Accelerated partial breast irradiation (APBI) is being rapidly introduced into the clinical management of early breast cancer. APBI, in fact, encompasses a number of different techniques and approaches that include brachytherapy, intraoperative, and external beam techniques. There is currently no single source that describes these techniques and their clinical implementation. This text will be a concise handbook designed to assist the clinician in the implementation of APBI. This will include a review of the principles that underlie APBI, a practical and detailed description of each technique for APBI, a review of current clinical results of APBI, and a review of the incidence and management of treatment related complications.

1;Contents;5 2;List of Contributors;7 3;1 Accelerated Partial Breast Irradiation: History, Rationale, and Controversies;9 3.1;1.1 Introduction;9 3.2;1.2 History of APBI;11 3.3;1.3 Controversies Regarding the Use of APBI;14 3.4;1.4 Convenience Benefits of APBI;19 3.5;1.5 Conclusions;20 3.6;References;21 4;2 Who is a Candidate for Accelerated Partial Breast Irradiation?;24 4.1;2.1 Introduction;24 4.2;2.2 Pathologic Data;26 4.3;2.3 Anatomic Patterns of In-Breast Failure after Breast- Conserving Treatment;26 4.4;2.4 Proper Selection Criteria;28 4.5;References;34 5;3 Pathologic Anatomy of Early-Stage Breast Cancer and its Relevance to Accelerated Partial Breast Irradiation: Defining the Target;38 5.1;3.1 Determining the Extent of Disease Beyond the Lumpectomy Cavity;38 5.2;3.2 Impact of Radiation on Elsewhere Failures;43 5.3;3.3 Conclusions;44 5.4;References;45 6;4 Physics of Partial Breast Irradiation: Coping with the New Requirements of the NSABP B39/RTOG 0413 Protocol;47 6.1;4.1 Introduction;48 6.2;4.2 Interstitial Multicatheter Technique;49 6.3;4.3 MammoSite;52 6.4;4.4 3D Conformal External Beam;57 6.5;4.5 Conclusions;59 6.6;References;59 7;5 The Radiobiology of Accelerated Partial Breast Irradiation;61 7.1;5.1 Introduction;61 7.2;5.2 Advantages of Accelerated Therapy;63 7.3;5.3 Volume of Breast Requiring Treatment in APBI;65 7.4;5.4 Dose Homogeneity;66 7.5;5.5 Dose Fractionation Schedules;67 7.6;5.6 Accuracy of Treatment Delivery;70 7.7;5.7 Summary;71 7.8;References;71 8;6 Surgical Considerations for Accelerated Partial Breast Irradiation;74 8.1;6.1 Introduction;74 8.2;6.2 Volume of Breast Resection;75 8.3;6.3 Brachytherapy;76 8.4;6.4 Intraoperative Radiation Therapy;78 8.5;6.5 External Beam Delivery of Conformal Radiation Therapy;80 8.6;6.6 APBI for Breast Preservation After Local Recurrence;81 8.7;References;81 9;7 The Virginia Commonwealth University (VCU) Technique of Interstitial Brachytherapy;83 9.1;7.1 History;83 9.2;7.2 Implantation Technique;85 9.3;7.3 Dosimetric Guidelines;89 9.4;7.4 Results;90 9.5;7.5 Conclusion;92 9.6;References;92 10;8 The William Beaumont Hospital Technique of Interstitial Brachytherapy;94 10.1;8.1 History;94 10.2;8.2 Physics;95 10.3;8.3 Implantation Technique;96 10.4;8.4 Clinical Results;101 10.5;8.5 Future Directions;103 10.6;References;104 11;9 Brachytherapy Techniques: the University of Wisconsin/Arizona Approach;107 11.1;9.1 Introduction: a 14-year Historical Perspective on the Evolution of APBI;107 11.2;9.2 A New Hypothesis and a Potential Paradigm Shift;110 11.3;9.3 The Target Volume;111 11.4;9.4 Irradiating the Target Volume;111 11.5;9.5 Brachytherapy Techniques;113 11.6;9.6 Judgment: Selecting the Optimal Technique for a Particular Patient;126 11.7;9.7 Summary;127 11.8;References;128 12;10 The MammoSite Technique for Accelerated Partial Breast Irradiation;130 12.1;10.1 Introduction;130 12.2;10.2 History of the Applicator;132 12.3;10.3 Physics of the MammoSite;133 12.4;10.4 Implantation Techniques;136 12.5;10.5 Other Considerations;137 12.6;10.6 Appropriateness for Treatment;138 12.7;10.7 Clinical Results;138 12.8;10.8 Conclusions;141 12.9;References;142 13;11 3D Conformal External Beam Technique;144 13.1;11.1 Introduction;144 13.2;11.2 History;145 13.3;11.3 Physics and Techniques;148 13.4;11.4 Clinical Results;149 13.5;11.5 Challenges and Limiting Factors in the Application of 3D Conformal APBI;160 13.6;11.6 Future Directions;161 13.7;References;162 14;12 Intraoperative Radiotherapy: a Precise Approach for Partial Breast Irradiation;164 14.1;12.1 The "New" Thinking that Became the New Dogma;164 14.2;12.2 Intraoperative Radiotherapy: an Elegant Method of Partial Breast Irradiation;166 14.3;12.3 Radiobiology of Intraoperative Radiotherapy;166 14.4;12.4 The Intrabeam Machine and Surgical Technique;169 14.5;12.5 The Novac7 System;172 14.6;12.6 Results of Clinical Trials with the Intrabeam System;173 14.7;12.7 Health Economics;174 14.8;References;175 15;13 Quality Assurance for Breast Brachyt