Accelerated Partial Irradiation of the Breast: New Altered Fractionation
Accelerated Partial Irradiation of the Breast: New Altered Fractionation
The aim of this observational study is to evaluate a dose fractionation scheme for APBI using
 external radiotherapy with modulated intensity technique (IMRT), with the possible impact on
 the quality of life of patients as it decreases the treatment number of sessions and improves
 the efficiency and accessibility.
Breast cancer is the most common tumor among women; although its treatment used to be very
 aggressive, nowadays is based on the minimum effective treatment.

 In non-metastatic patients, the therapeutical strategy is based on surgery, systemic therapy
 and radiotherapy. Usually in the early stages of the disease, the treatment begins with a
 conservative surgery followed by adjuvant therapy.

 It´s been proved that the majority of relapses after conservatory surgery occur near the
 surgical bed which suggests that the main benefit of radiotherapy treatment lies in its
 primary effect on residual microscopic disease in the surgical bed. Regarding the
 radiotherapy used after conservative surgery, it´s accepted as standard treatment
 hypofractionated schemes, after they have demonstrated at least the same grade of
 effectiveness as the classic fractionation in terms of locoregional control, survival,
 aesthetic results or toxicity.

 One of the options of hypofractionated schemes is APBI (Accelerated Partial Breast
 Irradiation), that by reducing the volume of the radiated breast and an accelerated dose
 fractionation scheme, can eliminate the residual microscopic disease in the surgical bed. The
 main advantage of APBI is that can shorten the overall time (total treatment time) by
 increasing the dose per fraction.

 In patients who meet the following criteria:≥ 45 years or 40-44 if there isn´t any other risk
 factor, diagnosed with infiltrating ductal carcinoma (IDC) or ductal carcinoma in situ (DCIS)
 and that have undergone conservative surgery without ganglionar involvement (pN0) of any
 histological degree except from invasive lobular carcinoma and with a size ≤ 3 cm, with a
 free margin of at least 2 mm, as well as with positive and negative estrogen receptor tumors;
 APBI is currently considered standard treatment.

 This radiotherapy modality can be administered using 4 different techniques: interstitial
 brachytherapy, spherical balloons, intraoperative radiotherapy with electrons or with
 dedicated kilovoltage (RIO) systems and External Radiotherapy (3D shaped RT or modulated
 intensity radiotherapy - IMRT-). Each of them have their advantages and disadvantages,
 without any of them being superior to the others in terms of survival or local control,
 however, IMRT achieves a more shaped and uniformed dose after conservative surgery.

 The aim of this observational study is to evaluate a dose fractionation scheme for APBI (28
 Gy in 5 fractions of 5.6 GY, 5 days/week) using external radiotherapy with modulated
 intensity technique (IMRT), with the possible impact on the quality of life of patients.
Inclusion Criteria:

 -  ≥ 45 years or 40-44 if there isn´t any other risk factor

 -  Diagnosed with infiltrating ductal carcinoma (IDC) or ductal carcinoma in situ (DCIS)
 and that have undergone conservative surgery without ganglionar involvement (pN0) of
 any histological degree except from invasive lobular carcinoma and with a size ≤ 3 cm.

 -  Disease free margins (R0: > 2mm).

 -  Positive and negative estrogen receptor tumors.

 Exclusion Criteria:

 -  Multicentric and multifocal tumors, except from if it´s focal and the only risk
 factor.

 -  Patients must not have undergone a neoadjuvant QT therapy.

 -  Patients with BRCA positive mutation will be excluded.

 -  Those patients unable or unsuitable to understand and accept the informed consent.

 -  Metastasic´s affectation evidence.

 -  Extensive lymphovascular invasion, except from if the total resulting size of the
 focus and breast parenchyma addition is ≤ 3cm.

 -  Breast implants presence in the breast that´s going to be treated.

 -  Contraindicated radiotherapy treatment due to a diagnosis of cutaneous lupus,
 pregnancy or scleroderma.

 -  Inability to fully know the dosimetric data of the APBI plan.