International Journal of Radiation Oncology * Biology * Physics
Volume 74, Issue 4 , Pages 987-1001 , 15 July 2009

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

  • Benjamin D. Smith, M.D.

      Affiliations

    • 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
    • Corresponding Author InformationReprint requests to: Benjamin D. Smith, M.D., 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236. Tel: (210) 292-5589; Fax: (210) 292-3773
    • ,
  • Douglas W. Arthur, M.D.

      Affiliations

    • Department of Radiation Oncology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA
    • ,
  • Thomas A. Buchholz, M.D.

      Affiliations

    • Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
    • ,
  • Bruce G. Haffty, M.D.

      Affiliations

    • Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, New Brunswick, NJ
    • ,
  • Carol A. Hahn, M.D.

      Affiliations

    • Department of Radiation Oncology, Duke University Medical School, Durham, NC
    • ,
  • Patricia H. Hardenbergh, M.D.

      Affiliations

    • Shaw Regional Cancer Center, Veil, CO
    • ,
  • Thomas B. Julian, M.D.

      Affiliations

    • Department of Human Oncology, Allegheny General Hospital, Pittsburgh, PA
    • ,
  • Lawrence B. Marks, M.D.

      Affiliations

    • Department of Radiation Oncology, University of North Carolina Medical School, Chapel Hill, NC
    • ,
  • Dorin A. Todor, Ph.D.

      Affiliations

    • Department of Radiation Oncology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA
    • ,
  • Frank A. Vicini, M.D.

      Affiliations

    • Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
    • ,
  • Timothy J. Whelan, M.D.

      Affiliations

    • Department of Radiation Oncology, Juravinski Cancer Center, Hamilton, ON, Canada
    • ,
  • Julia White, M.D.

      Affiliations

    • Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
    • ,
  • Jennifer Y. Wo, M.D.

      Affiliations

    • Harvard Radiation Oncology Residency Program, Boston, MA
    • ,
  • Jay R. Harris, M.D.

      Affiliations

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

Received 4 February 2009 ,Accepted 25 February 2009.

