Accelerated partial breast irradiation with brachytherapy: patient selection and technique considerations

Figures & data

Table 1 Criteria for accelerated partial breast irradiation appropriateness by consensus statement or clinical trial

	ASBS^Citation6	ASTRO “suitable”^Citation4	ASTRO “cautionary”^Citation4	GEC-ESTRO low-risk group^Citation7	GEC-ESTRO intermediate-risk group^Citation7	NSABP B-39^Citation3 (in progress)	ABS^Citation5
Published	2008	2009	2009	2010	2010	2011	2013
Risk of local IBTR
Tumor size	≤3 cm	≤2 cm	2.1–3.0 cm	≤3 cm	≤3 cm	≤3 cm	≤3 cm
Margin	Negative	≥2 mm	Close (<2 mm)	≥2 mm	Close (<2 mm)	Negative	Negative
Hormonal status	–	Positive	Negative	Any	Any	Any	Any
Risk of regional IBTR
Histology	Any	Ductal	Lobular	Ductal	Any	Any	Any
LVSI	–	None	Limited	None	None	Yes	None
Pure DCIS	Yes	No	Yes	No	Yes	Yes	Yes
Multifocal	–	Clinically unifocal, ≤2 cm total	Clinically unifocal, ≤3 cm total	Unifocal	Yes, within <2 cm of index lesion	Microscopic, <3 cm total	–
Multicentric	–	Unicentric	Unicentric	Unicentric	Unicentric	Unicentric	–
Risk of nodal or distant failure
Age (years)	≥45 if invasive, ≥50 if DCIS	≥60	50–59	≥50	>40–50	≥18	≥50
Nodal status	pN0	pN0	pN0	pN0	pN1mi, pN1a (by ALND)	pN0–1* no ECE	pN0

Note:

* At least six axillary nodes pathologically evaluated if pN1.

Abbreviations: ABS, American Brachytherapy; ALND, axillary lymph node dissection; ASBS, American Society of Breast Surgeons; ASTRO, American Society for Therapeutic Radiology and Oncology; DCIS, ductal carcinoma in situ; ECE, extracapsular extension; GEC-ESTRO, Groupe Européen de Curiethérapie and European Society for Radiotherapy and Oncology; IBTR, ipsilateral breast tumor recurrence; LVSI, lymphovascular space invasion; NSABP, National Surgical Adjuvant Breast and Bowel Project; pN, pathologic nodal status; –, not included in the criteria.

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