Accelerated Partial Breast Irradiation (APBI) Using Multicatheter Brachytherapy After Breast Conserving Surgery Is as Effective as Whole Breast Irradiation (WBI) for Low-Risk Patients

“For some early stage breast cancer patients, accelerated partial breast irradiation (APBI) using multicatheter brachytherapy following breast conserving surgery may be an excellent treatment option, as it has now been proven to be as effective as the current standard treatment – whole breast irradiation (WBI) – in local control, disease-free and overall survival rates, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 57th Annual Meeting.

“Breast cancer patients often receive radiation therapy (RT) after breast-conserving surgery to help lower the chance that the cancer will recur or metastasize in the nearby lymph nodes. WBI using external beam radiation is a longstanding standard RT for breast cancer patients, during which the entire breast and often the surrounding chest area receives radiation for several weeks, followed by an extra boost of radiation to the area where the cancer was removed. Many women in the U.S. who are eligible for breast conserving surgery still choose to undergo mastectomy in the hopes that it will make subsequent WBI unnecessary, due largely to the long-duration of WBI and/or because of fears concerning the potential side effects of radiation to surrounding organs.”

Partial Breast Irradiation Sufficient in Early Disease

“Accelerated partial breast irradiation (APBI) was shown to be just as effective and safe as whole breast irradiation (WBI), according to the results of a randomized phase III clinical trial conducted in Italy. There was no difference between APBI, delivered as intensity-modulated radiation therapy (IMRT), and WBI after a 5-year median follow-up. APBI also resulted in significantly better safety and cosmetic outcomes for patients. The results were presented by the study’s principal investigator, Lorenzo Livi, MD, of the radiotherapy-oncology unit at Florence University Hospital in Florence, Italy, at the 2014 San Antonio Breast Cancer Symposium (SABCS), held December 9–13 in San Antonio, Texas.

“The mean time to ipsilateral breast tumor recurrence (IBTR) was 2.9 years. There was no statistically significant difference in the 5-year IBTR rate (1.4% and 1.5% in the WBI and APBI arms, respectively; P = .86) or the 5-year overall survival rate (96.6% and 99.4% in the WBI and APBI arms, respectively; P = .057). Because of the low IBTR rate, a longer follow-up is still needed.

“ ‘Our results showed a very low recurrence rate [for APBI] and no differences in terms of distant metastases and overall survival rate. Partial breast [irradiation] certainly will be an effective option for treatment in selected breast cancer patients,’ Livi told Cancer Network via e-mail.”

Shorter, Cheaper Radiation Treatment Not given to Most Breast Cancer Patients

“In 2011, expert guidelines endorsed shorter whole breast radiation for early-stage breast cancer patients. However, a new study finds that this less costly treatment has not reached many patients who meet guidelines to receive it.

“The study – led by Dr. Justin E. Bekelman, of the University of Pennsylvania Perelman School of Medicine in Philadelphia – is published in JAMA and is released to coincide with the San Antonio Breast Cancer Symposium.

“The researchers explain that breast conservation therapy is the most common treatment for early-stage breast cancer, with whole breast irradiation (WBI) recommended for most women after surgery, as it reduces recurrence and improves overall survival.

“Conventional WBI has been the ‘mainstay’ of treatment in the US and consists of 5-7 weeks of daily radiation treatments. However, hypofractionated WBI is a shorter alternative to conventional WBI, consisting of fewer higher-dose treatments over 3 weeks.

” ‘Hypofractionated WBI increases convenience, reduces treatment burden and lowers health care costs,’ note the authors, ‘while offering similar cancer control and cosmesis (cosmetic outcomes) to conventional WBI.’ They also note that patients naturally prefer shorter radiation treatments.”

Proton Therapy Shown to be Less Costly than Some Alternative Radiotherapy Techniques

“In terms of duration of treatment and cost, patients with early stage breast cancer may benefit from accelerated partial breast irradiation (APBI) with proton therapy versus whole breast irradiation (WBI), according to new research from The University of Texas MD Anderson Proton Therapy Center.

“In a cost analysis study based on typical patient characteristics, researchers used Medicare reimbursement codes to analyze allowable charges for eight different types of partial and whole breast irradiation therapies and treatment schedules available to early stage breast cancer patients. Taken together, these represent roughly 98% of the treatment options available to these patients. The cost of proton therapy when used for APBI, introduced to decrease overall treatment time and toxicity, was estimated at $13,833. Comparatively, WBI using IMRT (x-ray) therapy resulted in the highest Medicare charges at $19,599. The average charges across the eight treatment regimens were $12,784; thus, proton costs were similar to that of other types of radiation.

“The findings were presented at the inaugural North America meeting of the Particle Therapy Co-Operative Group (PTCOG) held at MD Anderson Proton Therapy Center. A manuscript detailing the study findings is underway.”