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Accelerated Partial Breast Irradiation After Conservative Surgery for Breast Cancer

Kuerer, Henry M. MD, PhD*; Julian, Thomas B. MD; Strom, Eric A. MD; Lyerly, H Kim MD§; Giuliano, Armando E. MD; Mamounas, Eleftherios P. MD, MPH; Vicini, Frank A. MD*

doi: 10.1097/01.sla.0000114219.71899.13
Reviews

Objective: To critically review the theoretical and actual risks and benefits of accelerated partial breast irradiation (APBI) after breast-conserving surgery.

Summary Background Data: Because of rapid evolution of radiation therapy techniques related to brachytherapy and three-dimensional conformal radiation therapy, APBI has very recently come to the forefront as a potential local treatment option for women with breast cancer. This review aims to give an overview of the biologic rationale for APBI techniques, and benefits and limitations of APBI techniques.

Methods: The authors reviewed the currently available published world medical literature on breast-conserving surgery with and without postoperative irradiation; all studies involving partial breast irradiation, including brachytherapy, for breast cancer; and currently accruing and planned APBI trials. The focus of this review was the early results of treatment in terms of toxicity, complications, cosmesis, and local control.

Results: On average, approximately 3% of patients treated with breast-conserving surgery will have an in-breast local recurrence away from the original lumpectomy site with or without postoperative standard whole-breast irradiation. The results of phase I-II studies involving approximately 500 patients treated with APBI after breast-conserving surgery have been published. Although many of the studies have limited long-term follow-up and potential selection bias, early results suggest that toxicity, cosmesis, and local control are comparable to outcomes seen after breast-conserving surgery followed by standard whole-breast irradiation.

Conclusions: Recent advances in radiation delivery and published series of partial breast irradiation support large randomized trials comparing APBI with standard whole-breast irradiation after breast-conserving surgery.

Rapid evolution of radiation therapy techniques has brought accelerated partial breast irradiation to the forefront as a potential local treatment option for women with breast cancer who are treated with conservative surgery. This review gives an overview of the biological rationale, techniques, potential benefits, complications, and planned national trials evaluating accelerated partial breast irradiation after conservative surgery.

From the *Departments of Surgical Oncology and ‡Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; †Department of Human Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania; §Department of Surgery, Duke University Medical Center, Durham, North Carolina; ¶John Wayne Cancer Institute, Santa Monica, California; ∥Aultman Hospital, Canton, Ohio; and **Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan.

Reprints: Henry M. Kuerer, MD, PhD, Department of Surgical Oncology, Box 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. E-mail: hkuerer@mdanderson.org.

© 2004 Lippincott Williams & Wilkins, Inc.