Minireviews
Copyright ©The Author(s) 2016.
World J Clin Oncol. Oct 10, 2016; 7(5): 370-379
Published online Oct 10, 2016. doi: 10.5306/wjco.v7.i5.370
Table 1 Additional selected, non-randomized clinical experience with interstitial brachytherapy with more than 5 years follow-up
Ref.No. of patientsFollow-up interval (yr)ModalitySchemeTotal dose (Gy)5-yr LR (%)Good/excellent cosmesis
Strnad et al[57]2745.25PDR/HDRPDR = 0.6 Gy/hPDR = 50 Gy2.9%90%
HDR = 4 Gy × 8HDR = 32 Gy
Rabinovitch et al[32,58]9811.3LDR/HDRLDR = 3.5-5 dLDR = 45 Gy4%68%
HDR = 3.4 Gy × 10HDR = 34 Gy
Shah et al[59,60]19912.0LDR/HDRLDR 0.52 Gy/h × 96 hLDR = 50 Gy5% (12-yr 5%)99%
HDR = 4 Gy × 8HDR = 32 Gy
HDR = 3.4 Gy × 10HDR = 34 Gy
King et al[27]516.25LDR/HDRLDR = 4 dLDR = 45 Gy3.9%75%
HDR = 4 Gy × 8HDR = 32 Gy
Ott et al[61,62]2745.33PDR/HDRPDR = 0.6 Gy/hPDR = 49.8 Gy2.3%92%
HDR = 4 Gy × 8HDR = 32 Gy
Polgár et al[63]4511.1HDR4.33 Gy × 730.3 Gy4.4% (12-yr 9.3%)78%
5.2 Gy × 736.4 Gy
Table 2 Accelerated partial breast irradiation patient selection criteria according to American Society for Radiation Oncology consensus statement[52]
FactorsSuitableCautionaryUnsuitable
Age (yr)> 6050-59< 50
BRCA1/2 mutationNot presentNSPresent
Tumor size< 2 cm2.1-3.0 cm> 3 cm
T stageT1T0 or T2T3-4
MarginsNegative (> 2 mm)Close (< 2 mm)Positive
GradeAnyNSNS
LVSINoLimited/focalExtensive
ER statusPositiveNegativeNS
MulticentricityUnicentric onlyNSPresent
MultifocalityClinically unifocal with total size < 2 cmClinically unifocal with total size 2.1-3.0 cmMicroscopically multifocal > 3 cm in total size or if clinically multifocal
HistologyInvasive ductal or other favorable subtypesInvasive lobularNS
Pure DCISNot allowed< 3 cm> 3 cm
EICNot allowed< 3 cm> 3 cm
Associated LCISAllowedNSNS
LN statuspN0 (i-, i+)NSpN1, pN2, pN3, or if not evaluated
Neoadjuvant therapyNot allowedNSIf used
Table 3 Accelerated partial breast irradiation patient selection criteria from selected organizations
OrganizationAgeTumor sizeMarginHistologyLN status
American Brachytherapy Society[64]> 50< 3 cmNegative (at inked margin)Invasive ductal carcinomapN0; by SLN or axillary dissection
American Society of Breast Surgeons[36]> 45< 2 cmNegative (> 2 mm)Invasive ductal carcinoma or DCISpN0; by SLN or axillary dissection
ASTRO[52]> 60< 2 cmNegative (> 2 mm)Invasive ductal or other favorable subtypes (mucinous, tubular, and colloid)pN0; by SLN or axillary dissection
Table 4 Phase III prospective randomized trials evaluating the equivalence or non-inferiority of accelerated partial breast irradiation with whole-breast irradiation
TrialNo. of patientsFollow-up interval (yr)Inclusion criteriaAPBI technique5-yr LR APBI vs WBI (%)
TARGIT-A[45]34512.4Age ≥ 45 yr; T1, small T2, N0, N1; ductal; non-lobular and no EIC20 Gy in 1 fraction, IORT low energy X-rays (50 kV)3.3 vs 1.3
ELIOT[47]13055.8Age ≥ 48 yr; T ≤ 2.5 cm, N0; invasive carcinoma; quadrantectomy21 Gy in 1 fraction, IORT, electrons up to 9 MeV4.4 vs 0.4
RAPID (OCOG)[41]2135PendingAge > 40 yr; T ≤ 3 cm, N0; DCIS or invasive carcinoma; negative margins38.5 Gy in 10 fractions (5-8 d) using 3D-CRTPending
GEC-ESTRO[35]11845.0Age ≥ 40 yr; T ≤ 3 cm, pN0-Nmi; stage 0, I, II; DCIS, ductal or lobular carcinoma; margin ≥ 2 mm32 Gy in 8 fractions or 30.3 Gy in 7 fractions MIB HDR or 50 Gy MIB PDR (1 pulse/h, 24 h/d; 0.6-0.8 Gy/h)1.4 vs 0.9
Florence (NCT02104895)[42]5205.0Age > 40 yr; T < 2.5 cm; clear margins > 5 mmIMRT 30 Gy in 5 daily fractions1.5 vs 1.5
IMPORT-LOW2018PendingAge ≥ 50 yr; T ≤ 3 cm, node negative; invasive adenocarcinoma; margin ≥ 2 mmIMRT; Arm 1: 40 Gy in 15 fractions to primary tumor region + 36 Gy in 15 fractions to low-risk region (EBRT) Arm 2: 40 Gy in 15 fractions to primary tumor region (EBRT)Pending
IRMA (NCT01803958)3302 (Currently Enrolling)PendingAge ≥ 49 yr; T < 3 cm, N0; invasive carcinoma; margins ≥ 2 mm38.5 Gy in 10 fractions using 3D-CRT, BIDPending
SHARE (NCT01247233)1006PendingAge ≥ 50 yr; invasive carcinoma; T ≤ 2 cm; margin≥ 2 mm; pN0 (i+/-)3D-CRT 40 Gy in 10 fractions, BIDPending
NSABP B-39/RTOG 04134300PendingAge ≥ 18 yr; DCIS or invasive adenocarcinoma; stage 0, I, II (T < 3 cm); lumpectomy; margins free of tumor; ≤ 3 positive nodes34 Gy in 10 fractions using MIB or MammoSite®/MammoSite® ML/SAVI® or 38.5 Gy over 10 fractions using 3D-CRTPending