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Breast Cancer > APBI > Flashcards

APBI Flashcards

1
Q

Florence, Livi 2015

Why consider APBI?

A

Shorter treatment time
improved breast cosmesis (low tx volume)
Cost reduction

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2
Q

Florence, Livi 2015

Do we have any large RCT w/ comparison?

A

Not yet
Awaiting results of B-39/RTOG 0413

However, many people have been using APBI off-protocol

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3
Q

Florence, Livi 2015

Inclusion criteria?

A

Age > 40
Early stage BC (pT1-pT2, or <2.5 cm)
-ve margins

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4
Q

Florence, Livi 2015

Exclusion Criteria

A 
Previous solid tumors
LVEF < 50%
MI
other CVD
FEV1 < 1
extensive IDC
multifocal cancer
surgical margins <5mm
absence of surgical clips within the tumor bed
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5
Q

Florence, Livi 2015

How many pts?

A

520, 260 in each arm

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6
Q

Florence, Livi 2015

Follow-up time?

A

5 yrs

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7
Q

Florence, Livi 2015

RT txs?

A

WBI: 50 Gy + 10 Gy boost
APBI: 30 Gy in 5 fx QOD

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8
Q

Florence, Livi 2015

Constraints?

A 
100% PTV covered by 95% Dose
PTV max < 105%, PTV min 28 Gy
Uninvolved breast V15 < 50%
ipsilateral lung V10 < 20%
Contralateral lung V5 < 10%
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9
Q

Florence, Livi 2015

Pt positioning?

A

Supine on a breast board

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10
Q

Florence, Livi 2015

How was local relapse defined?

A

Tumor within the index quadrant

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11
Q

Florence, Livi 2015

What were ipsilateral breast tumors?

A

Tumors within any other quadrant besides the index one

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12
Q

Florence, Livi 2015

How was ipsilateral breast tumor recurrence defined?

A

IBTR = recurrent in index quad + ipsilateral breast tumors

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13
Q

Florence, Livi 2015

How was locoregional recurrence defined?

A

recurrence within the ipsilateral axilalry, spraclav, and internal mammary chain nodes

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14
Q

Florence, Livi 2015

How was toxicity assessed?

A

Using the RTOG and EORTX acute and late radiation morbidity scoring scheme

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15
Q

Florence, Livi 2015

How was cosmesis assessed?

A

Using Harvard Breast Cosmesis scale

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16
Q

Florence, Livi 2015

What was the primary end-point?

A

IBTR

17
Q

Florence, Livi 2015

What were the ssecondary end-point?

A

OS

18
Q

Florence, Livi 2015

Tumor characteristics?

A

G1-2 (88.9%)
ER+ (95.4%)
-LN (86.2%)

19
Q

Florence, Livi 2015

Results IBTR?

A

1.5%

NS b/w groups

20
Q

Florence, Livi 2015

Results LRR?

A

1.7%

NS b/w groups

21
Q

Florence, Livi 2015

Contralateral breast recurrence?

A

2.5%

NS b/w groups

22
Q

Florence, Livi 2015

OS?

A

2.1%

NS b/w groups

23
Q

Florence, Livi 2015

Toxicity?

A

Significantly less in the APBI

24
Q

Florence, Livi 2015

Cosmesis?

A

> 90% excellent/good in both

Sig better w/ APBI

25
Q

Florence, Livi 2015

Who should we offer it to?

A

Unclear, as of yet

Could consider for

26
Q

Florence, Livi 2015

What was the most significant late tox?

A

Grade 1-2 fibrosis

27
Q

Florence, Livi 2015

RT techniques?

A

Conventional: Tangential beams
APBI: IMRT

Breast Cancer (9 decks)

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