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Accelerated Partial Breast Irradiation for Breast Cancer

NOMINATED TOPIC | July 17, 2020

Accelerated Partial Breast Irradiation for Breast Cancer

1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?

1:8 women will be diagnosed with breast cancer in their lifetime. Therefore, providing the most recent evidence for treatment of this prevalent disease is an important public health initiative. Additionally, radiation therapy is integral to the treatment of breast cancer. ASTRO has previously published consensus statements on accelerated partial breast irradiation (APBI) in 2009 and 2016. In accordance with the National Academy of Medicine (formerly Institute of Medicine) standards for the development of high quality, evidence-based clinical practice guidelines, ASTRO intends to use the evidence report developed by AHRQ as the basis to replace the previous documents to ensure that current guidance provided to clinicians is accurate, and reflects current evidence. The following key questions will be addressed:

KQ 1: In patients with early stage breast cancer, what are the appropriate indications and criteria of patient selection for APBI, and how does this differ from whole breast irradiation?

KQ 2: In patients with early stage breast cancer, what are the differences of ipsilateral breast tumor control rates between whole breast and the different APBI techniques?

KQ 3: In patients with early stage breast cancer, what are the appropriate dose-fractionation schemes, target volumes, and optimal planning parameters for APBI.

KQ 4: In patients with early stage breast cancer receiving APBI, how do the different treatment planning techniques (3-D, IMRT, HDR cavity brachytherapy, HDR interstitial brachytherapy) impact on treatment toxicities and quality of life?

KQ 5: In patients with early stage breast cancer, what is the optimal imaging assessment for patients considering APBI?

KQ 6: In patients with early stage breast cancer, what are the differences in cosmesis and treatment toxicities between APBI and whole breast irradiation?

The population of patients that will be assisted by this guideline are those with early stage breast cancer. Early stage breast cancer is defined as invasive or non-invasive carcinoma less than or equal to 3 cm and N0/1. The interventions that will be evaluated in this guideline are whole breast versus APBI. The comparison groups that will be utilized in this guideline will include patients who receive whole breast irradiation versus APBI. The outcomes that will be examined in this guideline include ipsilateral breast local control, short- and long-term toxicity.

2. Why are you struggling with this issue?

Because of the prevalence and early detection of breast cancer, there are many studies on the optional treatment options for women. It is critical that ASTRO, the leading radiation therapy society within the US, provide the most accurate and up-to-date guidelines regarding this disease. It is critical that these patients are offered the most effective, safe, evidence-based, and patient-centered recommendations to optimize the likelihood of benefit and minimize the potential for treatment-related toxicity, whether physical, financial, psychological, or otherwise. Despite an evidence base with findings that support strong, evidence-based recommendations, contemporary studies continue to demonstrate significant variation in care. Clinicians face difficult patient presentations where numerous factors related to patient-specific values and expectations, and varied imaging and clinical features that must be considered, all of which appear to make it more difficult to provide care that is consistent with guideline recommendations. Given the multifactorial issues that face the patient and their healthcare providers, in realizing the benefits of treatment while reducing risk and adhering to evidence-based standards, it is critically important to educate both groups to empower good medical decision-making in the face of a highly curative disease. 3. What do you want to see changed? How will you know that your issue is improving or has been addressed? One goal of publishing this clinical practice guideline is to achieve a significantly higher rate of radiation treatment courses that adhere to the evidence-based standards that are recommended in ASTRO clinical practice guidelines on the treatment of early stage breast cancer. There are several groups that regularly measure patterns of care and publish on adherence with ASTRO guidelines. ASTRO will collaborate and support patterns of care studies to measure and compare rates of concordance with evidence-based recommendations for the treatment of patients with early stage breast cancer to evaluate whether this issue is improving or has been addressed.

4. When do you need the evidence report?

Monday, August 1, 2022

5. What will you do with the evidence report?

ASTRO intends to use the evidence report developed by AHRQ as the basis for a comprehensive evidence-based, clinical practice guideline on accelerated partial breast irradiation. An AHRQ report, with a literature search, data extraction, and analysis according to the highest standards of systematic reviews, would significantly aid in the completion of a guideline to provide timely, current, evidence-based recommendations to clinicians in an area of great clinical importance. ASTRO guidelines are scientifically and methodologically rigorous and are published in high impact journals. They are also widely read and cited by cancer care providers, as demonstrated by citation frequency and quantitative measurement of downloads from the journal website. Once an AHRQ report is available, the ASTRO Guidelines Subcommittee will convene a panel of disease-site experts and general cancer care practitioners from academic, community, and government-run practice settings, including a patient representative and physician-in-training representative, to complete this important guideline. ASTRO staff with expertise in clinical practice guideline development will support this process.

Supporting Document

Title or short description: Evidence review request on accelerated partial breast irradiation (APBI) (PDF, 237 KB)

Comments or notes about this file: ASTRO has worked with AHRQ on previous reviews in support of clinical practice guidelines and has an understanding regarding the timelines involved with these processes. This guideline topic was selected based on a high level of confidence that an anticipated timeline of 2 years for completion is appropriate, and our disease-site experts believe there is adequate flexibility based on the recent literature and clinical trial publications, at this timeline will be appropriate for this guideline project.

(Optional) About You

What is your role or perspective? Radiation therapy professional society

If you are you making a suggestion on behalf of an organization, please state the name of the organization: American Society of Radiation Oncology

May we contact you if we have questions about your nomination? Yes

Page last reviewed March 2021
Page originally created July 2020

Internet Citation: Accelerated Partial Breast Irradiation for Breast Cancer. Content last reviewed March 2021. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/accelerated-partial-breast-irradiation-cancer

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