Current modalities of accelerated partial breast irradiation

Nature Reviews Clinical Oncology

Volumn 10, Issue 6, 2013, Pages 344-356

  Cox, John A ^a   Swanson, Todd A ^a  

^a University of Texas Medical Branch School of Medicine   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ESTROGEN RECEPTOR; TAMOXIFEN;

BALLOON CATHETER; BRACHYTHERAPY; BREAST CANCER; CANCER ADJUVANT THERAPY; CANCER CONTROL; CANCER RADIOTHERAPY; CLINICAL PRACTICE; COMPUTER ASSISTED RADIOTHERAPY; DISEASE FREE SURVIVAL; DISEASE SEVERITY; DOSIMETRY; EXTERNAL BEAM RADIOTHERAPY; FEASIBILITY STUDY; FOLLOW UP; HUMAN; NON PROFIT ORGANIZATION; OUTCOME ASSESSMENT; OVERALL SURVIVAL; PARTIAL MASTECTOMY; PRIORITY JOURNAL; RADIATION SICKNESS; RADIOGRAPHY DEVICE; REPRODUCIBILITY; REVIEW; TUMOR VOLUME;

BRACHYTHERAPY; BREAST NEOPLASMS; FEMALE; GUIDELINES AS TOPIC; HUMANS; PATIENT SELECTION; RADIOTHERAPY, ADJUVANT;

EID: 84878525208     PISSN: 17594774     EISSN: 17594782     Source Type: Journal    
DOI: 10.1038/nrclinonc.2013.65     Document Type: Review

References (111)

1. Hayat, M. J., Howlader, N., Reichman, M. E. & Edwards, B. K. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist 12, 20-37 (2007).
2. National Cancer Institute. Seer cancer statistics review, 1975-2006 [online], http://seer.cancer.gov/csr/1975-2006/ (2009).
3. [No authors listed] Consensus statement: Treatment of early-stage breast cancer. National Institutes of Health Consensus Development Panel. J. Natl Cancer Inst. Monogr. 11, 1-5 (1992).
4. Fisher, B. et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N. Engl. J. Med. 347, 1233-1241 (2002).
5. van Dongen, J. A. et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J. Natl Cancer Inst. 92, 1143-1150 (2000).
6. Veronesi, U. et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N. Engl. J. Med. 347, 1227-1232 (2002).
7. National Comprehensive Cancer Network. NCCN≈Clinical Practice Guidelines in Oncology Breast Cancer version 2.2013 [online], http://www.nccn.org/professionals/physician-gls/pdf/breast.pdf (2013).
8. Whelan, T. J. et al. Long-term results of hypofractionated radiation therapy for breast cancer. N. Engl. J. Med. 362, 513-520 (2010).
9. Smith, T. E., Lee, D., Turner, B. C., Carter, D. & Haffty, B. G. True recurrence vs. new primary ipsilateral breast tumor relapse: An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int. J. Radiat. Oncol. Biol. Phys. 48, 1281-1289 (2000).
10. Huang, E. et al. Classifying local disease recurrences after breast conservation therapy based on location and histology: New primary tumors have more favorable outcomes than true local disease recurrences. Cancer 95, 2059-2067 (2002).
11. Fowble, B., Solin, L. J., Schultz, D. J., Rubenstein, J. & Goodman, R. L. Breast recurrence following conservative surgery and radiation: Patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int. J. Radiat. Oncol. Biol. Phys. 19, 833-842 (1990).
12. Gage, I. et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 33, 245-251 (1995).
13. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomised trials. Lancet 365, 1687-1717 (2005).
14. Saphner, T., Tormey, D. C. & Gray, R. Annual hazard rates of recurrence for breast cancer after primary therapy. J. Clin. Oncol. 14, 2738-2746 (1996).
