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ASTRO updates its guidelines for accelerated partial breast irradiation

by Lauren Dubinsky, Senior Reporter | November 17, 2016
Rad Oncology Population Health Radiation Therapy Women's Health
More patients populations should
receive the treatment
The American Society for Radiation Oncology announced today that it has updated its 2009 guidelines for accelerated partial breast irradiation to treat early-stage breast cancer.

Patients with early-stage breast cancer commonly receive whole breast irradiation after breast-conserving surgery to minimize their risk of recurrence or metastasis, but APBI is a newer, localized alternative.

APBI delivers the radiation directly to the tissue at risk, which reduces treatment time and may limit adverse side effects. Over 75,000 women in the U.S. have received APBI since it was introduced in the late 1990s, according to ASTRO.

The updated guidelines were influenced by eight years' worth of published studies. They suggest that more breast cancer patients can benefit from APBI, including younger patients and those with low-risk ductal carcinoma in situ.

The guidelines recommend that patients aged 50 and over should be considered suitable for APBI. Patients between the ages of 40 and 49 who meet other pathologic suitability criteria should be considered cautionary, and those who are younger than 40 or don't meet the pathologic criteria should be considered unsuitable.

The previous guideline didn't consider any patients with DCIS suitable for APBI, but the new guidelines state that those with low-risk DCIS should be considered suitable.

The update used two large clinical trials that compared WBI and intraoperative RT to also provide guidance for the use of IORT on early-stage breast cancer patients.

The guidelines recommend that physicians should counsel patients that the risk of recurrence may be higher with IORT than WBI, and that all patients treated with IORT should undergo routine long-term follow-up for at least 10 years to screen for recurrence.

It suggests that electron beam IORT should only be used on patients with invasive cancer who are also considered suitable for partial breast irradiation. It also suggests that low-energy X-ray IORT should only be used in the context of a prospective registry or clinical trial and limited to women with invasive cancer.

ASTRO based these guidelines on a systemic literature review of studies that have been published since May 2008. A total of 419 abstracts were taken from PubMed, and the 44 articles that met inclusion criteria were evaluated by a task force comprising radiation oncologists, medical oncologists and experts in IORT.

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