Accelerated Partial Breast Irradiation (eBook)

Contents 5
List of Contributors 7
1 Accelerated Partial Breast Irradiation: History, Rationale, and Controversies 9
1.1 Introduction 9
1.2 History of APBI 11
1.3 Controversies Regarding the Use of APBI 14
1.4 Convenience Benefits of APBI 19
1.5 Conclusions 20
References 21
2 Who is a Candidate for Accelerated Partial Breast Irradiation? 24
2.1 Introduction 24
2.2 Pathologic Data 26
2.3 Anatomic Patterns of In-Breast Failure after Breast- Conserving Treatment 26
2.4 Proper Selection Criteria 28
References 34
3 Pathologic Anatomy of Early-Stage Breast Cancer and its Relevance to Accelerated Partial Breast Irradiation: Defining the Target 38
3.1 Determining the Extent of Disease Beyond the Lumpectomy Cavity 38
3.2 Impact of Radiation on Elsewhere Failures 43
3.3 Conclusions 44
References 45
4 Physics of Partial Breast Irradiation: Coping with the New Requirements of the NSABP B39/RTOG 0413 Protocol 47
4.1 Introduction 48
4.2 Interstitial Multicatheter Technique 49
4.3 MammoSite 52
4.4 3D Conformal External Beam 57
4.5 Conclusions 59
References 59
5 The Radiobiology of Accelerated Partial Breast Irradiation 61
5.1 Introduction 61
5.2 Advantages of Accelerated Therapy 63
5.3 Volume of Breast Requiring Treatment in APBI 65
5.4 Dose Homogeneity 66
5.5 Dose Fractionation Schedules 67
5.6 Accuracy of Treatment Delivery 70
5.7 Summary 71
References 71
6 Surgical Considerations for Accelerated Partial Breast Irradiation 74
6.1 Introduction 74
6.2 Volume of Breast Resection 75
6.3 Brachytherapy 76
6.4 Intraoperative Radiation Therapy 78
6.5 External Beam Delivery of Conformal Radiation Therapy 80
6.6 APBI for Breast Preservation After Local Recurrence 81
References 81
7 The Virginia Commonwealth University (VCU) Technique of Interstitial Brachytherapy 83
7.1 History 83
7.2 Implantation Technique 85
7.3 Dosimetric Guidelines 89
7.4 Results 90
7.5 Conclusion 92
References 92
8 The William Beaumont Hospital Technique of Interstitial Brachytherapy 94
8.1 History 94
8.2 Physics 95
8.3 Implantation Technique 96
8.4 Clinical Results 101
8.5 Future Directions 103
References 104
9 Brachytherapy Techniques: the University of Wisconsin/Arizona Approach 107
9.1 Introduction: a 14-year Historical Perspective on the Evolution of APBI 107
9.2 A New Hypothesis and a Potential Paradigm Shift 110
9.3 The Target Volume 111
9.4 Irradiating the Target Volume 111
9.5 Brachytherapy Techniques 113
9.6 Judgment: Selecting the Optimal Technique for a Particular Patient 126
9.7 Summary 127
References 128
10 The MammoSite Technique for Accelerated Partial Breast Irradiation 130
10.1 Introduction 130
10.2 History of the Applicator 132
10.3 Physics of the MammoSite 133
10.4 Implantation Techniques 136
10.5 Other Considerations 137
10.6 Appropriateness for Treatment 138
10.7 Clinical Results 138
10.8 Conclusions 141
References 142
11 3D Conformal External Beam Technique 144
11.1 Introduction 144
11.2 History 145
11.3 Physics and Techniques 148
11.4 Clinical Results 149
11.5 Challenges and Limiting Factors in the Application of 3D Conformal APBI 160
11.6 Future Directions 161
References 162
12 Intraoperative Radiotherapy: a Precise Approach for Partial Breast Irradiation 164
12.1 The “New” Thinking that Became the New Dogma 164
12.2 Intraoperative Radiotherapy: an Elegant Method of Partial Breast Irradiation 166
12.3 Radiobiology of Intraoperative Radiotherapy 166
12.4 The Intrabeam Machine and Surgical Technique 169
12.5 The Novac7 System 172
12.6 Results of Clinical Trials with the Intrabeam System 173
12.7 Health Economics 174
References 175
13 Quality Assurance for Breast Brachytherapy 180
13.1 Quality Assurance During the Implantation Process 181
13.2 Quality Assurance during Localization and Reconstruction 184
13.3 Quality Assurance of the Treatment Plan 189
13.4 Quality Assurance at the Time of Treatment 194
13.5 Post- Treatment Verification 196
References 196
14 New and Novel Treatment Delivery Techniques for Accelerated Partial Breast Irradiation 198
14.1 APBI: Established, New, and Novel Approaches 198
14.2 Teletherapy 199
14.3 Brachytherapy 202
14.4 Summary 205
References 206
15 Overview of North American Trials 208
15.1 Introduction 208
15.2 Patient Selection 209
15.3 Interstitial Technique 210
15.4 MammoSite Balloon 218
15.5 External Beam APBI 221
15.6 Conclusion 224
References 225
16 An Overview of European Clinical Trials of Accelerated Partial Breast Irradiation 227
16.1 Introduction 227
16.2 Early European APBI Trials 229
16.3 Contemporary European APBI Trials 232
16.4 European MammoSite Brachytherapy Trials 238
16.5 European (GEC-ESTRO) Multicentric Randomized APBI Trial 241
16.6 Summary and Future Directions 242
References 243
17 Normal Tissue Toxicity after Accelerated Partial Breast Irradiation 246
17.1 Introduction 246
17.2 Terminology, Techniques, and Radiation Biology 247
17.3 Interstitial Brachytherapy 249
17.4 MammoSite Brachytherapy 254
17.5 3D Conformal External Beam APBI 257
17.6 Intraoperative APBI 258
17.7 Conclusion 258
References 259
18 Future Directions: Phase III Cooperative Group Trials 261
18.1 Introduction 261
18.2 Patient Selection/Study Eligibility 264
18.3 Target Delineation 265
18.4 Technique and Dosimetry 267
18.5 Quality Assurance 269
18.6 Conclusion 269
References 270
Subject Index 271