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New Guidelines for Radiation Therapy in Breast Cancer

By MedImaging International staff writers
Posted on 09 Nov 2017

Image: New guidelines have been release for accelerated partial-breast irradiation (Photo courtesy of Cleveland Clinic).

A new consensus statement provides updated guidelines for the appropriate and safe utilization of accelerated partial-breast irradiation (APBI).

Developed by researchers at the Cleveland Clinic (Cleveland, OH, USA), Tufts Medical Center (Boston, MA, USA), and other members of the American Brachytherapy Society (Reston, VA, USA) with expertise in breast cancer and breast brachytherapy, the new guidelines are intended to provide updated data for clinicians and recommendations regarding appropriate patient selection and techniques. Appropriate candidates for APBI include patients aged 45 years or older with all invasive histologies and ductal carcinoma in situ (DCIS).

The guidelines suggest tumors should be three cm or less, node negative, estrogen receptor positive or negative, without lymphovascular space invasion, and with negative margins. The strongest evidence is for interstitial brachytherapy and intensity-modulated radiation therapy APBI, with moderate evidence for applicator brachytherapy or three-dimensional (3D) conformal radiotherapy APBI. Intraoperative radiation therapy and electronic brachytherapy should not be offered, regardless of technique, outside of a clinical trial. The new guidelines were published on October 23, 2017, in Brachytherapy.

“The updated guidelines support clinicians by offering them the ability to appropriately select patients for APBI, and data that supports the techniques,” said lead author Chirag Shah, MD, of the Cleveland Clinic. “Guidelines allow for the selection of patients who can finish radiation treatment in one week or less, compared to the traditional period of three to six weeks, and potentially a reduction in side effects depending on the APBI technique.”

APBI is an approach that treats only the lumpectomy bed plus a 1-2 cm margin, rather than the whole breast. Hence, a small volume of irradiation at a higher dose can be delivered in a shorter period of time. There has been growing interest for APBI and other approaches developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy, and intra-operative radiation therapy (IORT).

Related Links:
Cleveland Clinic
Tufts Medical Center
American Brachytherapy Society

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72 (41.961669921875): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (59.127807617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (77.009201049805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294771414 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (41.961669921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294771414 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.014785766602): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

105 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

106 (77.009201049805): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294771414 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (66.041946411133): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294771414 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

109 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

110 (73.19450378418): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294771414 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (622.98774719238): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294771414 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (771.99935913086): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (416.99409484863): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (125.88500976562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

115 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

116 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

117 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

118 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

119 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

120 (320.1961517334): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 32111.883163452): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (126.83868408203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

123 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

124 (615.83518981934): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294771414 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294771414 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 612680.19676208): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (106.0962677002): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (74.148178100586): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (47.922134399414): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (97.990036010742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (51.021575927734): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (50.067901611328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (744.10438537598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (693.08280944824): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (77.962875366211): SELECT name FROM jos_deeppockets WHERE id=211

136 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=211

137 (783.92028808594): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (690.93704223633): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (119.92454528809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

140 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

141 (!!!!! 24108.88671875): TRUNCATE TABLE jos_trademed_module

142 (87.976455688477): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294771414 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (55.074691772461): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294771414 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (648.02169799805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

147 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

148 (!!!!! 1225.9483337402): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

150 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

151 (59.843063354492): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294771414 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294771414 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (49.114227294922): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

153 (34.809112548828): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

154 (38.862228393555): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

156 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294771414 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294771414 AND published='1' LIMIT 1

157 (54.121017456055): select jos_twitters.link from jos_twitters where cat=10

158 (39.100646972656): select jos_facebook.link from jos_facebook where cat=10

159 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

160 (44.107437133789): select jos_linkedin.link from jos_linkedin where cat=10

161 (354.05158996582): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1650.0949859619): insert into jos_banners_delta values (14615,'2025-06-20 17:41:34','216.73.216.120','view'),(14202,'2025-06-20 17:41:34','216.73.216.120','view'),(14203,'2025-06-20 17:41:34','216.73.216.120','view')

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