Accelerated partial breast irradiation (APBI) allows appropriately selected patients with early-stage breast cancer to complete adjuvant radiation in one week or less following breast conserving surgery. To date, multiple randomized trials have demonstrated no difference in rates of recurrence or survival with APBI delivered using brachytherapy or external beam radiation techniques.
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In this video, Cleveland Clinic radiation oncologist Chirag Shah, MD, discusses the American Society of Radiation Oncology’s newly released updated guidelines for the off-protocol use of APBI. Most significantly, the guidelines lower the age cut-off from age 60 and older to age 50 and older, as well as include patients with ductal carcinoma in citu (low/intermediate grade, < 2.5 cm, negative surgical margins).
Dr. Shah also explains that suitable candidates for APBI include those 50 years or older with tumors < 3.0 cm, with negative margins, and that are estrogen receptor positive. With respect to intraoperative radiation (IORT), the new guidelines recommend counseling that IORT is associated with higher rates of local recurrence and that electron IORT be limited to only suitable APBI patients, while low-energy X-ray IORT should be limited to prospective registries or clinical trials.