Patterns of recurrence among higher-risk patients receiving daily external beam accelerated partial-breast irradiation to 40 Gy in 10 fractions Journal Article


Authors: Fitzgerald, K.; Flynn, J.; Zhang, Z.; Cost, Z.; Mueller, B.; Gillespie, E. F.; McCormick, B.; Khan, A.; Cahlon, O.; Powell, S. N.; Braunstein, L. Z.
Article Title: Patterns of recurrence among higher-risk patients receiving daily external beam accelerated partial-breast irradiation to 40 Gy in 10 fractions
Abstract: Purpose: The 2016 American Society for Radiation Oncology consensus guidelines for the use of accelerated partial-breast irradiation (APBI) define “suitable,” “cautionary,” and “unsuitable” populations for this adjuvant breast radiation therapy technique. We sought to determine whether patients in the cautionary group exhibited adverse outcomes after APBI compared with their suitable counterparts. Methods and Materials: We identified 252 consecutively treated patients from a single institution with in situ or early-stage invasive breast cancer who underwent APBI between 2008 and 2017. Treatment technique was uniform throughout the population, consisting of 3-dimensional conformal radiation therapy to 40 Gy administered in 10 daily fractions. Results: One hundred seventy-eight patients (70%) were classified as suitable, 69 (27%) as cautionary, and 5 (2.0%) as unsuitable. Because unsuitable patients were few and had no recurrences, they were excluded from analysis. At a median follow-up time of 3.9 years, 97.2% of patients were free of recurrence. Four patients (1.5% overall; 3 suitable and 1 cautionary) experienced ipsilateral in-breast recurrences, and 1 cautionary patient developed an ipsilateral regional recurrence in an axillary lymph node. There was no significant difference in the rate of ipsilateral breast recurrence (2.4% vs 1.0%) between cautionary and suitable groups. Conclusions: Local recurrences are rare among guideline-defined cautionary patients with in situ or invasive breast cancer treated with APBI delivered via daily 3-dimensional conformal radiation therapy to 40 Gy. At a median follow-up of 3.9 years, no significant differences in local control were noted between cautionary and suitable patient groups. Further study is needed to characterize long-term disease outcomes among various risk groups. © 2019 The Author(s)
Keywords: adult; cancer chemotherapy; controlled study; aged; cancer surgery; major clinical study; cancer recurrence; cancer patient; cancer radiotherapy; comparative study; follow up; lymph node metastasis; antineoplastic agent; computer assisted tomography; radiotherapy dosage; retrospective study; high risk patient; cancer hormone therapy; axillary lymph node; adverse outcome; early cancer; breast carcinoma; partial mastectomy; recurrent disease; external beam radiotherapy; papillary carcinoma; estrogen receptor; colloid carcinoma; intraductal carcinoma; antiestrogen; lumpectomy; accelerated partial breast irradiation; lobular carcinoma; planning target volume; lymph vessel metastasis; human; female; priority journal; article
Journal Title: Advances in Radiation Oncology
Volume: 5
Issue: 1
ISSN: 2452-1094
Publisher: Elsevier Inc.  
Date Published: 2020-01-01
Start Page: 27
End Page: 33
Language: English
DOI: 10.1016/j.adro.2019.07.017
PROVIDER: scopus
PMCID: PMC7004933
PUBMED: 32051887
DOI/URL:
Notes: Article -- Export Date: 2 March 2020 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Zhigang Zhang
    275 Zhang
  2. Simon Nicholas Powell
    193 Powell
  3. Boris A Mueller
    49 Mueller
  4. Oren Cahlon
    104 Cahlon
  5. Beryl McCormick
    306 McCormick
  6. Atif Jalees Khan
    41 Khan
  7. Jessica Flynn
    40 Flynn
  8. Zachary H Cost
    4 Cost