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Accelerated partial breast irradiation
Author(s) -
Sauer Rolf,
SautterBihl MarieLuise,
Budach Wilfried,
Feyer Petra,
Harms Wolfgang,
Souchan Rainer,
Wollwiener Diethelm,
Kreienberg Rolf,
Wenz Frederik
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22910
Subject(s) - medicine , breast cancer , radiation therapy , brachytherapy , external beam radiotherapy , breast conserving surgery , randomized controlled trial , medical physics , radiology , nuclear medicine , surgery , cancer , mastectomy
BACKGROUND. Breast‐conserving surgery followed by whole‐breast radiotherapy (WBRT) has become the standard treatment for the majority of patients with early breast cancer. Whereas the indications for systemic adjuvant treatment have continuously expanded, there is a tendency to restrict postoperative radiotherapy to accelerated partial breast irradiation (APBI) instead of WBRT. METHODS. The different techniques of APBI are described and their respective advantages or potential drawbacks outlined. Moreover, the results described in the literature are briefly reviewed as a basis for the consensus statements and recommendations of the German Society of Radiation Oncology, the German Society of Senology, and the Working Group for Gynecological Oncology of the German Cancer Society. RESULTS. The methods mainly used for APBI are: interstitial radiotherapy with multicatheter technique, intraoperative radiotherapy (IORT) using either electrons produced by linear accelerators or 50 kV x‐rays (Intrabeam), the balloon‐catheter technique (MammoSite), or 3D conformal external beam radiotherapy. These techniques have marked differences in dose distribution and homogeneity. The published range of local recurrence rates varies between 0% to 37%, the median follow‐up from 8 to 72 months. CONCLUSIONS. To date, follow‐up times mostly do not yet permit a definite judgment concerning the long‐term effectiveness and side effects of APBI. The relevant societies in Germany support randomized clinical studies comparing APBI with WBRT in a well‐defined subset of low‐risk patients. However, the authors expressly discourage the routine use of APBI outside clinical trials. Until definite results show that APBI neither impairs therapeutic outcome nor cosmetic results, WBRT remains the gold standard in the treatment of early breast cancer. Cancer 2007. © 2007 American Cancer Society.