D105 APBI Future - My Point of View

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Institut Catal dOncologia

Dr. F. Guedea 28 de enero 2011

APBI future: My point of view.

Congreso Portugus de Oncologa Radioterpica

Porto, 27 al 29 de Enero 2011


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Institut Catal dOncologiaICO+centre. Servei/Unitat

11.. TheThe futurefuture forfor RTRT inin BreastBreast cancercancer::

11..11 HypofractionationHypofractionation inin BreastBreast CancerCancer

11..22 IMRTIMRT inin BreastBreast CancerCancer

11..33 APBIAPBI

22.. RationaleRationale forfor APBIAPBI::

33.. ModalitiesModalities ofof APBIAPBI::

44.. LiteratureLiterature reviewreview forfor APBIAPBI::

55.. CatalanCatalan InstituteInstitute ofof OncologyOncology experienceexperience..66.. GeneralGeneral ConclusionsConclusions::


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1.RMH/GOC Phase III Trial (UK): 19861.RMH/GOC Phase III Trial (UK): 1986--19981998

2.Ontario Phase III Trial (Canada): 19932.Ontario Phase III Trial (Canada): 1993--19961996

3.START A Phase III Trial (UK):3.START A Phase III Trial (UK): A 1999A 1999--200220024.START B Phase III Trial (UK): 19994.START B Phase III Trial (UK): 1999--20012001

PhasePhase IIIIII trialstrials forfor

hypofractionationhypofractionation inin BreastBreast cancercancer

J. Yarnold, S. Bentzen et al.

Hypofractionated whole-breast RT for women with early breast cancer:Myths and realities.

IJROBP in press. Accepted august 2010.


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2.Ontario Phase III (Canada, Whelan et al.)19932.Ontario Phase III (Canada, Whelan et al.)1993--19961996

50.0/25/5.0 (2.0) LR: 3.2% Good Cosmesis: 79.2%50.0/25/5.0 (2.0) LR: 3.2% Good Cosmesis: 79.2%42.5/16/3.2 (2.66) LR: 2.8% Good Cosmesis: 77.9%42.5/16/3.2 (2.66) LR: 2.8% Good Cosmesis: 77.9%

with median FU > 132 monthswith median FU > 132 months

1234 patients1234 patients

Phase III trials forPhase III trials for

hypofractionation in Breast cancerhypofractionation in Breast cancer

Whelan T., et al..

Long-term results of Hypofractionated RT for breast cancer:

NEJM 362: 513-520. 2010


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11..11 HypofractionationHypofractionation inin BreastBreast CancerCancer

11..22 IMRTIMRT inin BreastBreast CancerCancer

11..33 ABPIABPI






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Pignol JP., Olivotto I., et al.Pignol JP., Olivotto I., et al.

JCO. 15, 2488JCO. 15, 2488--2493. 2007.2493. 2007.

Randomised trial of 3D RT vs IMRT in 358 patientsRandomised trial of 3D RT vs IMRT in 358 patientsIMRT compared to conventional RT (P=0.002) significantly reduces theIMRT compared to conventional RT (P=0.002) significantly reduces the

development of severe moist descamation (31.2 vs 47.8%).development of severe moist descamation (31.2 vs 47.8%).

ThreeThree phasephase IIIIII studystudy publishedpublished forfor BreastBreast

tumorstumors ((ComparingComparing IMRT vs Standard RT)IMRT vs Standard RT)

Donovan E., Yarnold J., et al.Donovan E., Yarnold J., et al.

Rad. & Oncol. 82, 254Rad. & Oncol. 82, 254--264. 2007.264. 2007.

Randomised trial of standard 2D RT vs IMRT in 306 patients.Randomised trial of standard 2D RT vs IMRT in 306 patients.Incidence of change in breast appearance was higher with standard RTIncidence of change in breast appearance was higher with standard RT

compared to IMRT (P=0.008).compared to IMRT (P=0.008).


