[乳癌] ASTRO APBI guideline

考試很愛考, 非記起來不可的APBI guideline

APBI 全名為accelerated partial breast irradiation

其實現方法包括 IORT(electron or x-ray); EBRT; interstitial brachytherapy 

Patient group	Risk factor	Criteria
Suitable	Age	五十歲以上
	Margins	至少2mm
	T stage	Tis or T1
	DCIS	Screen-detected Low to intermediate nuclear grade Size ≤2.5 cm Resected with margins negative at ≥3 mm
Cautionary	Age	40-49 y if all other criteria for "suitable" are met ≥50 y if patient has at least 1 of the pathologic factors below and does not have any "unsuitable" factors Pathologic factors: Size 2.1-3.0 cm(a); T2; Close margins (<2mm)  ; Limited/focal LVSI; ER(-); Clinically unifocal with total size 2.1-3.0 cm(b); Invasive lobular histology; Pure DCIS ≤3 cm if criteria for "suitable" not fully met; EIC ≤3 cm
	Margins	Close (<2 mm)
	DCIS	≤3 cm and does not meet criteria for “suitable”
Unsuitable	Age	<40 y 40-49 y and do not meet the criteria for cautionary
	Margins	positive
	DCIS	>3cm

a. The size of the invasive tumor component.

b. Microscopic multifocality allowed, provided the lesion is clinically unifocal (a single discrete lesion by physical examination and ultrasonography/ mammography) and the total lesion size (including foci of multifocality and intervening normal breast parenchyma) falls between 2.1 and 3.0 cm.

EIC = extensive intraductal component 

breast cancer:

T1: 小於等於兩公分

T2: 大於兩公分,  小於等於五公分

T3: 大於五公分

T4: 吃到 chest wall 或/且 skin

表格可以在整理成另一種形式, 如下, 方便記憶suitable 所需的情形

Factors	Suitable (all factor)
Age	≥ 50 y
BRCA 1/2	Not present
Tumor size	≤2 cm
T stage	Tis or T1
Margin	≥ 2mm
Grade	Any
LVSI	No
ER status	positive
Multicentricity	Unicentric
Multifocality	Clinically unifocal with total size ≤2 cm
Histology	Invasive ductal or mucinous, tubular, and colloid
Pure DCIS	screen-detected, low to intermediate nuclear grade, ≤ 2.5 cm size, and resected with margins negative at ≥ 3 mm
EIC	No
Associated LCIS	allowed
N stage	pN0 (i-,i+)
Nodal surgery	SN Bx or ALND
Prior chemotherapy	no

unsuitable 的表格

Factors	unsuitable (any factor)
Age	< 40 y
BRCA 1/2	present
Tumor size	>3 cm
T stage	T3, T4
Margin	positive
LVSI	extensive
Multicentricity	present
Multifocality	If microscopically multifocal > 3 cm in total size or if clinically multifocal
Pure DCIS	If >3 cm in size
EIC	If >3 cm in size
N stage	pN1, N2, N3
Nodal surgery	None performed
Prior chemotherapy	If used

reference:

1. ASTRO APBI guideline
2. NCCN guideline

3. https://www.practicalradonc.org/cms/10.1016/j.prro.2016.09.007/attachment/44c2751f-db2e-47de-9180-685c894dd136/mmc1.pdf