Bookmarks
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Abbreviations
- Accelerated partial breast irradiation (APBI)
- Ipsilateral breast tumor recurrence (IBTR)
Definitions
- APBI: Short course of intraoperative &/or postoperative radiation lasting 1-10 days
- Radiation focused on lumpectomy cavity plus 1- to 2-cm margin surrounding postsurgical cavity
- Goal is to provide equal local control as in conventional adjuvant XRT following breast-conserving surgery
- Minimize radiation to normal tissue
- Rationale: ~ 90% of tumor recurrences occur at or within 1-2 cm of lumpectomy site
- Focusing radiation treatment to this vulnerable region may be beneficial
- Brachytherapy: Therapeutic range in mm
- Radioisotope delivers XRT at short distance from source, limiting dose to normal tissue
- Radioactive materials are placed directly at or near operated site
- 1 or a few fractions
- Variable dose rates, energies, shielding
- Radioisotope delivers XRT at short distance from source, limiting dose to normal tissue
- Interstitial (within tissue) brachytherapy
- Multiple catheters placed in operating room 1 cm apart, encompassing postlumpectomy area to be treated
- Advantage: Most conformal, best control of skin and chest wall dose
- Suitable for all breast shapes and types
- Disadvantage: Requires higher level of skill, training, and OR time (~ 45 minutes) and is most invasive
- Advantage: Most conformal, best control of skin and chest wall dose
- Multiple catheters placed in operating room 1 cm apart, encompassing postlumpectomy area to be treated
- Single lumen intracavitary, balloon brachytherapy (MammoSite)
- Ease of insertion: At surgery or under US guidance
- Requires good conformance and at least 7 mm skin-to-balloon-surface distance to avoid skin toxicity
- Multilumen intracavitary devices [Contoura, strut-adjusted volume implant (SAVI)]
- Advantage: Ease of insertion like MammoSite plus dosimetric advantages of interstitial brachytherapy
- Limits dose to chest wall and skin without compromising target coverage; preferred devices
- Device usually placed under US guidance postoperatively in lumpectomy cavity
- Satisfactory device placement confirmed by CT
- 3D planning to optimize dose-to-target volume and reduce dose to skin and chest wall
- 2 daily doses of 3.4 Gy each, separated by at least 6 hours for total of 5 days = 34 Gy in 10 fractions
- Accelerated external beam with 3D conformal (3DCRT) or intensity-modulated radiation therapy (IMRT)
- External beam restricted to lumpectomy site and immediate surrounding tissue
- Advantage: Noninvasive, easily available in most radiation departments
- Disadvantage: Higher dose to normal breast tissue and to greater volume of normal breast tissue vs. brachytherapy → sometimes poor cosmetic results
- External beam restricted to lumpectomy site and immediate surrounding tissue
- Intraoperative radiation therapy (IORT)
- Single fraction in operating room immediately following lumpectomy with either 3 or 9 MeV electrons or 50 kVp x-ray intrabeam device
- Requires careful lesion selection: Unifocal T1N0, ER(+) disease
- Treated before final pathologic assessment; if margins or nodes positive, need whole-breast irradiation (WBI) (~ 15% of TARGIT trial)
- External beam with protons (investigational)
- May be able to ↓ volume of normal breast tissue included in high-dose region vs. photon 3DCRT
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
Microscopic Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Paudel N et al: Impact of breast MRI in women eligible for breast conservation surgery and intra-operative radiation therapy. Surg Oncol. 27:95-99, 2018
- Coles CE et al: Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet. ePub, 2017
- Correa C et al: Accelerated partial breast irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Pract Radiat Oncol. 7(2):73-79, 2017
- Morrow M et al: Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ. Pract Radiat Oncol. 6(5):287-95, 2016
- Strnad V et al: 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet. 387(10015):229-38, 2016
- Ibrahim NB et al: Radiographic findings after treatment with balloon brachytherapy accelerated partial breast irradiation. Radiographics. 35(1):6-13, 2015
- Livi L et al: Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 51(4):451-63, 2015
- Buchholz TA et al: Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 32(14):1502-6, 2014
- Vaidya JS et al: Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 383(9917):603-13, 2014
- Lei RY et al: Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT). Breast Cancer Res Treat. 140(1):119-33, 2013
- Olivotto IA et al: Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. 31(32):4038-45, 2013
- Leonardi MC et al: How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology. Int J Radiat Oncol Biol Phys. 83(3):806-13, 2012
- Vaidya J et al: Targeted intraoperative radiotherapy for early breast cancer: TARGIT-a trial-updated analysis of local recurrence and first analysis of survival [abstract]. Cancer Res. 72 (Suppl. 3), S4-2, 2012
- Ivanov O et al: Twelve-month follow-up results of a trial utilizing Axxent electronic brachytherapy to deliver intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol. 18(2):453-8, 2011
- Monticciolo DL et al: Breast conserving therapy with accelerated partial breast versus external beam whole breast irradiation: comparison of imaging sequela and complications in a matched population. Breast J. 17(2):187-90, 2011
- Ahmed HM et al: Mammographic appearance following accelerated partial breast irradiation by using MammoSite brachytherapy. Radiology. 255(2):362-8, 2010
- Shaitelman SF et al: Five-year outcome of patients classified using the American Society for Radiation Oncology consensus statement guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial. Cancer. 116(20):4677-85, 2010
- Smith BD et al: Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 74(4):987-1001, 2009
- Esserman LE et al: Imaging findings after breast brachytherapy. AJR Am J Roentgenol. 187:57-64, 2006
- Evans SB 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. 65(2):333-9, 2006
- Vicini F 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. 63(5):1531-7, 2005
- TARGIT-B
