Accelerated, Partial Breast Irradiation Overview

  • Amanda J. Wheeler
  • Frederick M. Dirbas
  • Kathleen C. Horst


The Halsted radical mastectomy was introduced in 1894 and became the standard of care for the surgical management of primary breast cancer. As mortality from breast cancer declined with this new treatment, women increasingly sought medical attention earlier in the natural history of the disease. This was associated with a progressive decrease in tumor size at presentation. The trend towards smaller lesions was further accelerated by the introduction of screening mammography. For some, this observation raised the question as to whether removal of the entire breast was necessary for all women. In the 1970’s, clinical trials in early stage breast cancer first began to demonstrate that breast conservation surgery followed by whole breast radiotherapy could provide equivalent survival to mastectomy as well as comparable local control. Subsequently, investigators questioned whether a parallel paradigm shift was possible from whole breast radiotherapy to partial breast irradiation. Although early clinical studies of partial breast irradiation demonstrated high rates of ipsilateral breast tumor recurrence, refinements in patient selection, breast conservation surgery technique, and radiation treatment planning have since yielded promising results with partial breast irradiation at 5 years of follow-up. This chapter provides an overview of ongoing efforts, including phase III clinical trials, designed to test the safety and efficacy of accelerated, partial breast irradiation.


Breast Conservation Surgery Breast Radiotherapy Breast Conservation Therapy Ipsilateral Breast Tumor Recurrence Partial Mastectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Veronesi U et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305(1):6–2010.PubMedCrossRefGoogle Scholar
  2. 2.
    Fisher B et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312(2010):665–73.PubMedCrossRefGoogle Scholar
  3. 3.
    Blichert-Toft M, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr. 1992;(2010):19–25.Google Scholar
  4. 4.
    Schroen AT et al. Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. J Clin Oncol. 2005;23(28):7074–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Recht A et al. Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int J Radiat Oncol Biol Phys. 1985;2010(7):1271–6.CrossRefGoogle Scholar
  6. 6.
    Clark R et al. Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992;84(9):683–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Anon. Sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. The Uppsala-Orebro Breast Cancer Study Group. J Natl Cancer Inst. 1990;82(23):1851.Google Scholar
  8. 8.
    Veronesi U et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001;12(7):997–1003.PubMedCrossRefGoogle Scholar
  9. 9.
    Fisher B, Anderson S. Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. National Surgical Adjuvant Breast and Bowel Project. World J Surg. 1994;18(1):63–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Jones B et al. The role of biologically effective dose (BED) in clinical oncology. Clin Oncol (R Coll Radiol). 2001;13(2):71–81.Google Scholar
  11. 2010.
    Morrow M. Rational local therapy for breast cancer. N Engl J Med. 2002;347(16):1270–1.PubMedCrossRefGoogle Scholar
  12. 12.
    Ribeiro G et al. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5(5):278–83.CrossRefGoogle Scholar
  13. 13.
    Fentiman IS, Poole C, Tong D, Winter PJ, Gregory WM, Mayles HM, et al. Inadequacy of iridium implant as sole radiation treatment for operable breast cancer. Eur J Cancer. 1996;32A(4):608–2010.PubMedCrossRefGoogle Scholar
  14. 14.
    King TA, Bolton JS, Kuske RR. Long term results of wide field brachytherapy as the sole method of radiation after segmental mastectomy for Tis, T1, T2 breast cancer. Am J Surg. 2000;180(4):299–304.PubMedCrossRefGoogle Scholar
  15. 15.
    Vicini FA, Chen PY, Fraile M, Gustafson GS, Edmundson GK, Jaffray DA, et al. Low-dose-rate brachytherapy as the sole radiation modality in the management of patients with early-stage breast cancer treated with breast-conserving therapy: preliminary results of a pilot trial. Int J Radiat Oncol Biol Phys. 1997;38(2):301–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Dirbas FM. Accelerated partial breast irradiation: where do we stand? J Natl Compr Canc Netw. 2009;7(2):215–25.PubMedGoogle Scholar
  17. 17.
    Dirbas FM, Jeffrey SS, Goffinet DR. The evolution of accelerated, partial breast irradiation as a potential treatment option for women with newly diagnosed breast cancer considering breast conservation. Cancer Biotherapy & Radiopharmaceuticals. 2004;19(6):673–705.PubMedGoogle Scholar

Copyright information

© Springer New York 2010

Authors and Affiliations

  • Amanda J. Wheeler
  • Frederick M. Dirbas
  • Kathleen C. Horst
    • 1
  1. 1.Department of Radiation OncologyStanford University School of MedicineStanfordUSA

Personalised recommendations