Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer

Abstract

The aim of this study was to evaluate mammographic and sonographic changes at the surgical site within the first 2 years after IORT as a boost followed by whole-breast radiotherapy (WBRT), compared with a control group treated with WBRT alone. All patients had breast-conserving surgery for early-stage breast cancer. Group A: n = 27, IORT (20 Gy) followed by WBRT (46 Gy). Group B (control group): n = 27, WBRT alone (56-66 Gy). Mammography: fat necrosis in 14 group A versus four group B patients (P < 0.001); parenchymal scarring classified as unorganized at the last follow-up in 16 vs seven cases, respectively (P = 0.03). Ultrasound: overall number of patients with circumscribed findings 27 vs 18 (P < 0.001); particular hematomas/seromas in 26 vs 13 patients (P < 0.001). Synopsis of mammography and ultrasound: overall postoperative changes were significantly higher classified in group A (P = 0.01), but not judged to have a significantly higher impact on interpretation. Additional diagnostic procedures, due to unclear findings at the surgical site, were performed on four patients of both groups. Within the first 2 years after IORT as a boost, therapy-induced changes at the original tumor site are significantly more pronounced compared with a control group. There is no evidence that the interpretation of findings is complicated after IORT.

Mammographic Findings of Partial Breast Irradiation

“…Wasser et al (21) reported similar findings, in addition to increased fat necrosis at the boost IORT site. In contrast, our IORT patients had fewer postoperative fluid collections and less fat necrosis on follow-up mammography than our WBRT patients.…”

“…Only two studies have reviewed the mammographic findings of breast conservation surgery followed by IORT alone (20) and another on breast conservation surgery with IORT applied as a boost, followed by WBRT (21). Our study is the first to analyze the mammographic findings of treating breast cancer in vivo with IORT first and then immediately followed by breast conservation surgery (8).…”

“…In addition, our results contradict those of the two previous studies. In both studies, the authors claimed that the postoperative changes on mammography were more pronounced in patients treated with IORT compared to those treated with conventional WBRT (20,21).…”

Postoperatif Değerlendirme: Sorunlar ve Zamanlama

“…Nüksten ayırt edilmeleri oldukça zordur ve tanı sıklıkla kesici iğne biyopsisi ile konur. Yağ nekrozu bulgularının intraoperatif radyoterapi uygulanan hastalarda daha şiddetli olduğu bildirilmiştir [17].…”

Intraoperative Radiotherapie (IORT) beim Mammakarzinom mit dem INTRABEAM-System

“…Ebenso wird aufgrund der protrahierten Dosisapplikation ein niedriges Risiko einer Fibrose innerhalb der Brust postuliert, was mit den bisherigen klinischen Beobachtungen nach einer medianen Nachbeobachtungszeit von etwa 2 Jahren (maximal 5 Jahre) übereinstimmt [13,14,15,24].…”