Daily or every-other-day external beam PBI regimen preferred over twice-daily regimen due to late toxicity concerns
By Elana Gotkine HealthDay Reporter
FRIDAY, Dec. 1, 2023 (HealthDay News) — In a clinical practice guideline issued by the American Society for Radiation Oncology (ASTRO) published online Nov. 15 in Practical Radiation Oncology, recommendations are presented to inform best clinical practices on the use of partial breast irradiation (PBI).
Simona F. Shaitelman, M.D., from the University of Texas MD Anderson Cancer Center in Houston, and colleagues convened a task force to address four questions related to appropriate indications and techniques for PBI as an alternative to whole breast irradiation (WBI). The guidelines were developed based on a systematic review, and recommendations were created using a predefined consensus-building methodology.
PBI is strongly recommended for patients with early-stage invasive breast cancer with grade 1 to 2 disease, estrogen receptor-positive histology, age 40 years or older, and tumor size ≤2 cm. The authors noted that using three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, multicatheter brachytherapy, and single-entry brachytherapy to deliver PBI results in similar ipsilateral breast recurrence (IBR) as WBI with long-term follow-up. Due to underrepresentation of certain patient characteristics and tumor features in randomized controlled trials, the IBR risk for patients with these features could not be fully defined. Compared with WBI, intraoperative radiation therapy is associated with a higher IBR rate. Due to late toxicity concerns, a daily or every-other-day external beam PBI regimen is preferred over twice-daily regimens.
“These data should be driving a change in practice, and partial breast radiation should be a larger part of the dialogue when we consult with patients on decisions about how best to treat their early-stage breast cancer,” Shaitelman said in a statement.
Several authors disclosed ties to the biopharmaceutical industry.
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