Statement indicates need for more research on partial breast irradiation

NEW YORK (Reuters Health) - The American Society for Radiation Oncology (ASTRO) has released a consensus statement regarding patient selection and best practices in using accelerated partial breast irradiation (APBI) outside the context of a clinical trial.

A key message, however, is that there is simply a lack of data at present to assess its long-term safety and how it performs against whole breast irradiation, the gold standard.

The statement is published in the July 15th issue of the International Journal of Radiation Oncology, Biology, Physics.

Whole-breast irradiation (WBI) has been the standard therapy for early breast cancers treated with breast-conserving therapy, Dr. Benjamin D. Smith, chief of the radiation oncology department at Wilford Hall Medical Center, Lackland Air Force Base, Texas, and colleagues note. Recently, however, there has been increasing interest in APBI, which reduces the total treatment time from several weeks to just 4 or 5 days.

In addition to the reduced treatment time, APBI also delivers less radiation to nearby healthy tissues. Exactly how APBI stacks up against WBI and its long-term safety, however, are unclear. Data from randomized trials comparing the two treatments will not be available for several years.

The consensus statement, which is based on a review of 42 studies, outlines which patients may be considered for APBI. It recommends that patients be divided into three groups -- suitable, cautionary, and unsuitable -- based on whether APBI is acceptable for the patient outside of a clinical trial.

In addition to patient selection, the statement addresses such issues as informed consent, appropriate diagnostic imaging tests, integration of APBI into surgical and medical treatment, and the different APBI techniques.

The statement was created "to serve as a framework for promoting more clinical investigations into the role of APBI in treating breast cancer," Dr. Smith said in a statement.

"It is unlikely that APBI will replace WBI for most patients treated with breast-conserving surgery," he noted, "but further study may establish APBI as an appropriate and desirable treatment for certain selected patient groups."

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