The pre-operative use of accelerated partial breast irradiation in treating early-stage breast cancer

This study investigated whether accelerated partial-breast irradiation (APBI) was useful for preoperative treatment of early-stage breast cancer (BC) patients. APBI was found to be an effective treatment option with good cosmetic results for certain early-stage BC patients.

Breast conserving therapy (surgery to remove the tumor followed by radiation therapy) is the standard of care for early-stage BC patients. APBI is a form of radiation therapy that focuses small radiation volumes on areas close to the site of tumor removal. Post-operative APBI can lead to healthy breast tissue receiving unnecessary radiation and therefore may have undesirable cosmetic outcomes. Preoperative APBI on the other hand exposes healthy tissues to a much lower dose of radiation and may therefore lead to better cosmetic outcomes.

This study involved 27 postmenopausal patients with early-stage, node-negative invasive ductal BC. Patients received APBI twice daily for 5 days. Breast conserving surgery was performed at least 21 days after radiation therapy. Following surgery, chemotherapy and hormonal therapy were delivered in keeping with standards of care.  Average follow up time was 3.6 years.

The level of KI-67( a protein associated with the growth of new cells) was used to determine the effect of APBI treatment on tumor growth. Ki-67 levels were found to be 14% on average before treatment and 4.2% following APBI. 

79% of patients were satisfied with the cosmetic outcome following surgery. There were no local or regional cancer recurrences in the 3.6 years of follow-up.

Mild side effects such as tiredness, light swelling and some breast discomfort occurred among participants, however these were considered low-grade and none were severe enough to interrupt treatment.

The study concluded preoperative APBI treatment is viable and well tolerated in some early-stage BC patients. No local recurrence and good to excellent cosmetic results encourage further research into this treatment strategy.

The study was limited to a small number of patients over a short duration, for this reason a larger, longer term study is needed to confirm the results.

Discuss preoperative treatment options with your physician.