Accelerated Partial Breast Irradiation Consensus Statement From the American Society for Radiation Oncology (ASTRO)

Received 4 February 2009; accepted 25 February 2009.

Purpose

To present guidance for patients and physicians regarding the use of accelerated partial-breast irradiation (APBI), based on current published evidence complemented by expert opinion.

Methods and Materials

A systematic search of the National Library of Medicine's PubMed database yielded 645 candidate original research articles potentially applicable to APBI. Of these, 4 randomized trials and 38 prospective single-arm studies were identified. A Task Force composed of all authors synthesized the published evidence and, through a series of meetings, reached consensus regarding the recommendations contained herein.

Results

The Task Force proposed three patient groups: (1) a “suitable” group, for whom APBI outside of a clinical trial is acceptable, (2) a “cautionary” group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an “unsuitable” group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety.

Conclusion

Accelerated partial-breast irradiation is a new technology that may ultimately demonstrate long-term effectiveness and safety comparable to that of WBI for selected patients with early breast cancer. This consensus statement is intended to provide guidance regarding the use of APBI outside of a clinical trial and to serve as a framework to promote additional clinical investigations into the optimal role of APBI in the treatment of breast cancer.

Accelerated partial-breast irradiation, Breast cancer, Consensus statement

∗ Radiation Oncology Flight, Wilford Hall Medical Center, Lackland AFB, TX

† Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX

‡ Department of Radiation Oncology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA

§ Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, New Brunswick, NJ

‖ Department of Radiation Oncology, Duke University Medical School, Durham, NC

¶ Shaw Regional Cancer Center, Veil, CO

# Department of Human Oncology, Allegheny General Hospital, Pittsburgh, PA

∗∗ Department of Radiation Oncology, University of North Carolina Medical School, Chapel Hill, NC

†† Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI

‡‡ Department of Radiation Oncology, Juravinski Cancer Center, Hamilton, ON, Canada

§§ Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI

‖‖ Harvard Radiation Oncology Residency Program, Boston, MA

¶¶ Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA

Reprint requests to: Benjamin D. Smith, M.D., 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236. Tel: (210) 292-5589; Fax: (210) 292-3773

Supplementary material for this article can be found at www.redjournal.org.

This document was prepared by the Accelerated Partial Breast Irradiation Consensus Statement Task Force of the Health Services Research Committee of the American Society for Radiation Oncology (ASTRO).

Before initiation of this Consensus Statement, all members of the Task Group writing the Statement were required to complete conflict of interest statements. These statements are maintained at ASTRO Headquarters in Fairfax, VA, and pertinent conflict information is published with the report. Individuals with disqualifying conflicts have been recused from participation in this Consensus Statement.

ASTRO Consensus Statements present scientific, health, and safety information and may to some extent reflect scientific or medical opinion. They are made available to ASTRO members and to the public for educational and informational purposes only. Any commercial use of any content in this Statement without the prior written consent of ASTRO is strictly prohibited.

Adherence to the guidelines set forth in this Consensus Statement will not ensure successful treatment in every situation. Furthermore, these guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient. ASTRO assumes no liability for the information, conclusions, and findings contained in its consensus statements. In addition, these guidelines cannot be assumed to apply to the use of these interventions performed in the context of clinical trials, given that clinical studies are designed to evaluate or validate innovative approaches in a disease for which improved staging and treatment are needed or are being explored.

This Consensus Statement was prepared on the basis of information available at the time the Task Group was conducting its research and discussions on the topic. There may be new developments that are not reflected in this Statement, and that may, over time, be a basis for ASTRO to consider revisiting and updating the Statement.

Conflict of interest: D. W. Arthur, T. B. Julian, D. A. Todor, and F. A. Vicini have served as consultants to SenoRx, Irvine, CA.

PII: S0360-3016(09)00313-7

doi:10.1016/j.ijrobp.2009.02.031

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