IBTR) and regional nodal failure (RNF) were assessed. Median follow-up was 53.6 months.


The 5-year actuarial rate of IBTR for unsuitable cases was 5.25% (RNF rate was 0.63%). By comparison, the 5-year actuarial IBTR rates for various subsets of patients were: all 1,449 cases, 3.89% (p = 0.2365); all 1,449 cases excluding unsuitable cases [n = 1,273] (3.6%, p = 0.1683); invasive only cases [n = 1,255] (3.86%, p = 0.2464); and invasive only cases excluding unsuitable invasive cases [n = 1,105] (3.89%, p = 0.2396). On univariate analysis for variables potentially associated with IBTR in all 1,255 cases with invasive cancer (including age, tumor size, nodal status, overall stage, margin status, ER status, presence of an EIC, and ASTRO unsuitable category), only negative ER (−) status was associated with the 5-year rate of IBTR (p = 0002). No other variable (including unsuitable CP designation) was associated with IBTR.


The ASTRO CP guideline designation of unsuitable did not differentiate a subset of patients with a significantly worse rate of IBTR when treated with the MammoSite® breast brachytherapy catheter to deliver APBI.


  1. 1.
    Swanson TA, Vicini FA. Overview of accelerated partial breast irradiation. Curr Oncol Rep. 2008;10:54–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Arthur DW, Vicini FA. Accelerated partial breast irradiation as a part of breast conservation therapy. J Clin Oncol. 2005;23:1726–35.CrossRefPubMedGoogle Scholar
  3. 3.
    Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med. 1995;333:1444–55.CrossRefGoogle Scholar
  4. 4.
    Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 2000;355:1757–70.CrossRefGoogle Scholar
  5. 5.
    Polgar C, Fodor J, Major T, Nemeth G, Lovey K, Orosz Z, 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;69:694–702.PubMedGoogle Scholar
  6. 6.
    Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg. 2009;209:269–77.CrossRefPubMedGoogle Scholar
  7. 7.
    Vicini F, Beitsch PD, Quiet CA, Keleher AJ, Garcia D, Snider HC Jr, et al. Three-year analysis of treatment efficacy, 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. 2008;112:758–66.CrossRefPubMedGoogle Scholar
  8. 8.
    Keisch M, Vicini F, Kuske RR, Hebert M, White J, Quiet C, et al. Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2003;55:289–93.PubMedGoogle Scholar
  9. 9.
    Vicini FA, Beitsch PD, Quiet CA, Keleher A, Garcia D, Snider HC, et al. First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer. 2005;104:1138–48.CrossRefPubMedGoogle Scholar
  10. 10.
    Keisch M, Vicini F. Applying innovations in surgical and radiation oncology to breast conservation therapy. Breast J. 2005;11(Suppl 1):S24–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Chao KK, Vicini FA, Wallace M, Mitchell C, Chen P, Ghilezan M, et al. Analysis of treatment efficacy, 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. 2007;69:32–40.PubMedGoogle Scholar
  12. 12.
    Patel RR, Christensen ME, Hodge CW, Adkison JB, Das RK. Clinical outcome analysis in “high-risk” versus “low-risk” patients eligible for national surgical adjuvant breast and bowel B-39/radiation therapy oncology group 0413 trial: 5-year results. Int J Radiat Oncol Biol Phys. 2008;70:970–3.PubMedGoogle Scholar
  13. 13.
    Antonucci JV, Wallace M, Goldstein NS, Kestin L, Chen P, Benitez P, et al. Differences in patterns of failure in patients treated with accelerated partial breast irradiation versus whole-breast irradiation: a matched-pair analysis with 10-year follow-up. Int J Radiat Oncol Biol Phys. 2009;74:447–52.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Peter Beitsch
    • 1
  • Frank Vicini
    • 2
  • Martin Keisch
    • 3
  • Bruce Haffty
    • 4
  • Simona Shaitelman
    • 2
  • Maureen Lyden
    • 5
  1. 1.SurgeryDallas Breast CenterDallasTexas
  2. 2.Radiation OncologyWilliam Beaumont HospitalRoyal OakUSA
  3. 3.Cancer HealthCare AssociatesUniversity of Miami HospitalMiamiUSA
  4. 4.Robert Wood Johnson University Hospital/Cancer Institute of New JerseyNew BrunswickUSA
  5. 5.BioStat International, IncTampaUSA

Personalised recommendations