Outcomes of intraoperative radiotherapy for early-stage breast cancer: Experience from a multidisciplinary breast oncology program

Rana, Shushan; Naik, Arpana; Pillai, S.; Vetto, John T.; Pommier, Rodney F.; Kubicky, Charlotte Dai

doi:10.1016/j.amjsurg.2019.06.014

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…The secondary endpoint was adverse events such as prolonged wound healing, excessive seroma or hematoma, or necrosis and was lower in BCS + IORT compared to the mastectomy groups. These results are concordant to a low complication rate of IORT in earlier publications [13,29].…”

Section: Discussionsupporting

confidence: 92%

Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient’s perspective

et al. 2020

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Purpose When ipsilateral breast-tumor recurrence (IBTR) following breast-conserving surgery (BCS) occurs, the cure of a potentially life-threatening disease is the main goal. If, however, this is diagnosed early, prognosis is still good and patient-reported outcomes become more important. Despite the fact that many patients would prefer a further BCS, international breast cancer guidelines still recommend mastectomy, mainly because previous radiation implies limited options. Our comparative study evaluates the long-term quality-of-life and outcome in patients with IBTR who received BCS plus intraoperative radiotherapy (IORT) versus mastectomy. Methods Patients with IBTR were retrospectively divided into three groups according to the local treatment: group 1 (n = 26) was treated with BCS + IORT; group 2 (n = 35) received a standard mastectomy; group 3 (n = 52) had a mastectomy with subsequent reconstruction. Outcomes were analyzed after a mean follow-up of 5 years after IBTR. Quality-of-life was evaluated by the validated questionnaire BREAST-Q in 50 patients who fulfilled the inclusion criteria. Results Quality-of-life scores varied within the groups, ranging from 51.4 to 91.3 (out of 100 points). We observed satisfactory scores in all items, with no statistical difference within the groups. Disease-free survival of all groups did not statistically differ, and overall mortality was very low (0.9%). The postinterventional complication rate was lower after BCS (19.2% versus 34.3% after mastectomy and 30.8% after mastectomy with reconstruction). Conclusion For patients with previous surgery and radiation who demand a second BCS in the recurrent situation, this surgical technique can be offered in combination with IORT. Our long-term results imply oncological safety, lower complication rate, and good patient satisfaction.

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Section: Discussionsupporting

confidence: 92%

Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient’s perspective

et al. 2020

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“…25 The Intraoperative Radiotherapy With Electrons (ELIOT) trials assessed the frequency and grade of RT-induced pulmonary fibrosis, comparing patients receiving intraoperative electron radiation therapy (IOERT) with those receiving EBRT; the results showed that 4% of the ELIOT arm versus 46% of the EBRT arm developed pulmonary fibrosis, with a higher risk-adjusted recurrence rate in the EBRT arm. 14 Although this study provides compelling evidence, notable differences from contemporary IORT studies included the use of IOERT equipment and the visual assessment used for the evaluation of fibrosis.…”

Section: Discussionmentioning

confidence: 88%

“…13 IORT has gained popularity in the past two decades, with multiple studies, including outcome-based studies, detailing its efficacy and noninferior results as compared with EBRT for early-stage breast cancer. 10,[14][15][16][17][18][19][20][21] IORT as a single fraction immediately after surgery (partial mastectomy) for early-stage small breast cancers, categorized as accelerated partial breast irradiation, has shown to produce positive cosmetic results with a single fraction of in situ RT delivered intraoperatively. 22 More than 90% of recurrences of breast cancer occur at or near the tumor bed; hence, a targeted dose of radiation near the operation site should intuitively reduce the recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

“…A recent retrospective study of 127 female patients from 2009 to 2016 characterized patients treated exclusively or with TARGIT-IORT (Zeiss Intrabeam) and detailed demographics, treatment outcomes, complication rates and the feasibility of IORT as a substitute for salvage mastectomy. 14 Limitations of the study included the use of a cohort restricted to a single institution with a short followup time (4 years) as compared with the minimum 5 years recommended.…”

Section: Discussionmentioning

confidence: 99%

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First Intraoperative Radiation Therapy Center in Africa: First 2 Years in Operation, Including COVID-19 Experiences

Ramdas

Benn

Heerden³

2020

JCO Global Oncology

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PURPOSE There is a shortage of radiation therapy service centers in low- to middle-income countries. TARGIT–intraoperative radiation therapy (IORT) may offer a viable alternative to improve radiation treatment efficiency and alleviate hospital patient loads. The Breast Care Unit in Johannesburg became the first facility in Africa to offer TARGIT-IORT, and the purpose of this study was to present a retrospective review of patients receiving IORT at this center between November 2017 and May 2020. PATIENTS AND METHODS Patient selection criteria were based mainly on the latest American Society of Radiation Oncology guidelines. Selection criteria included early-stage breast carcinoma (luminal A) and luminal B with negative upfront sentinel lymph node biopsy that negated external-beam radiation therapy (EBRT). Patient characteristics, reasons for choosing IORT, histology, and use of oncoplastic surgery that resulted in complications were recorded. RESULTS One hundred seven patients successfully received IORT/TARGIT-IORT. Mean age was 60.8 years (standard deviation, 9.3 years). A total of 73.8% of patients presented with luminal A, 15.0% with luminal B, and 5.6% with triple-negative cancer. One patient who presented with locally advanced breast cancer (T4N2) opted for IORT as a boost in addition to planned EBRT. Eighty-seven patients underwent wide local excision (WLE) with mastopexy, and 12 underwent WLE with parenchymal. Primary reasons for selecting IORT/TARGIT-IORT were distance from the hospital (43.9%), choice (40.2%), and age (10.3%). CONCLUSION This retrospective study of IORT/TARGIT-IORT performed in Africa confirms its viability, with low complication rates and no detrimental effects with breast conservation, resulting in positive acceptance and the potential to reduce Oncology Center patient loads. Limitations of the study include the fact that only short-term data on local recurrence were available. Health and socioeconomic value models must still be addressed in the African setting.

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“…With the wide application of radiotherapy in clinical practice, researchers have paid more attention on how to make better use of radiotherapy to improve the life quality of breast cancer patients. Recently, there have been many studies on radiotherapy for breast cancer, and researchers have proposed some options about its improvement and regimens [3][4][5]. However, researchers did not have a unified view on the improvement of radiotherapy for breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Low Expression of DDX60 Gene Might Associate with the Radiosensitivity for Patients with Breast Cancer

Xin

Liu

et al. 2020

Journal of Oncology

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DEXD/H box helicase 60 (DDX60) is a new type of DEAD-box RNA helicase, which is induced to express after virus infection. It might involve in antiviral immunity by promoting RIG-I-like receptor-mediated signal transduction. In addition, previous studies had shown that the expression of DDX60 is related to cancer, but there was still a lack of relevant research in breast cancer. In this study, we used the information of patients with breast cancer in the TCGA database for statistical analysis and found that the breast cancer patients with low expression of DDX60 exhibited radiosensitivity. Comparing the radiotherapy groups with the nonradiotherapy groups, for patients with low expression of DDX60, the adjusted hazard ratio (HR) values for radiotherapy were 0.244 (0.064–0.921) and 0.199 (0.062–0.646) in the training and validation datasets, with the p values 0.040 and 0.007, respectively. However, for patients with high expression of DDX60, the adjusted hazard ratio (HR) values were 3.582 (0.627–20.467) and 2.421 (0.460–12.773), with the p values 0.054 and 0.297, respectively. These results suggested that the expression of DDX60 might strongly associate with individualized radiosensitivity in patients with breast cancer.

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Outcomes of intraoperative radiotherapy for early-stage breast cancer: Experience from a multidisciplinary breast oncology program

Cited by 9 publications

References 24 publications

Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient’s perspective

Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient’s perspective

First Intraoperative Radiation Therapy Center in Africa: First 2 Years in Operation, Including COVID-19 Experiences

Low Expression of DDX60 Gene Might Associate with the Radiosensitivity for Patients with Breast Cancer

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