Local Recurrence Rates in Breast Cancer Patients Treated with Intraoperative Electron-Boost Radiotherapy Versus Postoperative External-Beam Electron-Boost Irradiation

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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“…Using sophisticated surgical techniques, the skin dose can be minimized. However, doses to the ribs and chest wall may still be problematic [23].…”

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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“…ELIOT is also be used to give booster doses. 31 A booster dose of 10-15 Gy given intraoperatively extends surgery by only 10-20 min, yet reduces the length of the conventional radiotherapy course by 2 weeks, with improved patient wellbeing and again reduced costs.…”

Section: Intraoperative Radiotherapymentioning

confidence: 99%

Breast conservation: Current results and future perspectives at the European Institute of Oncology

Veronesi¹,

Zurrida²

2007

Intl Journal of Cancer

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In the recent 10 years breast cancer treatments' scenario is radically changed. Extraordinary new surgical approaches give more and more conservative solutions both for the breast and especially for the axilla avoiding dissection in more than 80% of early cases. Instrumental early diagnosis and clinical prediction are now able to identify very initial cases often in premalignant stage. Technology arrived in the operating theatre for the intraoperative radiotherapy treatments giving to the patients the better quality of life with the help also of the plastic surgeons. There are still near horizons to reach: modern neo-adjuvant and adjuvant treatments are going quickly from the laboratory to patient's bed. ' 2007 Wiley-Liss, Inc.Key words: breast conservation; cancer prevention; genetics; diagnosis; therapy Over the last 4 decades, profound changes have occurred in breast cancer treatment, diagnosis and prevention, and radically new ways of conducting research have developed. Prognosis for the disease has improved markedly, patient quality of life has become a central concern and researchers and senologists are caught up in a whirlwind of new findings and concepts that has swept away notions thought consolidated just a few years ago. Conservative surgeryThe revolution in breast cancer treatment began in the 1970s with the large Milan I trial. This trial randomized 701 patients to either breast-conserving surgery (quadrantectomy, complete axillary dissection plus breast radiotherapy, QUART) or Halsted mastectomy. 1 Eligible patients had infiltrating carcinoma up to 2 cm, without clinically evident axillary involvement (T1N0), and were randomized in the operating room after excisional biopsy had confirmed histology and tumor size. The results, which ushered in the era of conservative surgery for all types of cancer, showed no difference in survival between the 2 arms. The most recent analysis of the Milan I results, after more than 20 years of follow-up 2 confirmed indistinguishable survival curves for the 2 arms ( Fig. 1): 28 (7.9%) conservatively treated patients and 8 (2.3%) in the Halsted arm developed local recurrences, but these events had no impact on survival. The low rate of adverse events in the QUART arm was partly attributable to the quadrantectomy operation, which was developed with the aim of achieving local control (in contrast to lumpectomy). Earlier studies had indicated that intraductal spread was relatively frequent in breast cancer, and in quadrantectomy, the entire portion of the ductal tree (up to the nipple) involved by the carcinoma is excised. Sentinel node biopsyA second major development in the surgical treatment of breast cancer was sentinel node biopsy. The first major study in this area, conducted at the European Institute of Oncology (EIO), randomized 516 patients to compare sentinel node biopsy plus immediate axillary dissection, with sentinel node biopsy plus axillary dissection only if the sentinel node was positive. After more than 5 years of follow-up, no differences between the ...

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“…The University of Salzburg treated two consecutive series of patients with Stages I and II breast cancer [ 68 ]. Group I consisted of 188 patients treated with breast-conserving surgery and postoperative irradiation to the whole breast, followed by a postoperative external beam boost to the tumor bed.…”

Section: Boost Clinical Results: Ioertmentioning

confidence: 99%

The Emerging Role of Intraoperative Radiation Therapy [IORT] in Breast Cancer

Goer¹,

Silverstein

2014

Breast Disease

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Local Recurrence Rates in Breast Cancer Patients Treated with Intraoperative Electron-Boost Radiotherapy Versus Postoperative External-Beam Electron-Boost Irradiation

Abstract: Immediate IORT boost yielded excellent local control figures in this prospective investigation and appears to be superior to conventional postoperative boost in a short-term follow-up.

Cited by 79 publications

References 31 publications

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

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

Breast conservation: Current results and future perspectives at the European Institute of Oncology

The Emerging Role of Intraoperative Radiation Therapy [IORT] in Breast Cancer

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