1;Contents;5 2;List of Contributors;7 3;1 Accelerated Partial Breast Irradiation: History, Rationale, and Controversies;9 3.1;1.1 Introduction;9 3.2;1.2 History of APBI;11 3.3;1.3 Controversies Regarding the Use of APBI;14 3.4;1.4 Convenience Benefits of APBI;19 3.5;1.5 Conclusions;20 3.6;References;21 4;2 Who is a Candidate for Accelerated Partial Breast Irradiation?;24 4.1;2.1 Introduction;24 4.2;2.2 Pathologic Data;26 4.3;2.3 Anatomic Patterns of In-Breast Failure after Breast- Conserving Treatment;26 4.4;2.4 Proper Selection Criteria;28 4.5;References;34 5;3 Pathologic Anatomy of Early-Stage Breast Cancer and its Relevance to Accelerated Partial Breast Irradiation: Defining the Target;38 5.1;3.1 Determining the Extent of Disease Beyond the Lumpectomy Cavity;38 5.2;3.2 Impact of Radiation on Elsewhere Failures;43 5.3;3.3 Conclusions;44 5.4;References;45 6;4 Physics of Partial Breast Irradiation: Coping with the New Requirements of the NSABP B39/RTOG 0413 Protocol;47 6.1;4.1 Introduction;48 6.2;4.2 Interstitial Multicatheter Technique;49 6.3;4.3 MammoSite;52 6.4;4.4 3D Conformal External Beam;57 6.5;4.5 Conclusions;59 6.6;References;59 7;5 The Radiobiology of Accelerated Partial Breast Irradiation;61 7.1;5.1 Introduction;61 7.2;5.2 Advantages of Accelerated Therapy;63 7.3;5.3 Volume of Breast Requiring Treatment in APBI;65 7.4;5.4 Dose Homogeneity;66 7.5;5.5 Dose Fractionation Schedules;67 7.6;5.6 Accuracy of Treatment Delivery;70 7.7;5.7 Summary;71 7.8;References;71 8;6 Surgical Considerations for Accelerated Partial Breast Irradiation;74 8.1;6.1 Introduction;74 8.2;6.2 Volume of Breast Resection;75 8.3;6.3 Brachytherapy;76 8.4;6.4 Intraoperative Radiation Therapy;78 8.5;6.5 External Beam Delivery of Conformal Radiation Therapy;80 8.6;6.6 APBI for Breast Preservation After Local Recurrence;81 8.7;References;81 9;7 The Virginia Commonwealth University (VCU) Technique of Interstitial Brachytherapy;83 9.1;7.1 History;83 9.2;7.2 Implantation Technique;85 9.3;7.3 Dosimetric Guidelines;89 9.4;7.4 Results;90 9.5;7.5 Conclusion;92 9.6;References;92 10;8 The William Beaumont Hospital Technique of Interstitial Brachytherapy;94 10.1;8.1 History;94 10.2;8.2 Physics;95 10.3;8.3 Implantation Technique;96 10.4;8.4 Clinical Results;101 10.5;8.5 Future Directions;103 10.6;References;104 11;9 Brachytherapy Techniques: the University of Wisconsin/Arizona Approach;107 11.1;9.1 Introduction: a 14-year Historical Perspective on the Evolution of APBI;107 11.2;9.2 A New Hypothesis and a Potential Paradigm Shift;110 11.3;9.3 The Target Volume;111 11.4;9.4 Irradiating the Target Volume;111 11.5;9.5 Brachytherapy Techniques;113 11.6;9.6 Judgment: Selecting the Optimal Technique for a Particular Patient;126 11.7;9.7 Summary;127 11.8;References;128 12;10 The MammoSite Technique for Accelerated Partial Breast Irradiation;130 12.1;10.1 Introduction;130 12.2;10.2 History of the Applicator;132 12.3;10.3 Physics of the MammoSite;133 12.4;10.4 Implantation Techniques;136 12.5;10.5 Other Considerations;137 12.6;10.6 Appropriateness for Treatment;138 12.7;10.7 Clinical Results;138 12.8;10.8 Conclusions;141 12.9;References;142 13;11 3D Conformal External Beam Technique;144 13.1;11.1 Introduction;144 13.2;11.2 History;145 13.3;11.3 Physics and Techniques;148 13.4;11.4 Clinical Results;149 13.5;11.5 Challenges and Limiting Factors in the Application of 3D Conformal APBI;160 13.6;11.6 Future Directions;161 13.7;References;162 14;12 Intraoperative Radiotherapy: a Precise Approach for Partial Breast Irradiation;164 14.1;12.1 The "New" Thinking that Became the New Dogma;164 14.2;12.2 Intraoperative Radiotherapy: an Elegant Method of Partial Breast Irradiation;166 14.3;12.3 Radiobiology of Intraoperative Radiotherapy;166 14.4;12.4 The Intrabeam Machine and Surgical Technique;169 14.5;12.5 The Novac7 System;172 14.6;12.6 Results of Clinical Trials with the Intrabeam System;173 14.7;12.7 Health Economics;174 14.8;References;175 15;13 Quality Assurance for Breast Brachyt