Partial Breast Irradiation for Patients With Early-Stage Invasive Breast Cancer or Ductal Carcinoma In Situ: An ASTRO Clinical Practice Guideline

被引：85

作者：

Shaitelman, Simona F. ^{[1
]}

Anderson, Bethany M. ^{[2
]}

Arthur, Douglas W. ^{[3
]}

Bazan, Jose G. ^{[4
]}

Bellon, Jennifer R. ^{[5
,6
]}

Bradfield, Lisa ^{[7
]}

Coles, Charlotte E. ^{[8
]}

Gerber, Naamit K. ^{[9
]}

Kathpal, Madeera ^{[10
]}

Kim, Leonard ^{[11
]}

Laronga, Christine ^{[12
]}

Meattini, Icro ^{[13
]}

Nichols, Elizabeth M. ^{[14
]}

Pierce, Lori J. ^{[15
]}

Poppe, Matthew M. ^{[16
]}

Spears, Patricia A. ^{[17
]}

Vinayak, Shaveta ^{[18
]}

Whelan, Timothy ^{[19
]}

Lyons, Janice A. ^{[20
]}

机构：

[1] Univ Texas MD Anderson Canc Ctr, Dept Breast Radiat Oncol, Houston, TX 77030 USA

[2] Univ Wisconsin, Dept Radiat Oncol, Madison, WI USA

[3] Virginia Commonwealth Univ, Dept Radiat Oncol, Richmond, VA USA

[4] City Hope Comprehens Canc Ctr, Dept Radiat Oncol, Duarte, CA USA

[5] Dana Farber Canc Inst, Dept Radiat Oncol, Boston, MA USA

[6] Brigham & Womens Hosp, Boston, MA USA

[7] Amer Soc Radiat Oncol, Arlington, VA USA

[8] Univ Cambridge, Dept Oncol, Cambridge, England

[9] New York Univ, Dept Radiat Oncol, Grossman Sch Med, New York, NY USA

[10] Duke Univ, Dept Radiat Oncol, Wake Cty Campus, Raleigh, NC USA

[11] MD Anderson Canc Ctr Cooper, Dept Radiat Oncol, Camden, NJ USA

[12] H Lee Moffitt Canc Ctr & Res Inst, Dept Breast Oncol, Tampa, FL USA

[13] Univ Florence, Dept Radiat Oncol, Florence, Italy

[14] Univ Maryland, Sch Med, Dept Radiat Oncol, Baltimore, MD USA

[15] Univ Michigan, Sch Med, Dept Radiat Oncol, Ann Arbor, MI USA

[16] Huntsman Canc Inst, Dept Radiat Oncol, Salt Lake City, UT USA

[17] Univ North Carolina Chapel Hill, Patient Representat, Chapel Hill, NC USA

[18] Univ Washington, Dept Med Oncol, Seattle, WA USA

[19] McMaster Univ, Dept Oncol, Hamilton, ON, Canada

[20] Univ Hosp Seidman Canc Ctr, Dept Radiat Oncol, Cleveland, OH USA

来源：

PRACTICAL RADIATION ONCOLOGY | 2024年 / 14卷 / 02期

关键词：

TARGETED INTRAOPERATIVE RADIOTHERAPY; INTENSITY-MODULATED RADIOTHERAPY; ONCOLOGY CONSENSUS GUIDELINE; TARGIT-A TRIAL; CONSERVING SURGERY; RADIATION-THERAPY; AMERICAN SOCIETY; EUROPEAN-SOCIETY; TUMOR RECURRENCE; RANDOMIZED-TRIAL;

D O I：

10.1016/j.prro.2023.11.001

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose: This guideline provides evidence -based recommendations on appropriate indications and techniques for partial breast irradiation (PBI) for patients with early -stage invasive breast cancer and ductal carcinoma in situ. Methods: ASTRO convened a task force to address 4 key questions focused on the appropriate indications and techniques for PBI as an alternative to whole breast irradiation (WBI) to result in similar rates of ipsilateral breast recurrence (IBR) and toxicity outcomes. Also addressed were aspects related to the technical delivery of PBI, including dose -fractionation regimens, target volumes, and treatment parameters for different PBI techniques. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus -building methodology and system for grading evidence quality and recommendation strength. Results: PBI delivered using 3 -dimensional conformal radiation therapy, intensity modulated radiation therapy, multicatheter brachytherapy, and single-entry brachytherapy results in similar IBR as WBI with long-term follow-up. Some patient characteristics and tumor features were underrepresented in the randomized controlled trials, making it difficult to fully define IBR risks for patients with these features. Appropriate dose -fractionation regimens, target volume delineation, and treatment planning parameters for delivery of PBI are outlined. Intraoperative radiation therapy alone is associated with a higher IBR rate compared with WBI. A daily or every -other -day external beam PBI regimen is preferred over twice -daily regimens due to late toxicity concerns. Conclusions: Based on published data, the ASTRO task force has proposed recommendations to inform best clinical practices on the use of PBI. (c) 2023 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

引用

页码：112 / 132

页数：21

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