Annals of Surgical Oncology

, Volume 19, Issue 13, pp 4094–4098 | Cite as

Feasibility of Accelerated Partial Breast Irradiation in a Large Inner-City Public Hospital

  • Miral Amin
  • Sheryl Gabram
  • Harvey Bumpers
  • Jerome Landry
  • Ashesh B. Jani
  • Roberto Diaz
  • Monica Rizzo
Breast Oncology



Breast conserving therapy (BCT) that include breast conserving surgery followed by adjuvant radiation therapy has revolutioned medicine by allowing women to avoid mastectomy. Accelerated partial breast irradiation (APBI) has emerged as a valid alternative to whole-breast irradiation that requires a shorter time commitment. We report our novel experience with APBI at a large public hospital that serves low-income and potentially noncompliant patients.


A retrospective chart review was conducted of women who underwent BCT for stage 0–IIA breast cancer from August 2007 to August 2010 treated with APBI with a brachytherapy catheter.


Twenty-four patients (20 African American) were considered for APBI. Average age was 61 years. Four patients could not undergo APBI for technical reasons and completed whole-breast irradiation over a 5 week period. Median follow-up was 19 months. Nine patients (37.5 %) had ductal carcinoma-in-situ, and 15 patients (62.5 %) had invasive ductal carcinoma with an average tumor size of 1.1 cm. All patients had negative margins of >2 mm. Two patients (8 %) treated with the brachytherapy catheter had in-breast tumor recurrence. Thus, all 24 patients initially identified for APBI successfully completed adjuvant radiotherapy.


Patient compliance with postoperative irradiation is key to minimize local recurrence after BCT for breast cancer. This success with a brachytherapy catheter in underserved women in a U.S. public hospital setting indicates that outcomes of compliance and complications are comparable to nationally published results.


Sentinel Node Biopsy Invasive Ductal Carcinoma Breast Conserve Therapy Accelerate Partial Breast Irradiation Partial Mastectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Vinh-Hung V, Verschraegen C. Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst. 2004;96:115–21.PubMedCrossRefGoogle Scholar
  2. 2.
    Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.PubMedGoogle Scholar
  3. 3.
    Lazovich DA, White E, Thomas DB, Moe RE. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA. 1991;266:3433–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Farrow DC, Hunt WC, Samet JM. Geographic variation in the treatment of localized breast cancer. N Engl J Med. Apr 1992;326:1097–101.PubMedCrossRefGoogle Scholar
  5. 5.
    Nattinger AB, Hoffmann RG, Kneusel RT, Schapira MM. Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery. Lancet. 2000;356(9236):1148–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Jagsi R, Abrahamse P, Morrow M, et al. Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer. J Clin Oncol. 2010;28:2396–403.PubMedCrossRefGoogle Scholar
  7. 7.
    Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. 2002;94:334–57.PubMedCrossRefGoogle Scholar
  8. 8.
    Beitsch PD, Shaitelman SF, Vicini FA. Accelerated partial breast irradiation. J Surg Oncol. 2011;103:362–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Polgar C, Major T. Current status and perspectives of brachytherapy for breast cancer. Int J Clin Oncol. 2009;14:7–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Shaitelman SF, Vicini FA, Beitsch P, Haffty B, Keisch M, Lyden M. Five-year outcome of patients classified using the American Society for Radiation Oncology consensus statement guidelines for the application of accelerated partial breast irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial. Cancer. 2010;116:4677–85.PubMedCrossRefGoogle Scholar
  11. 11.
    Huang E, Buchholz TA, Meric F, et al. Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences. Cancer. 2002;95:2059–67.PubMedCrossRefGoogle Scholar
  12. 12.
    Fowble B, Solin LJ, Schultz DJ, Rubenstein J, Goodman RL. Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys. 1990;19:833–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Gage I, Recht A, Gelman R, et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1995;33:245–51.PubMedCrossRefGoogle Scholar
  14. 14.
    Smith TE, Lee D, Turner BC, Carter D, Haffty BG. True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys. 2000;48:1281–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Albuquerque K, Janusek L, Mathews H, Millbrandt L, Gabram S. Short-term quality of life following partial breast irradiation with balloon brachytherapy—comparison with whole breast irradiation. Breast J. 2010;16:325–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Wadasadawala T, Budrukkar A, Chopra S, et al. Quality of life after accelerated partial breast irradiation in early breast cancer: matched pair analysis with protracted whole breast radiotherapy. Clin Oncol (R Coll Radiol). 2009;21:668–75.CrossRefGoogle Scholar
  17. 17.
    Sher DJ, Wittenberg E, Suh WW, Taghian AG, Punglia RS. Partial-breast irradiation versus whole-breast irradiation for early-stage breast cancer: a cost-effectiveness analysis. Int J Radiat Oncol Biol Phys. 2009;74:440–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Pandey M, Thomas BC, SreeRekha P, et al. Quality of life determinants in women with breast cancer undergoing treatment with curative intent. World J Surg Oncol. 2005;3:63.PubMedCrossRefGoogle Scholar
  19. 19.
    Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst. 1996;88:716–26.PubMedCrossRefGoogle Scholar
  20. 20.
    Rizzo M, Bumpers H, Okoli J, et al. Improving on national quality indicators of breast cancer care in a large public hospital as a means to decrease disparities for African American women. Ann Surg Oncol. 2011;18:34–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Vicini F, Arthur D, Wazer D, et al. Limitations of the American Society of Therapeutic Radiology and Oncology Consensus Panel guidelines on the use of accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79:977–84.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Miral Amin
    • 1
    • 2
  • Sheryl Gabram
    • 1
    • 2
  • Harvey Bumpers
    • 2
    • 3
  • Jerome Landry
    • 4
    • 5
  • Ashesh B. Jani
    • 4
    • 5
  • Roberto Diaz
    • 4
    • 5
  • Monica Rizzo
    • 1
    • 2
  1. 1.Division of Surgical Oncology, Department of SurgeryEmory University School of MedicineAtlantaUSA
  2. 2.Avon Comprehensive Breast Center at GradyAtlantaUSA
  3. 3.Morehouse School of MedicineAtlantaUSA
  4. 4.Department of Radiation OncologyEmory University School of MedicineAtlantaUSA
  5. 5.Winship Cancer InstituteEmory University School of MedicineAtlantaUSA

Personalised recommendations