Accelerated partial breast irradiation

Accelerated partial breast irradiation, APBI

allgemeines

Die akzelerierte Teilbrustbestrahlung (APBI) ist eine Alternative zur adjuvanten Ganzbrustbestrahlung (WBRT) nach brusterhaltender Operation.

Dosierung

32 Gy; ED 4 Gy; 2x täglich; 4 Tage lang (4, Harvard)

30 Gy; ED 6 Gy; 5x; jeden 2. Tag in 2 Wochen (5, Florenz)

38.5 Gy; ED 3,85 Gy; 10x; 2x täglich; 1 Woche (5 NSABP B-39, 6 RAPID)

Eignung

ASTRO(1) -und ESTRO(2) - Guidelines: Kriterien für die Eignung

		geeignet	bedingt geeignet	ungeeignet
Patienten- faktoren	Alter	≥60a	50-59a	<50a
Patienten- faktoren	BRCA1/2 Mutation	nein	nein	ja
Pathologische Faktoren	Tumorgröße	≤2cm	>3 - 3 cm	>3cm
	pT	pT1	pT0, pT2	pT3 - pT4
	Schnittrand	negativ	knapp	positiv
	Grading	-	-	-
	Lymphangiosis carcinomatosa	nein	begrenzt, fokal	extensiv
	ER Status	Positiv	Negativ	-
	Multizentrisch	nein	nein	ja
	Multifokal	nein	nein	ja
	Histology	Invasiv NST, muzinös, tubulär, colloidal u.a.	Invasiv lobulär	-
	reines DCIS	nein	≤3cm	>3cm
	EIC	nein	≤3cm	>3cm
Nodale Faktoren	Nodalstatus	pN0 (i-,i+)	pN0 (i-,i+)	pN1, pN2, pN3
Nodale Faktoren	LK-Operation	SNB, ALND	SNB, ALND	keine LK-Operation
Behandlung	Neoadjuvante Therapie	nein	nein	ja

APBI versus WBI

MDACC:
Partial Breast Brachytherapy Is Associated with Inferior Effectiveness and Increased Toxicity Compared with Whole Breast Radiation in Older Patients.
San Antonio Breast Symposium 2011.
Daten der SEER-Datenbank

Die Arbeit hat ziemlichen Streit ausgelöst und ist stark angegriffen worden.

Retrospektive Analyse

	WBI	APBI
Patienten	123.244	7291	≥67a, 2000-2007
spätere Mastektomie	2335 = 2,2%	177 = 4%	p < 0,001
Hospitalisiert oder Infektion innerhalb 120 Tage nach Therapie	5,7%	9,6%	p < 0,001
Rippenfrakturen (5 Jahre)	3,6%	4,2%
Fettnekrose	3,7%	9,1%
Brustschmerzen	11,7%	14,9%
Pneumonitis	0,8%	0,1%

MK-BRT

interstitielle Multikatheter-Brachytherapie (3)

Quellen

1.) Smith BD, et al.:
Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO).
IJROBP 2009;74:987-1001

2.) Polgar C, et al.:
Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery:recommendations of the Groupe European de Curietherapie-European Siciety for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working groupe based on clinical evidence (2009).
Radiother Oncol 2010;94:264-273

3.) Strnad V, Ott OJ, et al.:
5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial.
Lancet 2016; 387: 229–38

4.)Taghian A G, et al.: De ﬁ ning the Optimal Dose for 3-Dimensional Conformal Accelerated Partial Breast Irradiation: 15-Year Follow-Up of a Dose-Escalation Trial.
Int J Radiation Oncol Biol Phys 2025;121(4);900−909

5.) Meattini I, Marrazzo L, Saieva C, et al.:
Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer:
Long-term results of the randomized phase III APBI-IMRT-Florence trial.
J Clin Oncol 2020;38:4175-4183.

6.) Whelan TJ, Julian JA, Berrang TS, et al.:
External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and nodenegative breast cancer (RAPID): A randomised controlled trial.
Lancet 2019;394:2165-2172.

7.) Vicini FA, Cecchini RS, White JR, et al.:
Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: A randomised, phase 3, equivalence trial.
Lancet 2019;394:2155-2164.

Impressum Zuletzt geändert am 17.04.2016 21:38