Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: Recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009)

• Published in: Radiotherapy and oncology Vol. 94; no. 3; pp. 264 - 273
• Main Authors: Polgár, Csaba, Limbergen, Erik Van, Pötter, Richard, Kovács, György, Polo, Alfredo, Lyczek, Jaroslaw, Hildebrandt, Guido, Niehoff, Peter, Guinot, Jose Luis, Guedea, Ferran, Johansson, Bengt, Ott, Oliver J, Major, Tibor, Strnad, Vratislav
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-03-2010
• Subjects: Accelerated partial breast irradiation; Adult; Age Factors; Brachytherapy; Breast Neoplasms - radiotherapy; Europe; Female; Hematology, Oncology and Palliative Medicine; Humans; Mastectomy, Segmental; Middle Aged; Patient Selection; Prognosis; Radiotherapy; Societies, Medical; Systematic review; Europe; Accelerated partial breast irradiation; Systematic review; Brachytherapy; Patient selection
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2010.01.014

Abstract Purpose To give recommendations on patient selection criteria for the use of accelerated partial-breast irradiation (APBI) based on available clinical evidence complemented by expert opinion. Methods and materials Overall, 340 articles were identified by a systematic search of the PubMed database using the keywords “partial-breast irradiation” and “APBI”. This search was complemented by searches of reference lists of articles and handsearching of relevant conference abstracts and book chapters. Of these, 3 randomized and 19 prospective non-randomized studies with a minimum median follow-up time of 4 years were identified. The authors reviewed the published clinical evidence on APBI, complemented by relevant clinical and pathological studies of standard breast-conserving therapy and, through a series of personal communications, formulated the recommendations presented in this article. Results The GEC-ESTRO Breast Cancer Working Group recommends three categories guiding patient selection for APBI: (1) a low-risk group for whom APBI outside the context of a clinical trial is an acceptable treatment option; including patients ageing at least 50 years with unicentric, unifocal, pT1–2 (⩽30 mm) pN0, non-lobular invasive breast cancer without the presence of an extensive intraductal component (EIC) and lympho-vascular invasion (LVI) and with negative surgical margins of at least 2 mm, (2) a high-risk group, for whom APBI is considered contraindicated; including patients ageing ⩽40 years; having positive margins, and/or multicentric or large (>30 mm) tumours, and/or EIC positive or LVI positive tumours, and/or 4 or more positive lymph nodes or unknown axillary status (pNx), and (3) an intermediate-risk group, for whom APBI is considered acceptable only in the context of prospective clinical trials. Conclusions These recommendations will provide a clinical guidance regarding the use of APBI outside the context of a clinical trial before large-scale randomized clinical trial outcome data become available. Furthermore they should promote further clinical research focusing on controversial issues in the treatment of early-stage breast carcinoma.