Shah Chirag, Vicini Frank, Shaitelman Simona F, Hepel Jaroslaw, Keisch Martin, Arthur Douglas, Khan Atif J, Kuske Robert, Patel Rakesh, Wazer David E
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH.
21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI.
Brachytherapy. 2018 Jan-Feb;17(1):154-170. doi: 10.1016/j.brachy.2017.09.004. Epub 2017 Oct 23.
Adjuvant radiation after breast-conserving surgery remains the standard-of-care treatment for patients with ductal carcinoma in situ and early-stage invasive breast cancer. Multiple alternatives to standard whole-breast irradiation exist including accelerated partial-breast irradiation (APBI). Therefore, the purpose of this APBI guideline is to provide updated data for clinicians as well as recommendations regarding appropriate patient selection and techniques to deliver APBI.
Members of the American Brachytherapy Society with expertise in breast cancer and breast brachytherapy in particular created an updated guideline for appropriate patient selection based on an extensive literature search and clinical experience. In addition, data were evaluated with respect to APBI techniques and recommendations presented.
Appropriate candidates for APBI include patients aged 45 years or older, all invasive histologies and ductal carcinoma in situ, tumors 3 cm or less, node negative, estrogen receptor positive/negative, no lymphovascular space invasion, and negative margins. With respect to techniques, the strongest evidence is for interstitial brachytherapy and intensity-modulated radiation therapy APBI with moderate evidence to support applicator brachytherapy or three-dimensional conformal radiotherapy APBI. Intraoperative radiation therapy and electronic brachytherapy should not be offered regardless of technique outside of clinical trial.
The updated guidelines presented offer clinicians with a summary of data supporting APBI and guidelines for the appropriate and safe utilization of the technique.
保乳手术后的辅助放疗仍然是导管原位癌和早期浸润性乳腺癌患者的标准治疗方法。除了标准的全乳照射外，还有多种替代方法，包括加速部分乳腺照射（APBI）。因此，本APBI指南的目的是为临床医生提供最新数据，以及关于合适的患者选择和实施APBI技术的建议。
美国近距离放射治疗学会中尤其在乳腺癌和乳腺近距离放射治疗方面具有专业知识的成员，基于广泛的文献检索和临床经验，制定了一份关于合适患者选择的更新指南。此外，还对所呈现的APBI技术和建议的数据进行了评估。
APBI的合适候选者包括年龄45岁及以上的患者、所有浸润性组织学类型和导管原位癌、肿瘤直径3厘米及以下、淋巴结阴性、雌激素受体阳性/阴性、无淋巴管侵犯且切缘阴性的患者。关于技术，最有力的证据支持组织间近距离放射治疗和调强放射治疗APBI，有中等证据支持施源器近距离放射治疗或三维适形放射治疗APBI。无论技术如何，在临床试验之外不应提供术中放射治疗和电子近距离放射治疗。
所呈现的更新指南为临床医生提供了支持APBI的数据总结以及该技术合适且安全应用的指南。
