title: Accelerated partial breast irradiation: An update on published Level I evidence.
abstract: Multiple adjuvant radiation therapy options currently exist for women following breast-conserving surgery including standard fractionated whole breast irradiation (WBI), accelerated whole breast irradiation (AWBI), and accelerated partial breast irradiation (APBI). The recent publication of several randomized trials comparing APBI to standard WBI provides Level I evidence supporting APBI. The purpose of this review is to summarize the Level I data supporting APBI in an effort to provide guidance when to offer this treatment approach vs. standard WBI, AWBI, or excision alone and to address questions related to its application. Four contemporary trials with over 2000 patients comparing APBI and WBI have been published and demonstrate no differences in the rates of local/regional recurrence or survival though long-term followup is limited to one study. In addition, reductions in the rates of acute and chronic toxicity and improvements in cosmetic outcome were noted in two of these trials (the University of Florence and the Hungarian Phase III trials, respectively). When contrasting other treatment approaches to APBI, patients treated in studies using AWBI have many comparable clinical and pathologic characteristics, whereas studies investigating endocrine therapy alone (surgery with no adjuvant radiation therapy) have much "lower risk" patients based on clinical, pathologic, and treatment-related criteria. Although significant Level I evidence now exists supporting the use of APBI as an alternative to WBI in selected patients undergoing breast-conserving therapy, additional data are needed to (1) help further refine patient selection criteria, (2) better clarify the optimal partial breast irradiation target and technique for each clinical setting, (3) determine when AWBI, standard WBI, or excision alone may be more appropriate, and (4) investigate if further reductions in fractionation schedules are possible.
authors.affiliation: 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI. Electronic address: frank.vicini@21co.com.
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Rahul
authors.initials: R
authors.lastname: Tendulkar
authors.affiliation: Department of Radiation Oncology, Ohio State University, Columbus, OH.
authors.forename: Jessica
authors.initials: J
authors.lastname: Wobb
authors.affiliation: Department of Radiation Oncology, Massey Cancer Center, Virgina Commonwealth University, Richmond, VA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Arthur
authors.affiliation: Department of Radiation Oncology, Robert Wood Johnson University Hospital/Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Atif
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Brown University, Providence, RI.
authors.forename: David
authors.initials: D
authors.lastname: Wazer
authors.affiliation: Cancer HealthCare Associates, Miami, FL.
authors.forename: Martin
authors.initials: M
authors.lastname: Keisch
mesh_terms: D001918:Brachytherapy; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant / Q000379:methods
keywords: APBI; Brachytherapy; Breast cancer; Partial breast irradiation