title: Five-year outcome of patients classified using the American Society for Radiation Oncology consensus statement guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial.
abstract: BACKGROUND
  The American Society for Radiation Oncology (ASTRO) consensus statement (CS) for the application of accelerated partial breast irradiation (APBI) was applied to patients who were treated with this technique on the American Society of Breast Surgeons MammoSite Registry Trial to determine potential differences in clinical outcome based on classification group.
  
  
  METHODS
  Patients were classified based on the CS groups of "suitable," "cautionary," and "unsuitable." Rates of ipsilateral breast tumor recurrence (IBTR), regional lymph node failure, distant metastases, disease-free survival, cause-specific survival, and overall survival were assessed.
  
  
  RESULTS
  Of the 1449 cases who were treated, 1025 patients (71%) could be classified according to the CS groupings, including 419 patients (41%) who fit the "suitable" criteria, 430 patients (42%) who fit the "cautionary" criteria, and 176 patients (17%) who fit the "unsuitable" criteria. At a median follow-up of 53.5 months, the 5-year actuarial rates of IBTR for the "suitable," "cautionary," and "unsuitable" groups were 2.59%, 5.43%, and 5.28%, respectively (P = .1884). Univariate analysis of factors potentially associated with IBTR indicated that negative estrogen receptor status was the only variable associated with IBTR among patients with invasive breast cancer (odds ratio [OR], 4.01; P = .0003). Larger tumor size was associated with a greater risk of distant metastasis (OR, 3.05; P = .0001). Among patients with ductal carcinoma in situ, only age <50 years and close-positive margins were associated with IBTR (OR, 1.12 [P = .0079] and OR, 7.81 [P = .0131], respectively).
  
  
  CONCLUSIONS
  The ASTRO CS groupings did not differentiate a subset of patients with a significantly worse rate of IBTR when they were treated with the MammoSite breast brachytherapy catheter to deliver APBI.
authors.affiliation: Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont Hospital, Royal Oak, Michigan 48072, USA.
authors.forename: Simona F
authors.initials: SF
authors.lastname: Shaitelman
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
authors.forename: Peter
authors.initials: P
authors.lastname: Beitsch
authors.forename: Bruce
authors.initials: B
authors.lastname: Haffty
authors.forename: Martin
authors.initials: M
authors.lastname: Keisch
authors.forename: Maureen
authors.initials: M
authors.lastname: Lyden
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D001918:Brachytherapy / Q000379:methods; D001943:Breast Neoplasms / Q000532:radiotherapy; D002986:Clinical Trials as Topic; D018579:Patient Selection; D016896:Treatment Outcome; D003245:Consensus Statements as Topic