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BarnettBarnett G., et al.G., et al.Radio. &Radio. & OncolOncol. 92, 34. 92, 34--41. 2009.41. 2009.

AA randomisedrandomised controlledcontrolled trial of forwardtrial of forward--plannedplanned RT (IMRT)RT (IMRT) forfor 11451145 patientspatients

withwith earlyearly breastbreast cancercancer:: baselinebaseline characteristicscharacteristics andand dosimetrydosimetry resultsresults..

ConclusionConclusion:: ThisThis trialtrial confirmedconfirmed thatthat dosimetrydosimetry cancan bebe significantlysignificantlyimprovedimproved withwith aa simplesimple methodmethod ofof forwardforward--plannedplanned dosimetrydosimetry.. ItIt isis shownshown

thatthat patientspatients withwith largerlarger breastsbreasts areare moremore likelylikely withwith dosedose inhomogeneitiesinhomogeneities

andand breastbreast separationseparation givesgives somesome indicationsindications ofof thisthis likelihoodlikelihood..

PhotographsPhotographs assessmentassessment ofof patientspatients atat 22 yearsyears afterafter RT,RT, asas thethe nextnext partpart ofof

thisthis randomisedrandomised controlledcontrolled trial,trial, willwill showshow whetherwhether thesethese resultsresults forfor IMRTIMRT

translatetranslate intointo improvedimproved cosmeticcosmetic outcomeoutcome..

Breast IMRT Phase III trialBreast IMRT Phase III trial


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33.. ModalitiesModalities ofof APBIAPBI::44.. LiteratureLiterature reviewreview forfor APBIAPBI::

55.. CatalanCatalan InstituteInstitute ofof OncologyOncology experienceexperience::

66.. GeneralGeneral ConclusionsConclusions::


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Location of local recurrence in the breast after tumorectomy

AuthorsAuthors NN casescases NN recurrencesrecurrences NN recurrencesrecurrences inin

thethe samesame quadrantquadrant

Clark 1982Clark 1982 680680 8787 84 ( 96 % )84 ( 96 % )SchnittSchnitt 154154 1212 10 ( 83 %)10 ( 83 %)

Clarke 1985Clarke 1985 436436 1515 9 ( 60 % )9 ( 60 % )

LeungLeung 19861986 493493 4848 36 ( 75 % )36 ( 75 % )

LimbergenLimbergen 19871987 238238 2222 19 ( 86 % )19 ( 86 % )

TOTALTOTAL 19911991 184184 158 ( 86 % )158 ( 86 % )

VeronesiVeronesi,, MilanMilan, 12, 12 yearyear followfollow--up. 86% localup. 86% local relapsesrelapses inin thethe samesame quadrantquadrant..

Rationale for APBIRationale for APBI


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PorcentagePorcentage dede controlcontrol locallocal aa loslos 55 aaosos:: 8282%% enen pacientespacientes dedemenosmenos dede 3535 aaosos..

PorcentagePorcentage dede controlcontrol locallocal aa loslos 55 aaosos:: 8585%% enen pacientespacientes dedeentreentre 3636--4040 aaosos..

PorcentagePorcentage dede controlcontrol locallocal aa loslos 55 aaosos:: 9292%% enen pacientespacientes dedeentreentre 4141--5050 aaosos..

PorcentagePorcentage dede controlcontrol locallocal aa loslos 55 aaosos:: 9696%% enen pacientespacientes dede

entreentre 5151--6060 aaosos.. PorcentagePorcentage dede controlcontrol locallocal aa loslos 55 aaosos:: 9797%% enen pacientespacientes dede

mmss dede 6060 aaosos

P


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SelectedSelected patientspatients::

elderlyelderly patientspatients ((SupSup toto 5555--6060 yearsyears))

