A Perspective from Frank Vicini, MD
Frank A. Vicini, M.D., radiation oncologist, 21st Century Oncology, Royal Oak, Mich. and contributing author to the 2009 and 2013 ASTRO and ABS APBI guidelines shares his views on the new data.
How might these data potentially impact current clinical practice?
I believe these data have the ability to impact clinical practice. As women learn about the potential advantages of APBI, they will undoubtedly request it. ASTRO announced at the annual meeting a reduction in the age limit for suitable candidates from APBI from 60 to 50 years of age. This is a significant change and the guidelines will go out for commentary this December 2015.
The GEC-ESTRO trial used interstitial multicatheter brachytherapy which is not commonly performed in the United States. Do you expect divergent clinical outcomes with this procedure vs. single entry, strut-based brachytherapy?
In the States, other forms of brachytherapy, such as strut-based, inter-cavity devices are used to deliver radiation. There is no reason to believe that these devices cannot produce the same results as the ones shown in the GEC -ESTRO trial. As long as the radiation is covering the same target area around the tumor bed and delivering that dose safely one should expect the same results as interstitial brachytherapy.
Now that a sizable body of solid clinical evidence exists to support the use of accelerated treatment with brachytherapy, what does the future hold?
I believe we will continue to see shorter periods of radiation treatment for appropriately selected patients. In fact, the GEC-ESTRO data used 7 to 8 fractions (instead of the commonly used 10). A trial known as the “TRI-fraction Radiotherapy Utilized to Minimize Patient Hospital Trips” (TRIUMPH-T) is underway to explore the efficacy of treating patients with radiation delivered over a shortened period of only two to three days. Researchers expect that results from TRIUMPH-T will confirm a similar previous study by the Cancer Institute of New Jersey where researchers showed the approach of giving radiation therapy over a two day period was safe.