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  • Review Article
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Current modalities of accelerated partial breast irradiation

Nature Reviews Clinical Oncology volume 10, pages 344–356 (2013)Cite this article

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Abstract

The benefits of adjuvant whole-breast irradiation (WBI) after breast-conserving surgery are well established and WBI is a standard of care. In selected patients with early stage breast cancer, accelerated partial breast irradiation (APBI) has emerged as an alternative treatment option to WBI. Early trials of APBI have demonstrated an excellent local control rate and an associated good-to-excellent cosmetic outcome. APBI can reduce both the treatment volume and overall treatment time of adjuvant radiation therapy, which potentially overcomes logistical barriers associated with WBI that have previously prevented eligible women from pursuing breast-conserving therapy. Likewise, the addition of new modalities for APBI delivery has increased the number of patients who might be eligible for this adjuvant treatment—in the setting of breast-conserving surgery—despite the limited availability of long-term data on APBI outcomes compared to historical WBI outcomes. Ongoing phase III trials aim to compare APBI with WBI and also point the practitioner to the appropriate APBI patient selection criteria. Here, we review available modalities, patient selection criteria and consensus guideline recommendations, and current controversies in APBI.

Key Points

  • Accelerated partial breast irradiation (APBI) is based on the principle that most early stage breast cancer recurrences are immediately adjacent to the index lumpectomy site

  • APBI offers patients pursuing breast conserving therapy an effective and expedient option to receive the obligate radiation therapy following lumpectomy, in select cases

  • Several innovative methods of delivering APBI include catheter and balloon or strut brachytherapy applicators, numerous intraoperative techniques, as well as the adaptation of more-traditional external-beam radiotherapy techniques

  • There is a shortage of mature randomized controlled data with long-term follow-up comparing whole breast irradiation (WBI) to APBI in the management of early stage breast cancer

  • Consensus guidelines have been developed to determine who might be appropriate candidates for APBI treatment, outside the auspices of a clinical trial

  • Randomized prospective data of multicatheter interstitial brachytherapy comparing WBI with APBI has produced encouraging results; the use of APBI in select patients is supported by the NCCN in recent updated guidelines

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Figure 1: Multicatheter interstitial brachytherapy configuration.
Figure 2: Applicators of accelerated partial breast irradiation.
Figure 3: Example of 3D-conformal radiation therapy beam arrangement.

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References

  1. Hayat, M. J., Howlader, N., Reichman, M.E. & Edwards, B.K. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist 12, 20–37 (2007).

    Article  PubMed  Google Scholar 

  2. National Cancer Institute. Seer cancer statistics review, 1975–2006 [online], (2009).

  3. [No authors listed] Consensus statement: treatment of early-stage breast cancer. National Institutes of Health Consensus Development Panel. J. Natl Cancer Inst. Monogr. 11, 15 (1992).

  4. Fisher, B. et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N. Engl. J. Med. 347, 1233–1241 (2002).

    Article  PubMed  Google Scholar 

  5. van Dongen, J. A. et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J. Natl Cancer Inst. 92, 1143–1150 (2000).

    Article  CAS  PubMed  Google Scholar 

  6. Veronesi, U. et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N. Engl. J. Med. 347, 1227–1232 (2002).

    Article  PubMed  Google Scholar 

  7. National Comprehensive Cancer Network. NCCN≈Clinical Practice Guidelines in Oncology Breast Cancer version 2.2013 [online], (2013).

  8. Whelan, T. J. et al. Long-term results of hypofractionated radiation therapy for breast cancer. N. Engl. J. Med. 362, 513–520 (2010).

    Article  CAS  PubMed  Google Scholar 

  9. Smith, T. E., Lee, D., Turner, B. C., Carter, D. & Haffty, B. G. True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int. J. Radiat. Oncol. Biol. Phys. 48, 1281–1289 (2000).

    Article  CAS  PubMed  Google Scholar 

  10. Huang, E. et al. Classifying local disease recurrences after breast conservation therapy based on location and histology: New primary tumors have more favorable outcomes than true local disease recurrences. Cancer 95, 2059–2067 (2002).

    Article  PubMed  Google Scholar 

  11. Fowble, B., Solin, L. J., Schultz, D. J., Rubenstein, J. & Goodman, R. L. Breast recurrence following conservative surgery and radiation: Patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int. J. Radiat. Oncol. Biol. Phys. 19, 833–842 (1990).