T1T1 tumorstumors

EstrogenEstrogen receptorsreceptors positivepositive

WithoutWithout EICEIC

WithoutWithout lymphovascularlymphovascular invasioninvasion

NegativeNegative axillaryaxillary nodesnodes

MarginsMargins freefree

APBI

Fowble B, Radiother Oncol 55, 26, 2000Fowble B, Radiother Oncol 55, 26, 2000


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11.. RationaleRationale forfor APBIAPBI::22.. ModalitiesModalities ofof APBIAPBI::

2.1 Multicatheters Technique.2.1 Multicatheters Technique.2.2 Baloon Technique (Mamosite).2.2 Baloon Technique (Mamosite).2.3 IORT with electrons.2.3 IORT with electrons.2.4 IORT with Intrabeam.2.4 IORT with Intrabeam.

2.5 Electronic Brachytherapy (Xoft).2.5 Electronic Brachytherapy (Xoft).2.6 EBRT with 32.6 EBRT with 3--D or IMRT.D or IMRT.

2.7 Seeds.2.7 Seeds.2.8 Non invasive Brachytherapy (Accuboost)2.8 Non invasive Brachytherapy (Accuboost)

3. Literature review for APBI:3. Literature review for APBI:



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2.1 Multicatheters technique: advantages

TumorTumor parametersparameters areare exactlyexactly knowknow atat thethe time oftime of implantimplant ((IfIf thethe

implantimplant isis donedone postoperativepostoperative).).

TargetTarget volumevolume coveragecoverage isis notnot limitedlimited inin formform andand volumevolume..

VeryVery goodgood reproducibilityreproducibility..

TreatmentTreatment planningplanning simple andsimple and reliablereliable..


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2.1 Multicatheters technique: disadvantages

Individually long learning curve.

Some puncture sites


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2.2 Balloon technique: advantages

Short learning curve.

Good reproducibility.

One puncture site.


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2.2 Balloon technique: disadvantages

Volume coverage is very limited in form and volume. Tumor parameters are not exactly know at the time of implant

Dose to the skin.


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2.3 Single fraction 21 Gy with an IORT

dedicated accelerator : advantages

Good target volume coverage with sufficient dose.


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2.3 Single fraction 21 Gy with an IORT

dedicated accelerator : disadvantages

Tumor parameters are not exactly known at the

time of irradiation.

Availability of this expensive system is limited.


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2.4 Single fraction with 50 kV x-ray

machine: advantages

More flexibility

compared with singlefraction from a Linac.

Less expensive system

compared to dedicated

IORT Linac.


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2.4 Single fraction with 50 kV x-ray

machine: disadvantages

Tumor parameters are not exactly known at the

time of irradiation.

Dose distribution is limited in form and volume.

Insuficient 20 Gy surface and 5-6 Gy single

fraction in 1 cm tissue depth?


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2.5 Electronic Brachytherapy with an

HDR X-Ray source: advantages

No radioactive isotopes

Minimal room shielding requirements.


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2.5 Electronic brachytherapy with an

HDR X-Ray source: disadvantages

Minimal clinical references and information


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2.6. External radiation therapy with 3-D or

IMRT: advantages Tumor parameters are exactly know at the time of external beam.

Target volume coverage is not limited in form and volume.


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2.6 External radiation therapy with 3-D or

IMRT: disadvantages

Daily breast fixation and reproducibility.

High integral dose.


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2.7 Brachytherapy with seeds:

Advantages.

Invasive treatment with a technique very usefull in other

locations.


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2.7 Brachytherapy with seeds:

disadvantages

Minimal clinical references and information.

Mammography FU with seeds?


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44.. CatalanCatalan InstituteInstitute ofof OncologyOncology experienceexperience..



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2.8 Non-Invasive HDR Brachytherapy

with AccuBoost: Advantages.

Non invasive treatment

HDR

Mammography based IGRT

with CR System for digital

Image.

Different apllicators.

Minimal exposure to heart

and lungs.


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2.8 Non-Invasive HDR brachytherapy

with AccuBoost: disadvantages

Minimal clinical references and information.

