Abstract：
OBJECTIVE: This guideline provides evidence-based recommendations on appropriate indications and techniques for partial breast irradiation (PBI) for patients with early-stage invasive breast cancer and ductal carcinoma in situ.
METHODS: ASTRO convened a task force to address 4 key questions focused on the appropriate indications and techniques for PBI as an alternative to whole breast irradiation (WBI) to result in similar rates of ipsilateral breast recurrence (IBR) and toxicity outcomes. Also addressed were aspects related to the technical delivery of PBI, including dose-fractionation regimens, target volumes, and treatment parameters for different PBI techniques. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.
RESULTS: PBI delivered using 3-dimensional conformal radiation therapy, intensity modulated radiation therapy, multicatheter brachytherapy, and single-entry brachytherapy results in similar IBR as WBI with long-term follow-up. Some patient characteristics and tumor features were underrepresented in the randomized controlled trials, making it difficult to fully define IBR risks for patients with these features. Appropriate dose-fractionation regimens, target volume delineation, and treatment planning parameters for delivery of PBI are outlined. Intraoperative radiation therapy alone is associated with a higher IBR rate compared with WBI. A daily or every-other-day external beam PBI regimen is preferred over twice-daily regimens due to late toxicity concerns.
CONCLUSIONS: Based on published data, the ASTRO task force has proposed recommendations to inform best clinical practices on the use of PBI.
METHODS: ASTRO convened a task force to address 4 key questions focused on the appropriate indications and techniques for PBI as an alternative to whole breast irradiation (WBI) to result in similar rates of ipsilateral breast recurrence (IBR) and toxicity outcomes. Also addressed were aspects related to the technical delivery of PBI, including dose-fractionation regimens, target volumes, and treatment parameters for different PBI techniques. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.
RESULTS: PBI delivered using 3-dimensional conformal radiation therapy, intensity modulated radiation therapy, multicatheter brachytherapy, and single-entry brachytherapy results in similar IBR as WBI with long-term follow-up. Some patient characteristics and tumor features were underrepresented in the randomized controlled trials, making it difficult to fully define IBR risks for patients with these features. Appropriate dose-fractionation regimens, target volume delineation, and treatment planning parameters for delivery of PBI are outlined. Intraoperative radiation therapy alone is associated with a higher IBR rate compared with WBI. A daily or every-other-day external beam PBI regimen is preferred over twice-daily regimens due to late toxicity concerns.
CONCLUSIONS: Based on published data, the ASTRO task force has proposed recommendations to inform best clinical practices on the use of PBI.
摘要：
目的：本指南为早期浸润性乳腺癌和导管原位癌患者部分乳腺照射（PBI）的适当适应症和技术提供了循证建议。
方法：ASTRO召集了一个工作组来解决四个关键问题，重点是PBI作为全乳照射（WBI）的替代方案的适当适应症和技术，以导致相似的同侧乳腺复发率（IBR）和毒性结果。还涉及与PBI技术交付有关的方面，包括剂量分割方案，目标卷,和不同PBI技术的治疗参数。该指南基于医疗保健研究和质量机构提供的系统评价。建议是使用预定义的共识建立方法和系统创建的，用于对证据质量和建议强度进行分级。
结果：使用三维适形放射治疗的PBI，调强放射治疗,多导管近距离放射治疗,与长期随访的WBI相似的IBR和单次近距离放射治疗结果。一些患者特征和肿瘤特征在随机对照试验中代表性不足，这使得很难完全定义具有这些特征的患者的IBR风险。适当的剂量分割方案，目标体积轮廓，并概述了PBI的治疗计划参数。与WBI相比，单独的术中放射治疗与更高的IBR率相关。由于晚期毒性问题,每日或每隔一天的外部束PBI方案优于每日两次方案。
结论：根据已发布的数据，ASTRO特别工作组提出了建议,以告知使用PBI的最佳临床实践.
方法：ASTRO召集了一个工作组来解决四个关键问题，重点是PBI作为全乳照射（WBI）的替代方案的适当适应症和技术，以导致相似的同侧乳腺复发率（IBR）和毒性结果。还涉及与PBI技术交付有关的方面，包括剂量分割方案，目标卷,和不同PBI技术的治疗参数。该指南基于医疗保健研究和质量机构提供的系统评价。建议是使用预定义的共识建立方法和系统创建的，用于对证据质量和建议强度进行分级。
结果：使用三维适形放射治疗的PBI，调强放射治疗,多导管近距离放射治疗,与长期随访的WBI相似的IBR和单次近距离放射治疗结果。一些患者特征和肿瘤特征在随机对照试验中代表性不足，这使得很难完全定义具有这些特征的患者的IBR风险。适当的剂量分割方案，目标体积轮廓，并概述了PBI的治疗计划参数。与WBI相比，单独的术中放射治疗与更高的IBR率相关。由于晚期毒性问题,每日或每隔一天的外部束PBI方案优于每日两次方案。
结论：根据已发布的数据，ASTRO特别工作组提出了建议,以告知使用PBI的最佳临床实践.
