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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 10, 2016; 7(5): 370-379
Published online Oct 10, 2016. doi: 10.5306/wjco.v7.i5.370
Accelerated partial breast irradiation: Past, present, and future
Anne W Tann, Sandra S Hatch, Melissa M Joyner, Lee R Wiederhold, Todd A Swanson
Anne W Tann, Sandra S Hatch, Melissa M Joyner, Lee R Wiederhold, Todd A Swanson, Department of Radiation Oncology, the University of Texas Medical Branch, Galveston, TX 77555-0711, United States
Author contributions: Tann AW drafted and composed the paper; Hatch SS, Joyner MM, Wiederhold LR and Swanson TA reviewed and edited the paper.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Todd A Swanson, MD, PhD, Department of Radiation Oncology, the University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0711, United States. taswanso@utmb.edu
Telephone: +1-409-7722531 Fax: +1-409-7470025
Received: April 29, 2016
Peer-review started: April 29, 2016
First decision: June 17, 2016
Revised: August 3, 2016
Accepted: August 17, 2016
Article in press: August 19, 2016
Published online: October 10, 2016
Abstract

Accelerated partial breast irradiation (APBI) focuses higher doses of radiation during a shorter interval to the lumpectomy cavity, in the setting of breast conserving therapy for early stage breast cancer. The utilization of APBI has increased in the past decade because of the shorter treatment schedule and a growing body of outcome data showing positive cosmetic outcomes and high local control rates in selected patients undergoing breast conserving therapy. Technological advances in various APBI modalities, including intracavitary and interstitial brachytherapy, intraoperative radiation therapy, and external beam radiation therapy, have made APBI more accessible in the community. Results of early APBI trials served as the basis for the current consensus guidelines, and multiple prospective randomized clinical trials are currently ongoing. The pending long term results of these trials will help us identify optimal candidates that can benefit from ABPI. Here we provide an overview of the clinical and cosmetic outcomes of various APBI techniques and review the current guidelines for selecting suitable breast cancer patients. We also discuss the impact of APBI on the economics of cancer care and patient reported quality of life.

Keywords: Breast cancer, Intracavitary brachytherapy, Accelerated partial breast irradiation, Interstitial brachytherapy

Core tip: Given that accelerated partial breast irradiation (APBI) is becoming increasingly utilized in the management of early breast cancer patients, it is crucial to address the evolution of studies that led to the current guidelines in identifying the suitable group of patients who obtain the most benefit clinically and cosmetically. We, herein, discuss the available clinical and cosmetic outcomes of different APBI techniques in addition to details of ongoing phase III randomized clinical trials. We also discuss the effects of APBI on breast cancer patient quality of life.