Who are the optimal candidates for partial breast irradiation?

At the 2017 St. Gallen International Expert Consensus Conference on the Primary Therapy for Early Breast Cancer, the consensus panel recognized “partial breast irradiation as an option for women meeting the low‐risk criteria put forward by the American Society for Radiation Oncology/European Society for Radiotherapy and Oncology (ASTRO/ESTRO) guideline,” although acknowledging that there was less evidence for this approach. Partial breast irradiation is defined as irradiation localized to the surgical resection cavity only as opposed to the entire breast. Accelerated partial breast irradiation (APBI) involves intensive treatment in a short time period. The methods vary, and three available APBI options are brachytherapy, external beam and intra‐operative irradiation. The long‐term follow‐up results from two large‐scale, well‐designed phase III randomized clinical trials have been released. However, further discussion of the optimal treatment candidates and delivery method is needed before the clinical application of APBI as a mainstream breast conservation treatment. APBI involves intensive treatment in a short time period to resection cavity only. Eagerly awaited results of randomized clinical trials, RAPID and NSABP B‐39/RTOG 0413, have been released. The recurrence of IBTR incidence was reassuringly low in both trials. Current clinical guidelines and future research directions are reviewed.