Are the American Society for Radiation Oncology Guidelines Accurate Predictors of Recurrence in Early Stage Breast Cancer Patients Treated with Balloon-Based Brachytherapy?
The American Society for Radiation Oncology (ASTRO) consensus statement (CS) provides guidelines for patient selection for accelerated partial breast irradiation (APBI) following breast conserving surgery. The purpose of this study was to evaluate recurrence rates based on ASTRO CS groupings. A single institution review of 238 early stage breast cancer patients treated with balloon-based APBI via balloon based brachytherapy demonstrated a 4-year actuarial ipsilateral breast tumor recurrence (IBTR) rate of 5.1%. There were no significant differences in the 4-year actuarial IBTR rates between the “suitable,” “cautionary,” and “unsuitable” ASTRO categories (0%, 7.2%, and 4.3%, resp., ). ER negative tumors had higher rates of IBTR than ER positive tumors. The ASTRO groupings are poor predictors of patient outcomes. Further studies evaluating individual clinicopathologic features are needed to determine the safety of APBI in higher risk patients. 1. Introduction The concept of treating the entire breast with radiation after breast conserving surgery for breast cancer arose from early data demonstrating a high incidence of invasive or in situ carcinoma remote from the primary tumor in mastectomy specimens [1, 2]. However, clinical data evaluating patterns of recurrence have demonstrated that patients treated with lumpectomy alone have a low rate of recurrences at remote sites, so-called “elsewhere” recurrences. In fact, less than 5% of recurrences in unirradiated patients occur in a quadrant away from the primary tumor and the addition of whole breast irradiation (WBI) has not been shown to reduce the rates of these “elsewhere” failures [3]. Based on documented patterns of breast tumor recurrence after breast conserving surgery, accelerated partial breast irradiation (APBI) emerged as an alternative to WBI [4, 5]. However, data from randomized controlled trials comparing the safety and efficacy of APBI with standard WBI will not be available for several years [6]. In response to the growing interest in APBI, the American Society for Radiation Oncology (ASTRO) Health Services Research Committee convened a Task Force to help guide patient selection for APBI use outside of a clinical trial. In July 2009, the Task Force published a consensus statement (CS) that classified patients as “suitable,” “cautionary,” and “unsuitable” based on patient and tumor characteristics [7]. It is noteworthy that CS groupings were constructed largely without the use of long-term clinical data on the efficacy of APBI and may not be ideal in identifying appropriate patients for this
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