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Recent guidelines for accelerated partial breast irradiation (APBI) for breast cancer treatment may unnecessarily exclude many women who are good candidates for the procedure, withholding potentially significant benefits compared to radiating the entire breast.

According to a study presented this week at the American Society of Breast Surgeons (ASBrS) annual meeting, breast cancer patients treated with APBI who were considered unsuitable by the new American Society of Therapeutic Radiology and Oncology ( ASTRO ) guidelines had a similar five-year recurrence rate as those considered suitable.
 
"The study examined patients enrolled in the Society’s MammoSite Registry, the largest single data set of its kind, and the evidence was clear,” comments Peter Beitsch, MD, Director, Dallas Breast Center, and lead author of the study. “When we looked at the patients in the Registry, the new ASTRO Consensus Panel (CP) Guidelines failed to differentiate a group who had a higher rate of cancer recurrence in their breasts with the abbreviated radiation treatments.  This study clearly suggests that the ASTRO criteria for APBI are not a predictor of eventual patient outcomes.”

The study retrospectively examined 1440 breast cancer patients with 1449 breast cancers, including nine patients with bilateral disease, who were enrolled in the Registry from May 2002 until July 2004.  The MammoSite Registry provides historical data on women who received APBI using the MammoSite balloon catheter. For this study, these patients, who have been followed since enrollment, were classified according to the ASTRO guidelines.  Under the guidelines, women are deemed unsuitable for APBI if they meet a single criteria associated with the category. This includes all women who are less than 50 years of age as well as patients with tumors measuring greater than 3 cm., positive lymph nodes, positive margins or an extensive intraductal component (>3cm) within their tumor.
 
“The ASTRO guidelines considerably restrict the number of women qualifying for APBI,” comments Dr. Beitsch. “Accelerated partial breast irradiation offers important benefits, from minimizing the risk of radiation damage to healthy tissue to shortening the entire course of radiation therapy from six to seven weeks to just five days.  Following ASTRO guidelines will significantly limit the number of women who will benefit from APBI, and now this study also suggests that this will not have any measurable impact on breast disease recurrence.”

Dr. Beitsch emphasizes that physicians and patients must remember that the ASTRO guidelines are not based on evidence that accelerated radiation has a negative patient impact, only that a review of the current literature fails to provide a certain level of supporting evidence for the efficacy of APBI in some groups of women.   “This is an important difference, and we hope that insurance companies, in particular, will take this into account.”
 
“With today’s rapidly expanding understanding of breast disease, sophisticated therapies and advanced technologies, treatment is increasingly tailored to the individual patient and the nuances of her disease,” he says. “For example, excluding women from APBI therapy who are a few months shy of their 50th birthday is simply arbitrary and violates common sense. Yet, that’s exactly what these guidelines propose to do.”

Dr. Beitsch believes that physicians involved in the care of patients with breast cancer should examine the risks and benefits of APBI as well as all treatments in the context of the individual patient.  “All patients considering APBI should discuss it with their doctors,” he says.  “Women should seek out opinions from all physicians involved in their breast care to get their different points of view.  An informed decision to undergo APBI is appropriate for many women, even those deemed unsuitable by the ASTRO guidelines.”

Source: American Society of Breast Surgeons

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