HighlightsGastrointestinal (GI) tract metastasis in breast cancer is rare and occurs more commonly in invasive lobular carcinoma.The interval between the index breast cancer and GI tract spread may be as long as 30 years.20% of patients with GI tract metastasis are asymptomatic, and detection may rely on physical examination and imaging.Management follows the principles of treatment in systemic disease in breast cancer, with consideration for surgery in obstruction, perforation or bleeding.

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This study aims to evaluate in vivo skin dose delivered by intraoperative radiotherapy (IORT) and determine the factors associated with an increased risk of radiation-induced skin toxicity.Methodology: A total of 21 breast cancer patients who underwent breastconserving surgery and IORT, either as IORT alone or IORT boost plus external beam radiotherapy (EBRT), were recruited in this prospective study. EBT3 film was calibrated in water and used to measure skin dose during IORT at concentric circles of 5 mm and 40 mm away from the applicator. For patients who also had EBRT, the maximum skin dose was estimated using the radiotherapy treatment planning system. Mid-term skin toxicities were evaluated at 3 and 6 months post-IORT. Results:The average skin dose at 5 mm and 40 mm away from the applicator was 3.07 ± 0.82 Gy and 0.99 ± 0.28 Gy, respectively. Patients treated with IORT boost plus EBRT received an additional skin dose of 41.07 ± 1.57 Gy from the EBRT component. At 3 months post-IORT, 86% of patients showed no evidence of skin toxicity. However, the number of patients suffering from skin toxicity increased from 15% to 38% at 6 months post-IORT. We found no association between the IORT alone or with the IORT boost plus EBRT and skin toxicity. Older age was associated with increased risk of skin toxicities. A mathematical model was derived to predict skin dose. Conclusion:EBT3 film is a suitable dosimeter for in vivo skin dosimetry in IORT, providing patient-specific skin doses. Both IORT alone and IORT boost techniques resulted in similar skin toxicity rates.

Background There is a paucity of data on the use of intraoperative radiotherapy (IORT) with low‐energy X‐rays in Malaysian women with early breast cancer. The aim of this study is to evaluate the clinical, cosmetic, and patient‐reported outcomes in low‐ and high‐risk early breast cancer patients treated with breast conserving surgery (BCS) and IORT. Methodology Patients suitable for BCS who were treated with IORT between January 2016 and June 2019 from three centres were analysed. They were divided into low‐risk and high‐risk groups based on the risk of recurrence according to the TARGeted Intraoperative radioTherapy (TARGIT) A and B study criteria. Outcomes of interest included local recurrence, wound complications, and radiation toxicity, with a subset analysed for cosmetic and patient‐reported outcomes. Results Within a median follow‐up of 31 months, there were 104 and 211 patients in the low‐ and high‐risk groups, respectively. No significant difference was observed in local recurrence rates (low‐risk, 1.0% vs. high‐risk, 1.4%; p = 1.000). Both cohorts exhibited low frequencies of severe wound complications ranging between 1.4 and 1.9%. No major radiation toxicities were reported in either group. In the subgroup analysis, low‐risk patients had significantly better mean scores in the subscales of inframammary fold and scar. Based on the BREAST‐Q patient‐reported outcomes questionnaire, seven out of nine parameters were scored similarly between both groups with no significant difference. Conclusion This study showed that the use of IORT in both low‐ and high‐risk early breast cancers is efficacious and safe with low recurrence rates and an acceptable toxicity profile.