APBI with Brachytherapy Remains a Key Therapy for Patients with Early Stage Breast Cancer


 
The SAVI SCOUT® Radar Localization System has been adopted by hospitals throughout the country. Brought to you by the same team behind the SAVI brachytherapy applicator, SCOUT
®
 is a FDA-cleared medical device used to provide tumor localization and real-time guidance during breast surgery. 

 
If you would like to be kept up to date on the latest information and updates regarding SCOUT, including details on clinical experience and product availability, you are invited
 to join the SCOUT Report® community.
 
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March 2017 

APBI with Brachytherapy Remains a Key Therapy for Patients with Early Stage Breast Cancer
Chirag Shah, MD  is Associate Staff and Director of Clinical Research in the Department of Radiation Oncology and a member of the Taussig Cancer Institute at the Cleveland Clinic. He is also an Assistant Professor at Northeast Ohio Medical University. He is board certified by the American Board of Radiology and serves as the co-editor of the Radiation Oncology section of the American Society of Breast Surgeons BESAP program. Dr. Shah previously served on the American Brachytherapy Society APBI guidelines committee, is an editor for the journal Brachytherapy and is an author on over 100 peer-reviewed publications, reviews, editorials, and book chapters.
 
Do you believe that APBI with brachytherapy is relevant in 2017?  
I do believe that brachytherapy based APBI remains not only relevant but a major consideration for appropriately selected patients. Brachytherapy offers the ability for patients to complete treatment in one week or less, which is still significantly shorter than hypo-fractionated whole breast irradiation. Additionally, the smaller target volume allows for less dose to the remaining breast tissue. Compared with other partial breast options, brachytherapy represents the technique with the longest follow-up and dosimetrically offers several advantages.
Have you seen a change in physician practice patterns for APBI since the ASTRO consensus change in late 2016?
I have not personally seen a substantial changes in practice patterns though it has only been a few months. I would expect use of APBI to increase based on the new guidelines which support treating patients 50 years or older and allows for low-risk DCIS in the suitable category. Additionally, with the publication of the GEC-ESTRO and Florence trials and the presentation of the IMPORT LOW trial, there is increased interest in partial breast approaches
.

 

Dr. Chirag Shah was recently featured on USA Radio Network, 
sharing his 
perspectives on brachytherapy with one of the 
l
argest talk radio networks in the country.

Dosimetry Matters
John Kordomenos, PhD
A while back I was speaking with a colleague about APBI and he stated that if the consensus of the community is that APBI is equally efficacious as WBI then why bother treating with HDR simply use external beam.  At first glance this may seem like a very plausible argument, after all every center has modern linear accelerators with advanced integrated imaging and IMRT.  
But it is so much more than that. Brachytherapy APBI is in fact the most optimal way to deliver APBI because of the dosimetry, specifically the inherent dose gradient associated with APBI.
Let’s remember the rationale for APBI in the first place, when a lumpectomy is performed and pathology samples are taken at the margins, we are told margins are clear but we know there is still likely some disease left in the surrounding tissue. After all if there was absolutely no diseased tissue remaining there would be no need for any radiation since we are not treating future cancers. The microscopic disease that may remain is almost always within a 1 cm margin of the original tumor bed with the highest density closest to the lumpectomy. This last point is important, residual disease is not equally spread out in this 1 cm margin but concentrated near the surgical excision zone.
Brachytherapy has an inherent dose gradient with the highest dose being delivered closest to the source (lumpectomy margin) and falling off with distance. This is exactly what we want isn’t it ?  Think of the reason we perform a boost treatment in many radiation protocols.  
Ultimately it all comes down to dosimetry.

2017 APBI Patient Selection Criteria
The new ASTRO guidelines allow for more women to be treated with brachytherapy. To request a small laminated copy of this 2017 Patient Selection Criteria reference chart, contact us at
info@ciannamedical.com with your name and shipping address.