Daily Mammography.

Dose to the skin.

Necesity of a Mammography Unit for the

treatment.


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PhasePhase II--IIII trialstrialsPhasePhase IIIIII trialstrials

OngoingOngoing PhasePhase IIIIII trialstrials44.. CatalanCatalan InstituteInstitute ofof OncologyOncology experienceexperience..



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Vicini F., Martinez A., et al.

Int. J. Radiat. Oncol. Biol. Phys. 69, 1124-1130. 2007.

Interim cosmetic results and toxicity using 3D CRT to

deliver APBI ( 34-38.5 Gy in 10 fractions over 5 consecutive

days) in 91 pts with early breast cancer

ConclusionConclusion:: DeliveryDelivery ofof APBIAPBI withwith 33DD--CRTCRTresultedresulted inin minimalminimal chronicchronic (>(>66 months)months)toxicitytoxicity toto datedate withwith good/excellentgood/excellent cosmeticcosmeticresultsresults.. AdditionalAdditional FUFU isis neededneeded toto assessassess

thethe longlong termterm efficacyefficacy ofof thisthis formform ofof APBIAPBI..


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3-DCRT APBI: Summary

InstitutionInstitutionPt.Pt.

No.No.

MedianMedian

ageage

F/UF/U

mo.mo.

T sizeT size

(cm)(cm)

medianmedian

N+N+

%%

ER +ER +

%%

LocalLocal

relapserelapse

%%

BeaumontBeaumont 9292 6262 2323 -- 22 -- 00

NYUNYU 7878 67.567.5 2828 0.90.9 00 100100 00

MGHMGH 6161 62621212

(min)(min)0.90.9 00 -- 00

RTOGRTOG03190319 4242 6161 -- 0.850.85 -- -- --


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Ott O., Ptter R., Strnad V., et al.

Radiat. & Oncol. 82, 281-286. 2007.

Accelerated Partial Breast Irradiation (APBI) with multi-

catheter brachytherapy: local control (LC), side effects and

cosmetic outcome for 274 patients. Results of the German-

Austrian multi-centre trial.

ConclusionConclusion:: LCLC waswas 9999,,33%%,, andand 33yy locallocal

recurrencerecurrence FreeFree SurvivalSurvival waswas 9999,,66%%.. LateLate

effectseffects GradeGrade 33 occurredoccurred inin 11..88%%.. ThisThis

analysisanalysis underlinedunderlined thethe safetysafety andand effectivenesseffectivenessofof APBIAPBI..


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MultiCatheter APBI: HDR/ LDR SummaryMultiCatheter APBI: HDR/ LDR Summary

Institution

Pt.Pt.

No.No.

MedianMedian

ageage

F/UF/U

mo.mo.

T sizeT size

(cm)(cm)

medianmedian

N+N+

%%

ER +ER +

%%

TamTam

%%

LRLR

%%

ExcExc//

goodgood

CosmesisCosmesis

%%

Oschner 5151 6363 7575 1.41.4 1818 -- -- 22 --

Beaumont 199199 6565 6565 1.11.1 1212 -- 5757 1.21.2 9999

Tufts-NEMC 3232 6363 3333 1.31.3 99 7979 6161 33 8888

VCU 4444 6262 4242 1.21.2 1818 -- 6666 00 8080

Nat. Inst.Onc.

Budapest4545 5656 8181 1.21.2 22 8282 1616 6.76.7 9797

Guys Cs 137 4949 5858 7575 2.52.5 4646 -- -- 1818 8181


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MF. Clemente, J. Garcia, MT. Murillo, et al.MF. Clemente, J. Garcia, MT. Murillo, et al.

Rev. Fis. Med. 10, 133Rev. Fis. Med. 10, 133--137. 2009.137. 2009.Irradiacin parcial de la mama con el palicador Mammosite:Irradiacin parcial de la mama con el palicador Mammosite:

Primera experiencia en Espaa.Primera experiencia en Espaa.

