The American Society for Radiation Oncology (ASTRO) has updated to its Evidence-Based Consensus Statement for the use of Accelerated Partial Breast Irradiation (APBI) brachytherapy to include younger patients and those with low-risk ductal carcinoma in situ (DCIS).
APBI brachytherapy is a targeted form of radiation that is delivered after surgical excision of the tumour (lumpectomy) to only the area of the breast where the cancer was removed.
This is accomplished by introducing a radiation source through a series of narrow tubes or struts that are placed inside the tumour cavity.
APBI brachytherapy offers less radiation exposure, reduced treatment time, better cosmetic outcomes and more flexibility with respect to future treatment options.
ASTRO updated its APBI Consensus Statement to reflect data from three large-scale randomised trials evaluating APBI vs. whole breast irradiation (WBI).
The data from these trials were sufficiently robust that the committee voted unanimously to change the guidelines, expanding the group of patients for whom APBI brachytherapy is suitable, which now includes patients ≥50 years of age (previously, patients ≥60 years of age were included).
“Evidence-based guidelines have the potential to fundamentally alter clinical practice. These important changes to ASTRO’s guidelines were based on a systematic review of 45 published clinical studies, significantly expanding the eligible patient population,” said Atif J. Khan, MD, Director of Brachytherapy Services at the Rutgers Cancer Institute of New Jersey in New Brunswick. “Several recent clinical studies, including well-designed randomised trials directly comparing APBI to WBI, demonstrate that APBI brachytherapy offers potential advantages over WBI including a shorter course of treatment and decreased radiation while maintaining similarly low rates of cancer recurrence. We anticipate that ASTRO’s recommendations will drive significant changes in how clinicians approach early stage breast cancer treatment.”
Two decades of data have established breast conservation therapy (BCT) as the standard of care in early stage breast cancer.
The traditional approach for radiation therapy as part of BCT has been a full course of whole breast irradiation (WBI), which exposes the entire breast and surrounding critical structures to radiation and requires daily treatments for four to six-and-a-half weeks.
“APBI brachytherapy is an attractive treatment option for many women with early stage breast cancer. It offers several advantages over WBI, while maintaining similar clinical outcomes, including the possibility of less radiation exposure to critical organs such as the heart, and improved cosmetic outcomes,” said Julie A. Margenthaler, MD, FACS, professor, division of general surgery at Washington University School of Medicine, chair of American Society of Breast Surgeons communications committee. “With the wide body of evidence supporting the safety and efficacy of APBI for women with early stage breast cancer and the guidelines update from ASTRO, we should soon see more widespread adoption of this clinically proven and convenient approach that targets only the tissue at risk and is kinder to patients. Indeed, treating these women with WBI may represent overtreatment.”