7% vs. 1.5%, p < 0.001) patients compared with negative-margin patients; however, no differences in TR/MM Buparlisib concentration were noted. Univariate analysis of IBTR was performed for patients with negative and close/positive margins and is presented in Table 5. For close/positive margins, age was associated with a trend for IBTR (p = 0.07), whereas in the DCIS subset a trend was noted for age (p = 0.07), grade (p = 0.07), and hormonal therapy (p = 0.07).
For negative-margin patients, ER negativity (p < 0.001) and extensive intraductal component (p = 0.05) were significantly associated with IBTR. The results of this analysis confirm previous publications highlighting the efficacy of APBI using intracavitary brachytherapy in women who are appropriately selected. The first conclusion drawn from our analysis is that although no significant differences in IBTR were found between patients treated with APBI with negative vs. close or positive margins, a trend (p = 0.07) was noted when close and positive margins were pooled. Of note, the rates of IBTR were greater than twofold higher for close margins and greater than threefold higher for positive margins. Although not reaching statistically significant values, these data suggest that in patients wishing to undergo APBI, reasonable attempts to achieve negative margins should be made before the delivery of RT. An earlier analysis of the ASBrS Registry had found that margin selleck kinase inhibitor status was not associated with IBTR in invasive cancers (p = 0.75), whereas a statistically significant association was noted in patients with DCIS (hazard ratio = 7.81, p = 0.01) (13). Our updated analysis, however, found nonsignificant increases in IBTR for invasive and significant increases for DCIS patients. This analysis is supported
by data from William Beaumont Hospital evaluating the impact of margin status on IBTR that also found a nonsignificant decrease in local control for close/positive margins (p = 0.07) (14). It should be noted that positive-margin cases did represent higher risk cases with patients having larger tumors and were more likely to be ER-negative tumors. Previous studies have confirmed ER negativity as a risk factor for IBTR, which was confirmed in our univariate Cyclin-dependent kinase 3 analysis as well (15). At this time, the current analysis continue to support the use of margin status in identifying suitable patients for partial breast irradiation, which is in agreement with the American Society for Radiation Oncology and Groupe Europeen de Curietherapie-European Society of Therapeutic Radiology and Oncology guidelines  and . A second conclusion that can be inferred from this analysis and review of the literature is that outcomes in patients with close or positive margins may be similar between partial breast irradiation and WBI cases. As previously mentioned, an analysis by Park et al. (6) found an 8-year IBTR rate of 27% for extensively positive margins and 14% for focally positive margins in patients treated with WBI (vs.