Whole Breast Irradiation Versus Intraoperative Electron Radiation Therapy for Breast Conserving Therapy: A Large Mature Single Institution Matched-Pair Evaluation of True Local Relapse, Progression Free Survival, and Overall Survival

Rose, F. De; Mussari, S.; Brina, Lucia Di; Ravanelli, Daniele; Ziglio, F.; Menegotti, L.; Ferro, Antonella; Caldara, A.; Berlanda, G; Gasperetti, Fabio; Magri, Elena; Bandera, L; Ferrazza, P.; Fersino, S.; Andolina, Maria; Martignano, A.; Delana, Anna; Selman, S. Bou; Vanoni, Valentina

doi:10.1016/j.ijrobp.2023.01.049

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…While several studies and meta-analyses have shown promising results of PBI in suitable low-risk breast cancer patients, 17,18 two recently published cohort studies and a randomized clinical trial reported higher than expected rates of IBTR in patients treated with electron beam IORT. [19][20][21] No effects were reported on distant metastasis rates, nor on cancer-specific or overall survival. 20,22,23 The aim of this study was to report our data on a large series of IBTR after electron beam IORT and to identify possible risk factors for IBTR in patients with suitable low-risk breast cancer.…”

Section: Introductionmentioning

confidence: 99%

“…While several studies and meta‐analyses have shown promising results of PBI in suitable low‐risk breast cancer patients, 17,18 two recently published cohort studies and a randomized clinical trial reported higher than expected rates of IBTR in patients treated with electron beam IORT 19–21 . No effects were reported on distant metastasis rates, nor on cancer‐specific or overall survival 20,22,23 …”

Section: Introductionmentioning

confidence: 99%

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Breast conserving surgery with intraoperative electron beam radiation therapy for low‐risk breast cancer: Five‐year follow‐up of 306 patients

de Jonge,

Schipper,

Walstra

et al. 2024

Intl Journal of Cancer

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Recent studies have reported a higher than expected risk of ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) and a single dose of electron beam intra‐operative radiotherapy (IORT). This finding was the rationale to perform a retrospective single center cohort study evaluating the oncologic results of consecutive patients treated with BCS and IORT. Women were eligible if they had clinical low‐risk (N0, ≤2 cm unifocal, Bloom and Richardson grade 1–2), estrogen receptor‐positive and human‐epidermal‐growth‐factor‐receptor‐2‐negative breast cancer. Prior to BCS, pN0 status was determined by sentinel lymph node biopsy. Data on oncologic follow‐up were analyzed. Between 2012 and 2019, 306 consecutive patients were treated and analyzed, with a median age of 67 (50–86) years at diagnosis. Median follow‐up was 60 (8–120) months. Five‐year cumulative risk of IBTR was 13.4% (95% confidence interval [CI] 9.4–17.4). True in field recurrence was present in 3.9% of the patients. In 4.6% of the patients, the IBRT was classified as a local recurrence due to seeding of tumor cells in the cutis or subcutis most likely related to percutaneous biopsy. In 2.9% of the patients, the IBRT was a new outfield primary tumor. Three patients had a regional lymph node recurrence and two had distant metastases as first event. One breast cancer‐related death was observed. Estimated 5‐year overall survival was 89.8% (95% CI 86.0–93.6). In conclusion, although some of IBTR cases could have been prevented by adaptations in biopsy techniques and patient selection, BCS followed by IORT was associated with a substantial risk of IBTR.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Breast conserving surgery with intraoperative electron beam radiation therapy for low‐risk breast cancer: Five‐year follow‐up of 306 patients

de Jonge,

Schipper,

Walstra

et al. 2024

Intl Journal of Cancer

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Intraoperative Radiation for Breast Tumors

Jones,

Johnson

2023

Interventional Oncology

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Improvement of plan quality in whole-breast radiation following BCS using feasibility DVH by less-experienced planners

Zhang,

Huang,

Luo

et al. 2024

Phys Eng Sci Med

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Variability in plan quality of radiotherapy is commonly attributed to the planner’s skill rather than technological parameters. While experienced planners can set reasonable parameters before optimization, less experienced planners face challenges. This study aimed to assess the quality of volumetric-modulated arc therapy (VMAT) in patients with left-sided breast cancer following breast-conserving surgery. Twenty-eight patients requiring whole-breast irradiation were randomly selected for inclusion. Each patient underwent two VMAT treatment plans: one optimized by an experienced planner (VMAT-EXP group) and the other designed by a less experienced planner using feasibility dose-volume histogram (FDVH) parameters from PlanIQ (VMAT-FDVH group). Both plans aimed to deliver a prescription dose of 50 Gy in 25 fractions to the planning target volume (PTV). Dosimetry parameters for the PTV and organs at risk (OARs) were compared between the two groups. Both the VMAT-EXP and VMAT-FDVH groups met the clinical plan goals for PTV and OARs. VMAT-FDVH demonstrated a PTV coverage and homogeneity comparable to those of VMAT-EXP. Compared to VMAT-EXP plans, VMAT-FDVH plans resulted in a significant reduction in the mean ipsilateral lung dose, with an average decrease of 0.9 Gy (8.5 Gy vs. 7.6 Gy, P < 0.001). The V5Gy and V20Gy of the ipsilateral lung were also reduced by 3.2% and 1.8%, respectively. Minor differences were observed in the heart, contralateral lung, breast, and liver. Personalized objectives derived from the feasibility DVH tool facilitated the generation of acceptable VMAT plans. Less experienced planners achieved lower doses to the ipsilateral lung while maintaining adequate target coverage and homogeneity. These findings suggest the potential for the effective use of VMAT in in patients with left-sided breast cancer following breast-conserving surgery, especially when guided by feasibility DVH parameters.

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Whole Breast Irradiation Versus Intraoperative Electron Radiation Therapy for Breast Conserving Therapy: A Large Mature Single Institution Matched-Pair Evaluation of True Local Relapse, Progression Free Survival, and Overall Survival

Cited by 6 publications

References 33 publications

Breast conserving surgery with intraoperative electron beam radiation therapy for low‐risk breast cancer: Five‐year follow‐up of 306 patients

Breast conserving surgery with intraoperative electron beam radiation therapy for low‐risk breast cancer: Five‐year follow‐up of 306 patients

Intraoperative Radiation for Breast Tumors

Improvement of plan quality in whole-breast radiation following BCS using feasibility DVH by less-experienced planners

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