Caution Urged in Selecting Patients for Accelerated Radiation

Accelerated radiation treatments are showing promise in the treatment of early-stage breast cancer, according to researchers, but the American Society of Breast Surgeons is urging a cautious approach in selection of patients until more data is available.

While standard external-beam radiation therapy for breast cancer usually lasts several weeks, accelerated partial breast irradiation (APBI) is accomplished by brachytherapy, where radioactive matgerial is placed directly around the site of a recent lumpectomy.

With APBI, a high dose of radiation is delivered to the breast region at highest risk for disease recurrence, reducing the treatment period to just 4 to 5 days.

While the American Society of Breast Surgeons said that APBI looks promising, caution should be exercised in its use until a randomized trial is conducted comparing it with standard radiation therapy. It recommended that:

• APBI be performed as part of a treatment protocol at an individual institution or in the setting of a multi-institutional trial.
• The treatment should only be performed by clinicians well versed in the various APBI techniques.
• Potential APBI candidates be limited to patients older than 50 years, who have ductal carcinoma, a total tumor size no greater than 2 cm in diameter, and have no axillary/sentinel lymph node disease.
• Patients be followed closely for adverse events and recurrences with reporting of such occurrences to institutional review boards, study groups, or product manufacturers.

Other sources: American Society of Breast Surgeons, American Society of Breast Disease