    Article  CAS  PubMed  Google Scholar 

  12. Gage, I. et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 33, 245–251 (1995).

    Article  CAS  PubMed  Google Scholar 

  13. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomised trials. Lancet 365, 1687–1717 (2005).

  14. Saphner, T., Tormey, D. C. & Gray, R. Annual hazard rates of recurrence for breast cancer after primary therapy. J. Clin. Oncol. 14, 2738–2746 (1996).

    Article  CAS  PubMed  Google Scholar 

  15. Nattinger, A. B., Gottlieb, M. S., Veum, J., Yahnke, D. & Goodwin, J. S. Geographic variation in the use of breast-conserving treatment for breast cancer. N. Engl. J. Med. 326, 1102–1107 (1992).

    Article  CAS  PubMed  Google Scholar 

  16. Hiotis, K., Ye, W., Sposto, R. & Skinner, K. A. Predictors of breast conservation therapy: size is not all that matters. Cancer 103, 892–899 (2005).

    Article  PubMed  Google Scholar 

  17. Morrow, M., Bucci, C. & Rademaker, A. Medical contraindications are not a major factor in the underutilization of breast conserving therapy. J. Am. Coll. Surg. 186, 269–274 (1998).

    Article  CAS  PubMed  Google Scholar 

  18. Legorreta, A. P., Liu, X. & Parker, R. G. Examining the use of breast-conserving treatment for women with breast cancer in a managed care environment. Am. J. Clin. Oncol. 23, 438–441 (2000).

    Article  CAS  PubMed  Google Scholar 

  19. Farrow, D. C., Hunt, W. C. & Samet, J. M. Geographic variation in the treatment of localized breast cancer. N. Engl. J. Med. 326, 1097–1101 (1992).

    Article  CAS  PubMed  Google Scholar 

  20. Lazovich, D. A., White, E., Thomas, D. B. & Moe, R. E. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA 266, 3433–3438 (1991).

    Article  CAS  PubMed  Google Scholar 

  21. Ballard-Barbash, R., Potosky, A. L., Harlan, L. C., Nayfield, S. G. & Kessler, L. G. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J. Natl Cancer Inst. 88, 716–726 (1996).

    Article  CAS  PubMed  Google Scholar 

  22. Fisher, B. et al. Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J. Clin. Oncol. 20, 4141–4149 (2002).

    Article  CAS  PubMed  Google Scholar 

  23. Kuerer, H. M. et al. Accelerated partial breast irradiation after conservative surgery for breast cancer. Ann. Surg. 239, 338–351 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Swanson, T. A. & Vicini, F. A. Overview of accelerated partial breast irradiation. Curr. Oncol. Rep. 10, 54–60 (2008).

    Article  PubMed  Google Scholar 

  25. Kahán, Z. et al. The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int. J. Radiat. Oncol. Biol. Phys. 68, 673–681 (2007).

    Article  PubMed  Google Scholar 

  26. Kwa, S. L. et al. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int. J. Radiat. Oncol. Biol. Phys. 42, 1–9 (1998).

    Article  CAS  PubMed  Google Scholar 

  27. Darby, S. C., McGale, P., Taylor, C. W. & Peto, R. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: Prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol. 6, 557–565 (2005).

    Article  PubMed  Google Scholar 

  28. Kirova, Y. M. et al. Risk of second malignancies after adjuvant radiotherapy for breast cancer: a large-scale, single-institution review. Int. J. Radiat. Oncol. Biol. Phys. 68, 359–363 (2007).

    Article  PubMed  Google Scholar 

  29. Schaapveld, M. et al. Risk of new primary nonbreast cancers after breast cancer treatment: a Dutch population-based study. J. Clin. Oncol. 26, 1239–1246 (2008).

    Article  PubMed  Google Scholar 

  30. Schaapveld, M. et al. The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer: a population based study in the Netherlands. Breast Cancer Res. Treat. 110, 189–197 (2008).

    Article  CAS  PubMed  Google Scholar 

  31. Keisch, M., Arthur, D., Patel, R., Rivard, M. & Vicini, F. American Brachytherapy Society, Breast Brachytherapy Task Group [online], (2007).

    Google Scholar 

  32. The American Society of Breast Surgeons. Consensus Statement for Accelerated Partial Breast Irradiation [online], (2008).

  33. Radiation Therapy Oncology Group. RTOG 0413 Protocol Information [online], (2011).

  34. Smith, B. D. et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int. J. Radiat. Oncol. Biol. Phys. 74, 987–1001 (2009).

