IORT for Early Breast Cancer: A Report on Long-Term Results

Merrick, Hollis W.; Battle, J.A.; Padgett, Bethany; Dobelbower, Ralph R.

doi:10.1159/000061177

Cited by 58 publications

(33 citation statements)

References 4 publications

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“…So far, dose applications with intraoperative techniques have shown excellent treatment tolerance with no increased rates of acute adverse effects such as delayed wound healing or infection rates in comparison to conventional external radiotherapy [7,26,27,28]. …”

Section: Clinical Resultsmentioning

confidence: 99%

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Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer

et al. 2018

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IOERT (intraoperative electron radiotherapy) in breast cancer is used either as a boost (10-12 Gy) followed by whole breast irradiation (WBI) or as full-dose partial breast irradiation (PBI, 20-24 Gy) during breast-conserving surgery. IOERT has the longest evidence of all IORT techniques. When administered as a boost, excellent low local recurrence rates were observed in long-term follow-up >5 years. Even in high-risk groups like triple-negative or locally advanced breast cancers, IOERT contributes to long-term local control rates of more than 90%. For selected low-risk groups, IOERT as PBI with 21 Gy seems to be a viable treatment alternative to standard WBI. IOERT has been shown to be advantageous for several reasons: Geographic misses are avoided due to direct visualization of the tumor bed; thus, a high single dose is delivered with utmost precision to small volumes, completely sparing the skin and ensuring good long-term cosmetic outcome. Furthermore, high single doses seem to induce biological mechanisms with verifiable antitumor capability in in-vitro cell-line studies. In addition, IOERT markedly shortens the overall treatment time both in combination with (now mostly hypofractionated) WBI or as a PBI in selected low-risk constellations.

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Section: Clinical Resultsmentioning

confidence: 99%

“…Intraoperative electron radiotherapy (IOERT) was introduced over 20 years ago in 2 small series published by Merrick et al [7 ]and DuBois et al [8]. …”

Section: Rationale For a Boost And Biology Of High Single Dosesmentioning

confidence: 99%

Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer

et al. 2018

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“…Additional radiotherapy should play the same role as in the breast conservative treatment reducing the local recurrence risk in the remaining breast tissue. Therefore, we proposed combining subcutaneous mastectomy with intraoperative radiotherapy with electrons (ELIOT) [19]. Since 2002, a growing number of patients received this new treatment modality, termed nipple sparing mastectomy (NSM).…”

Section: Introductionmentioning

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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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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“…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 Early Breast Cancer: A Report on Long-Term Results

Cited by 58 publications

References 4 publications

Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer

Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer

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

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