References 

  1. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet. 2005;366:2087–2106
  2. Vinh-Hung V, Verschraegen C. Breast-conserving surgery with or without radiotherapy: Pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst. 2004;96:115–121
  3. Cytyc. MammoSite: Targeted radiation therapy. Available at: www.mammosite.com/physicians. Accessed October 30, 2008.
  4. Ribeiro GG, Magee B, Swindell R, et al. The Christie Hospital breast conservation trial: An update at 8 years from inception. Clin Oncol (R Coll Radiol). 1993;5:278–283
  5. Ribeiro GG, Dunn G, Swindell R, et al. Conservation of the breast using two different radiotherapy techniques: Interim report of a clinical trial. Clin Oncol (R Coll Radiol). 1990;2:27–34
  6. Polgar C, Fodor J, Major T, et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma—5-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007;69:694–702
  7. Lovey K, Fodor J, Major T, et al. Fat necrosis after partial-breast irradiation with brachytherapy or electron irradiation versus standard whole-breast radiotherapy—4-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007;69:724–731
  8. Polgar C, Sulyok Z, Fodor J, et al. Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: Five-year results of a phase I-II study and initial findings of a randomized phase III trial. J Surg Oncol. 2002;80:121–128discussion 129
  9. Holmes DR, Baum M, Joseph D. The TARGIT trial: Targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update). Am J Surg. 2007;194:507–510
  10. Dodwell DJ, Dyker K, Brown J, et al. A randomised study of whole-breast vs tumour-bed irradiation after local excision and axillary dissection for early breast cancer. Clin Oncol (R Coll Radiol). 2005;17:618–622
  11. Stevens MJ, Cooper SG, Cross P, et al. Accelerated partial breast irradiation using interstitial high dose rate iridium brachytherapy: Early Australian experience and review of the literature. Australas Radiol. 2006;50:143–151
  12. Vicini FA, Chen P, Wallace M, et al. Interim cosmetic results and toxicity using 3D conformal external beam radiotherapy to deliver accelerated partial breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2007;69:1124–1130
  13. Vicini FA, Remouchamps V, Wallace M, et al. Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2003;57:1247–1253
  14. Baglan KL, Sharpe MB, Jaffray D, et al. Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT). Int J Radiat Oncol Biol Phys. 2003;55:302–311
  15. Vicini FA, Antonucci JV, Wallace M, et al. Long-term efficacy and patterns of failure after accelerated partial breast irradiation: A molecular assay-based clonality evaluation. Int J Radiat Oncol Biol Phys. 2007;68:341–346
  16. Chen PY, Vicini FA, Benitez P, et al. Long-term cosmetic results and toxicity after accelerated partial-breast irradiation: A method of radiation delivery by interstitial brachytherapy for the treatment of early-stage breast carcinoma. Cancer. 2006;106:991–999
  17. Benitez PR, Chen PY, Vicini FA, et al. Partial breast irradiation in breast conserving therapy by way of interstitial brachytherapy. Am J Surg. 2004;188:355–364
  18. Vicini FA, Kestin L, Chen P, et al. Limited-field radiation therapy in the management of early-stage breast cancer. J Natl Cancer Inst. 2003;95:1205–1210
  19. Baglan KL, Martinez AA, Frazier RC, et al. The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2001;50:1003–1011
  20. Vicini F, Kini VR, Chen P, et al. Irradiation of the tumor bed alone after lumpectomy in selected patients with early-stage breast cancer treated with breast conserving therapy. J Surg Oncol. 1999;70:33–40
  21. Vicini FA, Chen PY, Fraile M, et al. Low-dose-rate brachytherapy as the sole radiation modality in the management of patients with early-stage breast cancer treated with breast-conserving therapy: Preliminary results of a pilot trial. Int J Radiat Oncol Biol Phys. 1997;38:301–310
  22. Chao KK, Vicini FA, Wallace M, et al. Analysis of treatment efficacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial-breast irradiation: The William Beaumont hospital experience. Int J Radiat Oncol Biol Phys. 2007;69:32–40
  23. Leonard C, Carter D, Kercher J, et al. Prospective trial of accelerated partial breast intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67:1291–1298
  24. Slampa P, Soumarova R, Ruzickova J, et al. Pilot study of sole conformal preoperative interstitial brachyradiotherapy of early stage breast carcinoma using high-dose rate afterloading. Neoplasma. 2005;52:292–296
  25. Luini A, Orecchia R, Gatti G, et al. The pilot trial on intraoperative radiotherapy with electrons (ELIOT): Update on the results. Breast Cancer Res Treat. 2005;93:55–59
  26. Veronesi U, Orecchia R, Luini A, et al. Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: Experience with 590 cases. Ann Surg. 2005;242:101–106
