Accelerated partial breast irradiation (APBI) may prove to be an exciting advance in breast cancer treatment, in that APBI reduces the six-week traditional course of whole breast radiation to a one-week schedule. This schedule is more convenient for most patients and may allow for a breast-conserving approach for patients who are unable to come to a facility for the more protracted course of whole breast treatment. However, it is important to note that the benefits of whole breast treatment have been well defined through at least two decades of study. It is clear that this whole breast irradiation is highly effective at reducing the risk of breast recurrence, and importantly, by reducing this risk, improves overall survival. While it is possible that APBI may be able to achieve similar excellent outcomes in appropriately selected patients, to date, the popular APBI techniques such as balloon-based brachytherapy and external-beam radiation do not have five-year outcome data. Accordingly, there remains some uncertainty regarding the safety and efficacy of these techniques. Fortunately, a number of prospective randomized trials comparing APBI and whole breast radiation are meeting accrual goals and will be able to define the role of APBI in breast cancer management.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
American Society of Breast Surgeons (2008) Consensus statement for accelerated partial breast irradiation. http://www.breastsurgeons.org/officialstmts/officialstmt3.html, accessed 24 June 2008
Arthur D, Vicini F, Kuske RR, et al. (2003) Accelerated partial breast irradiation: an updated report from the American Brachytherapy Society. Brachytherapy 2:124–130
Arthur DW, Winter K, Kuske RR, et al. (2008) A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 9517. Int J Radiat Oncol Biol Phys 72:467–473
Athas WF, Adams-Cameron M, Hunt WC, et al. (2000) Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst 92(3):269–271
Bartelink H, Horiot JC, Poortmans, et al. (2002) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. J Clin Oncol 20:4141–4149
Bedrosian I, Mick R, Orel SG, et al. (2003) Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 98:468–473
Bentzen SM, Turesson I, Thames HD (1990) Fractionation sensitivity and latency of telangiectasia after postmastectomy radiotherapy: a graded-response analysis. Radiother Oncol 18:95–106
Bluemke D, Gatsonis CA, Chen MH, et al. (2004) Magnetic resonance imaging of the breast prior to biopsy. JAMA 292(22):2735–2742
Borghero YO, Salehpour M, McNeese MD, et al. (2007) Multileaf field-in-field forward-planned intensity-modulated dose compensation for whole-breast irradiation is associated with reduced contralateral breast dose: a phantom model comparison. Radiother Oncol 82:324–328
Buchholz TA (2003) Partial breast irradiation: is it ready for prime time? Int J Radiat Oncol Biol Phys 57(5):1214–1216
Buchholz TA, Kuerer HM, Strom Buchholz EA (2005) Is partial breast irradiation a step forward or backward? Semin Radiat Oncol 15(2):69–75
Cabioglu N, Hunt KK, Buchholz TA, et al. (2005) Improving local control with breast-conserving therapy: a 27-year single-institution experience. Cancer 104(1):20–29
Clark RM, McCulloch PB, Levine MN, et al. (1992) Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst 84:683–689
Dewar JA, Haviland JS, Agrawal RK, et al. (2007) Hypofractionation for early breast cancer: first results of the UK standardization of breast radiotherapy (START) trials. Proc Am Soc Clin Oncol 25(18):LBA518
Donovan E, Bleakley N, Denholm E, et al. (2007) Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 82:254–264
Early Breast Cancer Trialists' Collaborative Group (2005) 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 366:2087–2106
Farrow DC, Hunt WC, Samet JM (1992) Geographic variation in the treatment of localized breast cancer. N Engl J Med 326:1097–1101
Faverly DR, Hendriks JH, Holland R (2001) Breast carcinomas of limited extent: frequency, radiologic— pathologic characteristics, and surgical margin requirements. Cancer 91:647–659
Fentiman IS, Poole C, Tong D, et al. (1991) Iridium implant treatment without external radiotherapy for operable breast cancer: a pilot study. Eur J Cancer 27(4):447–450
Fentiman IS, Poole C, Tong D, et al. (1996) Inadequacy of iridium implant as sole radiation treatment for operable breast cancer. Eur J Cancer 32A:608–611
Fisher B, Anderson S, Bryant J, et al. (2002a) 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 347:1233–1241
Fisher B, Bryant J, Dignam JJ, et al. National Surgical Adjuvant Breast and Bowel Project (2002b) Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol 20:4141–4149
