title: Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features.
abstract: 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.
authors: Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
authors: Derek R
authors: DR
authors: McHaffie
authors: Rakesh R
authors: RR
authors: Patel
authors: Jarrod B
authors: JB
authors: Adkison
authors: Rupak K
authors: RK
authors: Das
authors: Heather M
authors: HM
authors: Geye
authors: George M
authors: GM
authors: Cannon
mesh_terms: 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