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Purpose: Assessment of a second surgical conservative treatment (T) [N = 41] compared to total mastectomy (M) [N = 93] for ipsilateral breast tumor recurrence after initial breast conserving surgery in a retrospective study of 134 patients. Results: Five years global survival was 82.5% in each group. No statistical difference for the specific survival and survival without metastasis. The 5 years local control was 92.9% in group M and 66.2% in group T (RR = 4.48). Lymphovascular invasion (LVI), multifocal tumors, and clinical symptoms of the recurrence are pejorative factors for survival. Over the 134 patients, 25 have preserved their breast. Conclusion: In order to lower the risk of recurrence after a second breast conserving surgery, one may propose this second conserving surgery for an isolated recurrence, < 2 cm, low grade, without LVI and strictly unifocal. Surgery must ensure clear margins and a good cosmetic result. The patient is involved in the choice of the treatment. [ABSTRACT FROM AUTHOR]

Résumé L’expérience actuelle de l’irradiation partielle et accélérée du sein permet de distinguer au moins deux pré-requis indispensables au succès thérapeutique : le strict respect de ses indications et l’emploi d’une technique parfaitement évaluée et maîtrisée. Les techniques permettant de délivrer une irradiation partielle et accélérée du sein postopératoire sont la curiethérapie interstitielle, la curiethérapie endocavitaire et la radiothérapie externe. Après sélection appropriée des candidates, toutes les modalités d’irradiation nécessitent une définition la plus exacte possible du volume-cible et le respect de critères dosimétriques propres à chaque technique. Les données à venir des essais randomisés devraient permettre d’approfondir la connaissance de tous ces paramètres et d’apporter des réponses concernant la comparaison des différentes techniques. Accelerated Partial Breast Irradiation (APBI) appears to be an efficient therapeutic modality provided that it uses strict selection criteria and a reliable and well-managed technique. The techniques that enable to deliver postoperative APBI are interstitial brachytherapy, endocavitary brachytherapy and external beam radiation therapy. Once an appropriate selection of the candidates is made, each radiation technique needs an exact target volume definition and a strict compliance with its own dosimetric constraints. Results of ongoing randomized trials should increase our knowledge of all these parameters, and give us responses about the comparison of the different techniques. [ABSTRACT FROM AUTHOR]

Résumé Les bénéfices d’une radiothérapie après une tumorectomie dans le cancer du sein localisé sont bien établis. Actuellement, la méthode la plus courante consiste à administrer environ vingt-cinq fractions de radiothérapie mammaire. Dans les dernières années, il y a une tendance croissante vers des régimes de radiothérapie externe hypofractionnés. Plusieurs se sont avérés équivalents au régime standard en termes de contrôle tumoral et de résultats esthétiques, tout en minimisant les inconvénients et coûts pour le patient et pour la société. Dans cet article, nous présentons les différentes modalités d’hypofractionnement, les critères de sélection des patientes, les recommandations de consensus et un aperçu sur des indications à venir. The benefits of adjuvant radiotherapy following lumpectomy for early-stage breast cancer are well established. The most widely used method consists of roughly twenty-five fractions of whole-breast irradiation. In recent years, there has been a growing trend towards hypofractionated external beam radiotherapy regimens. Many of these techniques have been shown to be equivalent in terms of tumor control and cosmetic results while minimizing inconvenience and costs both to the patient and health care system. Here, we present the various hypofractionation modalities, patient selection criteria, consensus guideline recommendations and a look at future indications. [ABSTRACT FROM AUTHOR]

