Dr. Vratislav Strnad and Dr. Csaba Polgár outline the case for APBI

Dr. Vratislav Strnad and Dr. Csaba Polgár outline the case for APBI

July 26, 2016
Vratislav Strnad, M.D.
From the July 2016 issue of HealthCare Business News magazine

By Dr. Vratislav Strnad and Dr. Csaba Polgár

For decades, women with early-stage breast cancer have been treated with external whole breast irradiation (WBI), where high-dose radiation is delivered to the entire breast from outside the body over the course of five to six weeks. As our understanding of breast cancer evolved, and based on the observation that most breast cancers recur close to the original tumor bed, clinicians began randomized trials to evaluate if a shorter course of therapy, treating only the cancerous part of the breast, could reduce side effects common to WBI while maintaining adequate cancer control. Accelerated partial breast irradiation with brachytherapy (APBI brachytherapy) involves a four- to five-day postoperative course of radiotherapy delivered into the breast cavity following a lumpectomy.

Recent large-scale prospective clinical studies evaluating this technique add to an established and growing body of evidence that APBI brachytherapy is a safe and effective alternative to WBI with fewer late side effects and improved cosmetic outcomes.

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GEC-ESTRO overview
The Groupe Européen de Curiethérapie European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) trial is an ongoing European multicenter prospective study to assess the role of APBI brachytherapy alone compared to WBI, with a boost in a defined group of patients with invasive (stage I-IIA) breast cancer or ductal carcinoma in situ (DCIS; stage 0) who underwent breast-conserving surgery. Researchers evaluated 1,184 patients aged 40 years and above who were randomized to a standardized treatment arm (WBI, n=551) or an investigational treatment arm (APBI, n=633). Patients received follow-up examinations every three months initially and annually after 60 months. The median age of enrolled patients was 62 years old, with a median post-treatment follow up period of 6.6 years.

Csaba Polgár, M.D.

Key study takeaways
Benefit No. 1: APBI is clinically equivalent to WBI, with significantly reduced treatment time.

Investigators found adjuvant APBI with brachytherapy after breast conserving surgery is not inferior to adjuvant WBI with a boost for selected patients with early breast cancer, with equivalent local recurrence rates observed with both treatment modalities. At five-year follow-up, nine patients treated with APBI and five patients treated with WBI had a local recurrence, equating to cumulative recurrence rates of 1.44 percent and 0.92 percent (p=0.42), respectively. No significant differences in regional and distant recurrences were observed between groups.

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