Breast
Guideline update only; no new trial efficacy data, but the expanded low-risk criteria directly widen who qualifies for APBI in routine practice.
GEC-ESTRO APBI Patient Selection Guidelines (2026 Update)
TL;DR2026 update expands low-risk APBI eligibility: age>40, ≤30mm, pN0/pN1mi, all histologies; high-risk (contraindicated) = BRCA, age<40, TNBC, EIC, extensive LVI.
vs leading data
- vs 2010 GEC-ESTRO criteria: source states selection can be 'significantly expanded,' enlarging the eligible pool
8 details
Methods
- 🔍 Evidence base: 10 prospective RCTs + 7 retrospective comparative studies, min median f/u 5 yr
- 🔍 Systematic search 2010-2024 (PubMed/Medline/Scopus/Cochrane), 618 articles screened
- 🔍 Consensus update to the 2010 GEC-ESTRO criteria; clinical evidence supplemented by expert opinion
- 🔍 Selection criteria only; APBI technique, dose, and fractionation not addressed in source
Results
- 📊 GEC-ESTRO selection criteria: low-risk (good APBI candidate) vs high-risk (APBI contraindicated)
Criterion Low-risk (APBI OK) High-risk (contraindicated) Age >40 yr <40 yr Tumor size pTis, T1-2, ≤30 mm >30 mm Nodes pN0 or pN1mi ≥pN1a or pNx Focality unifocal / multifocal ≤2 cm multicentric Histology all types triple negative Margins (invasive) negative positive Margins (DCIS) ≥2 mm <2 mm EIC absent present LVI no extensive LVI extensive LVI BRCA — BRCA 1-2 mutation - 📊 Net effect: low-risk group broadened, so more pts become APBI-eligible in routine practice
Critique
- ⚠️ Consensus guideline supplemented by expert opinion; no new outcome data, recommendation strength not graded in source
- ⚠️ 'All histology types' admits ILC to low-risk; lobular multifocality gated only by the ≤2cm size/margin criteria
Open questions
- APBI safety in invasive lobular carcinoma
- Local control in the expanded pN1mi and DCIS subgroups
📚 Sources · 📄 1 paper
Patient selection for accelerated partial breast irradiation (APBI) after breast-conserving surgery: Updated evidence-based recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) Breast Cancer Working Group.
Abstract
PURPOSE: To update recommendations on patient selection criteria for accelerated partial breast irradiation (APBI) based on available clinical evidence supplemented by expert opinions.<br/><br/>METHODS AND MATERIALS: Between 2010 and 2024, a systematic search of the PubMed, Medline, Scopus and Cochrane database identified 618 articles using the keywords "accelerated partial breast irradiation" and "APBI". This search was complemented by reviewing the reference lists of articles and manual reviewing of relevant conference abstracts and book chapters. Of these, ten prospective randomized clinical trials and seven retrospective comparative studies with a minimum median follow-up time of five years were identified. The authors reviewed the clinical evidence published on APBI, supplemented it with relevant clinical and pathological studies on breast-conserving therapy, and then formulated the recommendations presented in this manuscript.<br/><br/>RESULTS: Based on published new clinical evidence, the GEC-ESTRO Breast Cancer Working Group recommends two categories as guidelines for selecting patients eligible for APBI: (1) low-risk group representing good candidates for APBI including patients ageing > 40 years with unifocal or multifocal within 2 cm, pTis,T1-2 (≤30 mm) pN0 or pN1mi, all histology types of breast cancer without the presence of an extensive intraductal component (EIC), without extensive lympho-vascular invasion (LVI) and with negative surgical margins for invasive tumors (≥2 mm for DCIS), (2) high-risk group, for whom APBI is considered contraindicated including patients with BRCA 1-2 mutations or ageing < 40 years; having positive margins for invasive tumor (<2 mm for DCIS), and/or multicentric or large (>30 mm), and/or triple negative tumours, and/or EIC positive, and/or extensive lympho-vascular invasion (LVI) or macrometastatic positive lymph nodes (≥pN1a) or unknown axillary status (pNx).<br/><br/>CONCLUSIONS: Based on emerging clinical evidence, the 2010 GEC-ESTRO APBI patient selection criteria can be significantly expanded, meaning that in the future, more patients may receive APBI as a part of routine clinical practice.
📝 https://pmc.ncbi.nlm.nih.gov/articles/PMC13122701/