Résumé L’irradiation partielle et accélérée du sein se positionne dans l’arsenal thérapeutique du cancer du sein dans un processus de désescalade thérapeutique et de projet de personnalisation des soins. Cette étude fait le point sur les données actuellement disponibles et notamment les résultats des essais de phase III randomisés ayant comparé irradiation partielle et accélérée du sein et irradiation totale du sein. Actuellement, six de ces essais proposent des résultats sur l’efficacité et/ou sur la toxicité. Les études non randomisées ont globalement montré les résultats escomptés : faibles taux de rechute et de toxicité locales. Les premiers résultats des études randomisées de phase III ont montré des résultats encourageants en termes de contrôle local alors que la toxicité est variable en fonction de la technique d’irradiation partielle et accélérée du sein utilisée. Cependant, le suivi de la majorité des études reste insuffisant. Le strict respect des indications d’irradiation partielle et accélérée du sein est vraisemblablement un point-clé du succès thérapeutique et les résultats à venir devraient permettre de mieux définir ces critères de sélection. In the frame of treatment de-escalation and personalization, accelerated partial breast irradiation is taking its place in the breast cancer therapeutic options. This study analyzed the results of phase III randomized trials having compared accelerated partial breast irradiation versus whole breast irradiation. Currently, among those trails, six proposed some results regarding efficacy and/or toxicity. Globally, the non-randomized studies confirmed the expected results showing a low rate of local recurrence and toxicity. The first results of the phase III randomized trials showed encouraging data in terms of local control while the toxicity varied mainly according to the accelerated partial breast irradiation technique used. However, the follow-up of the majority of these studies remains insufficient. The strict respect of accelerated partial breast irradiation indications likely represents one of the key factors of the therapeutic success. The next results could allow proposing a better definition of the accelerated partial breast irradiation selection criteria. [ABSTRACT FROM AUTHOR]

Abstract: Breast conserving treatment (breast conserving surgery followed by whole breast irradiation) has commonly been used in early breast cancer since many years. New radiation modalities have been recently developed in early breast cancers, particularly accelerated partial breast irradiation. Three-dimensional conformal accelerated partial breast irradiation is the most commonly used modality of radiotherapy. Other techniques are currently being developed, such as intensity-modulated radiotherapy, arctherapy, and tomotherapy. The present article reviews the indications, treatment modalities and side effects of accelerated partial breast irradiation. [Copyright &y& Elsevier]

Abstract: Purpose: Since 2009, accelerated partial breast irradiation (APBI) in North America has been allowed to be used for selected group of patients outside a clinical trial according to the ASTRO consensus statement. In France, accelerated partial breast irradiation is still considered investigational, several clinical trials have been conducted using either intraoperative (Montpellier) or Mammosite® (Lille) or brachytherapy modality (PAC GERICO/FNCLCC). Here, we report the original dosimetric results of this technique. Patients and methods: Since October 2007, Institut Gustave-Roussy has initiated a phase II trial using 3D-conformal accelerated partial breast irradiation (40Gy in 10 fractions BID in 1week). Twenty-five patients with pT1N0 breast cancer were enrolled and were treated by two minitangent photons beams (6MV) and an “en face” electron beam (6–22MeV). Results: The mean clinical target volume and planning target volume were respectively 15.1cm3 (range: 5.2–28.7cm3) and 117cm3 (range: 52–185cm3). The planning target volume coverage was adequate with at least a mean of 99% of the volume encompassed by the isodose 40Gy. The mean dose to the planning target volume was 41.8Gy (range: 41–42.4Gy). Dose inhomogeneity did not exceed 5%. Mean doses to the ipsilateral lung and heart were 1.6Gy (range: 1.0–2.3Gy) and 1.2Gy (range: 1.0–1.6Gy), respectively. Conclusion: The 3D conformal accelerated partial breast irradiation using two minitangent and “en face” electron beams using a total dose of 40Gy in 10 fractions BID over 5days achieves appropriate planning target volume coverage and offers significant normal-tissue sparing (heart, lung). Longer follow-up is needed to evaluate the tissue tolerance to this radiation dose. [ABSTRACT FROM AUTHOR]

Abstract: Hypofractionated and accelerated partial breast irradiation are more and more widely used for early breast cancer. Here, this short communication would expose the role of hypofractionated radiotherapy in adjuvant breast radiotherapy, rational, techniques and indications of accelerated partial breast irradiation. [Copyright &y& Elsevier]