15. Nattinger, A. B., Gottlieb, M. S., Veum, J., Yahnke, D. & Goodwin, J. S. Geographic variation in the use of breast-conserving treatment for breast cancer. N. Engl. J. Med. 326, 1102-1107 (1992).
16. Hiotis, K., Ye, W., Sposto, R. & Skinner, K. A. Predictors of breast conservation therapy: Size is not all that matters. Cancer 103, 892-899 (2005).
17. Morrow, M., Bucci, C. & Rademaker, A. Medical contraindications are not a major factor in the underutilization of breast conserving therapy. J. Am. Coll. Surg. 186, 269-274 (1998).
18. Legorreta, A. P., Liu, X. & Parker, R. G. Examining the use of breast-conserving treatment for women with breast cancer in a managed care environment. Am. J. Clin. Oncol. 23, 438-441 (2000).
19. Farrow, D. C., Hunt, W. C. & Samet, J. M. Geographic variation in the treatment of localized breast cancer. N. Engl. J. Med. 326, 1097-1101 (1992).
20. Lazovich, D. A., White, E., Thomas, D. B. & Moe, R. E. Underutilization of breast conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA 266, 3433-3438 (1991).
21. Ballard-Barbash, R., Potosky, A. L., Harlan, L. C., Nayfield, S. G. & Kessler, L. G. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J. Natl Cancer Inst. 88, 716-726 (1996).
22. Fisher, B. et al. Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J. Clin. Oncol. 20, 4141-4149 (2002).
23. Kuerer, H. M. et al. Accelerated partial breast irradiation after conservative surgery for breast cancer. Ann. Surg. 239, 338-351 (2004).
24. Swanson, T. A. & Vicini, F. A. Overview of accelerated partial breast irradiation. Curr. Oncol. Rep. 10, 54-60 (2008).
25. Kahán, Z. et al. The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int. J. Radiat. Oncol. Biol. Phys. 68, 673-681 (2007).
26. Kwa, S. L. et al. Radiation pneumonitis as a function of mean lung dose: An analysis of pooled data of 540 patients. Int. J. Radiat. Oncol. Biol. Phys. 42, 1-9 (1998).
27. Darby, S. C., McGale, P., Taylor, C. W. & Peto, R. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: Prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol. 6, 557-565 (2005).
28. Kirova, Y. M. et al. Risk of second malignancies after adjuvant radiotherapy for breast cancer: A large-scale, single-institution review. Int. J. Radiat. Oncol. Biol. Phys. 68, 359-363 (2007).
29. Schaapveld, M. et al. Risk of new primary nonbreast cancers after breast cancer treatment: A Dutch population-based study. J. Clin. Oncol. 26, 1239-1246 (2008).
30. Schaapveld, M. et al. The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer: A population based study in the Netherlands. Breast Cancer Res. Treat. 110, 189-197 (2008).
31. Keisch, M., Arthur, D., Patel, R., Rivard, M. & Vicini, F. American Brachytherapy Society, Breast Brachytherapy Task Group [online], www.americanbrachytherapy.org/guidelines/abs-breast-brachytherapy-taskgroup.pdf (2007).
32. The American Society of Breast Surgeons. Consensus Statement for Accelerated Partial Breast Irradiation [online], www.breastsurgeons.org/ statements/PDF-Statements/APBI-statement-revised-100708.pdf (2008).
33. Radiation Therapy Oncology Group. RTOG 0413 Protocol Information [online], www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0413 (2011).
34. Smith, B. D. et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int. J. Radiat. Oncol. Biol. Phys. 74, 987-1001 (2009).
35. King, T. A. et al. Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for t(is, 1, 2) breast cancer. Am. J. Surg. 180, 299-304 (2000).
36. Vicini, F. A. et al. Long-term efficacy and patterns of failure after accelerated partial breast irradiation: A molecular assay-based clonality evaluation. Int. J. Radiat. Oncol. Biol. Phys. 68, 341-346 (2007).