APBI with MammositeAPBI with Mammosite

Vicini F., et al.Vicini F., et al.

Cancer 15, 112, 758Cancer 15, 112, 758--766. 2008.766. 2008.

33--year analysis of treatment efficacy, cosmesis, and toxicity in pactients treatedyear analysis of treatment efficacy, cosmesis, and toxicity in pactients treatedwith APBI using MammoSitewith APBI using MammoSite

Benitez P., Keisch M., Vicini F., et al.Benitez P., Keisch M., Vicini F., et al.

The American Journal of Surgery 194, 456The American Journal of Surgery 194, 456--462, 2007.462, 2007.

55--year results: the initial clinical trial of Mammosite balloon brachytherapyyear results: the initial clinical trial of Mammosite balloon brachytherapy

for APBI in earlyfor APBI in early--stage breast cancerstage breast cancerExcellent cosmetic results in 83.3% and 5y local recurrence similar to BCTExcellent cosmetic results in 83.3% and 5y local recurrence similar to BCT

with a median FU of 5.5 y.with a median FU of 5.5 y.


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MammoSite PBI: summary

InstitutionInstitutionPt.Pt.

No.No.

MedianMedian

ageage

F/UF/U

mo.mo.

T sizeT size(cm)(cm)

medianmedian

N+N+

%%

ER +ER +

%%

LocalLocalrelapserelapse

%%

Exc/Exc/

goodgood

CosmesisCosmesis

%%

Initial MultiInitial Multi--

InstitutionalInstitutional4343 6969 4848 1.01.0 00 -- 00 8080

Rush Univ.Rush Univ. 112112 6464 --88%88%

TisTis--T1T177 -- 00 8080

TuftsTufts--NEMC/NEMC/

VCUVCU2828 6262 1919 1.11.1 00 100100 00 8686

St. VincentSt. Vincent

HospitalHospital3232 6262 1111 97% T197% T1 99 9494 -- 8686


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Polgar C., et al.


Breast conserving treatment with Partial breast irradiation with

HDR multicathethers (PBI, 128 pts, 7 x 5.2 Gy) or whole breast

irradiation (WBI, 130 pts, 50 Gy) for low-risk breast cancer

patients: 5-y results of a randomized trial phase III of 258 pts

ConclusionConclusion:: AtAt aa medianmedian FUFU ofof 6666 months,months, thetheresultsresults areare similarsimilar:: OSOS ((9494..66%% vsvs 9191..88%%),), DFSDFS((8888..33%% vsvs 9090..33%%),), LR LR ((44..77%% vsvs 33..44%%)).. ForFor

cosmeticcosmetic resultsresults:: 8181..22%% inin APBIAPBI vsvs 7070%% ininWBIWBI (p=(p=00..009009))..


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Vaidya J., Saunders M., et al. (28 centres in 9 countries)

Targeted intraoperative RT vs WBRT for breast cancer (TARGIT-A Trial):

an international, prospective, randomised, non inferiorty Phase III Trial.

Lancet 376, 91-102. 2010.

1119 WBRT1119 WBRT

with a dose of 45with a dose of 45--5656 GyGy

with or without a boost of 10with or without a boost of 10--1616 GyGy

2232 patients2232 patients randomisedrandomised to:to: vsvs

1113 with1113 with IntraopRTIntraopRTwith a dose of 20with a dose of 20 GyGy surface and 5surface and 5--77 GyGy atat1 cm (8561 cm (856 TargitTargit only and 142only and 142 TargitTargit andand

EBRT)EBRT)


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Targeted intraoperative RT vs WBRT for breast cancer

(TARGIT-A Trial):an international, prospective, randomised, non inferiorty Phase III Trial.

Lancet 376, 91-102. 2010.

