Accelerated partial breast irradiation
Consensus statement of 3 German Oncology societies
Article first published online: 23 JUL 2007
Copyright © 2007 American Cancer Society
Volume 110, Issue 6, pages 1187–1194, 15 September 2007
How to Cite
Sauer, R., Sautter-Bihl, M.-L., Budach, W., Feyer, P., Harms, W., Souchan, R., Wollwiener, D., Kreienberg, R. and Wenz, F. (2007), Accelerated partial breast irradiation. Cancer, 110: 1187–1194. doi: 10.1002/cncr.22910
- Issue published online: 31 AUG 2007
- Article first published online: 23 JUL 2007
- Manuscript Accepted: 14 MAY 2007
- Manuscript Revised: 8 MAY 2007
- Manuscript Received: 26 MAR 2007
- breast cancer;
- whole breast irradiation;
- accelerated partial breast irradiation
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.
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.
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.
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.