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Accelerated Partial Breast Irradiation, or APBI, is an accelerated and targeted form of radiation treatment for breast cancer that focuses only on the area where the tumor is removed, along with a small amount of healthy tissue around it. Rather than treating the entire breast daily over the course of five to six weeks, which has been the standard of care for anyone having a lumpectomy for breast cancer, APBI treats just the area around the tumor. This is the area where recurrences are most likely to occur. Because it is treating a smaller amount of tissue, it can be done safely over a much shorter timeframe.Ìý APBI can be deliveredÌýusing a single radiation dose during surgery, or after surgery, over the course of five days.

There are several types of APBI. At Stanford, we focus on two types: Intraoperative Radiotherapy (IORT) and external beam 3-dimensional conformal radiotherapy (3D-CRT). APBI using IORT is done during surgery at the time of the lumpectomy procedure. Radiation is delivered directly to the area where the tumor was removed, using a specialized radiation machine in the operating room. No further radiation is needed. External Beam 3D-CRT APBI is delivered after surgery using the same machine as we use for whole breast radiation, but instead targets the tissue around where the tumor was removed. This treatment is given twice a day for five days.

In general, patients over the age of 50 with small tumors measuring < 2 cm without lymph node involvement may be good candidates. We have also treated some patients with ductal carcinoma in situ (DCIS).ÌýIt is important for ABPI candidates to beÌýreliable and compliant with their follow-up appointments and appropriate systemic therapy.

IORT has many benefits, the most obvious of which is reducing radiation treatments from five to six weeks down to one treatment done at the time of surgery. This allows people to get back to their normal routine quickly, with fewer side effects compared to whole breast radiation. Because the radiation goes directly to the targeted area during surgery and bypasses the skin, the irritation or blistering that can occur with whole breast irradiation is reduced. Additionally, because the radiation area is smaller than other radiation options, people don't experience the radiation-induced fatigue that typically occurs with whole breast irradiation. This lessens the overall impact of radiation treatment on daily life.Ìý During IORT, the heart and underlying structures are protected from the radiation with a "beam stopper," thus reducing the long-term effects of radiation on the heart, ribs, and lungs.

Patients are thrilled with how quickly they recover and can get back to living life. One of our patients told us that she was aÌýspecial education teacher and because she had IORT, she could get back to her students right away, rather than take an additional six weeks off. Another patient's husband was very ill when she was diagnosed with breast cancer, and she was thankful to have IORT because she could get back to taking care of her husband and sharing the last precious months with him without worrying about having to go to daily radiation treatments. Another patient was diagnosed with breast cancer just a couple of months before a big family trip. With IORT, she was grateful she could complete her treatment before leaving for the trip. She did not have to postpone or cancel the trip and miss spending time with her family.

Our patients have had great cosmetic results from IORT. We see very little of theÌýpoor cosmetic outcomes thatÌýcan happen with whole breast radiation, such as skin discoloration, retraction, or firming of the breast tissue.Ìý