APBI makes move into clinical mainstream

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Promising data from a variety of ongoing clinical trials has encouraged the American Society for Therapeutic Radiology and Oncology (ASTRO) to publish a consensus statement outlining patient selection criteria and best practices for the use of accelerated partial breast irradiation (APBI). The consensus statement provides guidance to physicians seeking to implement the protocol outside the context of clinical trials

The standard of care for breast cancer patients, post-lumpectomy, is whole-breast irradiation (WBI). Typically it takes six to seven weeks, and administers a radiation dose to the entire breast along with some underlying ribs, muscles, a crescent of lung, sometimes a bit of heart, and all the skin on the breast.

APBI does not treat the entire breast, and instead, focuses on the part of the breast where the tumor was removed. It can be delivered via either brachytherapy or with 3D conformal external radiation beam techniques.

One of the main advantages with APBI is the reduction in overall treatment time (approximately one week), which  has an impact on the patient and healthcare resources. In addition, APBI also resolves the problems of sequencing chemotherapy and radiation, as the radiation is delivered immediately after surgery.

The ASTRO consensus statement comes on the heels of promising APBI clinical data presented at last month’s 2009 American Society of Clinical Oncology (ASCO) meeting in Orlando, Fla.

Antonis Valachis, MD, associate breast cancer researcher at the Panhellenic Association for Continual Medical Research in Athens, Greece, delivered the results of three clinical trials comparing ABPI with WBI. Data from 1,140 women who participated in the trials found no significant differences in overall survival or the development of metastases associated with death, distant metastasis or supraclavicular recurrences among the protocols.

However, there are still challenges to ABPI associated with clinical target volume after lumpectomy and the reproducibility and verification of fractionated courses (for external-beam ABPI). As ASTRO noted, “APBI has several benefits, including a decreased overall treatment time and a decrease in the radiation delivered to healthy tissue and adjacent organs, but its long-term safety and effectiveness compared with WBI are not yet known and results of randomized trials comparing APBI with WBI will not be available for many years.”

If you’re looking to add or bolster the radiotherapy or radiosurgery capabilities of your practice in the coming months with new technology or protocols, please stop by our Healthcare Tech Guide. We have listings for vendors, systems, training, and services for a variety of products spanning radiation oncology.

In closing, if you have a comment or report to share about radiation oncology in your practice, please contact me at the address below. I look forward to hearing from you.

Jonathan Batchelor, Web Editor