    Article  PubMed  Google Scholar 

  35. King, T. A. et al. Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for t(is, 1, 2) breast cancer. Am. J. Surg. 180, 299–304 (2000).

    Article  CAS  PubMed  Google Scholar 

  36. Vicini, F. A. et al. Long-term efficacy and patterns of failure after accelerated partial breast irradiation: a molecular assay-based clonality evaluation. Int. J. Radiat. Oncol. Biol. Phys. 68, 341–346 (2007).

    Article  PubMed  Google Scholar 

  37. Kaufman, S. A., DiPetrillo, T. A., Price, L. L., Midle, J. B. & Wazer, D. E. Long-term outcome and toxicity in a phase I/II trial using high-dose-rate multicatheter interstitial brachytherapy for t1/t2 breast cancer. Brachytherapy 6, 286–292 (2007).

    Article  PubMed  Google Scholar 

  38. Benitez, P. R. et al. Five-year results: the initial clinical trial of MammoSite balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am. J. Surg. 194, 456–462 (2007).

    Article  PubMed  Google Scholar 

  39. Arthur, D. W. et al. A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: tumor control and survival outcomes of RTOG 95–17. Int. J. Radiat. Oncol. Biol. Phys. 72, 467–473 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chen, P. Y. et al. Four-year efficacy, cosmesis, and toxicity using three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 76, 991–997 (2010).

    Article  PubMed  Google Scholar 

  41. Nelson, J. C. et al. Four-year clinical update from the American Society of Breast Surgeons MammoSite brachytherapy trial. Am. J. Surg. 198, 83–91 (2009).

    Article  PubMed  Google Scholar 

  42. Patel, R. R., Christensen, M. E., Hodge, C. W., Adkison, J. B. & Das, R. K. Clinical outcome analysis in “high-risk” versus “low-risk” patients eligible for National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 trial: five-year results. Int. J. Radiat. Oncol. Biol. Phys. 70, 970–973 (2008).

    Article  PubMed  Google Scholar 

  43. Clarke, M. Meta-analyses of adjuvant therapies for women with early breast cancer: The Early Breast Cancer Trialists' Collaborative Group overview. Ann. Oncol. 17 (Suppl. 10), x59–x62 (2006).

    Article  PubMed  Google Scholar 

  44. Mannino, M. & Yarnold, J. R. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld? Radiother. Oncol. 90, 14–22 (2009).

    Article  PubMed  Google Scholar 

  45. Hughes, K. S. et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N. Engl. J. Med. 351, 971–977 (2004).

    Article  CAS  PubMed  Google Scholar 

  46. Hughes, K. S. et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early stage breast cancer [abstract]. J. Clin. Oncol. 28 (Suppl. 15), a507 (2010).

    Article  Google Scholar 

  47. Kuske, R. R. Jr. Breast brachytherapy. Hematol. Oncol. Clin. North Am. 13, 543–558 (1999).

    Article  PubMed  Google Scholar 

  48. Cuttino, L. W., Todor, D. & Arthur, D. W. CT-guided multi-catheter insertion technique for partial breast brachytherapy: reliable target coverage and dose homogeneity. Brachytherapy 4, 10–17 (2005).

    Article  PubMed  Google Scholar 

  49. Kuske, R. R. et al. Phase II trial of brachytherapy alone after lumpectomy for select breast cancer: toxicity analysis of RTOG 95–17. Int. J. Radiat. Oncol. Biol. Phys. 65, 45–51 (2006).

    Article  PubMed  Google Scholar 

  50. Polgár, C. et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma--5-year results of a randomized trial. Int. J. Radiat. Oncol. Biol. Phys. 69, 694–702 (2007).

    Article  PubMed  Google Scholar 

  51. MammoSite®. What is MammoSite 5-Day Targeted Radiation Therapy? [online], (2013).

  52. Vicini, F. et al. Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 79, 808–817 (2011).

    Article  PubMed  Google Scholar 

  53. Goyal, S. et al. Factors associated with optimal cosmetic results at 36 months in patients treated with accelerated partial breast irradiation (APBI) on the American Society of Breast Surgeons (ASBrS) MammoSite Breast Brachytherapy Registry Trial. Ann. Surg. Oncol. 16, 2450–2458 (2009).

    Article  PubMed  Google Scholar 

  54. Jeruss, J. S., Kuerer, H. M., Beitsch, P. D., Vicini, F. A. & Keisch, M. Update on DCIS outcomes from the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Ann. Surg. Oncol. 18, 65–71 (2011).

