APBI 3D Conformal External Beam: The NYU Technique

  • Daniela Gidea-Addeo
  • Silvia C. Formenti


In early breast cancer, the rationale of using postlumpectomy adjuvant radiation therapy is to eradicate microscopic residual disease present in the breast that could be a source of local recurrence. Based on results of multiple randomized trials, the standard radiotherapeutic regimen has consisted of a protracted course of daily treatments delivered to the entire breast Monday through Friday for 6–6 1/2 weeks. The long overall treatment time can be inconvenient to some patients, especially elderly women with difficulty in accessing radiation treatment facilities. To overcome the inconvenience and high cost of long radiation courses, attempts have been made to decrease the overall treatment time by administration of higher doses per fraction over a total shorter period. Accelerated partial breast irradiation is a potential alternative to conventional whole breast irradiation, delivering treatment over several days. Among the possible techniques available for accelerated partial breast irradiation is 3D conformal radiotherapy which delivers treatment BID over 5 days. This chapter provides an overview of our group’s approach to post-lumpectomy radiotherapy with 3D conformal radiotherapy.


Gross Tumor Volume Radiation Therapy Oncology Group Accelerate Partial Breast Irradiation Negative Surgical Margin Microscopic Residual Disease 
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  1. 1.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty year follow up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRefGoogle Scholar
  2. 2.
    Blichert-Toft M, Rose C, Andersen JA, 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
  3. 3.
    Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: The National Cancer Institute randomized trial. Cancer. 2003;98:697–702.PubMedCrossRefGoogle Scholar
  4. 4.
    van Dongen JA, Voogd AC, Fentiman IS, et al. Long term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:201043–50.Google Scholar
  5. 5.
    Fisher B, Anderson S, Bryant J, et al. Twenty year follow up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRefGoogle Scholar
  6. 6.
    Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: Long term results of a randomized trial. Ann Oncol. 2001; 12:997–1003.PubMedCrossRefGoogle Scholar
  7. 7.
    Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y; Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.Google Scholar
  8. 8.
    Perez C, Brady LW. Principles and practice of radiation oncology, 4th ed. Lippincott-Raven; Philadelphia, PA. 2003.Google Scholar
  9. 9.
    Schnitt SJ, Hayman J, Gelman R, et al. A prospective study of conservative surgery alone in the treatment of selected patients with stage I breast cancer. Cancer. 1996;77:1094–100.PubMedCrossRefGoogle Scholar
  10. 10.
    Freeman GM, Anderson PR, Hanlon AL, Eisenberg DF, Nicolaou N. Pattern of local recurrence after conservative surgery and whole breast irradiation. Int J Radiat Oncol Biol Phys. 2005;61(5):1328–36.CrossRefGoogle Scholar
  11. 2010.
    Ribeiro GG et al. Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5:278–83.CrossRefGoogle Scholar
  12. 12.
    Formenti SC et al. T1 stage breast cancer: adjuvant hypo fractionated conformal radiation therapy to tumor bed in selected postmenopausal breast cancer patients-pilot feasibility study. Radiology. 2002;222:171–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Formenti SC et al. Prone accelerated partial breast irradiation after breast-conserving surgery; preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys. 2004;60:493–504.PubMedCrossRefGoogle Scholar
  14. 14.
    Vicini F et al. A phase I/II trial to evaluate three-dimensional conformal radiation therapy confined to the region of the lumpectomy cavity for stage I/II breast carcinoma: initial report of feasibility and reproducibility of RTOG Study 0319. Int J Radiat Oncol Biol Phys. 2005;63:1531–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Rosenstein BS, Lymberis SC, Formenti SC. Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol Biol Phys. 2004;60(5):1393–404.PubMedCrossRefGoogle Scholar
  16. 16.
    Formenti SC. External-beam-based partial-breast irradiation. Nat Clin Pract Oncol. 2007;4(6):326–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Kozak KR, Smith BL, Taghian AG, et al. Accelerated partial-breast irradiation using proton beams: initial clinical experience. Int J Radiat Oncol Biol Phys. 2006;66(3):691–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Wernicke G, Gidea-Addeo D, Magnolfi C, Formenti S. External beam partial breast irradiation following breast-conserving surgery: Preliminary results of cosmetic outcome of NYU 0023 (abstract 54). Int J Radiat Oncol Biol Phys. 2006;66(Suppl S):S32.CrossRefGoogle Scholar
  19. 19.
    Vicini F, Remouchamps W, Wallace M, et al. Ongoing clinical experience utilizing 3D ­conformal external bean radiation therapy to deliver partial breast irradiation in patients with early stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2003;57:1247–53.PubMedCrossRefGoogle Scholar

Copyright information

© Springer New York 2010

Authors and Affiliations

  1. 1.Department of Radiation OncologyNew York University Cancer Institute, New York UniversityNew YorkUSA

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