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Accumulating long-term evidence for partial breast irradiation
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Journal Article
Accumulating long-term evidence for partial breast irradiation
2023
Overview
In The Lancet Oncology, Vratislav Strnad and colleagues,1 report the long-term results of their multicentre, phase 3 trial investigating accelerated partial breast irradiation (APBI) using multicatheter brachytherapy for patients aged 40 years or older with early breast cancer, with a median follow-up of 10·36 years. 1328 women were randomly assigned to receive 50 Gy whole-breast irradiation delivered in 25 daily fractions over 5 weeks plus a 10 Gy tumour bed boost (n=673) or APBI (n=655) delivered as 30·1 Gy (seven fractions) and 32·0 Gy (eight fractions) of high-dose-rate brachytherapy in 5 days or as 50 Gy of pulsed-dose-rate brachytherapy over 5 treatment days. Burger/Phanie/Science Photo Library This high-quality study adds to other longer-term ipsilateral breast tumour recurrence results from mainly external-beam APBI versus whole-breast irradiation trials, namely the Florence trial (n=520, median follow-up 10·7 years),2 NSABP B-39/RTOG 0413 (n=4216, median follow-up 10·2 years),3 and the RAPID trial (n=2135, median follow-up 8·6 years).4 These trials show similar, low local recurrence rates with no difference in overall survival using APBI or whole-breast irradiation, for patients at low-risk of breast cancer recurrence, and we await the 10-year results of IMPORT Low (ISRCTN12852634) and the ongoing Early Breast Cancer Triallist Group individual patient data meta-analysis of APBI in due course. Additionally, research has focused on de-escalation, but some patients report substantial toxicity with endocrine therapy. [...]we should also investigate de-escalation of systemic therapy using health-related quality of life endpoints where survival outcomes are equivalent.10 In conclusion, both brachytherapy and external-beam APBI radiotherapy are important and relevant treatments today for patients with low-risk breast cancer.
Publisher
Elsevier Ltd,Elsevier Limited
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