eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
Current Issue Archive Supplements Articles in Press Journal Information Aims and Scope Editorial Office Editorial Board Register as Author Register as Reviewer Instructions for Authors Abstracting and indexing Subscription Advertising Information Links
SCImago Journal & Country Rank

Interview with Professor Janusz Skowronek
ABS 2015
vol. 10
Original paper

Should molecular subtype be recommended as one of the selection criteria for accelerated partial breast irradiation? Preliminary results from an Asian cohort

Tabassum Wadasadawala, Monidipa Mondal, Siji Nojin Paul, Vani Parmar, Nita Nair, Tanuja Shet, Sangeeta Desai, Sudeep Gupta, Rajiv Sarin

J Contemp Brachytherapy 2018; 10, 1: 47–57
Online publish date: 2018/02/28
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
The purpose of this study was to report clinical outcomes in patients treated with accelerated partial breast irradiation (APBI), stratified as per molecular subtype and American Society for Therapeutic Radio­logy and Oncology/Groupe Européen de Curiethérapie and European Society for Radiotherapy & Oncology (ASTRO/GEC-ESTRO) patient selection criteria in order to determine whether molecular subtype should be recommended as one of the selection criteria for APBI.

Material and methods
157 early-stage breast cancers patients, treated with APBI using multi-catheter interstitial brachytherapy with ≥ 6 months follow-up were included. Molecular subtype was assigned based on estrogen/progesterone receptor (ER/PR), Her2neu and tumor grade. Patients were stratified into ASTRO and GEC-ESTRO risk groups, as per updated ASTRO consensus statement (CS) and GEC-ESTRO recommendation, respectively. The Kaplan-Meier method was used to calculate the time to event data of clinical outcomes.

With a median follow-up of 35 months, local control (LC) and locoregional control (LRC) were not significantly different among the different molecular subtypes (p = 0.19, p = 0.41, respectively). None of the APBI guidelines predicted risk of local or locoregional recurrence. Re-analyzing the data by replacing ER status with molecular subtype in the ASTRO-CS did not show any significant difference in LC/LRC across the various categories. Her2neu subtype was associated with significantly lower disease-free survival, cause specific survival, and overall survival than the luminal subtypes.

None of the mentioned APBI guidelines predicted local or locoregional recurrence risk in our study population. Additional follow-up will be needed to recommend inclusion of molecular subtype (or at least HER2 receptor status) in the patient selection criteria for APBI.


accelerated partial breast irradiation, breast cancer, multicatheter interstitial brachytherapy

