Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
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Acknowledgement
The authors thank the numerous institutions, physicians, and health care personnel who enrolled patients in this trial.
Financial support
The MammoSite® Breast Brachytherapy Registry Trial was supported in part by a grant from Cytyc Corporation, a Hologic Company, to the American Society for Breast Surgeons and BioStat International.
Conflict of interest
There are no conflicts of interest to declare except Martin Keisch, M.D.: Consultant/Advisory Board, Hologic, Inc., Bedford, Massachusetts.
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Beitsch, P., Vicini, F., Keisch, M. et al. 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. Ann Surg Oncol 17 (Suppl 3), 219–225 (2010). https://doi.org/10.1245/s10434-010-1231-9
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DOI: https://doi.org/10.1245/s10434-010-1231-9