Intraoperative electrons

A randomised study of whole-breast vs tumour-bed irradiation after local excision and axillary dissection for early breast cancer

AIMS

Whole-breast radiotherapy (WBRT) after conservative surgery for early breast cancer is a routine standard of care. Despite this, a number of uncertainties in management still exist. Over recent years, a number of new technologies have allowed the development of partial-breast irradiation, with the intention of improving the risk-benefit relationship of routine breast radiotherapy. We report the results of a trial comparing partial- with WBRT, with prolonged follow-up.

MATERIALS AND METHODS

Between 1986 and 1990, 174 women were randomised to receive conventional whole-breast radiotherapy (WBRT) (40 Gy in 15 fractions), with a tumour-bed boost or partial-breast irradiation by a variety of techniques. Recruitment was problematic, and the trial closed prematurely well before meeting its recruitment target.

RESULTS

A trend was observed towards higher local recurrence and a higher locoregional recurrence rate after irradiation of the tumour bed alone. Distant recurrence and survival were the same.

CONCLUSIONS

Conclusions are limited in view of the failure to complete accrual of the target of 400 participants, and in the context of the techniques of partial-breast radiotherapy used during this study, which would not compare with those in current use. Tumour-bed irradiation alone cannot currently be recommended as routine treatment outside the context of clinical trial.

Update on accelerated partial-breast irradiation

Progress in radiotherapy technology, particularly the advent of CT-guided simulation and three-dimensional conformal planning, has given the radiation oncologist the ability to precisely treat part of the breast, instead of the whole breast, using either brachytherapy or external-beam techniques. Treating such a limited area may allow the course of treatment for patients with early-stage breast cancer to be drastically shortened and could reduce toxicity to other organs. This article summarizes the rationale for accelerated partial-breast irradiation (APBI), techniques for performing it, and outcome to date of studies of APBI.

Accelerated Partial Breast Irradiation as an Alternative to Whole-Breast Irradiation in Breast-Conserving Therapy for Early-Stage Breast Cancer

Breast-conserving therapy has been established as a standard treatment for women with early-stage breast cancer. Whole-breast irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole-breast irradiation after breast-conserving surgery has become controversial, with some investigators advocating accelerated partial breast irradiation as an alternative. Accelerated partial breast irradiation is delivered over a shorter period and only to a portion of the breast. This review will examine the emerging role of accelerated partial breast irradiation in the treatment of early-stage breast cancer and review the biologic rationale for, techniques of, and limitations of partial breast irradiation following breast-conserving surgery.

Accelerated partial breast irradiation as an alternative to whole breast irradiation in breast-conserving therapy for early-stage breast cancer

Breast-conserving therapy has been established as a standard treatment for women with early-stage breast cancer. Whole breast irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole breastwhole breast irradiation after breast-conserving surgery has become controversial, with some investigators advocating accelerated partial breast irradiation as an alternative. Accelerated partial breast irradiation is delivered over a shorter period and only to a portion of the breast. This review will examine the emerging role of accelerated partial breast irradiation in the treatment of early-stage breast cancer and review the biologic rationale for, techniques of, and limitations of partial breast irradiation following breast-conserving surgery.