July 15, 2009 The American Society for Radiation Oncology has published a consensus statement outlining patient selection criteria and best practices for the use of accelerated partial breast irradiation (APBI) outside the context of a clinical trial in the July 15 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of ASTRO.
For decades, whole-breast irradiation (WBI), where radiation is delivered to the whole breast every day for five to eight weeks, has been the standard treatment for patients with early breast cancer treated with breast conserving surgery. WBI has been shown to reduce the risk of recurrence in the affected breast and increase the likelihood of long-term survival. However, recently there has been growing interest in using APBI, where radiation is used to treat only the part of the breast affected by cancer and the treatment time is decreased from several weeks to four or five days.
APBI has several benefits, including a decreased overall treatment time and a decrease in the radiation delivered to healthy tissue and adjacent organs, but its long-term safety and effectiveness compared to WBI are not yet known and results of randomized trials comparing APBI with WBI will not be available for many years. In the meantime, guidance for use of APBI outside of a clinical trial is needed.
The ASTRO consensus statement explains which patients may be considered for APBI, what constitutes proper informed consent for patients treated with APBI, which diagnostic imaging tests are needed for patients treated with APBI, how to integrate APBI with surgical and chemotherapy treatment and how the various techniques for APBI compare with one another.
"ASTRO's Accelerated Partial Breast Irradiation Consensus Statement Task Force developed these recommendations to serve as a framework for promoting more clinical investigations into the role of APBI in treating breast cancer," Maj. Benjamin Smith, M.D., lead author of the study and chief of the Radiation Oncology Department at Wilford Hall Medical Center on Lackland Air Force Base in Texas, said. "It is unlikely that APBI will replace WBI for most patients treated with breast-conserving surgery, but further study may establish APBI as an appropriate and desirable treatment for certain selected patient groups."
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