Formenti SC, Truong MT, Goldberg JD, et al. (2004) Prone accelerated partial breast irradiation after breast-conserving surgery: Preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 60:493–504
Giordano SH, Kuo YF, Freeman JL, et al. (2005) Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 97:419–424
Holland R, Veling SH, Mravunac M, et al. (1985) Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5): 979–990
Imamura H, Haga S, Shimizu T, et al. (2000) Relationship between the morphological and biological characteristics of intraductal components accompanying invasive ductal breast carcinoma and patient age. Breast Cancer Res Treat 62(3):177–184
King TA, Bolton JS, Kuske RR, et al. (2000) Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer. Am J Surg 180(4):299–304
Liljegren G, Holmberg L, Bergh J, et al. (1999) 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol 17:2326–2333
Magee B, Young EA, Swindell R (1998) Patterns of breast relapse following breast conserving surgery and radiotherapy. Br J Cancer 78(Suppl 2):24, Abstract O69
McCormick B (2003) The politics and the ethics of breast cancer. Brachytherapy 2(2):119–120
Nattinger AB, Hoffmann RG, Kneusel RT, et al. (2000) Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery. Lancet 356:1148–1153
Patt DA, Goodwin JS, Kuo YF, et al. (2005) Cardiac morbidity of adjuvant radiotherapy for breast cancer. J Clin Oncol 23:7475–7482
Perera F, Yu E, Engel J, et al. (2003) Patterns of breast recurrence in a pilot study of brachytherapy confined to the lumpectomy site for early breast cancer with six years' minimum follow-up. Int J Radiat Oncol Biol Phys 57:1239–1246
Pignol JP, Olivotto I, Rakovitch E, et al. (2008) A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 26:2085–2092
Polgar C, Major T, Fodor J, et al. (2004) High-dose-rate brachytherapy alone versus whole-breast radiotherapy with or without tumor bed boost after breast-conserving surgery: seven-year results of a comparative study. Int J Radiat Oncol Biol Phys 60(4):1173–1181
Ravdin PM, Siminoff IA, Harvey JA (1998) Survey of breast cancer patients concerning their knowledge and expectations of adjuvant therapy. J Clin Oncol 16:515–521
Romestaing P, Lehingue Y, Carrie C, et al. (1997) Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol 15(3):963–968
Rosenstein BS, Lymberis SC, Formenti SC (2004) Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol Biol Phys 60(5):1393–1404
Suh WW, Pierce LJ, Vicini FA, et al. (2003) Comparing the cost of partial versus whole-breast irradiation following breast conserving surgery for early-stage breast cancer. Breast Cancer Res Treat (Abstract) 82:S181
Vaidya JS, Vyas JJ, Chinoy RF et al. (1996) Multicentricity of breast cancer: whole-organ implications. Br J Cancer 74:820–824
Vaidya JS, Tobias JS, Baum M, et al. (2004) Intraoperative radiotherapy for breast cancer. Lancet Oncol 5:165–173
Veronesi U, Marubini E, Mariani L, et al. (2001) Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 12:997–1003
Veronesi U, Gatti G, Luini A, et al. (2003) Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery. Arch Surg 138:1253–1256
Vicini FA, Kestin L, Chen P, et al. (2003a) Limited-field radiation therapy in the management of early-stage breast cancer. J Natl Cancer Inst 95:1205–1210
Vicini FA, Remouchamps V, Wallace M, et al. (2003b) Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 57:1247–1253
Vicini FA, Antonucci JV, Wallace M, et al. (2007) Long-term efficacy and patterns of failure after accelerated partial breast irradiation: a molecular assay-based clonality evaluation. Int J Radiat Oncol Biol Phys 68(2):341–346
Vicini F, Beitsch PD, Quiet CA, et al. (2008) 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 112(4):758–766
Vinh-Hung V, Verschraegen C (2004) Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 96:115–121
Whelan T, McKenzie R, Julian J, et al. (2002) Randomized trial of breast irradiation schedules after lumpectomy for women with node-negative breast cancer. J Natl Cancer Inst 94: 1143–1150
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Buchholz, T.A., Strom, E.A. (2009). Accelerated Partial Breast Irradiation: History, Rationale, and Controversies. In: Wazer, D.E., Arthur, D.W., Vicini, F.A. (eds) Accelerated Partial Breast Irradiation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88006-6_1
Download citation
DOI: https://doi.org/10.1007/978-3-540-88006-6_1
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-88005-9
Online ISBN: 978-3-540-88006-6
eBook Packages: MedicineMedicine (R0)