Trends in Breast Health Newsletter
IN THIS ISSUE VOL. 3  |  DEC. 2011
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ASTRO 2011 Summary
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3D Conformal APBI Toxicity: Discussion at ASTRO
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Meeting Highlights
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Literature Corner
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Editors' Bios

TRENDS' Editors
Pamela Benitez, MD
Dr. Benitez is a general surgeon focusing exclusively on diseases of the breast and breast cancer at William Beaumont Hospital in Royal Oak, Michigan

Martin Keisch, MD
Dr. Keisch is a board-certified radiation oncologist at University of Miami Hospital and President of Cancer HealthCare Associates (CHCA)

ASTRO 2011 Summary

In addition to the highlighted articles on possible toxicity from 3D Conformal APBI, several interesting breast cancer-related abstracts were presented. The following were selected by one of our editors (MK) for inclusion due to direct or potential implications for partial breast irradiation techniques. The 10-year update of the Massachusetts General Hospital (MGH) interstitial APBI dose escalation trial was presented. The data again showed significant toxicity and poor cosmetic results using LDR brachytherapy, especially in the group receiving 60 Gy. Local control remains excellent at 88% (Abstract 14).  Another paper presented showed the long-term results out to a minimum of 8 years for the Harvard DCIS trial examining wide local excision in a favorable subset (1 cm margin).  Read More »


 
3D Conformal APBI Toxicity: Discussion at ASTRO
The 53rd Annual ASTRO meeting held in Miami Beach, Florida in October included presentations and discussions regarding the possibility of excessive toxicity for patients receiving external beam 3D conformal radiotherapy to deliver APBI as per the NSABP/RTOG randomized trial. Data from Tufts/Brown radiation oncology were presented, which included 80 patients with a minimum of 6 months of follow-up. Additionally, a review of prior publications suggesting a problem with significant subcutaneous fibrosis and fat necrosis was presented. Tom Julian, M.D. presented the early toxicity data from the actual NSABP B39/RTOG 0413 trial, which included 1,391 patients treated with 3D conformal APBI. In this large multi-institution randomized controlled trial, which includes central physics review and toxicity review with a monitoring committee review, no significant excess toxicity is demonstrated. The phase III trial has much larger numbers and longer follow-up (mean 42.6 months), calling into question the validity of a small single series with short follow-up. Obviously, the final answer will need to wait until complete accrual and full analysis, but no clear indication of excessive toxicity exists at this time. Continued enrollment of 3D conformal patients on the trial is encouraged.
Hologic Sponsored Meetings
San Antonio Breast Care Symposium San Antonio, TX December 6–9, 2011
National Consortium of Breast Centers – Interdisciplinary Breast Center Conference Las Vegas, NV March 1014, 2012
Miami Breast Cancer Conference Miami, FL March 14-17 2012
American College of Radiology – National Conference on Breast Cancer Hollywood, FL April 13–15, 2012
American Society of Breast Surgeons Phoenix, AZ May 26,  2012
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