IORT for Breast Cancer

Battle, J.A.; Dubois, Jean‐Bernard; Merrick, Hollis W.; Dobelbower, Ralph R.

doi:10.1007/978-1-59259-696-6_28

Cited by 12 publications

(9 citation statements)

References 9 publications

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“…This suggests that despite the lack of pectoral muscle protection in the group of delayed radiotherapy, the patients did not show an increasing rate of capsular contracture. Many authors underline the possibility of NAC preservation without ELIOT [13,[20][21][22][23][24][26][27][28][29]. The lack of difference in the local recurrence rate between our study and others studies published should question the need of radiotherapy.…”

Section: Discussionmentioning

confidence: 46%

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Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)

Veronesi²,

Orecchia

et al. 2009

Breast Cancer Res Treat

214

138

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In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were performed from March 2002 to November 2007 at the European institute of oncology (EIO), for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%.Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 800 patients who received ELIOT and the 201 who underwent delayed one-shot radiotherapy on the days following the operation. The median follow up time was 20 months (range 1-69) for a follow up performed in 83% of the patients. The NAC necrosed totally in 35 cases (3.5%) and partially in 55 (5.5%) and was removed in 50 (5%). Twenty infections (2%) were observed and 43 (4.3%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 15% of the patients reported a partial sensitivity of the NAC. Of the fourteen (1.4%) local recurrences, ten occurred close to the tumour site, all far from the NAC corresponding to the field of radiation. No recurrences were observed in the NAC. In a group of patients characterized by a very close free margin under the areola, no local recurrence was observed. Overall, 36 cases of metastases and 4 deaths were observed. No significant outcome difference was observed between the 800 patients receiving intraoperative radiotherapy (ELIOT) and the 201 patients receiving delayed irradiation.

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Section: Discussionmentioning

confidence: 46%

“…The ELIOT technique has also already been described [21][22][23][24]. In our technique 16 Gy were delivered to the NAC in a single fraction with lead and aluminium disk protection of the pectoralis muscle and thoracic wall.…”

Section: Methodsmentioning

confidence: 99%

Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)

Veronesi²,

Orecchia

et al. 2009

Breast Cancer Res Treat

214

138

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“…Since the beginning of IORT in breast cancer treatment in the late 1990ies [24,25], new mobile technologies have been developed. Only few data are available regarding perioperative and short-term postoperative morbidity in IORT boost patients from pilot trials.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Radiotherapy (IORT) as a Boost in Patients with Early-Stage Breast Cancer – Acute Toxicity

Kraus-Tiefenbacher¹,

Bauer

Kehrer³

et al. 2006

Oncol Res Treat

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Background: We report on acute toxicities as well as the early cosmetic outcome of patients receiving intraoperative radiotherapy (IORT) followed by whole-breast radiotherapy (WBRT) compared to patients treated with standard WBRT alone. Patients and Methods: From 2/2002 until 2/2005, 84 breast cancer patients were treated with IORT during breast-conserving surgery (BCS) as a boost (20 Gy/50 kV X-rays) followed by WBRT. After wound healing, all IORT patients were treated with WBRT at a total dose of 46 Gy. For the purpose of comparison, 53 patients treated consecutively between 1/2003 and 12/2004 in our institution with BCS followed by WBRT at a total dose of 50-66 Gy, were analyzed. All patients had a defined followup schedule. Toxicities were prospectively documented using the CTC/EORTC Score. Cosmesis was evaluated after 6 months using a 1-4 score. Results: Treatment was well tolerated with no grade 3/4 acute toxicity. Rare adverse effects following IORT included wound healing problems (2%), erythema grade I-II (3%), palpable seroma (6%) and mastitis (2-4%). The number of patients with induration of the tumor bed was comparably low. Conclusion: IORT with the IntrabeamTM system applied as a boost during BCS, followed by 46 Gy WBRT, exerts similar acute toxicity as standard WBRT. Further follow-up is needed to assess long-term toxicity and efficacy.

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“…The technique of ELIOT has been described in breast conserving surgery [10,11,14]. A total dose of 16 Gy (at the point of maximum dose) is delivered in the region of the NAC.…”

Section: Eliotmentioning

confidence: 99%

“…Based on the results of intra-operative radiotherapy (ELIOT) studies [2,[9][10][11][12][13][14], we assumed that an intraoperative radiotherapy with electrons could avoid or decrease the risk of LR in selected patients with preserved NAC.…”

Section: Introductionmentioning

confidence: 99%

Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases

Petit

Veronesi

Rey

et al. 2008

Breast Cancer Res Treat

145

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International audienceWhen the conservative treatment is not recommended, Nipple Sparing Mastectomy (NSM) is proposed more and more frequently for the surgical treatment of breast cancer. The risk of local recurrence behind the nipple areolar complex (NAC) is the main limiting factor of the NSM procedure. To minimize such risk, we proposed in 2002 a intraoperative radiotherapy of the preserved NAC. From March 2002 to November 2006, 579 cases (in 570 patients) of NSM were performed for carcinoma. The median follow up time was 19 months (Range: 1–60). The subcutaneous mastectomy was performed through an incision removing a portion of the skin overlying the tumour. An extemporaneous histological examination was performed on the retroareolar glandular tissue. If the histology was positive the patient was not considered eligible. Then an intraoperative radiotherapy with electrons (ELIOT) of 16 Gy in one shot was delivered on the NAC area. An immediate breast reconstruction was done using implants in most cases and in several cases a musculocutaneous flaps, usually in large breast. The number of local recurrences was recorded and the correlation between their occurrence and the clinical and histological criteria were analysed using the Gray test statistical method in a competing framework. In 516 cases the negative retroareolar frozen section biopsy was confirmed by the final histology, while in 63 cases, the final histology showed foci of carcinoma. Seven out of these 63 cases underwent a secondary NAC removal. In the 56 cases which preserved areolas we did not observe any local recurrence after 19 months follow up. The probability of retro areola positive histology increases with the tumour size. and was not related to the nodal status. The rate of local relapses was 0.9% per year. We didn't find any significant difference in the local relapse rate according to different patient's and tumour's features. Most relapses were located close to the tumour bed but never in the NAC area. Our study confirms that the local recurrence rate in the NSM completed with local radiotherapy on the NAC is not higher than the usual rate observed in the literature and the preservation of the NAC does not increase the risk. The absence of local recurrence in the region where a portion of glandular tissue has been purposely preserved is a good argument in favour of ELIOT

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IORT for Breast Cancer

Cited by 12 publications

References 9 publications

Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)

Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO)

Intraoperative Radiotherapy (IORT) as a Boost in Patients with Early-Stage Breast Cancer – Acute Toxicity

Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases

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