External beam accelerated partial-breast irradiation using 32 gy in 8 twice-daily fractions: 5-year results of a prospective study
Itai M Pashtan, Abram Recht, Marek Ancukiewicz, Elena Brachtel, Rita F Abi-Raad, Helen A D'Alessandro, Antonin Levy, Jennifer Y Wo, Ariel E Hirsch, Lisa A Kachnic, Saveli Goldberg, Michelle Specht, Michelle Gadd, Barbara L Smith, Simon N Powell, Alphonse G Taghian, Itai M Pashtan, Abram Recht, Marek Ancukiewicz, Elena Brachtel, Rita F Abi-Raad, Helen A D'Alessandro, Antonin Levy, Jennifer Y Wo, Ariel E Hirsch, Lisa A Kachnic, Saveli Goldberg, Michelle Specht, Michelle Gadd, Barbara L Smith, Simon N Powell, Alphonse G Taghian
Abstract
Purpose: External beam accelerated partial breast irradiation (APBI) is an increasingly popular technique for treatment of patients with early stage breast cancer following breast-conserving surgery. Here we present 5-year results of a prospective trial.
Methods and materials: From October 2003 through November 2005, 98 evaluable patients with stage I breast cancer were enrolled in the first dose step (32 Gy delivered in 8 twice-daily fractions) of a prospective, multi-institutional, dose escalation clinical trial of 3-dimensional conformal external beam APBI (3D-APBI). Median age was 61 years; median tumor size was 0.8 cm; 89% of tumors were estrogen receptor positive; 10% had a triple-negative phenotype; and 1% had a HER-2-positive subtype. Median follow-up was 71 months (range, 2-88 months; interquartile range, 64-75 months).
Results: Five patients developed ipsilateral breast tumor recurrence (IBTR), for a 5-year actuarial IBTR rate of 5% (95% confidence interval [CI], 1%-10%). Three of these cases occurred in patients with triple-negative disease and 2 in non-triple-negative patients, for 5-year actuarial IBTR rates of 33% (95% CI, 0%-57%) and 2% (95% CI, 0%-6%; P<.0001), respectively. On multivariable analysis, triple-negative phenotype was the only predictor of IBTR, with borderline statistical significance after adjusting for tumor grade (P=.0537).
Conclusions: Overall outcomes were excellent, particularly for patients with estrogen receptor-positive disease. Patients in this study with triple-negative breast cancer had a significantly higher IBTR rate than patients with other receptor phenotypes when treated with 3D-APBI. Larger, prospective 3D-APBI clinical trials should continue to evaluate the effect of hormone receptor phenotype on IBTR rates.
Trial registration: ClinicalTrials.gov NCT00694577.
Copyright © 2012 Elsevier Inc. All rights reserved.
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Source: PubMed