Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features.
OBJECTIVE
To evaluate outcomes among women with American Society for Radiation Oncology (ASTRO) consensus statement cautionary features treated with brachytherapy-based accelerated partial breast irradiation (APBI).


METHODS
Between March 2001 and June 2006, 322 consecutive patients were treated with high-dose-rate (HDR) APBI at the University of Wisconsin. A total of 136 patients were identified who met the ASTRO cautionary criteria. Thirty-eight (27.9%) patients possessed multiple cautionary factors. All patients received 32 to 34 Gy in 8 to 10 twice-daily fractions using multicatheter (93.4%) or Mammosite balloon (6.6%) brachytherapy.


RESULTS
With a median follow-up of 60 months, there were 5 ipsilateral breast tumor recurrences (IBTR), three local, and two loco-regional. The 5-year actuarial rate of IBTR was 4.8%±4.1%. The 5-year disease-free survival was 89.6%, with a cause-specific survival and overall survival of 97.6% and 95.3%, respectively. There were no IBTRs among 32 patients with ductal carcinoma in situ (DCIS) vs. 6.1% for patients with invasive carcinoma (p=0.24). Among 104 patients with Stage I or II invasive carcinoma, the IBTR rate for patients considered cautionary because of age alone was 0% vs. 12.7% in those deemed cautionary due to histopathologic factors (p=0.018).


CONCLUSIONS
Overall, we observed few local recurrences among patients with cautionary features. Women with DCIS and patients 50 to 59 years of age with Stage I/II disease who otherwise meet the criteria for suitability appear to be at a low risk of IBTR. Patients with tumor-related cautionary features will benefit from careful patient selection.
McHaffie
Derek R
DR
Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Patel
Rakesh R
RR
Adkison
Jarrod B
JB
Das
Rupak K
RK
Geye
Heather M
HM
Cannon
George M
GM
D005260:Female; D006801:Humans; D008875:Middle Aged; D000367:Age Factors; D001918:Brachytherapy / Q000379:methods / Q000592:standards; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018579:Patient Selection; D018787:Radiation Oncology / Q000592:standards; D012306:Risk; D012955:Societies, Medical / Q000592:standards; D047368:Tumor Burden; D014922:Wisconsin; D003245:Consensus Statements as Topic