Strnad V, Ott OJ, Hildebrandt G et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 2016; 387: 229-238.
Harat A, Harat M, Makarewicz R. Whole breast irradiation vs. APBI using multicatheter brachytherapy in early breast cancer–simulation of treatment costs based on phase 3 trial data. J Contemp Brachytherapy 2016; 8: 505-511.
Bitter SM, Heffron-Cartwright P, Wennerstrom et al. WBRT vs. APBI: an interim report of patient satisfaction and outcomes. J Contemp Brachytherapy 2016; 8: 17-22.
Smith BD, Arthur DW, Buchholz TA et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 2009; 74: 987-1001.
Polgár C, Van Limbergen E, Pötter R et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010; 94: 264-273.
Shah C, Vicini F, Wazer DE et al. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy 2013; 12: 267-277.
The American Society of Breast Surgeons: Consensus Statement for Accelerated Partial Breast Irradiation. Available at: https://www.breastsurgeons.org/new_layout/about/statements/PDF_Statements/APBI.pdf; Revised August 15, 2011. Accessed: 20 August 2017.
Radiation Therapy Oncology Group. RTOG 0413/NSABP B-39 Study Protocol. Available at: http://www.rtog.org/members/protocols/0413/0413.pdf. Accessed: January 8, 2018.
Correa C, Harris EE, Leonardi MC et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol 2017; 7: 73-79.
Leonardi MC, Maisonneuve P, Mastropasqua MG et al. Accelerated partial breast irradiation with intraoperative electrons: Using GEC–ESTRO recommendations as guidance for patient selection. Radiother Oncol 2013; 106: 21-27.
Nguyen PL, Taghian AG, Katz MS et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 2008; 26: 2373-2378.
Voduc KD, Cheang MC, Tyldesley S et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 2010; 28: 1684-1691.
Albert JM, Gonzalez-Angulo AM, Guray M et al. Estrogen/progesterone receptor negativity and HER2 positivity predict locoregional recurrence in patients with T1a, bN0 breast cancer. Int J Radiat Oncol Biol Phys 2010; 77: 1296-1302.
Banerjee S, Reis-Filho JS, Ashley S et al. Basal-like breast carcinomas: clinical outcome and response to chemotherapy. J Clin Pathol 2006; 59: 729-735.
Wilkinson JB, Reid RE, Shaitelman SF et al. Outcomes of breast cancer patients with triple negative receptor status treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2011; 81: e159-164.
Wilkinson JB, Shah C, Amin M et al. Outcomes According to Breast Cancer Subtype in Patients Treated with Accelerated Partial Breast Irradiation. Clin Breast Cancer 2017; 17: 55-60.
Pashtan IM, Recht A, Ancukiewicz M et al. External beam accelerated partial-breast irradiation using 32 Gy in 8 twice-daily fractions: 5-year results of a prospective study. Int J Radiat Oncol Biol Phys 2012; 84: e271-277.
Anderson BM, Kamrava M, Wang PC et al. Locoregional recurrence by molecular subtype after multicatheter interstitial accelerated partial breast irradiation: Results from the Pooled Registry of Multicatheter Interstitial Sites research group. Brachytherapy 2016; 15: 788-795.
Gurram L, Wadasadawala T, Joshi K et al. Multi-catheter interstitial brachytherapy for partial breast irradiation: an audit of implant quality based on dosimetric evaluation comparing intra-operative versus post-operative placement. J Contemp Brachytherapy 2016; 8: 116-121.
Polgár C, Fodor J, Major T et al. Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol 2013; 108: 197-202.
Wadasadawala T, Sarin R, Budrukkar A et al. Accelerated partial-breast irradiation vs conventional whole-breast radiotherapy in early breast cancer: A case-control study of disease control, cosmesis, and complications. J Cancer Res Ther 2009; 5: 93-101.
Akhtari M, Abboud M, Szeja S et al. Clinical outcomes, toxicity, and cosmesis in breast cancer patients with close skin spacing treated with accelerated partial breast irradiation (APBI) using multi-lumen/catheter applicators. J Contemp Brachytherapy 2016; 8: 497-504.
Vicini F, Arthur D, Wazer D et al. Limitations of the American Society of Therapeutic Radiology and Oncology Consensus Panel guidelines on the use of accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2011; 79: 977-984.
McHaffie DR, Patel RR, Adkison JB et al. Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features. Int J Radiat Oncol Biol Phys 2011; 81: 46-51.
Stull TS, Goodwin MC, Gracely EJ et al. A single-institution review of accelerated partial breast irradiation in patients considered “cautionary” by the American Society for Radiation Oncology. Ann Surg Oncol 2012; 19: 553-559.
Christoudias MK, Collett AE, Stull TS et al. Are the American Society for Radiation Oncology guidelines accurate predictors of recurrence in early stage breast cancer patients treated with balloon-based brachytherapy? Intern J Surg Oncol 2013; 829050.
Shaitelman SF, Vicini FA, Beitsch P et al. Five-year outcome of patients classified using the American Society for Radiation Oncology consensus statement guidelines for the application of accelerated partial breast irradiation. Cancer 2010; 116: 4677-4685.
Wilkinson JB, Beitsch PD, Shah C et al. Evaluation of current consensus statement recommendations for accelerated partial breast irradiation: a pooled analysis of William Beaumont Hospital and American Society of Breast Surgeon MammoSite Registry Trial Data. Int J Radiat Oncol Biol Phys 2012; 85: 1179-1185.
Leonardi MC, Maisonneuve P, Mastropasqua MG et al. How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology. Int J Radiat Oncol Biol Phys 2012; 83: 806-813.
Aliyev JA, Isayev IH, Akbarov KS et al. High-dose-rate interstitial brachytherapy for accelerated partial breast irradiation–trial results of Azerbaijan National Center of Oncology. J Contemp Brachytherapy 2017; 9: 106-111.
Shah C, Wobb J, Manyam B et al. Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow. J Contemp Brachytherapy 2016; 8: 90-94.
Orecchia R, Leonardi MC. Partial breast irradiation: targeting volume or breast molecular subtypes? Breast 2013; 22 Suppl 2: S137-140.
Billar JA, Dueck AC, Stucky CC et al. Triple-negative breast cancers: unique clinical presentations and outcomes. Ann Surg Oncol 2010; 17: 384-390.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe