Accelerated partial breast irradiation after conservative surgery for breast cancer.
OBJECTIVE
To critically review the theoretical and actual risks and benefits of accelerated partial breast irradiation (APBI) after breast-conserving surgery.


BACKGROUND
Because of rapid evolution of radiation therapy techniques related to brachytherapy and three-dimensional conformal radiation therapy, APBI has very recently come to the forefront as a potential local treatment option for women with breast cancer. This review aims to give an overview of the biologic rationale for APBI techniques, and benefits and limitations of APBI techniques.


METHODS
The authors reviewed the currently available published world medical literature on breast-conserving surgery with and without postoperative irradiation; all studies involving partial breast irradiation, including brachytherapy, for breast cancer; and currently accruing and planned APBI trials. The focus of this review was the early results of treatment in terms of toxicity, complications, cosmesis, and local control.


RESULTS
On average, approximately 3% of patients treated with breast-conserving surgery will have an in-breast local recurrence away from the original lumpectomy site with or without postoperative standard whole-breast irradiation. The results of phase I-II studies involving approximately 500 patients treated with APBI after breast-conserving surgery have been published. Although many of the studies have limited long-term follow-up and potential selection bias, early results suggest that toxicity, cosmesis, and local control are comparable to outcomes seen after breast-conserving surgery followed by standard whole-breast irradiation.


CONCLUSIONS
Recent advances in radiation delivery and published series of partial breast irradiation support large randomized trials comparing APBI with standard whole-breast irradiation after breast-conserving surgery.
Kuerer
Henry M
HM
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. hkuerer@mdanderson.org
Julian
Thomas B
TB
Strom
Eric A
EA
Lyerly
H Kim
HK
Giuliano
Armando E
AE
Mamounas
Eleftherios P
EP
Vicini
Frank A
FA
D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000532:radiotherapy; D020266:Radiotherapy, Conformal; D012307:Risk Factors; D013997:Time Factors