Consensus Statement for Accelerated Partial
Breast Irradiation
Accelerated partial breast irradiation (APBI)
is a technique in which the portion of the breast at the highest
risk of recurrence (the tissue surrounding the lumpectomy cavity)
receives a shortened course of high dose radiation therapy. There
are several techniques that can deliver this therapy including
multiple catheters placed through the breast, a balloon catheter
inserted into the lumpectomy cavity, localized external beam
delivery, bead or seed implants, single dose intraoperative treatment
and others. Several single-institution, non-randomized studies
using the multicatheter technique have shown low local recurrence
rates that are comparable to standard external beam radiation
therapy. The radiation therapy and surgical communities continue
to actively investigate strategies to refine selection criteria
and maximize efficacy for APBI.
Based on the available data the American Society
of Breast Surgeons acknowledges the following:
1. Outside of multi-institutional studies
and institutional protocols, patients should be carefully selected
for APBI and properly informed of the benefits and risks of
this type of radiation treatment. The American Society of Breast
Surgeons recommends the following selection criteria when considering
patients for treatment with APBI, as a sole form of radiation
therapy, in lieu of whole breast irradiation:
• Age 45 years old or greater
•
Invasive ductal carcinoma or ductal carcinoma in situ
•
Total tumor size (invasive and DCIS) less than or equal to
3 cm in size
•
Negative microscopic surgical margins of excision
•
Axillary lymph nodes/sentinel lymph node negative
2. Surgeons, radiation oncologists and physicists
who will be utilizing the various APBI techniques should be
adequately trained to allow for optimum radiation therapy planning
and treatment.
3. All patients should be monitored regularly to identify
adverse events as well as local recurrences.
4. The published dataset for APBI supports
the recommendations summarized above. Continuous, long-term,
outcomes-based monitoring of APBI is desirable. The American
Society of Breast Surgeons maintains an ongoing Mammosite® Registry
(registration completed in 2004) collecting data on more than
1500 patients treated via the balloon catheter technique.
As is the case with all cancer treatments, participation in
multi-institutional clinical studies, or in single site protocols,
or in the context of data-gathering registries, is desirable,
if available.
Revised, December 8, 2005
Board of Directors
The American Society of Breast Surgeons
| 