  27. Intra M, Leonardi C, Luini A, et al. Full-dose intraoperative radiotherapy with electrons in breast surgery: Broadening the indications. Arch Surg. 2005;140:936–939
  28. Veronesi U, Gatti G, Luini A, et al. Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery. Arch Surg. 2003;138:1253–1256
  29. Veronesi U, Orecchia R, Luini A, et al. A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer. 2001;37:2178–2183
  30. Niehoff P, Ballardini B, Polgar C, et al. Early European experience with the MammoSite radiation therapy system for partial breast brachytherapy following breast conservation operation in low-risk breast cancer. Breast. 2006;15:319–325
  31. Livi L, Paiar F, Buonamici FB, et al. Accelerated intensity-modulated external radiotherapy as a new technical approach to treat the index quadrant after conserving surgery in early breast cancer: A preliminary study. Tumori. 2005;91:227–232
  32. Ott OJ, Hildebrandt G, Potter R, et al. Accelerated partial breast irradiation with multi-catheter brachytherapy: Local control, side effects and cosmetic outcome for 274 patients. Results of the German-Austrian multi-centre trial. Radiother Oncol. 2007;82:281–286
  33. Ott OJ, Potter R, Hammer J, et al. Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial. Strahlenther Onkol. 2004;180:642–649
  34. Niehoff P, Polgar C, Ostertag H, et al. Clinical experience with the MammoSite radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial. Radiother Oncol. 2006;79:316–320
  35. Fentiman IS, Deshmane V, Tong D, et al. Caesium(137) implant as sole radiation therapy for operable breast cancer: A phase II trial. Radiother Oncol. 2004;71:281–285
  36. Fentiman IS, Poole C, Tong D, et al. Inadequacy of iridium implant as sole radiation treatment for operable breast cancer. Eur J Cancer. 1996;32A:608–611
  37. Fentiman IS, Poole C, Tong D, et al. Iridium implant treatment without external radiotherapy for operable breast cancer: A pilot study. Eur J Cancer. 1991;27:447–450
  38. Taghian AG, Kozak KR, Doppke KP, et al. Initial dosimetric experience using simple three-dimensional conformal external-beam accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2006;64:1092–1099
  39. Kozak KR, Smith BL, Adams J, et al. Accelerated partial-breast irradiation using proton beams: Initial clinical experience. Int J Radiat Oncol Biol Phys. 2006;66:691–698
  40. Taghian A, Kozak KR, Katz A, et al. Accelerated partial breast irradiation using proton beams: Initial dosimetric experience. Int J Radiat Oncol Biol Phys. 2006;65:1404–1410
  41. Poti Z, Nemeskeri C, Fekeshazy A, et al. Partial breast irradiation with interstitial 60CO brachytherapy results in frequent grade 3 or 4 toxicity. Evidence based on a 12-year follow-up of 70 patients. Int J Radiat Oncol Biol Phys. 2004;58:1022–1033
  42. Polgar C, Major T, Fodor J, et al. High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: Seven-year results of a comparative study. Int J Radiat Oncol Biol Phys. 2004;60:1173–1181
  43. Polgar C, Major T, Somogyi A, et al. Sole brachytherapy of the tumor bed after breast conserving surgery: A new radiotherapeutic strategy for patients at low risk of local relapse. Neoplasma. 1999;46:182–189
  44. Tsai PI, Ryan M, Meek K, et al. Accelerated partial breast irradiation using the MammoSite device: Early technical experience and short-term clinical follow-up. Am Surg. 2006;72:929–934
  45. Krishnan L, Jewell WR, Tawfik OW, et al. Breast conservation therapy with tumor bed irradiation alone in a selected group of patients with stage I breast cancer. Breast J. 2001;7:91–96
  46. Bush DA, Slater JD, Garberoglio C, et al. A technique of partial breast irradiation utilizing proton beam radiotherapy: Comparison with conformal x-ray therapy. Cancer J. 2007;13:114–118
  47. Benitez PR, Keisch ME, Vicini F, et al. Five-year results: The initial clinical trial of MammoSite balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am J Surg. 2007;194:456–462
  48. Benitez PR, Streeter O, Vicini F, et al. Preliminary results and evaluation of MammoSite balloon brachytherapy for partial breast irradiation for pure ductal carcinoma in situ: A phase II clinical study. Am J Surg. 2006;192:427–433
  49. Keisch M, Vicini F, Kuske RR, et al. Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2003;55:289–293
  50. Vicini F, Beitsch PD, Quiet CA, et al. Three-year analysis of treatment efficacy, cosmesis, and toxicity by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation (APBI). Cancer. 2008;112:758–766
  51. Jeruss JS, Vicini FA, Beitsch PD, et al. Initial outcomes for patients treated on the American Society of Breast Surgeons MammoSite clinical trial for ductal carcinoma-in-situ of the breast. Ann Surg Oncol. 2006;13:967–976
