Hypofractionated whole breast irradiation after IORT treatment is safe in patients receiving adjuvant chemotherapy

PurposeThe purpose of this study was to assess the effectivity of upfront kilovoltage intraoperative radiotherapy (IORT) as a boost in high-risk early-stage breast cancer patients from an international pooled cohort.Materials/MethodsPatients from four centers in three different countries were retrospectively screened. Those with a minimum 1-year follow-up were included. Cumulative local (LR), regional (RR), and distant metastasis rates (DM) were analyzed. Additionally, the estimated overall survival (OS) was assessed. The Cox regression analysis was performed to identify failure predicting factors.ResultsA total of 653 patients from centers in Peru, Spain, and Germany were included. The median follow-up was 55 (12–180) months, and age was 58 (27–86) years. Clinical tumor (T) staging was T1 65.85%, T2 30.17%, and T3 3.98%. Positive margins were found in 7.9% and in-situ component in 20.06%. The median IORT dose was 20 (6–20). The median time from IORT to EBRT was 74.5 (13-364) days. An overall 3.4% (n = 22) of patients developed local recurrence at some point during follow-up. The 12-, 60-, and 120-month cumulative LR were 0.3%, 2.3%, and 7.9%, respectively. After multivariate analysis, only age <50 remained to be a significant prognostic factor for local recurrence (HR 0.19, 95% CI 0.08–0.47; p < 0.05). The 10-year estimated OS was 81.2%.ConclusionUpfront boost with IORT yields similar local control outcomes to those EBRT-based reports. Results from prospective trials, regarding toxicity, cosmesis, and effectivity are awaited to confirm these findings.

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“…Additionally, complementary hypofractionated EBRT does not seem to impair cosmetic outcomes, as recently reported by Burgos-Burgos et al. ( 37 )…”

Section: Discussionsupporting

confidence: 71%

Long-Term Outcomes of an International Cooperative Study of Intraoperative Radiotherapy Upfront Boost With Low Energy X-Rays in Breast Cancer

et al. 2022

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“…Hormonal therapy was prescribed according to international guidelines [ 18 , 19 ]. The IORT treatment in our institution has been previously described [ 15 , 16 ]. In short, a radiation dose of 20 Gy was prescribed to the surface of the applicator [ 15 , 16 ] of a portable low-energy X-ray accelerator (50 kv), Intrabeam ® (Carl-Zeiss Ober Kochen Germany).…”

Section: Methodsmentioning

confidence: 99%

“…The IORT treatment in our institution has been previously described [ 15 , 16 ]. In short, a radiation dose of 20 Gy was prescribed to the surface of the applicator [ 15 , 16 ] of a portable low-energy X-ray accelerator (50 kv), Intrabeam ® (Carl-Zeiss Ober Kochen Germany). Postoperative whole breast irradiation (WBI) was administered to patients showing the TARGIT A adverse factors present in the pathology report [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

“…WBI treatment after IORT in our institution has been previously described [ 15 , 16 ]. All patients were treated by the VMAT-Rapid Arc technique.…”

Section: Methodsmentioning

confidence: 99%

“…In these cases, photon-intraoperative radiotherapy (IORT) as a technique to administer this “boost” would be an attractive approach, allowing the administration of a single high dose of radiation in the same surgical procedure with direct visualization of the surgical bed (avoiding its geographic loss prior to oncoplastic manipulation), saving total treatment time and achieving significant savings in doses to the skin [ 14 ]. The safety and feasibility of the combination of moderate hypofractionation WBI and IORT boost have already been assessed by our group [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Combined Ultrahypofractionated Whole-Breast Irradiation and IORT-Boost: A Safety and Feasibility Analysis

Burgos-Burgos,

Vega,

Macias-Verde

et al. 2024

Cancers

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Background: The current standard of local treatment for patients with localized breast cancer (BC) includes whole breast irradiation (WBI) after breast-conserving surgery (BCS). Ultrahypofractionated WBI schemes (1-week treatment) were shown not to be inferior to the standard WBI. Tumor bed boost using photon intraoperative radiotherapy (IORT) is safe and feasible in combination with standard WBI. The aim of the present study is to assess, for the first time, the feasibility and safety of combining photon IORT with ultrahypofractionated WBI. Methods: Patients diagnosed with low-risk early BC candidates for BCS were included in this prospective study. IORT was administered at a dose of 20 Gy to the surface’s applicator, and WBI was administered 3–5 weeks after surgery at a total dose of 26 Gy in five consecutive days. Results: From July 2020 to December 2022, seventy-two patients diagnosed with low-risk early BC and treated in our institution were included in this prospective study. All patients completed the proposed treatment, and no severe acute or late grade 3 toxicity was observed 3 and 12 months after WBI, respectively. Conclusions: Our results confirm for the first time that the combination of ultrafractionation WBI and photon-IORT after BCS is a feasible and safe option in patients with early BC.

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IORT-photon boost plus hypofractionated whole breast irradiation in patients with breast cancer after primary systemic treatment: feasibility, safety and clinical results

Burgos-Burgos,

Vega,

Macias-Verde

et al. 2024

Clin Transl Oncol

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Hypofractionated whole breast irradiation after IORT treatment is safe in patients receiving adjuvant chemotherapy

Cited by 8 publications

References 13 publications

Long-Term Outcomes of an International Cooperative Study of Intraoperative Radiotherapy Upfront Boost With Low Energy X-Rays in Breast Cancer

Long-Term Outcomes of an International Cooperative Study of Intraoperative Radiotherapy Upfront Boost With Low Energy X-Rays in Breast Cancer

Combined Ultrahypofractionated Whole-Breast Irradiation and IORT-Boost: A Safety and Feasibility Analysis

IORT-photon boost plus hypofractionated whole breast irradiation in patients with breast cancer after primary systemic treatment: feasibility, safety and clinical results

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