    Article  PubMed  Google Scholar 

  55. Fisher, B. et al. Tumor bed-to-skin distance using accelerated partial-breast irradiation with the strut-adjusted volume implant device. Brachytherapy 11, 387–391 (2012).

    Article  PubMed  Google Scholar 

  56. Lee, K. et al. Acute toxicity and early cosmetic outcome in patients treated with multilumen balloon brachytherapy with skin spacing ≤7.0 millimeters. J. Contemp. Brachytherapy 4, 8–13 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Khan, A. J. et al. Dosimetric feasibility and acute toxicity in a prospective trial of ultrashort-course accelerated partial breast irradiation (APBI) using a multi-lumen balloon brachytherapy device. Ann. Surg. Oncol. 20, 1295–1301 (2013).

    Article  CAS  PubMed  Google Scholar 

  58. 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, 1531–1537 (2005).

    Article  PubMed  Google Scholar 

  59. Hepel, J. T. et al. Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 75, 1290–1296 (2009).

    Article  PubMed  Google Scholar 

  60. Jagsi, R. et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 76, 71–78 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Julian, T. B. et al. Early toxicity results with 3D conformal external beam (CEBT) from the NSABP B-39/RTOG 0413 accelerated partial breast irradiation (APBI) trial [abstract]. J. Clin. Oncol. 29 (Suppl. 15), a1011 (2011).

    Article  Google Scholar 

  62. Bourgier, C. et al. Higher toxicity with 42 Gy in 10 fractions as a total dose for 3D-conformal accelerated partial breast irradiation: results from a dose escalation phase II trial. Radiat. Oncol. 7, 141 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  63. Formenti, S. C., DeWyngaert, J. K., Jozsef, G. & Goldberg, J. D. Prone vs supine positioning for breast cancer radiotherapy. JAMA 308, 861–863 (2012).

    Article  CAS  PubMed  Google Scholar 

  64. Wang, X. et al. External-beam accelerated partial breast irradiation using multiple proton beam configurations. Int. J. Radiat. Oncol. Biol. Phys. 80, 1464–1472 (2011).

    Article  PubMed  Google Scholar 

  65. Dickler, A. et al. A dosimetric comparison of MammoSite high-dose-rate brachytherapy and Xoft Axxent electronic brachytherapy. Brachytherapy 6, 164–168 (2007).

    Article  PubMed  Google Scholar 

  66. Brenner, D. J., Leu, C. S., Beatty, J. F. & Shefer, R. E. Clinical relative biological effectiveness of low-energy x-rays emitted by miniature x-ray devices. Phys. Med. Biol. 44, 323–333 (1999).

    Article  CAS  PubMed  Google Scholar 

  67. Vaidya, J. S. et al. Targeted intraoperative radiotherapy (TARGIT): an innovative approach to partial-breast irradiation. Semin. Radiat. Oncol. 15, 84–91 (2005).

    Article  PubMed  Google Scholar 

  68. 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).

    Article  Google Scholar 

  69. Sawaki, M. et al. Phase I/II study of intraoperative radiotherapy for early breast cancer in Japan. Breast Cancer 19, 353–359 (2012).

    Article  PubMed  Google Scholar 

  70. Luini, A. et al. The pilot trial on intraoperative radiotherapy with electrons (ELIOT): update on the results. Breast Cancer Res. Treat. 93, 55–59 (2005).

    Article  PubMed  Google Scholar 

  71. Leonardi, M. C. 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, 806–813 (2012).

    Article  PubMed  Google Scholar 

  72. Orecchia, R. ELIOT trials in Milan: results [abstract]. Radiother. Oncol. 103 (Suppl. 2), S4 a10 (2013).

    Google Scholar 

  73. Orecchia, R. IORT update: what are the limits of radiation dose and volume? Radiother. Oncol. 103 (Suppl. 1), S38 (2012).

    Article  Google Scholar 

  74. Mannino, M. & Yarnold, J. Accelerated partial breast irradiation trials: diversity in rationale and design. Radiother. Oncol. 91, 16–22 (2009).

    Article  PubMed  Google Scholar 

  75. Offersen, B. V., Overgaard, M., Kroman, N. & Overgaard, J. Accelerated partial breast irradiation as part of breast conserving therapy of early breast carcinoma: a systematic review. Radiother. Oncol. 90, 1–13 (2009).