37. Kaufman, S. A., DiPetrillo, T. A., Price, L. L., Midle, J. B. & Wazer, D. E. Long-term outcome and toxicity in a phase I/II trial using high dose rate multicatheter interstitial brachytherapy for t1/t2 breast cancer. Brachytherapy 6, 286-292 (2007).
38. Benitez, P. R. et al. Five-year results: The initial clinical trial of MammoSite balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am. J. Surg. 194, 456-462 (2007).
39. Arthur, D. W. et al. A phase II trial of brachytherapy alone after lumpectomy for select breast cancer: Tumor control and survival outcomes of RTOG 95-17. Int. J. Radiat. Oncol. Biol. Phys. 72, 467-473 (2008).
40. Chen, P. Y. et al. Four-year efficacy, cosmesis, and toxicity using three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 76, 991-997 (2010).
41. Nelson, J. C. et al. Four-year clinical update from the American Society of Breast Surgeons MammoSite brachytherapy trial. Am. J. Surg. 198, 83-91 (2009).
42. Patel, R. R., Christensen, M. E., Hodge, C. W., Adkison, J. B. & Das, R. K. Clinical outcome analysis in "high-risk" versus "low-risk" patients eligible for National Surgical Adjuvant Breast and Bowel B 39/Radiation Therapy Oncology Group 0413 trial: Five-year results. Int. J. Radiat. Oncol. Biol. Phys. 70, 970-973 (2008).
43. Clarke, M. Meta-analyses of adjuvant therapies for women with early breast cancer: The Early Breast Cancer Trialists' Collaborative Group overview. Ann. Oncol. 17 (Suppl. 10), x59-x62 (2006).
44. Mannino, M. & Yarnold, J. R. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: Can radiotherapy ever be safely withheld? Radiother. Oncol. 90, 14-22 (2009).
45. Hughes, K. S. et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N. Engl. J. Med. 351, 971-977 (2004).
46. Hughes, K. S. et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early stage breast cancer [abstract]. J. Clin. Oncol. 28 (Suppl. 15), a507 (2010).
47. Kuske, Jr. R. R.Breast brachytherapy. Hematol. Oncol. Clin. North Am. 13, 543-558 (1999).
48. Cuttino, L. W., Todor, D. & Arthur, D. W. CT guided multi-catheter insertion technique for partial breast brachytherapy: Reliable target coverage and dose homogeneity. Brachytherapy 4, 10-17 (2005).
49. Kuske, R. R. et al. Phase II trial of brachytherapy alone after lumpectomy for select breast cancer: Toxicity analysis of RTOG 95-17. Int. J. Radiat. Oncol. Biol. Phys. 65, 45-51 (2006).
50. Polgár, C. et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma-5 year results of a randomized trial. Int. J. Radiat. Oncol. Biol. Phys. 69, 694-702 (2007).
51. MammoSite®. What is MammoSite 5-Day Targeted Radiation Therapy? [online], www.mammosite.com/breast-lumpectomy/whatis-mammosite.cfm (2013).
52. Vicini, F. et al. Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 79, 808-817 (2011).
53. Goyal, S. et al. Factors associated with optimal cosmetic results at 36 months in patients treated with accelerated partial breast irradiation (APBI) on the American Society of Breast Surgeons (ASBrS) MammoSite Breast Brachytherapy Registry Trial. Ann. Surg. Oncol. 16, 2450-2458 (2009).
54. Jeruss, J. S., Kuerer, H. M., Beitsch, P. D., Vicini, F. A. & Keisch, M. Update on DCIS outcomes from the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Ann. Surg. Oncol. 18, 65-71 (2011).
55. Fisher, B. et al. Tumor bed to skin distance using accelerated partial-breast irradiation with the strut-adjusted volume implant device. Brachytherapy 11, 387-391 (2012).
56. Lee, K. et al. Acute toxicity and early cosmetic outcome in patients treated with multilumen balloon brachytherapy with skin spacing ≤7.0 millimeters. J. Contemp. Brachytherapy 4, 8-13 (2012).
