1;Contents;5 2;Contributors;15 3;Accelerated Partial Breast Irradiation: History, Rationale, and Controversies;19 3.1;1.1 Introduction;19 3.2;1.2 History of APBI;22 3.3;1.3 Controversies Regarding the Use of APBI;25 3.4;1.4 Conclusions;31 3.5;References;32 4;Who Is a Candidate for APBI?;36 4.1;2.1 Introduction;36 4.2;2.2 Pathologic Data;38 4.3;2.3 Anatomic Patterns of In-Breast Failure After Breast-Conserving Treatment;39 4.4;2.4 Proper Selection Criteria;40 4.5;References;47 5;Pathologic Anatomy of Early-Stage Breast Cancer and Its Relevance to APBI: Defining the Target;52 5.1;3.1 Determining the Extent of Disease Beyond the Lumpectomy Cavity;52 5.2;3.2 Impact of Radiation on Local Recurrences;58 5.3;3.3 Conclusions;60 5.4;References;60 6;The Radiobiology of Accelerated Partial Breast Irradiation;63 6.1;4.1 General Radiobiology Principles;64 6.2;4.2 The Radiobiology of Breast Cancer;65 6.3;4.3 Intraoperative APBI;66 6.4;4.4 External-Beam APBI;67 6.5;4.5 Interstitial Implant APBI;68 6.6;4.6 Conclusion;70 6.7;References;71 7;Surgical Considerations in Partial Breast Irradiation;74 7.1;5.1 Introduction;74 7.2;5.2 Patient Selection;75 7.3;5.3 Tumor Location;75 7.4;5.4 Cavity Shape and Size;78 7.5;5.5 Technical Considerations;82 7.6;5.6 Impact of Oncoplastic Techniques on the Use of APBI;86 7.7;References;87 8;Physics of Accelerated Partial Breast Irradiation;88 8.1;6.1 Introduction;88 8.2;6.2 Interstitial Brachytherapy;89 8.3;6.3 Intracavitary Volume Implants;94 8.4;6.4 External Beam;110 8.5;References;114 9;Quality Assurance for Accelerated Partial Breast Irradiation;116 9.1;7.1 Quality Management for Breast Brachytherapy;116 9.2;7.2 Quality Management for External-Beam Partial Breast Irradiation;135 9.3;References;138 10;Overview of North American Trials;140 10.1;8.1 Introduction;140 10.2;8.2 Patient Selection;141 10.3;8.3 Interstitial Technique;142 10.4;8.4 Tufts/Brown/Rhode Island;146 10.5;8.5 MammoSite Balloon;150 10.6;8.6 External-Beam APBI;157 10.7;8.7 Conclusion;161 10.8;References;162 11;An Overview of European Clinical Trials of APBI;165 11.1;9.1 Introduction;165 11.2;9.2 Early European APBI Trials;165 11.3;9.3 Contemporary European APBI Trials;170 11.4;9.4 European MammoSite Brachytherapy Trials;177 11.5;9.5 European (GEC-ESTRO) Multicentric Randomized APBI Trial;181 11.6;9.6 Summary and Future Directions;183 11.7;References;184 12;The Phase III Trials: Obtaining Definitive Answers;187 12.1;10.1 Patient Selection and Study Eligibility;193 12.2;10.2 Target Delineation;194 12.3;10.3 Technique and Dosimetry;198 12.4;10.4 Quality Assurance;199 12.5;10.5 Conclusion;200 12.6;References;200 13;The Virginia Commonwealth University Technique of Interstitial Brachytherapy;202 13.1;11.1 History;202 13.2;11.2 Implantation Technique;204 13.3;11.3 Dosimetric Guidelines;210 13.4;11.4 Results;212 13.5;11.5 Conclusion;213 13.6;References;214 14;Accelerated Partial Breast Irradiation: The William Beaumont Hospital Technique of Interstitial Brachytherapy;216 14.1;12.1 History;216 14.2;12.2 Physics;217 14.3;12.3 Implantation Technique;218 14.4;12.4 Clinical Results;225 14.5;12.5 Future Directions;228 14.6;References;229 15;Brachytherapy Techniques: The Arizona Approach;232 15.1;13.1 Introduction: A 17-Year Historical Perspective on the Evolution of Accelerated Partial Breast Irradiation;232 15.2;13.2 A New Hypothesis and a Potential Paradigm Shift;235 15.3;13.3 The Target Volume;236 15.4;13.4 Irradiating the Target Volume;237 15.5;13.5 Brachytherapy Techniques;238 15.6;13.6 Judgment: Selecting the Optimal Technique for a Particular Patient;255 15.7;13.7 Summary;257 15.8;References;258 16;The MammoSite Technique for Accelerated Partial Breast Irradiation;260 16.1;14.1 History of the Applicator;260 16.2;14.2 MammoSite and the FDA Trial;261 16.3;14.3 Physics of the MammoSite;263 16.4;14.4 Single Dwell vs. Multidwell;264 16.5;14.5 Elliptical MammoSite;266 16.6;14.6 Contrast Effect;266 16.7;14.7 Implantation Techniques;266 16.8;14.8 Other Cons