  52. Vicini FA, Beitsch PD, Quiet CA, et al. First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: Results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer. 2005;104:1138–1148
  53. Wazer DE, Kaufman S, Cuttino L, et al. Accelerated partial breast irradiation: An analysis of variables associated with late toxicity and long-term cosmetic outcome after high-dose-rate interstitial brachytherapy. Int J Radiat Oncol Biol Phys. 2006;64:489–495
  54. Arthur DW, Koo D, Zwicker RD, et al. Partial breast brachytherapy after lumpectomy: Low-dose-rate and high-dose-rate experience. Int J Radiat Oncol Biol Phys. 2003;56:681–689
  55. Lawenda BD, Taghian AG, Kachnic LA, et al. Dose-volume analysis of radiotherapy for T1N0 invasive breast cancer treated by local excision and partial breast irradiation by low-dose-rate interstitial implant. Int J Radiat Oncol Biol Phys. 2003;56:671–680
  56. Beal K, McCormick B, Zelefsky MJ, et al. Single-fraction intraoperative radiotherapy for breast cancer: Early cosmetic results. Int J Radiat Oncol Biol Phys. 2007;69:19–24
  57. Formenti SC, Truong MT, Goldberg JD, et al. Prone accelerated partial breast irradiation after breast-conserving surgery: Preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys. 2004;60:493–504
  58. Formenti SC, Rosenstein B, Skinner KA, et al. T1 stage breast cancer: Adjuvant hypofractionated conformal radiation therapy to tumor bed in selected postmenopausal breast cancer patients—pilot feasibility study. Radiology. 2002;222:171–178
  59. King TA, Bolton JS, Kuske RR, et al. Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer. Am J Surg. 2000;180:299–304
  60. Perera F, Chisela F, Stitt L, et al. TLD skin dose measurements and acute and late effects after lumpectomy and high-dose-rate brachytherapy only for early breast cancer. Int J Radiat Oncol Biol Phys. 2005;62:1283–1290
  61. Perera F, Yu E, Engel J, et al. Patterns of breast recurrence in a pilot study of brachytherapy confined to the lumpectomy site for early breast cancer with six years' minimum follow-up. Int J Radiat Oncol Biol Phys. 2003;57:1239–1246
  62. Perera F, Engel J, Holliday R, et al. Local resection and brachytherapy confined to the lumpectomy site for early breast cancer: A pilot study. J Surg Oncol. 1997;65:263–267discussion 267–268
  63. Nose T, Komoike Y, Yoshida K, et al. A pilot study of wider use of accelerated partial breast irradiation: Intraoperative margin-directed re-excision combined with sole high-dose-rate interstitial brachytherapy. Breast Cancer. 2006;13:289–299
  64. Vicini F, Winter K, Straube W, et al. A phase I/II trial to evaluate three-dimensional conformal radiation therapy confined to the region of the lumpectomy cavity for Stage I/II breast carcinoma: Initial report of feasibility and reproducibility of Radiation Therapy Oncology Group (RTOG) Study 0319. Int J Radiat Oncol Biol Phys. 2005;63:1531–1537
  65. Kuske RR, Winter K, Arthur DW, et al. Phase II trial of brachytherapy alone after lumpectomy for select breast cancer: Toxicity analysis of RTOG 95-17. Int J Radiat Oncol Biol Phys. 2006;65:45–51
  66. Arthur DW, Winter K, Kuske RR, et al. A Phase II trial of brachytherapy alone after lumpectomy for select breast cancer: Tumor control and survival outcomes of RTOG 95-17. Int J Radiat Oncol Biol Phys. 2008;72:467–473
  67. Dowlatshahi K, Snider HC, Gittleman MA, et al. Early experience with balloon brachytherapy for breast cancer. Arch Surg. 2004;139:603–607discussion 607–608
  68. Mussari S, Sabino Della Sala W, Busana L, et al. Full-dose intraoperative radiotherapy with electrons in breast cancer. First report on late toxicity and cosmetic results from a single-institution experience. Strahlenther Onkol. 2006;182:589–595
  69. Richards GM, Berson AM, Rescigno J, et al. Acute toxicity of high-dose-rate intracavitary brachytherapy with the MammoSite applicator in patients with early-stage breast cancer. Ann Surg Oncol. 2004;11:739–746
  70. Kaufman SA, DiPetrillo TA, Price LL, et al. Long-term outcome and toxicity in a Phase I/II trial using high-dose-rate multicatheter interstitial brachytherapy for T1/T2 breast cancer. Brachytherapy. 2007;6:286–292
  71. Evans SB, Kaufman SA, Price LL, et al. Persistent seroma after intraoperative placement of MammoSite for accelerated partial breast irradiation: Incidence, pathologic anatomy, and contributing factors. Int J Radiat Oncol Biol Phys. 2006;65:333–339
  72. Shah NM, Tenenholz T, Arthur D, et al. MammoSite and interstitial brachytherapy for accelerated partial breast irradiation: Factors that affect toxicity and cosmesis. Cancer. 2004;101:727–734
  73. Wazer DE, Berle L, Graham R, et al. Preliminary results of a phase I/II study of HDR brachytherapy alone for T1/T2 breast cancer. Int J Radiat Oncol Biol Phys. 2002;53:889–897
