Brachytherapy in the treatment of breast cancer

Whole-breast external-beam radiation therapy (EBRT) involves a 6-week cours e of fractionated treatments. in contrast, brachytherapy can be completed i n a 4- to 5'-day treatment course. Because of this shortened time frame, th ere has been interest in breast brachytherapy as a sale modality after lump ectomy. The American Brachytherapy Society (ABS) has issued guidelines spec ifically for the use of brachytherapy in breast carcinoma. In these guideli nes, the ABS addresses important areas of controversy related to the indica tions, execution, and evaluation of breast implants when utilized in the fo llowing settings: as the sole treatment modality following lumpectomy, as a n alternative to a 6-week course of EBRT following lumpectomy, as a boost f ollowing whole-breast irradiation, and for the treatment of local recurrenc es following breast-conservation treatment. The ABS recommends a precise de finition and meticulous delineation of the clinical target volume. Ira addi tion, the Society recommends the routine use of dose-volume histograms and a dose-homogeneity index as tools to ensure reproducible brachytherapy and to allow interinstitutional comparisons. Brachytherapy as a sale modality i s currently considered investigational and should be performed in the conte xt of a controlled clinical trial. Practitioners and cooperative groups are encouraged to use these guidelines to formulate treatment and dose-reporti ng policies, but responsibility for medical decisions ultimately rests with the treating radiation oncologist.