Accelerated partial breast irradiation for early-stage invasive lobular carcinoma Journal Article
| Authors: | Braunstein, L. Z.; Boe, L.; Mueller, B.; Obrien, D. R.; Choi, I.; Cuaron, J.; Xu, A.; Bernstein, M.; McCormick, B.; Powell, S. N.; Khan, A. J. |
| Article Title: | Accelerated partial breast irradiation for early-stage invasive lobular carcinoma |
| Abstract: | Purpose: Invasive lobular carcinoma (ILC) represents 10% to 15% of invasive breast cancers with limited representation among trials of accelerated partial breast irradiation (APBI). Contemporary guidelines advise against treating ILC with APBI given a paucity of supportive evidence. Here, we evaluated oncologic outcomes among patients with ILC treated with APBI. Methods and Materials: Patients treated from 2010 to 2022 with APBI after breast conserving surgery for ILC (or mixed ILC with other histologies) were ascertained from a prospectively maintained institutional database. All patients received external beam APBI to 40 Gy in 10 daily fractions. Outcomes of interest included local recurrence (LR) and overall survival (OS). Results: Of 1248 patients who underwent APBI at our center, the study cohort comprised 132 (11%) who had ILC, either exclusively or mixed with another histology (median age 63). Median tumor size was 1.1 cm (interquartile range: 0.8-1.5), nearly all had estrogen receptor positive disease (99%) and received hormone therapy (91%), and most underwent sentinel node biopsy (89%) with the remainder having no axillary surgery. At 530 person-years and a median follow-up of 39 months, 2 LRs were observed yielding a 48-month cumulative incidence of LR of 3.0% (95% CI: 0.56%-9.5%). Both events arose in patients with mixed lobular histology (none arose in patients with pure ILC). Two unrelated deaths were also observed yielding a 48-month OS of 98% (95% CI: 95%-100%). Conclusions: Among patients with ILC who received APBI after breast conserving surgery, we observed a 4-year LR rate of 3%. No regional or distant recurrences were observed, and OS was excellent. The safety of APBI for ILC will require confirmation among larger trials with longer follow-up, although the excellent outcomes observed here are consistent with those seen for invasive ductal carcinomas among contemporary trials of APBI. © 2024 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; human tissue; treatment outcome; aged; major clinical study; overall survival; histopathology; cancer recurrence; follow up; antineoplastic agent; prospective study; sentinel lymph node biopsy; breast cancer; tumor volume; epidermal growth factor receptor 2; cohort analysis; lung cancer; cancer hormone therapy; early cancer; cancer specific survival; estrogen receptor; tumor size; cumulative incidence; local recurrence; accelerated partial breast irradiation; breast-conserving surgery; external beam; invasive lobular carcinoma; estrogen receptor positive breast cancer; methods and materials; human; female; article; human epidermal growth factor receptor 2 negative breast cancer; ductal breast carcinoma in situ; invasive lobular breast carcinoma |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 121 |
| Issue: | 4 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-03-15 |
| Start Page: | 894 |
| End Page: | 899 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2024.10.024 |
| PUBMED: | 39461598 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Lior Braunstein and Atif J. Khan -- Source: Scopus |
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