From the July 2016 issue of HealthCare Business News magazine
Benefit No. 2: APBI is associated with a low incidence of serious late side effects, with a significantly lower risk of Grade 2-3 breast pain.
Study results demonstrated a low incidence of all serious late side effects (approximately 3 percent in both arms). Importantly, the risk of grade 2-3 breast pain was significantly lower in patients treated with APBI (1.14 percent vs. 3.17 percent; p=0.0389). No grade 4 late side effects were reported and no difference in mastectomy rates was observed between arms.
Benefit No. 3: APBI associated with fewer late skin effects and improved cosmetic outcomes.
The five-year toxicity profile was similar for patients treated with breast conserving surgery followed by either APBI using interstitial multicatheter brachytherapy or conventional WBI with tumor bed boost. However, a trend toward fewer late skin side effects and better cosmetic results was observed in the APBI arm, with significantly more patients (43.6 percent vs. 30.9 percent; p=0.0002) experiencing excellent cosmetic results.
Conclusions
Early-stage breast cancer remains a disease with high unmet medical needs that places an enormous physical, emotional and economic burden on women, families and health care systems. These robust data, representing the largest randomized prospective study of its type ever conducted to date, confirm previous studies that show patients treated by a short course of APBI with multicatheter brachytherapy experience equivalent rates of recurrence, disease-free survival, overall survival and toxicity compared to those receiving a traditional longer course of external whole breast irradiation, with better cosmetic outcomes.
The findings are expected to drive significant changes in how clinicians approach early stage breast cancer treatment in patients 40 years and above and place APBI multicatheter brachytherapy as an accepted standard alternative to whole breast irradiation. The American Society for Radiation Oncology (ASTRO), the leading radiation oncology professional group in the U.S., has made an initial recommendation to lower the age of “suitable” candidates for APBI to 50, and the society’s professional guidelines are expected to be officially updated in the coming months.
About the authors: Professor Vratislav Strnad, M.D., Ph.D., is chair of the GEC-ESTRO Brachytherapy Working Group and radiation oncologist at the Department of Radiation Oncology of University Hospital, Erlangen, Germany. Csaba Polgár, M.D., Ph.D., M.Sc., is a professor and head of the Radiotherapy Center at the Hungarian National Institute of Oncology, Budapest, council member of GECESTRO and co-lead study author.Back to HCB News
