Breast surgeon group optimistic about new therapy, but urge cautious approach

Until more data are available, a cautious approach is warranted in determining which breast cancer patients can undergo accelerated partial breast irradiation (APBI) and who should perform the procedure, according to a statement released Thursday by the American Society of Breast Surgeons (ASBS).

APBI is a therapy to prevent breast cancer recurrence that promises to reduce the usual treatment period. With standard external beam radiation therapy, treatment usually lasts several weeks. In contrast, with APBI, a high dose of radiation is delivered to the breast region at highest risk for disease recurrence, effectively reducing the treatment period to just 4 to 5 days.”The ASBS likes to urge caution with any new therapies,” Dr. Pat Whitworth, a member of the ASBS and director of the Nashville Breast Center, told Reuters Health. “A whole lot of things are heralded as breakthrough technologies which may or may not be,” he added.”APBI really looks like an advance, and yet no one has defined its role,” Dr. Whitworth noted. “What we are really waiting to see is a prospective randomized trial comparing it with external beam radiation therapy.”Nonetheless, “there is enough evidence from studies that have been done to suggest that APBI is something that should be available for certain women,” Dr. Whitworth said. The Society’s statement addresses how APBI should be employed until more data are available, he added.The ASBS recommends that:–Ideally, APBI should be performed as part of a treatment protocol at an individual institution or in the setting of a multi-institutional trial.–The treatment should only be performed by clinicians well versed in the various APBI techniques.–Outside of institutional or trial protocols, careful patient selection is a must. Potential APBI candidates should be older than 50 years, have ductal carcinoma, have a total tumor size no greater than 2 cm in diameter, and have no axillary/sentinel lymph node disease.–Patients should be followed closely for adverse events and recurrences with reporting of such occurrences to institutional review boards, study groups, or product manufacturers.Dr. Whitworth noted that a randomized trial comparing APBI with standard radiation therapy is expected in the next year or two.(Source: Reuters Health: Anthony J. Brown, MD: May 2, 2003: Oncolink)