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Abbreviations
- Accelerated partial breast irradiation (APBI)
- Ipsilateral breast tumor recurrence (IBTR)
Definitions
- APBI: Short course of intraoperative &/or postoperative radiation lasting 1-10 days
- Radiation focused on lumpectomy cavity plus 1- to 2-cm margin surrounding postsurgical cavity
- Goal is to provide equal local control as in conventional adjuvant XRT following breast-conserving surgery
- Minimize radiation to normal tissue
- Rationale: ~ 90% of tumor recurrences occur at or within 1-2 cm of lumpectomy site
- Focusing radiation treatment to this vulnerable region may be beneficial
- Brachytherapy: Therapeutic range in mm
- Radioisotope delivers XRT at short distance from source, limiting dose to normal tissue
- Radioactive materials are placed directly at or near operated site
- 1 or a few fractions
- Variable dose rates, energies, shielding
- Radioisotope delivers XRT at short distance from source, limiting dose to normal tissue
- Interstitial (within tissue) brachytherapy
- Multiple catheters placed in operating room 1 cm apart, encompassing postlumpectomy area to be treated
- Advantage: Most conformal, best control of skin and chest wall dose
- Suitable for all breast shapes and types
- Disadvantage: Requires higher level of skill, training, and OR time (~ 45 minutes) and is most invasive
- Advantage: Most conformal, best control of skin and chest wall dose
- Multiple catheters placed in operating room 1 cm apart, encompassing postlumpectomy area to be treated
- Single lumen intracavitary, balloon brachytherapy (MammoSite)
- Ease of insertion: At surgery or under US guidance
- Requires good conformance and at least 7 mm skin-to-balloon-surface distance to avoid skin toxicity
- Multilumen intracavitary devices [Contoura, strut-adjusted volume implant (SAVI)]
- Advantage: Ease of insertion like MammoSite plus dosimetric advantages of interstitial brachytherapy
- Limits dose to chest wall and skin without compromising target coverage; preferred devices
- Device usually placed under US guidance postoperatively in lumpectomy cavity
- Satisfactory device placement confirmed by CT
- 3D planning to optimize dose-to-target volume and reduce dose to skin and chest wall
- 2 daily doses of 3.4 Gy each, separated by at least 6 hours for total of 5 days = 34 Gy in 10 fractions
- Accelerated external beam with 3D conformal (3DCRT) or intensity-modulated radiation therapy (IMRT)
- External beam restricted to lumpectomy site and immediate surrounding tissue
- Advantage: Noninvasive, easily available in most radiation departments
- Disadvantage: Higher dose to normal breast tissue and to greater volume of normal breast tissue vs. brachytherapy → sometimes poor cosmetic results
- External beam restricted to lumpectomy site and immediate surrounding tissue
- Intraoperative radiation therapy (IORT)
- Single fraction in operating room immediately following lumpectomy with either 3 or 9 MeV electrons or 50 kVp x-ray intrabeam device
- Requires careful lesion selection: Unifocal T1N0, ER(+) disease
- Treated before final pathologic assessment; if margins or nodes positive, need whole-breast irradiation (WBI) (~ 15% of TARGIT trial)
- External beam with protons (investigational)
- May be able to ↓ volume of normal breast tissue included in high-dose region vs. photon 3DCRT
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
Microscopic Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Paudel N et al: Impact of breast MRI in women eligible for breast conservation surgery and intra-operative radiation therapy. Surg Oncol. 27:95-99, 2018
- Coles CE et al: Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet. ePub, 2017
- Correa C et al: Accelerated partial breast irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Pract Radiat Oncol. 7(2):73-79, 2017
- Morrow M et al: Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ. Pract Radiat Oncol. 6(5):287-95, 2016
- Strnad V et al: 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet. 387(10015):229-38, 2016
- Ibrahim NB et al: Radiographic findings after treatment with balloon brachytherapy accelerated partial breast irradiation. Radiographics. 35(1):6-13, 2015
- Livi L et al: Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 51(4):451-63, 2015
- Buchholz TA et al: Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 32(14):1502-6, 2014
- Vaidya JS et al: Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 383(9917):603-13, 2014
- Lei RY et al: Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT). Breast Cancer Res Treat. 140(1):119-33, 2013
- Olivotto IA et al: Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol. 31(32):4038-45, 2013
- Leonardi MC et al: How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology. Int J Radiat Oncol Biol Phys. 83(3):806-13, 2012
- Vaidya J et al: Targeted intraoperative radiotherapy for early breast cancer: TARGIT-a trial-updated analysis of local recurrence and first analysis of survival [abstract]. Cancer Res. 72 (Suppl. 3), S4-2, 2012
- Ivanov O et al: Twelve-month follow-up results of a trial utilizing Axxent electronic brachytherapy to deliver intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol. 18(2):453-8, 2011
- Monticciolo DL et al: Breast conserving therapy with accelerated partial breast versus external beam whole breast irradiation: comparison of imaging sequela and complications in a matched population. Breast J. 17(2):187-90, 2011
- Ahmed HM et al: Mammographic appearance following accelerated partial breast irradiation by using MammoSite brachytherapy. Radiology. 255(2):362-8, 2010
- Shaitelman SF et al: Five-year outcome of patients classified using the American Society for Radiation Oncology consensus statement guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial. Cancer. 116(20):4677-85, 2010
- Smith BD et al: Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 74(4):987-1001, 2009
- Esserman LE et al: Imaging findings after breast brachytherapy. AJR Am J Roentgenol. 187:57-64, 2006
- Evans SB 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. 65(2):333-9, 2006
- Vicini F 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. 63(5):1531-7, 2005
- TARGIT-B