  74. Wazer DE, Lowther D, Boyle T, et al. Clinically evident fat necrosis in women treated with high-dose-rate brachytherapy alone for early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2001;50:107–111
  75. Ollila DW, Klauber-DeMore N, Tesche LJ, et al. Feasibility of breast preserving therapy with single fraction in situ radiotherapy delivered intraoperatively. Ann Surg Oncol. 2007;14:660–669
  76. Patel RR, Christensen ME, Hodge CW, et al. Clinical outcome analysis in “high-risk” versus “low-risk” patients eligible for national surgical adjuvant breast and bowel B-39/radiation therapy oncology group 0413 trial: Five-year results. Int J Radiat Oncol Biol Phys. 2008;70:970–973
  77. Arthur DW, Vicini FA, Kuske RR, et al. Accelerated partial breast irradiation: An updated report from the American Brachytherapy Society. Brachytherapy. 2003;2:124–130
  78. Radiation Therapy Oncology Group. NSABP Protocol B-39/RTOG Protocol 0413: A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer. Available at: www.rtog.org/members/protocols/0413/0413.pdf. Accessed November 15, 2008.
  79. Bartelink H, Horiot JC, Poortmans P, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–1387
  80. Bartelink H, Horiot JC, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25:3259–3265
  81. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging handbook. 6th ed.. New York: Springer; 2002;
  82. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–1241
  83. Wapnir I, Anderson S, Mamounas E, et al. Survival and IBTR in node negative NSABP protocols B-13, B-14, B-19, B-20, and B-23 (Abstr.). J Clin Oncol. 2005;23(Suppl.):517
  84. Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24:2028–2037
  85. Recht A, Ancukiewicz M, Lu X, et al. Lung dose-volume parameters and the risk of pneumonitis for patients treated with accelerated partial-breast irradiation (APBI) using 3D conformal radiotherapy (3D-CRT). Int J Radiat Oncol Biol Phys. 2008;72(Suppl.):S4–A9
  86. Hepel JT, Tokita M, MacAusland SG, et al. Toxicity of 3D-CRT for accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2008;72(Suppl.):S5–A10
  87. Jagsi R, Ben-David M, Moran J, et al. Adverse cosmesis in a protocol investigating IMRT with active breathing control for accelerated partial breast irradiation (APBI). Int J Radiat Oncol Biol Phys. 2008;72(Suppl.):S153–A1088
  88. Radiation Therapy Oncology Group. 0413 broadcast. Available at. www.rtog.org/members/protocols/0413/0413broadcast.htmlAccessed December 23, 2008
  89. Parikh JR. ACR appropriateness criteria on palpable breast masses. J Am Coll Radiol. 2007;4:285–288
  90. Godinez J, Gombos EC, Chikarmane SA, et al. Breast MRI in the evaluation of eligibility for accelerated partial breast irradiation. AJR Am J Roentgenol. 2008;191:272–277
  91. Haffty BG, Vicini FA, Beitsch P, et al. Timing of chemotherapy after MammoSite radiation therapy system breast brachytherapy: Analysis of the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial. Int J Radiat Oncol Biol Phys. 2008;72:1441–1448
  92. Rusthoven KE, Carter DL, Howell K, et al. Accelerated partial-breast intensity-modulated radiotherapy results in improved dose distribution when compared with three-dimensional treatment-planning techniques. Int J Radiat Oncol Biol Phys. 2008;70:296–302
  93. Khan AJ, Kirk MC, Mehta PS, et al. A dosimetric comparison of three-dimensional conformal, intensity-modulated radiation therapy, and MammoSite partial-breast irradiation. Brachytherapy. 2006;5:183–188
  94. Oliver M, Chen J, Wong E, et al. A treatment planning study comparing whole breast radiation therapy against conformal, IMRT and tomotherapy for accelerated partial breast irradiation. Radiother Oncol. 2007;82:317–323
  95. Patel RR, Becker SJ, Das RK, et al. A dosimetric comparison of accelerated partial breast irradiation techniques: Multicatheter interstitial brachytherapy, three-dimensional conformal radiotherapy, and supine versus prone helical tomotherapy. Int J Radiat Oncol Biol Phys. 2007;68:935–942
  96. Weed DW, Edmundson GK, Vicini FA, et al. Accelerated partial breast irradiation: A dosimetric comparison of three different techniques. Brachytherapy. 2005;4:121–129
  97. Kozak KR, Katz A, Adams J, et al. Dosimetric comparison of proton and photon three-dimensional, conformal, external beam accelerated partial breast irradiation techniques. Int J Radiat Oncol Biol Phys. 2006;65:1572–1578
  98. Dickler A, Kirk MC, Seif N, et al. A dosimetric comparison of MammoSite high-dose-rate brachytherapy and Xoft Axxent electronic brachytherapy. Brachytherapy. 2007;6:164–168

 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

International Journal of Radiation Oncology * Biology * Physics
Volume 74, Issue 4 , Pages 987-1001 , 15 July 2009

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