American Society of Breast SurgeonsBreast Surgery2025advanced

Accelerated Partial Breast Irradiation

Published by The American Society of Breast Surgeons

8Recommendations

61References

1Tables

Summary

AI-generated

Partial breast irradiation (PBI) delivers radiation locally to the lumpectomy cavity. Accelerated PBI (APBI) condenses treatment from 5-6 weeks to a week or less. This guide helps breast surgeons interpret multiple guidelines on APBI and apply them in clinical practice, noting comparable recurrence rates, reduced toxicity, and improved convenience compared to whole breast irradiation (WBI).

breast canceraccelerated partial breast irradiationAPBIASBrSbreast surgeryradiation therapyearly-stage breast cancerguidelines

Key Takeaways

1
Accelerated Partial Breast Irradiation (APBI) condenses radiation treatment time and delivers targeted radiation, showing comparable long-term local control to whole breast irradiation (WBI) for appropriately selected patients.
2
Appropriate candidates generally include patients aged 40 and older, with tumors ≤ 3cm, negative nodal status, and negative margins.
3
APBI is contraindicated for patients with known BRCA1 or BRCA2 germline mutations.
4
Shared decision-making and multidisciplinary team discussions are essential when applying guidelines to individual patients, especially for complex cases like omitted sentinel lymph node biopsy or prior radiation.

What's New in This Version

Updates the prior 2018 ASBrS resource guide by incorporating long-term results from randomized clinical trials (over 10,000 patients) comparing PBI with WBI, and aligns with recent clinical guideline updates from ASTRO and ABS.

Key Recommendations

Recommendations

REC-1
Age: Minimum of 40 years
Selection Criteria
REC-2
Histology: All invasive subtypes (recognizing ASTRO conditionally does not recommend APBI in lobular histology due to poor representation, while ABS recommends APBI in all invasive subtypes) and Ductal carcinoma in situ (DCIS).
Selection Criteria
REC-3
Total tumor size (invasive and DCIS): less than or equal to 3 cm in size
Selection Criteria
REC-4
T Size: Tis, T1, T2 (≤ 3 cm)
Selection Criteria
REC-5
Margins: No tumor on ink for invasive tumors and invasive tumors with associated DCIS; ≥ 2mm for DCIS.
Selection Criteria
REC-6
Nodal Status: Negative. Omission of sentinel lymph node biopsy may affect candidacy; multidisciplinary discussion is recommended.
Selection Criteria
REC-7
Other Factors: Multifocal disease allowed if combined area is ≤3cm. Estrogen receptor positive or negative allowed. Use caution with lymphovascular invasion (LVI). Do not use APBI if BRCA or other high-risk genetic mutation is present. Repeat breast-conserving surgery with APBI may be considered for unifocal ipsilateral recurrences <3cm in selected patients.
Selection Criteria
REC-8
Patient selection and counseling should be performed in a multidisciplinary fashion with collaboration between the treating surgeon and the treating radiation oncologist.
Clinical Practice

Scope & Objectives

Clinical Topic

Breast Cancer

Objectives

To outline the use of accelerated partial breast irradiation (APBI) for the treatment of breast cancer.

Target Patient Population

Patients with early-stage breast cancer considering partial breast irradiation

Target Providers

Breast SurgeonsRadiation Oncologists

Patient Criteria & Setting

Therapeutic Area

Oncology

Guideline Scope

TreatmentManagementGuideline Interpretation

Inclusion Criteria

Minimum of 40 years of age
All invasive subtypes and Ductal carcinoma in situ (DCIS)
Total tumor size (invasive and DCIS) less than or equal to 3 cm
T Size: Tis, T1, T2 (≤ 3 cm)
Margins: No tumor on ink for invasive tumors and ≥ 2mm for DCIS
Nodal Status: Negative

Exclusion Criteria

Age < 40 years
Positive lymph nodes (if invasive)
Positive surgical margins
Known germline BRCA1 or BRCA2 mutation or other genetic mutation conferring increased risk

Special Populations

Male patientsPatients with BRCA genetic mutationPatients with history of contralateral breast cancerPatients with omitted sentinel lymph node biopsy

Safety & Contraindications

Contraindications

Known germline BRCA1 or BRCA2 mutation
Positive lymph nodes
Positive surgical margins
Age < 40 years

Authors & Contributors

ASBrS Critical WritingEditing and Review Committee (CWERC)

Guideline Features

Dosing informationMultidisciplinary

Learning Context

Difficulty

advanced

Learning Paths

Breast CancerRadiation OncologyAccelerated Partial Breast IrradiationBreast-Conserving SurgeryPatient Selection