2. Accelerated partial breast irradiation PROF. HOD. DR. R. MOHANRAM PROF. DR. S. SHANMUGAKUMAR Dept. of Radiation oncology BIR&O, MMC, Chennai Dr. Arun Ramanan MD Resident

4. Introduction

6. Randomized Trials - BCT vs MRM Group No 10 Yr Survival (%) Loc. Rec(% ) BCT - MRM BCT - MRM NSABP 2105 62 - 62 10 - 8 French 179 78 - 79 7 - 9 Milan 701 71 - 69 4 - 2 EORTC 903 75 - 75 13 - 9 Danish 905 79 - 82 3 - 4 NCI 237 77 - 75 17 - 9

8. Local recurrence after BCT ©2003 Dowden Health Media | VOL 59 , NO 11 / NOV 2003 M.D. ANDERSON CANCER CENTER TELEMEDICINE SYMPOSIUM

9. Christie Hospital in Manchester, U.K., the first APBI from 1982 to 1987 Overall, this group concluded that APBI was feasible, but that improved local control would require improved patient selection and radiotherapy technique. Frederick M. Dirbas et al CANCER BIOTHERAPY&RADIOPHARMACEUTICALS Volume 19, Number 6, 2004 © Mary Ann Liebert, Inc. prospective, randomized study that accrued 708 patients 355 patients in a widefield (WF) irradiation group 353 patients in a limited-field (LF) irradiation

18. Techniques

19. Transportable HDR After loader…

21. multiple catheters are generally positioned at 1- to 1.5-cm intervals, with the total number of catheters and planes employed dependent on the size, extent, and shape of the target.

27. Intracavitary therapy

30. The MammoSite device was inserted using the scar entry technique, and sutures were placed around the incision to prevent opening of the scar Stolier et al. 2005, with permission

33. MammoSite radiation therapy system. External appearance and sagittal view of balloon with dosimetric target coverage. Target is defined as tissue within 1 cm of balloon surface.

34. IORT

38. The Intrabeam machine contains a miniature electron gun and electron accelerator contained in an x-ray tube “Soft” x-rays (50 kVp) are emitted from the point source.

39. Targeted intraoperative radiation therapy (TARGIT). A Various-sized sterile applicators for intraoperative delivery of radiation. B The applicator is in place and deep purse-string sutures have been placed to facilitate conformity of the applicator to the cavity wall. C Tungsten barrier in place just prior to treatment (photographs courtesy of Dr. Dennis R. Holmes, Kenneth Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California)

41. EBRT

43. s 3D-CRT & IMRT

44. Three-dimensional conformal external beam radiotherapy. Four-field beam arrangement and conformal, homogeneous dose coverage of the target. Target is shaded in purple.

45. 3D-CRT & IMRT in APBI..

47. RESULTS

48. J Clin Oncol 23:1726-1735. . 2005 by American Society of Clinical Oncology

49. J Clin Oncol 23:1726-1735. . 2005 by American Society of Clinical Oncology

50. J Clin Oncol 23:1726-1735. . 2005 by American Society of Clinical Oncology

52. J Clin Oncol 23:1726-1735. . 2005 by American Society of Clinical Oncology

53. J Clin Oncol 23:1726-1735. . 2005 by American Society of Clinical Oncology

54. Between 1998 and 2004 258 selected patients with T1 N0-1mi, Grade 1-2, nonlobular breast cancer without presence of extensive intraductal component And resected with negative margins were randomized after breast-conserving surgery 50 Gy/25 fractions WBI either 7 x 5.2 Gy high-dose-rate (HDR) multicatheter brachytherapy or 50 Gy/25 fractions electron beam (EB) irradiation.

55. RESULTS At a median follow-up of 66 months CONCLUSIONS : PBI using interstitial HDR implants or EB to deliver radiation to the tumor bed alone for a selected group of early-stage breast cancer patients produces results similar to those achieved with WBI. Significantly better cosmetic outcome can be achieved with carefully designed HDR multicatheter implants compared with the outcome after WBI. p(WBI/PBI) =0.009. 62.9% 77.6% cosmetic result no significant difference 90.3% 88.3% disease-free survival no significant difference 96.0% 98.3% cancer-specific survival no significant difference 91.8% 94.6% 5-year probability of overall survival p = 0.50 3.4% 4.7% 5-year actuarial rate of local recurrence WBI PBI

56. 3

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