57. Khan, A. J. et al. Dosimetric feasibility and acute toxicity in a prospective trial of ultrashort-course accelerated partial breast irradiation (APBI) using a multi-lumen balloon brachytherapy device. Ann. Surg. Oncol. 20, 1295-1301 (2013).
58. Vicini, F. et al. A phase I/II trial to evaluate three dimensional conformal radiation therapy confined to the region of the lumpectomy cavity for stage I/II breast carcinoma: Initial report of feasibility and reproducibility of Radiation Therapy Oncology Group (RTOG) study 0319. Int. J. Radiat. Oncol. Biol. Phys. 63, 1531-1537 (2005).
59. Hepel, J. T. et al. Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 75, 1290-1296 (2009).
60. Jagsi, R. et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 76, 71-78 (2010).
61. Julian, T. B. et al. Early toxicity results with 3D conformal external beam (CEBT) from the NSABP B 39/RTOG 0413 accelerated partial breast irradiation (APBI) trial [abstract]. J. Clin. Oncol. 29 (Suppl. 15), a1011 (2011).
62. Bourgier, C. et al. Higher toxicity with 42 Gy in 10 fractions as a total dose for 3D-conformal accelerated partial breast irradiation: Results from a dose escalation phase II trial. Radiat. Oncol. 7, 141 (2012).
63. Formenti, S. C., DeWyngaert, J. K., Jozsef, G. & Goldberg, J. D. Prone vs supine positioning for breast cancer radiotherapy. JAMA 308, 861-863 (2012).
64. Wang, X. et al. External-beam accelerated partial breast irradiation using multiple proton beam configurations. Int. J. Radiat. Oncol. Biol. Phys. 80, 1464-1472 (2011).
65. Dickler, A. et al. A dosimetric comparison of MammoSite high dose rate brachytherapy and Xoft Axxent electronic brachytherapy. Brachytherapy 6, 164-168 (2007).
66. Brenner, D. J., Leu, C. S., Beatty, J. F. & Shefer, R. E. Clinical relative biological effectiveness of low-energy x rays emitted by miniature x ray devices. Phys. Med. Biol. 44, 323-333 (1999).
67. Vaidya, J. S. et al. Targeted intraoperative radiotherapy (TARGIT): An innovative approach to partial-breast irradiation. Semin. Radiat. Oncol. 15, 84-91 (2005).
68. Vaidya, J. et al. Targeted intraoperative radiotherapy for early breast cancer: TARGIT A trial- updated analysis of local recurrence and first analysis of survival [abstract]. Cancer Res. 72 (Suppl. 3), S4-2 (2012).
69. Sawaki, M. et al. Phase I/II study of intraoperative radiotherapy for early breast cancer in Japan. Breast Cancer 19, 353-359 (2012).
70. Luini, A. et al. The pilot trial on intraoperative radiotherapy with electrons (ELIOT): Update on the results. Breast Cancer Res. Treat. 93, 55-59 (2005).
71. Leonardi, M. C. et al. How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology. Int. J. Radiat. Oncol. Biol. Phys. 83, 806-813 (2012).
72. Orecchia, R. ELIOT trials in Milan: Results [abstract]. Radiother. Oncol. 103 (Suppl. 2), S4 a10 (2013).
73. Orecchia, R. IORT update: What are the limits of radiation dose and volume? Radiother. Oncol. 103 (Suppl. 1), S38 (2012).
74. Mannino, M. & Yarnold, J. Accelerated partial breast irradiation trials: Diversity in rationale and design. Radiother. Oncol. 91, 16-22 (2009).
75. Offersen, B. V., Overgaard, M., Kroman, N. & Overgaard, J. Accelerated partial breast irradiation as part of breast conserving therapy of early breast carcinoma: A systematic review. Radiother. Oncol. 90, 1-13 (2009).
