Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

External-beam-based partial breast irradiation

Nature Clinical Practice Oncology volume 4, pages 326–327 (2007)Cite this article

Partial-breast irradiation (PBI) is becoming a new paradigm for breast cancer radiation, as discussed previously by Professor Sarin in this journal.1 No type I or type II evidence is currently available to demonstrate equivalence of this technique to standard whole-breast radiotherapy, and a prospective randomized trial jointly sponsored by the NSABP and RTOG (NSABP B-39 and RTOG 0413) is currently accruing patients to compare whole breast radiotherapy with PBI, performed either by brachytherapy or external-beam techniques. Until the results of this or similar trials are available PBI remains a research domain and should be offered to patients only in the context of a clinical experimental protocol.

Despite the fact that less extensive experience is available for external-beam PBI than for brachytherapy, PBI delivery through an external-beam approach presents many advantages. Firstly, external-beam PBI is likely to be more acceptable to the patient since it is noninvasive and does not require a surgical procedure or anesthesia. Moreover, since external-beam PBI is delivered after surgery the pathological analysis of the segmental mastectomy specimen is available to identify the best candidates for this approach. Secondly, external-beam PBI is likely to become more widely reproducible than brachytherapy, since successful application of external-beam PBI does not rely on the experience and skills of the radiation oncologist, unlike brachytherapy. Thirdly, once the technique of external-beam PBI is established, it can be widely applied at any facility that has a linear accelerator. Some brachytherapy approaches cannot be completed because of the unfavorable interplay of the patient's anatomy with the technical limitations of the applicator.2 External-beam PBI does not present this problem. Finally, in terms of health care economics, an external-beam approach spares the costs of an extra surgical procedure and those of several days of hospitalization (in the case of low-dose-rate brachytherapy).3

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Sarin R (2005) Partial-breast treatment for early breast cancer: emergence of a new paradigm. Nat Clin Pract Oncol 2: 40–47

    Article  Google Scholar 

  2. Keisch M et al. (2003) Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 55: 289–293

    Article  Google Scholar 

  3. Prosnitz LR and Marks LB (2006) Partial breast irradiation: a cautionary note. Int J Radiat Oncol Biol Phys 65: 319–321

    Article  Google Scholar 

  4. Ribeiro GG et al. (1993) The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol (R Coll Radiol) 5: 278–283

    Article  CAS  Google Scholar 

  5. Formenti SC et al. (2002) T1 stage breast cancer: adjuvant hypofractionated conformal radiation therapy to tumor bed in selected postmenopausal breast cancer patients—pilot feasibility study. Radiology 222: 171–178

    Article  Google Scholar 

  6. Vicini FA et al. (2003) Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 57: 1247–1253

    Article  Google Scholar 

  7. Formenti SC et al. (2004) Prone accelerated partial breast irradiation after breast-conserving surgery: preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 60: 493–504

    Article  Google Scholar 

  8. Vicini F et al. (2005) 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: 1531–1537

    Article  Google Scholar 

  9. Rosenstein BS et al. (2004) Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol Biol Phys 60: 1393–1404

    Article  Google Scholar 

  10. Owen JR et al. (2006) Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol 7: 467–471

    Article  Google Scholar 

  11. Formenti SC et al. (2006) External beam partial-breast radiotherapy: crucial differences between NYU 00-23 and RTOG 0319: in regard to Vicini et al. (Int J Radiat Oncol Biol Phys 2005; 63: 1531–1537). Int J Radiat Oncol Biol Phys 66: 630

    Google Scholar 

  12. Freedman GM et al. (2005) Pattern of local recurrence after conservative surgery and whole-breast irradiation. Int J Radiat Oncol Biol Phys 61: 1328–1336

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Department of Radiation Oncology, New York University School of Medicine, Room 123, 160 East 34th Street, New York, NY 10016, USA silvia.formenti@nyumc.org

Authors and Affiliations

  1. SC Formenti is Professor and Chair of the Department of Radiation Oncology, New York University School of Medicine, New York, NY, USA.,

    Silvia C Formenti

Authors
  1. Silvia C Formenti
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Formenti, S. External-beam-based partial breast irradiation. Nat Rev Clin Oncol 4, 326–327 (2007). https://doi.org/10.1038/ncponc0840

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc0840

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing