When using radiotherapy after breast-conserving surgery for early-stage breast cancer:
Accelerated whole-breast irradiation (AWBI) may be considered medically necessary for individuals who meet the following conditions:
Invasive carcinoma of the breast,
tumors ≤5 cm in diameter,
negative lymph nodes,
technically clear surgical margins, ie, no ink on tumor on invasive carcinoma or ductal carcinoma in situ, and
age at least 50 years old.
AWBI is considered investigational in all other situations involving treatment of early-stage breast cancer after breast-conserving surgery.
Interstitial or balloon brachytherapy may be considered medically necessary for individuals undergoing initial treatment for stage I or II breast cancer when used as local boost irradiation in those who are also treated with breast-conserving surgery and whole-breast external-beam radiotherapy.
Accelerated partial-breast irradiation (APBI), including interstitial APBI, balloon APBI, intraoperative APBI, external-beam APBI, and noninvasive brachytherapy using AccuBoost, is considered investigational.
Noninvasive brachytherapy using AccuBoost for individuals undergoing initial treatment for stage I or II breast cancer when used as local boost irradiation in those who are also treated with breast-conserving surgery and whole-breast external-beam radiotherapy is considered investigational.