76. Vicini, F. et al. Limitations of the American Society of Therapeutic Radiology and Oncology Consensus Panel guidelines on the use of accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 79, 977-984 (2011).
77. McHaffie, D. R. et al. Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features. Int. J. Radiat. Oncol. Biol. Phys. 81, 46-51 (2011).
78. Stull, T. S. et al. A single-institution review of accelerated partial breast irradiation in patients considered "cautionary" by the American Society for Radiation Oncology. Ann. Surg. Oncol. 19, 553-559 (2012).
79. Shaitelman, S. F. et al. Five-year outcome of patients classified using the American Society for Radiation Oncology consensus statement guidelines for the application of accelerated partial breast irradiation: An analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial. Cancer 116, 4677-4685 (2010).
80. Beitsch, P. et al. Five-year outcome of patients classified in the "unsuitable" category using the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel guidelines for the application of accelerated partial breast irradiation: An analysis of patients treated on the American Society of Breast Surgeons MammoSite® Registry trial. Ann. Surg. Oncol. 17 (Suppl. 3), 219-225 (2010).
81. Wilkinson, J. B. et al. Evaluation of current consensus statement recommendations for accelerated partial breast irradiation: A pooled analysis of William Beaumont Hospital and American Society of Breast Surgeon MammoSite registry trial data. Int. J. Radiat. Oncol. Biol. Phys. 85, 1179-1185 (2013).
82. Smith, G. L. et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA 307, 1827-1837 (2012).
83. Cuttino, L. W. et al. Accelerated partial-breast irradiation: Trial by media or by science? Int. J. Radiat. Oncol. Biol. Phys. 83, 1075-1077 (2012).
84. Khan, A. J., Vicini, F. A. & Arthur, D. Brachytherapy vs whole-breast irradiation for breast cancer. JAMA 308, 567 (2012).
85. Alpert, T. E., Kuerer, H. M., Arthur, D. W., Lannin, D. R. & Haffty, B. G. Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation. Int. J. Radiat. Oncol. Biol. Phys. 63, 845-851 (2005).
86. Shah, C. et al. Outcome after ipsilateral breast tumor recurrence in patients with early-stage breast cancer treated with accelerated partial breast irradiation. Clin. Breast Cancer 12, 392-397 (2012).
87. Adkison, J. B., Kuske, R. R. & Patel, R. R. Breast conserving surgery and accelerated partial breast irradiation after prior breast radiation therapy. Am. J. Clin. Oncol. 33, 427-431 (2010).
88. Radiation Therapy Oncology Group. RTOG 1014 Protocol Information [online], www.rtog.org/clinicalTrials/ProtocolTable/StudyDetails.aspx?study=1014 (2011).
89. Smith, G. L. et al. Brachytherapy for accelerated partial-breast irradiation: A rapidly emerging technology in breast cancer care. J. Clin. Oncol. 29, 157-165 (2011).
90. Abbott, A. M., Habermann, E. B. & Tuttle, T. M. Trends in the use of implantable accelerated partial breast irradiation therapy for early stage breast cancer in the United States. Cancer 117, 3305-3310 (2011).
91. Shah, C. et al. Cost-efficacy of acceleration partial-breast irradiation compared with whole-breast irradiation. Breast Cancer Res. Treat. 138, 127-135 (2013).
92. Shah, C. et al. Cost-effectiveness of 3 dimensional conformal radiotherapy and applicator-based brachytherapy in the delivery of accelerated partial breast irradiation. Am. J. Clin. Oncol. http://dx.doi.org/10.1097/COC. 0b013e318271b16d.
93. Darby, S. C. et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N. Engl. J. Med. 368, 987-998 (2013).
94. Moran, J. M. et al. Accelerated partial breast irradiation: What is dosimetric effect of advanced technology approaches? Int. J. Radiat. Oncol. Biol. Phys. 75, 294-301 (2009).
