Our intraoperative boost radiotherapy experience and applications

Abstract

INTRODUCTIONBreast conserving surgery (BCS) and radiotherapy (RT) has been the standard treatment in breast cancer therapy in appropriate cases, as a result of studies and improvements achieved especially within the last 30 years. Due to the high likelihood of recurrence rates if adjuvant RT is not applied, postoperative boost RT is applied to the tumor bed (1-3).Whole breast irradiation (WBI) performed as an adjuvant therapy and again boost RT effectively controls the primary tumor site and the around of 1-2 cm where recurrence is the most common. However, in the postoperative treatment plan after pathologic examination sometimes the timing of chemotherapy (CT) (RT-CT sequence) and sometimes the location of the tumor bed are subject to change (4). This situation may result in detrimental results in terms of tumor recurrence. It is reported that intraoperative boost radiotherapy (IObRT) effectively reduces the likelihood of local recurrence as compared to adjuvant boost RT, and generates a significant difference (5, 6). Thanks to this effect of IObRT, WBI may possibly be performed later giving chemotherapy a priority.Intraoperative boost radiotherapy is beneficial to the hospital both for the treatment of a particular patient and for the treatment of other patients being treated in the same center by enabling more time and improving service quality. MATERIAL AND METHODS Case Selection CriteriaPatients who were suitable for IObRT have been selected as a candidate in our hospital's breast council within breast cancer patients who were planned to undergo BCS. In this selection, the histologic features of the tumor, if the breast tissue will allow the required flap thickness to be created surgically, if it is fatty or pendular were taken into consideration. All patients under 60 years of age were regarded as candidates if their breast tissue complied with the above-mentioned features. Tumors smaller than 3 cm in diameter, clinical and radiologic N0 patients, those without an identified BRCA1 and/or 2 mutation, those with a high likelihood of local recurrence according to histopathologic variables, patients with invasive ductal carcinoma histologic and nuclear grade 2-3 were chosen as a espetially. The selection Objective: To present our experience since November 2013, and case selection criteria for intraoperative boost radiotherapy (IObRT) that significantly reduces the local recurrence rate after breast conserving surgery in patients with breast cancer. Material and Methods:Patients who were suitable for IObRT were identified within the group of patients who were selected for breast conserving surgery at our breast council. A MOBETRON (mobile linear accelerator for IObRT) was used for IObRt during surgery. Results:Patients younger than 60 years old with <3 cm invasive ductal cancer in one focus (or two foci within 2 cm), with a histologic grade of 2-3, and a high possibility of local recurrence were admitted for IObRT application. Informed consent was obtained from all participants. Lumpectomy and sentinel lymph n...

Effect of the Order of Adjuvant Treatment on the Cosmetic Results of Patients with Breast Cancer Treated with Breast- Conserving Surgery and Intraoperative Boost Radiotherapy

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Eficacia, efectividad y seguridad de la radioterapia intraoperatoria en carcinoma de mama

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