Accelerated partial breast irradiation: consensus statement of 3 German Oncology societies.
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.
Sauer
Rolf
R
Department of Radiation Oncology, University of Erlangen, Erlangen, Germany. sekretariat@strahlen.imed.uni-erlangen.de
Sautter-Bihl
Marie-Luise
ML
Budach
Wilfried
W
Feyer
Petra
P
Harms
Wolfgang
W
Souchan
Rainer
R
Wollwiener
Diethelm
D
Kreienberg
Rolf
R
Wenz
Frederik
F
D001918:Brachytherapy / Q000295:instrumentation; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D032921:Consensus; D005260:Female; D005858:Germany; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental; D010315:Particle Accelerators; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000295:instrumentation / Q000379:methods; D020266:Radiotherapy, Conformal; D012955:Societies, Medical