There are a number of guidelines that have considered the status of Partial Breast Irradiation, which requires a clinician to insert 10 to 20 catheters through multiple incisions on either side of the affected breast. The catheters allow delivery of a radiation source to the tissues that surround the malignancy.
Updated October 2008, the California Technology Assessment Forum (CTAF) reviewed current studies that have been conducted on the use of brachytherapy as a primary source of radiation therapy. The CTAF concluded that “the use of breast brachytherapy does not meet Technology Assessment Criteria 4 or 5 for safety, effectiveness and improvement in health outcomes when used as primary radiation therapy following breast conserving surgery for localized breast cancer.” The National Institute for Health and Clinical Excellence (NICE) (2008) in their guidance for brachytherapy as the sole method of adjuvant radiotherapy for breast cancer after local excision, stated “Current evidence on brachytherapy as the sole method of adjuvant radiotherapy for breast cancer after local excision raises no major safety concerns. Current evidence on its efficacy is limited in quantity and there is little information on long-term outcomes (5 years or more). Therefore, this procedure should be used only in the context of research, which should address control of local disease with a minimum of 5 years of follow-up.” This document addressed both interstitial and balloon brachytherapy. American Society of Breast Surgeons (ASBS): The ASBS Consensus Statement for Accelerated Partial Breast Irradiation (October, 2008) stated that several single-institution, non-randomized studies using the multicatheter technique have shown low local recurrence rates that are comparable to standard external beam radiation therapy.
American Society for Radiation Oncology (ASTRO): ASTRO published a consensus statement on APBI (Smith, et al., 2009). : “There are insufficient clinical and dosimetric data to determine the optimal technique for APBI delivery (Smith, et al., 2009). ”
American Brachytherapy Society (ABS) is more supportive and sets forth several criteria in which is considers brachyterapy appropriate. National Comprehensive Cancer Network Guidelines (v.2.2010) states the use of whole breast irradiation with boost (by photons, brachytherapy or electron beam) to the tumor bed is recommended to maximize local control, especially in patients 50 years of age or younger. The NCCN states that partial breast radiation (PBR) should be performed only as part of a prospective trial. If no trial eligible, PBI should be reserved for patients with a low risk of recurrence (NCCN, 2010).
In summary, most guidelines consider this technique not fully proven, although some are willing to endorse it for younger patients.
American College of Radiology (ACR). Practice guideline for the Breast Conservation Therapy in the Management of Invasive Breast Carcinoma. 2006.
American Society of Breast Surgeons (ASBS). Revised Consensus Statement for Accelerated Partial Breast Irradiation. Updated October 7, 2008. Accessed September, 2010. Available at URL address: http://www.breastsurgeons.org/statements/index.php
California Technology Assessment Forum (CTAF). Brachytherapy As Primary Radiation Therapy following Breast-Conserving Surgery for Stage 1 or II Breast Cancer.Available at URL address: http://www.ctaf.org/content/assessment/detail/937 Keisch M, Arthur D, Patel R, Rivard M, Vicini F. American Brachytherapy Society Breast Brachytherapy Task Group. Original 2003. Updated Feb 2007. Available at URL address: http://www.americanbrachytherapy.org/guidelines/index.cfm Coverage Policy Number: 020416.
National Comprehensive Cancer Network, Inc 2010, All Rights Reserved. Breast Cancer. V.2.2010.
National Institute for Health and Clinical Excellence (NICE). IPG268 Brachytherapy as the sole method of adjuvant radiotherapy for breast cancer after local excision: Guidance. Jul 2008. Available at URL address: http://www.nice.org.uk/guidance/index.jsp?action=download&o=41277
Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg. 2009 Aug;209(2):269-77.