Intraoperative radiotherapy in early breast cancer

Esposito, E.; Anninga, Bauke; Harris, Sarah; Capasso, Immacolata; D’Aiuto, Massimiliano; Rinaldo, Massimo; Douek, Michael

doi:10.1002/bjs.9781

Cited by 32 publications

(30 citation statements)

References 67 publications

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“…Although recent trials have reported lower recurrence rates, this is partly due to shorter follow‐up and better patient selection and may not generally apply to a community setting. A meta‐analysis found that older patients with small, low grade, oestrogen‐receptor (ER)‐positive tumours have a low recurrence rate and are possible candidates for omitting RT in some clinical circumstances, 5 and other researchers have tested accelerated partial breast irradiation in this low risk group 7 …”

Section: Radiation After Conservative Surgerymentioning

confidence: 99%

Radiation therapy and early breast cancer: current controversies

Boyages

2017

Medical Journal of Australia

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Radiation therapy (RT) is an important component of breast cancer treatment. RT reduces local recurrence and breast cancer mortality after breast conservation for all patients and for node-positive patients after a mastectomy. Short courses of RT over 3-4 weeks are generally as effective as longer courses. A patient subgroup where RT can be avoided after conservative surgery has not been consistently identified. A radiation boost reduces the risk of a recurrence in the breast but may be omitted for older patients with good prognosis tumours with clear margins. Axillary recurrences can take a long time to appear, with 35% occurring after 5 years. Leaving disease untreated in regional nodes is associated with reduced survival. Not all patients require radiation after neoadjuvant chemotherapy and a subsequent mastectomy. Modern RT equipment and techniques will further improve survival rates.

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Section: Radiation After Conservative Surgerymentioning

confidence: 99%

Radiation therapy and early breast cancer: current controversies

Boyages

2017

Medical Journal of Australia

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“…IORT can be delivered by various mechanismsincluding low-energy X-rays, electron beam radiation therapy (EBRT), high-dose-rate (HDR) afterloaders and other hybrid devices (11). IORT methods have been evaluated in the setting of early stage breast cancer (BC) in Europe, and, more recently, in the US with non-inferior mortality compared to WBI.…”

Section: Introductionmentioning

confidence: 99%

21-gene recurrence assay in patients receiving intraoperative radiotherapy: are “favorable” characteristics a surrogate for low recurrence?

et al. 2017

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Background: Intraoperative radiotherapy (IORT) has gained momentum for early stage and favorable breast cancers (BC). The 21-gene recurrence assay guides treatment of hormone positive and node-negative BC. Data collection included patient demographics, tumor characteristics, nodal status, recurrence test (RS) and adjuvant therapy.Results: The mean age was 68 years. Tumors were stage Ia (86.6%), 3.6% Ib and 9.8% IIa. Of 50 patients (61.0%) with RS testing, 72% (n=36) were low risk (RS 0-17), with 28% (n=14) at intermediate risk . The 39% (n=32) of patients without RS testing, were more likely to have smaller tumors (1.3 vs. 0.9 cm) and age >70 (P<0.05).Conclusions: Most patients selected for IORT based on clinical features were indeed low risk based on RS. Given the limited long-term clinical outcome and safety data of this technique, additional investigation is needed.

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“…); 4) less dose to normal tissues, reducing the risk of radiation-induced second primary tumors; 5) shortened overall treatment time; 6) better cosmetic outcome with less pigmentation, dryness and swelling of skin; 7) reduction in healthcare costs. The disadvantages of IORT are: 1) increased operating times; 2) lack of final pathological results before delivering IORT; 3) small increase local recurrence rates compared with conventional EBRT in two RCTs [ 17 , 18 ]; 4) staff training and operating room equipment efforts; 5) expensive devices [ 19 ].…”

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 radiotherapy in early breast cancer

Cited by 32 publications

References 67 publications

Radiation therapy and early breast cancer: current controversies

Radiation therapy and early breast cancer: current controversies

21-gene recurrence assay in patients receiving intraoperative radiotherapy: are “favorable” characteristics a surrogate for low recurrence?

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

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