Overview of North American trials

Abstract

This chapter discusses the results of nonrandomized, single and multi-institutional trials of APBI conducted in North America. Trials of interstitial brachytherapy, intracavitary brachytherapy, and external-beam techniques are each reviewed in detail. Clinical outcomes and toxicities as related to patient- and technique-related factors are presented. There remains a significant difference between these methods of APBI. The highlighted differences include the amount of tissue irradiated, the technical challenge involved in radiation delivery and planning, as well as the logistics for the patient (such as level of invasiveness). Additionally, the level of data supporting each modality is variable, as only the multicatheter approach has published outcome data extending beyond five years. The others have shown excellent feasibility and tolerability with minimal acute toxicity, and the efficacy data are mounting steadily. Further data, particularly from Phase III randomized trials, are needed. © 2009 Springer Berlin Heidelberg.