    Article  PubMed  Google Scholar 

  76. Vicini, F. et al. Limitations of the American Society of Therapeutic Radiology and Oncology Consensus Panel guidelines on the use of accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 79, 977–984 (2011).

    Article  PubMed  Google Scholar 

  77. McHaffie, D. R. et al. Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features. Int. J. Radiat. Oncol. Biol. Phys. 81, 46–51 (2011).

    Article  PubMed  Google Scholar 

  78. Stull, T. S. et al. A single-institution review of accelerated partial breast irradiation in patients considered “cautionary” by the American Society for Radiation Oncology. Ann. Surg. Oncol. 19, 553–559 (2012).

    Article  PubMed  Google Scholar 

  79. Shaitelman, S. F. 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, 4677–4685 (2010).

    Article  PubMed  Google Scholar 

  80. Beitsch, P. et al. Five-year outcome of patients classified in the “unsuitable” category using the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite® Registry trial. Ann. Surg. Oncol. 17 (Suppl. 3), 219–225 (2010).

    Article  PubMed  Google Scholar 

  81. Wilkinson, J. B. et al. Evaluation of current consensus statement recommendations for accelerated partial breast irradiation: a pooled analysis of William Beaumont Hospital and American Society of Breast Surgeon MammoSite registry trial data. Int. J. Radiat. Oncol. Biol. Phys. 85, 1179–1185 (2013).

    Article  PubMed  Google Scholar 

  82. Smith, G. L. et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA 307, 1827–1837 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  83. Cuttino, L. W. et al. Accelerated partial-breast irradiation: trial by media or by science? Int. J. Radiat. Oncol. Biol. Phys. 83, 1075–1077 (2012).

    Article  PubMed  Google Scholar 

  84. Khan, A. J., Vicini, F. A. & Arthur, D. Brachytherapy vs whole-breast irradiation for breast cancer. JAMA 308, 567 (2012).

    Article  CAS  PubMed  Google Scholar 

  85. Alpert, T. E., Kuerer, H. M., Arthur, D. W., Lannin, D. R. & Haffty, B. G. Ipsilateral breast tumor recurrence after breast conservation therapy: outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation. Int. J. Radiat. Oncol. Biol. Phys. 63, 845–851 (2005).

    Article  PubMed  Google Scholar 

  86. Shah, C. et al. Outcome after ipsilateral breast tumor recurrence in patients with early-stage breast cancer treated with accelerated partial breast irradiation. Clin. Breast Cancer 12, 392–397 (2012).

    Article  PubMed  Google Scholar 

  87. Adkison, J. B., Kuske, R. R. & Patel, R. R. Breast conserving surgery and accelerated partial breast irradiation after prior breast radiation therapy. Am. J. Clin. Oncol. 33, 427–431 (2010).

    Article  PubMed  Google Scholar 

  88. Radiation Therapy Oncology Group. RTOG 1014 Protocol Information [online], (2011).

  89. Smith, G. L. et al. Brachytherapy for accelerated partial-breast irradiation: a rapidly emerging technology in breast cancer care. J. Clin. Oncol. 29, 157–165 (2011).

    Article  PubMed  Google Scholar 

  90. Abbott, A. M., Habermann, E. B. & Tuttle, T. M. Trends in the use of implantable accelerated partial breast irradiation therapy for early stage breast cancer in the United States. Cancer 117, 3305–3310 (2011).

    Article  PubMed  Google Scholar 

  91. Shah, C. et al. Cost-efficacy of acceleration partial-breast irradiation compared with whole-breast irradiation. Breast Cancer Res. Treat. 138, 127–135 (2013).

    Article  PubMed  Google Scholar 

  92. Shah, C. et al. Cost-effectiveness of 3-dimensional conformal radiotherapy and applicator-based brachytherapy in the delivery of accelerated partial breast irradiation. Am. J. Clin. Oncol. http://dx.doi.org/10.1097/COC.0b013e318271b16d.

  93. Darby, S. C. et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N. Engl. J. Med. 368, 987–998 (2013).

    Article  CAS  PubMed  Google Scholar 

  94. Moran, J. M. et al. Accelerated partial breast irradiation: what is dosimetric effect of advanced technology approaches? Int. J. Radiat. Oncol. Biol. Phys. 75, 294–301 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  95. Patel, R. R., Becker, S. J., Das, R. K. & Mackie, T. R. A dosimetric comparison of accelerated partial breast irradiation techniques: multicatheter interstitial brachytherapy, three-dimensional conformal radiotherapy, and supine versus prone helical tomotherapy. Int. J. Radiat. Oncol. Biol. Phys. 68, 935–942 (2007).

