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ASBS: Early Data on Partial Breast Irradiation Are Promising By Norra MacReady LOS ANGELES, CA -- March 24, 2005 -- Accelerated partial breast irradiation (APBI) is gaining acceptance among doctors and patients as adjuvant treatment for breast cancer, researchers reported here on March 20th at the 6th annual meeting of the American Society of Breast Surgeons. The technique involves accelerated postoperative delivery of radiation specifically to the area around the tumor site, thus minimizing radiation to healthy tissue. A treatment course lasts 5 days, said Douglas W. Arthur, MD, associate professor and vice-chairman, Radiation Oncology, Virginia Commonwealth University Medical College, Richmond, Virginia, United States. Currently the most popular approach to APBI in the United States is a balloon device system called MammoSite, made by Proxima Therapeutics of Alpharetta, Georgia, United States. The United States Food and Drug Administration approved the system in 2002. In this procedure, a balloon catheter is placed in the surgical cavity during or after surgery. A radioactive seed inside the balloon delivers a prescribed amount of radiation, and is removed after 5 days. In the American Society of Breast Surgeons MammoSite Registry Trial involving 793 patients at 71 U.S. institutions, the technique showed good technical reproducibility, Dr. Arthur said. In 92% of the patients, cosmetic results at 12 months were good to excellent, and early toxicity rates appear acceptable, he said. The expected failure rate was also low, although follow-up time is still short, he added. Another promising approach to APBI is 3D-conformal external beam irradiation. It is noninvasive, delivers a more homogeneous dose of radiation than the balloon system, and has the potential for the best cosmesis. In Phase I and II trials on 87 patients, there were no recurrences and a 100% rate of good to excellent cosmetic results. However, these patient numbers are small, and the maximum follow-up time is only 18 months. Multicatheter APBI, which involves the placement of multiple radiation-bearing catheters around the target site, is the original technique, but it is rarely used in the United States today because it requires a longer learning curve and causes more pain and breast trauma than the newer methods, Dr. Arthur said. A growing number of physicians are using APBI as a viable treatment alternative, but phase 3 data are necessary to develop guidelines for its use and to establish it as the standard of care. A randomized trial comparing it to whole breast irradiation is now under way, with the goal of accruing 3000 patients within 29 months, Dr. Arthur said. [Presentation title: APBI --Techniques, Data, and Future.] E-mail this page to a friend or colleague! To print, use this version