Local recurrence at 4y.: 1,2% inLocal recurrence at 4y.: 1,2% in TargitTargit and 0.95% in WBRTand 0.95% in WBRT

Major Toxicity = in both groups (p=0.44)Major Toxicity = in both groups (p=0.44)

RT Toxicity Grade III was lower inRT Toxicity Grade III was lower in TargitTargit Group (0.5%)Group (0.5%)

compared with the WBRT group (2.1%) (p=0.002)compared with the WBRT group (2.1%) (p=0.002)


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Targeted intraoperative RT vs WBRT for breast cancer

(TARGIT-A Trial): an international, prospective, randomised,

non inferiorty Phase III Trial.

Lancet 376, 91-102. 2010.

In a series of 2232 patients, (1119 with WBRT and 1113 In a series of 2232 patients, (1119 with WBRT and 1113

withwith IntraoperativeIntraoperative RTRT --856856 TargitTargit only and 142only and 142 TargitTargit

and EBRTand EBRT-- with a dose of 20with a dose of 20 GyGy surface and 5surface and 5--77 GyGy at 1 cm),at 1 cm),a single dose of RT delivered at the time o surgery by usea single dose of RT delivered at the time o surgery by use

of targetedof targeted intraoperativeintraoperative RT should be considered as anRT should be considered as an

alternative to EBRT delivered over several weeks.alternative to EBRT delivered over several weeks.


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1.1. GECGEC--ESTRO Phase III trial (Europe)ESTRO Phase III trial (Europe)

2.2. NSABP BNSABP B--39 / RTOG0413 Phase III Trial (USA)39 / RTOG0413 Phase III Trial (USA)

3. ELIOT Phase III Trial (Milan, Italy)3. ELIOT Phase III Trial (Milan, Italy)4.4. Rapid Phase III Trial (Canada)Rapid Phase III Trial (Canada)

5.5. Irma Phase III Trial (Italy)Irma Phase III Trial (Italy)

OngoingOngoing PhasePhase IIIIII trialstrials forfor

APBI inAPBI in BreastBreast cancercancer

J. Yarnold, and J. Haviland.

Pushing the limits of hypofractionation of adjuvant WBRT.

The Breast 19. 176-179. 2010.


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Polgar C., Van Limbergen, Polo A., Guedea F., et al.

Radiotherapy and Oncology 94, 264-273. 2010.

Patient selection for APBI after breast-conserving surgery:

recommendations of the GEC-ESTRO breast cancer workinggroup based on clinical evidence.

ConclusionConclusion:: TheseThese recommendationsrecommendations willwill provideprovide aa clinicalclinical

guidanceguidance regardingregarding thethe useuse of of APBIAPBI outsideoutside thethe contextcontext ofof aaclinicalclinical trialtrial beforebefore largelarge--scalescale randomizedrandomized trialtrial outcomeoutcome datadata

becomebecome availableavailable.. FurthermoreFurthermore theythey shouldshould promotepromote furtherfurther

clinicalclinical researchresearch focusingfocusing onon controversilacontroversila issuesissues inin thethe

treatmenttreatment ofof earlyearly--stagestage breastbreast carcinomacarcinoma..


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Polgar C., Van Limbergen, Polo A., Guedea F., et al.

Radiotherapy and Oncology 94, 264-273. 2010.

Patient selection for APBI after breast-conserving surgery: recommendations of the

GEC-ESTRO breast cancer working group based on clinical evidence.


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Smith B., Arthur D., Buchholz T., Vicini F.,

Whelan T., Harris J., et al.


APBI consensus statement from the ASTRO.

