Who is Eligible for Breast Brachytherapy?
ABCs has put together the following selection criteria for Accelerated Partial Breast Irradiation (APBI).
To be a candidate for breast brachytherapy, a patient must have:
Invasive breast cancer or ductal carcinoma in situ (DCIS) 3 cm or less in size.
- Node negative of no more than three positive lymph nodes of the axilla (armpit area). For patients with 3 or fewer positive nodes, we insist that the tumor has not penetrated the capsule of a lymph node (medical term: extranodal extension). We believe that patients with more than three nodes involved, or with extranodal extension, should consider comprehensive external beam radiation therapy to the breast and lymph node areas instead of brachytherapy.
- Clear surgical margins of at least 1 mm.
- Unicentric breast cancer (no other areas of the breast with cancer).
- A negative pregnancy test or no possibility of pregnancy.
- A time interval of no more than 6 weeks from lumpectomy or re-excision surgery, or breast ultrasound or CT evidence for a clear lumpectomy cavity edge for target volume definition.
New Guidelines from the American Society of Radiation Oncology, Biology, and Physics
Please Note - we do not use or condone these extremely strict criteria written primarily by physicians who do not offer accelerated partial breast irradiation, but present them for your information.
Suitable for APBI:
- Age > 60 years
No BRCA 1/2 mutation
- Tumor size < 2 cm, unicentric
- Clinically unifocal with total size < 2 cm
Invasive ductal, mucinous, tubular, and colloid carcinomas
- Margins negative by at least 2 mm
- Node-negative or immunohistochemistry (+) cells only
- No extensive intraductal component
- No Lymphvascular Invasion
- Estrogen receptor positive
- No pure DCIS
- No neoadjuvant therapy
Any of these criteria should invoke caution and concern when considering APBI:
- Age 50 - 59 years
- Tumor size 2.1 - 3.0 cm (invasive component)
- Clinically unifocal with total size 2.1 - 3.0 cm
Invasive lobular carcinomas
- Margins close < 2 mm
- Extensive intraductal component < 3 cm
- Limited or focal Lymphvascular Invasion
- Estrogen receptor negative
- Pure DCIS < 3 cm
Patients unsuitable for breast brachytherapy unless they are on a clinical trial:
- Age < 50 years
- BRCA 1/2 mutation present
- Tumor size > 3.0 cm or stage T3 or T4
- Multifocal disease > 3 cm in total size or clinically multifocal
- Positive surgical margins
- Pathologic involvement of any lymph nodes or if nodal surgery not performed for invasive cancers
- Extensive intraductal component > 3 cm
- Extensive Lymphvascular Invasion
- Pure DCIS > 3 cm
- Neoadjuvant therapy