    Article  PubMed  Google Scholar 

  96. Antonucci, J. V. et al. Differences in patterns of failure in patients treated with accelerated partial breast irradiation versus whole-breast irradiation: a matched-pair analysis with 10-year follow-up. Int. J. Radiat. Oncol. Biol. Phys. 74, 447–452 (2009).

    Article  PubMed  Google Scholar 

  97. Ott, O. J. et al. Accelerated partial breast irradiation with interstitial implants: risk factors associated with increased local recurrence. Int. J. Radiat. Oncol. Biol. Phys. 80, 1458–1463 (2011).

    Article  PubMed  Google Scholar 

  98. Ott, O. J. et al. Accelerated partial breast irradiation with multi-catheter brachytherapy: local control, side effects and cosmetic outcome for 274 patients. Results of the German-Austrian multi-centre trial. Radiother. Oncol. 82, 281–286 (2007).

    Article  PubMed  Google Scholar 

  99. Polgár, C. et al. Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother. Oncol. 94, 274–279 (2010).

    Article  PubMed  Google Scholar 

  100. Khan, A. J. et al. Local control, toxicity, and cosmesis in women >70 years enrolled in the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Int. J. Radiat. Oncol. Biol. Phys. 84, 323–330 (2012).

    Article  PubMed  Google Scholar 

  101. Cuttino, L. W. et al. Multi-institutional experience using the MammoSite radiation therapy system in the treatment of early-stage breast cancer: 2-year results. Int. J. Radiat. Oncol. Biol. Phys. 71, 107–114 (2008).

    Article  PubMed  Google Scholar 

  102. Wilkinson, J. B. et al. Four-year results using balloon-based brachytherapy to deliver accelerated partial breast irradiation with a 2-day dose fractionation schedule. Brachytherapy 11, 97–104 (2012).

    Article  PubMed  Google Scholar 

  103. Dragun, A. E., Harper, J. L., Jenrette, J. M., Sinha, D. & Cole, D. J. Predictors of cosmetic outcome following MammoSite breast brachytherapy: a single-institution experience of 100 patients with two years of follow-up. Int. J. Radiat. Oncol. Biol. Phys. 68, 354–358 (2007).

    Article  PubMed  Google Scholar 

  104. Israel, P. Z. et al. Three-year clinical outcome using the Contura multilumen balloon breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI): improving radiation standards for the optimal application of APBI. Brachytherapy 11, 316–321 (2012).

    Article  PubMed  Google Scholar 

  105. Yashar, C. M. et al. Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast brachytherapy device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up. Int. J. Radiat. Oncol. Biol. Phys. 80, 765–770 (2011).

    Article  PubMed  Google Scholar 

  106. Vicini, F. A. et al. Initial efficacy results of RTOG 0319: three-dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/ II breast carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 77, 1120–1127 (2010).

    Article  PubMed  Google Scholar 

  107. Shah, C. et al. Five-year outcomes and toxicities using 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Clin. Breast Cancer http://dx.doi.org/10.1016/j.clbc.2012.09.020.

  108. Leonardi, M. C. et al. Accelerated partial breast irradiation with intraoperative electrons: Using GEC-ESTRO recommendations as guidance for patient selection. Radiother. Oncol. 106, 21–27 (2013).

    Article  PubMed  Google Scholar 

  109. Vaidya, J. S. et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376, 91–102 (2010).

    Article  PubMed  Google Scholar 

  110. Ivanov, O., Dickler, A., Lum, B. Y., Pellicane, J. V. & Francescatti, D. S. 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, 453–458 (2011).

    Article  PubMed  Google Scholar 

  111. Mehta, V. K. et al. Experience with an electronic brachytherapy technique for intracavitary accelerated partial breast irradiation. Am. J. Clin. Oncol. 33, 327–335 (2010).

    Article  PubMed  Google Scholar 

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  1. Department of Radiation Oncology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, 77555-0711, TX, USA

    John A. Cox & Todd A. Swanson

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  1. John A. Cox
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  2. Todd A. Swanson
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Both authors researched data for article, made a substantial contribution to discussion of content, and wrote and edited the article before submission.

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Correspondence to Todd A. Swanson.

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Cox, J., Swanson, T. Current modalities of accelerated partial breast irradiation. Nat Rev Clin Oncol 10, 344–356 (2013). https://doi.org/10.1038/nrclinonc.2013.65

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