Introduction: Carcinomas in situ represent more than 15 to 20% of breast cancers. Radiotherapy of whole breast is part of the therapeutic standard and follows surgery. However, the indication of tumor bed irradiation is still controversial and heterogeneous according to international practice even though it is a very frequent clinical situation. The aim of this study is to define the indications of tumor bed irradiation in the context of ductal carcinomas in situ and to discuss accelerated partial irradiation of the breast., Method: The selected papers were published between 2015 and 2020 and included as MeSH terms "ductal carcinoma in situ" and "boost" for the analysis of tumor bed irradiation, and "ductal carcinoma in situ" and "accelerated partial breast irradiation" for the analysis of accelerated partial irradiation., Results: Boost was more often performed when risk factors for local recurrence were present, such as age less than 40 or 50 years old, clinical mode of detection, tumor size greater than 15 to 20mm, high nuclear grade, presence of necrosis, positive or insufficient surgical margins, associated atypical hyperplastic lesions, and lobular carcinoma in situ. Accelerated partial irradiation is an option for favorable or intermediate prognosis CCIS, further studies involving more patients are required., Conclusion: Radiotherapy of the mammary gland in the context of DCIS has shown its effectiveness in terms of local and locoregional control of the disease, thus reducing in situ and infiltrating recurrences. However, the indication of operating bed irradiation is still debated, and the practice is very heterogeneous depending on the country. Another possible alternative for patients with a favorable prognosis and a small tumor bed volume would be IPA., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Abstract: Early breast cancer incidence increases owing to mammography screening. Hypofractionated radiotherapy is more and more proposed in women with low local relapse risk breast cancer, especially accelerated partial breast irradiation. Various irradiation modalities have been reported: brachytherapy, intraoperative irradiation, 3D-conformal accelerated partial breast irradiation. We describe limitations of intraoperative irradiation and the advantages of alternative techniques. [Copyright &y& Elsevier]

Accelerated Partial Breast Irradiation (APBI) appears to be an efficient therapeutic modality provided that it uses strict selection criteria and a reliable and well-managed technique. The techniques that enable to deliver postoperative APBI are interstitial brachytherapy, endocavitary brachytherapy and external beam radiation therapy. Once an appropriate selection of the candidates is made, each radiation technique needs an exact target volume definition and a strict compliance with its own dosimetric constraints. Results of ongoing randomized trials should increase our knowledge of all these parameters, and give us responses about the comparison of the different techniques., (Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

The benefits of adjuvant radiotherapy following lumpectomy for early-stage breast cancer are well established. The most widely used method consists of roughly twenty-five fractions of whole-breast irradiation. In recent years, there has been a growing trend towards hypofractionated external beam radiotherapy regimens. Many of these techniques have been shown to be equivalent in terms of tumor control and cosmetic results while minimizing inconvenience and costs both to the patient and health care system. Here, we present the various hypofractionation modalities, patient selection criteria, consensus guideline recommendations and a look at future indications., (Copyright © 2015 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

In the frame of treatment de-escalation and personalization, accelerated partial breast irradiation is taking its place in the breast cancer therapeutic options. This study analyzed the results of phase III randomized trials having compared accelerated partial breast irradiation versus whole breast irradiation. Currently, among those trails, six proposed some results regarding efficacy and/or toxicity. Globally, the non-randomized studies confirmed the expected results showing a low rate of local recurrence and toxicity. The first results of the phase III randomized trials showed encouraging data in terms of local control while the toxicity varied mainly according to the accelerated partial breast irradiation technique used. However, the follow-up of the majority of these studies remains insufficient. The strict respect of accelerated partial breast irradiation indications likely represents one of the key factors of the therapeutic success. The next results could allow proposing a better definition of the accelerated partial breast irradiation selection criteria., (Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Owing to breast cancer screening, breast cancer is more and more diagnosed at early stage. For those breast cancer women, breast conserving treatment (breast conserving surgery followed by whole breast irradiation) is commonly used since many years. New radiation modalities have been recently developed in early breast cancers particularly accelerated partial breast irradiation (APBI). Among all techniques of radiotherapy, 3D-conformal APBI and intraoperative radiotherapy (IORT) are the main modalities of radiotherapy used. The present review states on indications, treatment modalities and updated results of local control and side effects of partial breast irradiation.