Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

Malter, Wolfram; Kirn, Verena; Richters, Lisa; Fridrich, C; Markiefka, Birgid; Bongartz, Rudolf; Semrau, R.; Mallmann, Peter; Kraemer, Stefan

doi:10.1155/2014/637898

Cited by 13 publications

(7 citation statements)

References 38 publications

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“…In axillary lymph node dissection both insertion and omission have advantages and disadvantages [11]. Even though data from the TARGIT-A and ELIOT trial suggest that IORT may be an oncological reliable alternative to conventional postoperative fractionated irradiation in a low to medium risk collective [12], IORT is routinely used only as a boost followed by whole breast radiation in our hospital. IORT can be considered a safe treatment modality [13][14][15][16][17][18] but only a few authors have published data on IORT and seroma production [19].…”

Section: Discussionmentioning

confidence: 99%

Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost

Ebner

Schramm

Bottke

et al. 2016

Arch Gynecol Obstet

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Section: Discussionmentioning

confidence: 99%

Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost

Ebner

Schramm

Bottke

et al. 2016

Arch Gynecol Obstet

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“…The Cologne group has used IORT boost in 149 patients who also underwent an oncoplastic reconstruction (glandular rotation or mammoplasty), and have reported only post-operative toxicity, with a 2% seroma formation rate. Additional outcome and efficacy data from this and other series will be welcome ( 46 ).…”

Section: Io(e)rt Boostmentioning

confidence: 95%

Intraoperative Radiotherapy for Breast Cancer

Harris

Small

2017

Front. Oncol.

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Intraoperative radiotherapy (IORT) for early stage breast cancer is a technique for partial breast irradiation. There are several technologies in clinical use to perform breast IORT. Regardless of technique, IORT generally refers to the delivery of a single dose of radiation to the periphery of the tumor bed in the immediate intraoperative time frame, although some protocols have performed IORT as a second procedure. There are two large prospective randomized trials establishing the safety and efficacy of breast IORT in early stage breast cancer patients with sufficient follow-up time on thousands of women. The advantages of IORT for partial breast irradiation include: direct visualization of the target tissue ensuring treatment of the high-risk tissue and eliminating the risk of marginal miss; the use of a single dose coordinated with the necessary surgical excision thereby reducing omission of radiation and the selection of mastectomy for women without access to a radiotherapy facility or unable to undergo several weeks of daily radiation; favorable toxicity profiles; patient convenience and cost savings; radiobiological and tumor microenvironment conditions which lead to enhanced tumor control. The main disadvantage of IORT is the lack of final pathologic information on the tumor size, histology, margins, and nodal status. When unexpected findings on final pathology such as positive margins or positive sentinel nodes predict a higher risk of local or regional recurrence, additional whole breast radiation may be indicated, thereby reducing some of the convenience and low-toxicity advantages of sole IORT. However, IORT as a tumor bed boost has also been studied and appears to be safe with acceptable toxicity. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses. It may also be very useful in specific situations, such as prior to oncoplastic reconstruction to improve accuracy of adjuvant radiation delivery, or when used as a boost in higher risk patients to improve tumor control. Ongoing international clinical trials are studying these uses and follow-up data are accumulating on completed studies.

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“…However, in many countries, up to 30% patients who undergo BCS for early breast cancer decline RT or even opt for mastectomy to avoid radiotherapy because they live a substantial distance from a RT center, or have significant co-morbidities, or difficulties that prevent them from attending daily treatment, especially true for older women [ 7 , 8 ]. In addition, the increasing use of oncoplastic breast surgery which often rearranges the tumor bed position, amplifies the challenge of accurate delivery of RT boost to the tumor bed, even when the surgeon routinely places cavity clips to help in targeting the tumor bed [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis of intraoperative radiotherapy during breast-conserving surgery of early breast cancer in the Chinese Han population

et al. 2015

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PurposeWhile results of intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS) have been reported when used either as a boost at the time of surgery or as the sole radiation treatment, the clinical safety and cosmetic outcome of IORT in the Chinese Han population has not. This report reviews oncologic and cosmetic outcomes for Chinese Han breast cancer patients who received IORT either as a boost or as their sole radiation treatment at our hospital.MethodFrom July 2008 to December 2012, 50 early-stage Chinese Han breast cancer patients received BCS and IORT, either as boost or as their sole radiation treatment. Patients received adjuvant chemotherapy or hormonal therapy, according to our institution's guidelines. Patients were followed to determine oncologic events, short-term toxicity and overall cosmesis.ResultsWith a median follow-up of 51.8 months (range 22.6 months to 75.7 months), 2 patients (4.0%) developed local relapses and were salvaged by mastectomy. There were no metastases and no deaths. The average wound healing time was 17 days. Three patients (6.0%) developed postoperative infection, 5 patients (10.0%) had delayed wound healing, and 2 patients (4.0%) experienced wound edema. There were no lyponecrosis or hematomas observed. The evaluation of cosmetic outcome showed 44 patients (88.0%) graded as excellent or good while 6 patients (12.0%) were graded as fair or poor. No patients experienced radiotherapy related acute hematological toxicity, but 3 patients (6.0%), all IORT boost patients, developed skin pigmentation.ConclusionFor early-stage breast cancer patients, intraoperative radiotherapy after breast-conserving surgery in the Chinese Han population is both safe and reliable and has resulted in very acceptable cosmetic outcomes.

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Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

Cited by 13 publications

References 38 publications

Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost

Comparison of seroma production in breast conserving surgery with or without intraoperative radiotherapy as tumour bed boost

Intraoperative Radiotherapy for Breast Cancer

Clinical analysis of intraoperative radiotherapy during breast-conserving surgery of early breast cancer in the Chinese Han population

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