95. Patel, R. R., Becker, S. J., Das, R. K. & Mackie, T. R. A dosimetric comparison of accelerated partial breast irradiation techniques: Multicatheter interstitial brachytherapy, three-dimensional conformal radiotherapy, and supine versus prone helical tomotherapy. Int. J. Radiat. Oncol. Biol. Phys. 68, 935-942 (2007).
96. Antonucci, J. V. et al. Differences in patterns of failure in patients treated with accelerated partial breast irradiation versus whole-breast irradiation: A matched-pair analysis with 10-year follow-up. Int. J. Radiat. Oncol. Biol. Phys. 74, 447-452 (2009).
97. Ott, O. J. et al. Accelerated partial breast irradiation with interstitial implants: Risk factors associated with increased local recurrence. Int. J. Radiat. Oncol. Biol. Phys. 80, 1458-1463 (2011).
98. Ott, O. J. et al. Accelerated partial breast irradiation with multi-catheter brachytherapy: Local control, side effects and cosmetic outcome for 274 patients. Results of the German-Austrian multi-centre trial. Radiother. Oncol. 82, 281-286 (2007).
99. Polgár, C. et al. Accelerated partial-breast irradiation using high dose rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother. Oncol. 94, 274-279 (2010).
100. Khan, A. J. et al. Local control, toxicity, and cosmesis in women >70 years enrolled in the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Int. J. Radiat. Oncol. Biol. Phys. 84, 323-330 (2012).
101. Cuttino, L. W. et al. Multi-institutional experience using the MammoSite radiation therapy system in the treatment of early-stage breast cancer: 2 year results. Int. J. Radiat. Oncol. Biol. Phys. 71, 107-114 (2008).
102. Wilkinson, J. B. et al. Four-year results using balloon-based brachytherapy to deliver accelerated partial breast irradiation with a 2 day dose fractionation schedule. Brachytherapy 11, 97-104 (2012).
103. Dragun, A. E., Harper, J. L., Jenrette, J. M., Sinha, D. & Cole, D. J. Predictors of cosmetic outcome following MammoSite breast brachytherapy: A single-institution experience of 100 patients with two years of follow-up. Int. J. Radiat. Oncol. Biol. Phys. 68, 354-358 (2007).
104. Israel, P. Z. et al. Three-year clinical outcome using the Contura multilumen balloon breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI): Improving radiation standards for the optimal application of APBI. Brachytherapy 11, 316-321 (2012).
105. Yashar, C. M. et al. Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast brachytherapy device for accelerated partial-breast irradiation (APBI): First 100 patients with more than 1 year of follow-up. Int. J. Radiat. Oncol. Biol. Phys. 80, 765-770 (2011).
106. Vicini, F. A. et al. Initial efficacy results of RTOG 0319: Three-dimensional conformal radiation therapy (3D-CRT) confined to the region of the lumpectomy cavity for stage I/ II breast carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 77, 1120-1127 (2010).
107. Shah, C. et al. Five-year outcomes and toxicities using 3 dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Clin. Breast Cancer http://dx.doi.org/10.1016/j.clbc.2012.09.020.
108. Leonardi, M. C. et al. Accelerated partial breast irradiation with intraoperative electrons: Using GEC-ESTRO recommendations as guidance for patient selection. Radiother. Oncol. 106, 21-27 (2013).
109. Vaidya, J. S. et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT A trial): An international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376, 91-102 (2010).
110. Ivanov, O., Dickler, A., Lum, B. Y., Pellicane, J. V. & Francescatti, D. S. Twelve-month follow-up results of a trial utilizing Axxent electronic brachytherapy to deliver intraoperative radiation therapy for early-stage breast cancer. Ann. Surg. Oncol. 18, 453-458 (2011).
111. Mehta, V. K. et al. Experience with an electronic brachytherapy technique for intracavitary accelerated partial breast irradiation. Am. J. Clin. Oncol. 33, 327-335 (2010).