Clinical Outcomes of Robotic Stereotactic Accelerated Partial Breast Irradiation: A Structured Literature Review
Abstract
Accelerated partial breast irradiation (APBI) has emerged as an evidence-based alternative to whole-breast irradiation (WBI) in appropriately selected patients with early-stage breast cancer. Within this landscape, robotic stereotactic APBI delivered with the CyberKnife (CK) system (Accuray Incorporated, Madison, WI) represents a technologically refined external-beam implementation, integrating non-isocentric beam arrangements, high-frequency image guidance, and optional fiducial-based respiratory tracking that allow steep dose gradients and reduced geometric margins. This structured literature review synthesizes the available clinical, dosimetric, and technical evidence on CK-APBI to define its current role among contemporary APBI modalities. A structured review of peer-reviewed studies published between 2011 and 2025 reporting clinical or dosimetric outcomes of CK-based APBI in early-stage breast cancer was performed. Eligible studies included pilot feasibility reports, phase I/II prospective trials, retrospective cohorts, comparative analyses, and dosimetric evaluations. Endpoints of interest were ipsilateral breast tumor recurrence (IBTR), acute and late toxicity, cosmetic outcomes, and dose to organs at risk (heart, lungs, uninvolved breast). Patient selection, treatment technique (fiducial placement, simulation, target delineation, motion management, dose-fractionation), and CyberKnife platform evolution (Iris, InCise multileaf collimator) were also evaluated. Across…
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