AJCO Special Edition: Partial Breast Irradiation

Disclaimer: At the time of publication of the following articles, Dr. Vicini received compensation from Accuray Incorporated and Dr. Pignol is an employee of Accuray International Sàrl.

A new special issue of the American Journal of Clinical Oncology reports on the proceedings of a breast cancer radiotherapy summit held in Florence, Italy this past summer. Global thought leaders from the USA, Europe and Asia, have led major clinical and technical research into cutting-edge approaches for breast radiotherapy, called accelerated partial breast irradiation (APBI); APBI is when only a minimal amount of breast receives radiation therapy. The research and strategic discussions presented by the experts foretell a safer, kinder, gentler, and more efficient radiotherapy approach for breast cancer which is better delivered with a non-coplanar technique like the Accuray robotic platform, CyberKnife® System.

Follow the lead expert, Dr. Frank Vicini, from Genesis Care, Department of Radiation Oncology, Farmington Hills, MI, in his presentation of the special issue of the American Journal of Clinical Oncology.

Link to video #1 Introduction with Dr. Vicini

The first manuscript coming out of the summit discussed the cost of simplicity for early-stage breast cancer treatment. In essence, it really was a critique of oversimplifying breast cancer radiation treatment and refusing to invest the resources needed to deliver the minimum amount of radiation dose possible while achieving excellent results.

Link to video #2 The Cost of Simplicity for Early-Stage Breast Cancer Treatment
Link to corresponding open access article

This second manuscript focuses on treatment acceleration and minimizing the amount of breast tissue irradiated. A rationale for therapeutic de-escalation and the studies that are ongoing evaluating the use of radiation therapy alone as APBI, compared to endocrine therapy alone, and other studies that are evaluating Stereotactic Body Radiation Therapy (SBRT).

Link to video #3 Accelerated Partial Breast Irradiation: An Opportunity for Therapeutic De-Escalation
Link to corresponding open access article

This third manuscript discusses the Florence phase 3 trial experience of partial breast irradiation and the future perspective. It’s a discussion of the phase 3 trial from the Florence group comparing APBI in five fractions delivered every other day and conventionally fractionated whole breast irradiation delivered over five weeks plus a sequential boost.

Link to video #4 Accelerated Partial Breast Irradiation Florence Phase 3 Trial Experience and Future Perspectives
Link to corresponding open access article

This fourth manuscript focuses on APBI: the technological advances and the current challenges. It focuses on the importance of conformality, which translates into measurable outcome benefits, challenges and the questions that remain including reducing treatment margins due to the high dose volume, the target definition uncertainties, and the treatment setup uncertainties and inaccuracies:

Link to video #5 Accelerated Partial Breast Irradiation: Technological Advances and Current Challenges
Link to corresponding open access article

This fifth manuscript explores stereotactic partial breast irradiation: what does the future hold?
It looks more closely at the high dose per volume fractions, and the notion that the dose could be further escalated, especially when noncoplanar beam arrangements are used. It opens a very exciting area of research possibilities, similar to the stimulation of the immune system to increase the curative power of radiation therapy in overall breast cancer treatment.

Link to video #6 Stereotactic Partial Breast Irradiation: What Does the Future Hold?
Link to corresponding open access article

The final manuscript is a user’s guide. It looks at 5-fraction external beam radiation therapy. It outlines patient selection criteria, and workflow to aid the implementation of patient-centered evidence-based external beam partial breast irradiation.

Link to video #7 Five Fraction External Beam Partial Breast Irradiation: A User’s Guide
Link to corresponding open access article