ASTRO raises concerns about APBI study

The American Society for Radiation Oncology (ASTRO) issued a statement on December 9 expressing concern about the potential "misinterpretation of data" in a study on accelerated partial-breast irradiation (APBI) presented at the San Antonio Breast Cancer Symposium last week.

Researchers from MD Anderson Cancer Center at the University of Texas analyzed billing codes for more than 130,000 Medicare patients older than 66 years who underwent either APBI brachytherapy or whole-breast irradiation following breast-conservation surgery for early-stage breast cancer.

The data demonstrated a small but statistically significant increase (4% versus 2.2%) in the rate of mastectomies in those patients who had APBI. Radiation oncologist Dr. Benjamin D. Smith and colleagues also found that APBI patients had a higher rate of acute and late toxicities, postradiation treatment complications, and hospitalization.

In its critique of the study, ASTRO stated that "there are limitations to the interpretation of the data, given that it was drawn from records of patients [with] varying risk factors and stages treated between 2000 and 2007. Since that time, technology has dramatically improved, including the use of newer multichannel applicators with tighter dose constraints."

The society's 2009 APBI consensus guidelines outlined the appropriate criteria for selecting patients to be treated with APBI outside of a clinical trial, the statement also noted.

The MD Anderson study is a good example of why it is important to be selective in choosing which patients receive the accelerated treatment, according to ASTRO. The organization also recommended that patients who are candidates for APBI be enrolled in the currently ongoing clinical trials.

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