ConclusionConclusion:: TheThe TaskTask forceforce proposedproposed 33 patientspatients groupsgroups::11)) AA suitablesuitable

groupgroup,, fofo whomwhom APBIAPBI ousideouside aa clinicalclinical trialtrial isis acceptableacceptable,, 22)) AA cautionarycautionary

groupgroup,, fromfrom whomwhom cautioncaution andand concernconcern shouldshould bebe appliedapplied whenwhen

consideringconsidering APBIAPBI outsideoutside ofof aa clinicalclinical trialtrial andand 33)) AnAn unsuitableunsuitable groupgroup,,forfor whomwhom APBIAPBI outsideoutside aa clinicalclinical trialtrial isis notnot generallygenerally consideredconsidered

warrantedwarranted.. PatientsPatients whowho choosechoose treatmenttreatment withwith APBIAPBI shouldshould bebe informedinformed

thatthat wholewhole--breastbreast irradiationirradiation isis anan establisedestablised treatmenttreatment withwith aa muchmuch longerlonger

tracktrack recordrecord thatthat hashas documenteddocumented longlong--termterm effectivenesseffectiveness andand safetysafety..


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Step-by-Step multicatheters technique


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1.1. Short learning curve.Short learning curve.

2.2. Good reproducibility.Good reproducibility.

3.3. One puncture site.One puncture site.

4.4. Excellent integration between surgeons and RadiationExcellent integration between surgeons and Radiation

Oncologists.Oncologists.

Our team has selected theOur team has selected the

Balloon technique at DexeusBalloon technique at Dexeus


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Institut Catal dOncologiaRADIATION THERAPY DEPARTMENT

To evaluate our experience with brachytherapy alone used as a partial

breast irradiation technique following conservative breast

surgery(lumpectomy).

This was a phase II single-center trial of 42 patients between 66 to 89

years old with early breast cancer. High-dose rate brachytherapy (HDR-BT)

was applied through plastic catheters in all cases.

Ultrasound localization was used to insert the catheters into the border areaof the surgical bed.

Ten fractions of 3.4 Gy each were administred, b.i.d. (twice daily), atintervals of at least 6 hours. After tube placement, a CT was performed to

evaluate dosimetry.

The mean follow up was 4.5 years (1.4-5.3y)

Purpose & Materials (APBI)


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Treatment outcome

One patient (2,38%) had a local relapse requiring salvage mastectomy.

A second patient (2,38%) developed multiple bone and lung metastases anddied in September 2009.

A third patient (2,38%) was diagnosed with a primary lungadenocarcinoma (treated with chemotherapy) and bone metastasis, wichwas treated with palliative radiotherapy.

The remaining 39 (92,86%) patients are alive free of disease.

Cosmetic results are excellent in 24 patients (57,14%), good in 3 patients

(7,14%), bad in 6 patients (14,29%), the remaining 9 no cosmetic resultsevaluated.

Treatment outcome and

cosmetic results (APBI)


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Modified from J. Yarnold, S. Bentzen et al.

Hypofractionated whole-breast RT for women with

early breast cancer: Myths and realities.

IJROBP in press. Accepted august 2010.

... Recent randomized trials justify the routine... Recent randomized trials justify the routineuse of modest hypofractionation with APBIuse of modest hypofractionation with APBI

in women with early breast cancer .in women with early breast cancer .....


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Prosnitz L., Horner J., and Wallner P.

Int. J. Rad. Oncol. Biol. Phys. 74, 981-984. 2009.

APBI: caution and concern form an ASTRO Task Force.

WBI in a conventional courseWBI in a conventional course

remains the gold standard, andremains the gold standard, andpatients should be so informed.patients should be so informed.


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Azria D., and Bourgier C.

Partial Breast Irradiation: new standard for selected

patients.

Lancet 376, 71-72. 2010.

In elderly patients, we are already convinced In elderly patients, we are already convinced

that APBI is the new standardthat APBI is the new standardand intraoperative RT an excellent approach.and intraoperative RT an excellent approach.


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www.iconcologia.net


ICO lHospitalet

Hospital Duran i Reynals

Gran Via de lHospitalet, 199-203

08907 lHospitalet de Llobregat

ICO Badalona

Hospital Germans Trias i Pujol

Ctra. del Canyet s/n

08916 Badalona

ICO Girona

Hospital Doctor Trueta

Av. Frana s/n

17007 Girona


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D105 APBI Future - My Point of View