In advanced high risk prostatic cancer, hyperthermia is feasible and well tolerated. It may be useful to enhance the radiotherapy efficacy at intermediate dose in order to avoid higher doses of irradiation which increases acute and late sequelae. The advantage of LHT combined with CRT should be confirmed by a randomized phase III trial, comparing irradiation plus AST with or without hyperthermia.

Preoperative CRT combined with regional HT yielded acceptable toxicity. The rate of pCR was encouraging, although further studies are needed to prove the long-term efficacy of adding HT to CRT.

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Background: Intraoperative radiotherapy during breast-conserving surgery is being studied as an alternative to 6 weeks of external beam radiotherapy (EBRT) for low-risk women; it can be delivered using electrons (intraoperative electron radiotherapy, IOERT) or 50-kV X-rays. Materials and Methods: We analyzed both single institutional and randomized studies involving single-fraction IOERT treatments. Rates for ipsilateral breast tumor recurrences, disease-specific survival, and overall survival were obtained. Results: IOERT had true 5-year recurrence rates of < 1.5% for ASTRO (American Society for Radiation Oncology) and ESTRO (European Society for Therapeutic Radiology and Oncology) suitable women, or for low-risk women as defined by the ELIOT trial. Women with ductal carcinoma in situ eligible for breast-conserving therapy, older women that currently receive no EBRT, and younger women with favorable biology are additional potential candidates. Conclusion: ASTRO suitable and ESTRO good women for accelerated partial breast irradiation are low-risk groups. Higher-risk women with favorable biology might also be suitable candidates for IOERT, providing the tumor biology can be determined prior to surgery. For intraoperative radiotherapy using 50-kV X-rays, follow-up was too short to assess the effectiveness of the treatment.

143 Background: We report the results of a single-institution phase II trial of accelerated partial breast irradiation (APBI) using a single dose of intraoperative electron radiotherapy (IOERT) in patients with low-risk early-stage breast cancer. Methods: From July 2006 to December 2009, 226 patients suitable for BCT were enrolled in a phase II trial with IOERT as radical treatment immediately after surgical resection. All patients had biopsy-proven cancer. After the surgeon temporarily re-approximated the excision cavity, a dose of 21 Gy using IOERT was delivered to the tumor bed with a margin of 2 cm laterally. Results: No acute reactions were reported after irradiation. Three patients experienced a transient edema. In 7 others a haematoma was observed. No cases of liponecrosis were observed. With a mean follow-up of 49 months (range 31-66 months), only one case of local recurrence has been reported. The observed toxicity was considered acceptable. As to cosmetic results, at 6 months after the end of IORT, 71/226 patients (31.4.%) had a score of 2 for symmetry and contour (asymmetry exhibited by 1/3 or less of volume breast), while 19/226 (8.4%) had a score 3 (asymmetry greater than 1/3 of breast volume). These findings remained unchanged at the following examinations. No breast oedema, discoloration at site or scar prominence were observed. Conclusions: IOERT offers the advantage of an excellent delineation of the tumor bed under visual control and high sparing of normal tissue, including the skin. IOERT delivers a very high biologically dose at the time of the surgery, when residual tumor cells are more rapidly proliferating. IOERT is insensitive to chemotherapy sequencing since all of the radiation is given during the surgery. The absolute recurrence rate of 0.4% and the recurrence rate per year of 0.2% of the present study are very encouraging. APBI using a single dose of IOERT can be delivered safely in women with early, low-risk breast cancer. A longer follow-up is needed to ascertain its efficacy compared to that of the current standard treatment of whole breast irradiation.

Background: Women with early stage disease not only have a better prognosis, but also have the opportunity to preserve their breasts. Despite the positive evidence and outcomes for breast-conserving therapy (BCT), many women are unable or unwilling to undergo 5–7 weeks of external-beam radiotherapy (EBRT). We report the results of a single-institution phase II trial of accelerated partial breast irradiation (APBI) using a single dose of intraoperative electron radiotherapy (IOERT) in patients with low risk early stage breast cancer. Methods and materials: From July 2006 to December 2009, 226 patients suitable for BCT were enrolled in a phase II trial with IOERT as radical treatment immediately after surgical resection. All patients had biopsy proven cancer. After the surgeon temporarily re-approximated the excision cavity, a dose of 21 Gy using IOERT was delivered to the tumor bed with a margin of 2 cm laterally. Results: No acute reactions were reported after irradiation. Three patients experienced a transient edema. In 7 others a haematoma was observed. No cases of liponecrosis were observed. With a mean follow-up of 49 months (range 31–66 months), only one case of local recurrence has been reported. The observed toxicity was considered acceptable. As to cosmetic results, at 6 months after the end of IORT, 71/226 patients (31.4.%) had a score of 2 for symmetry and contour (asymmetry exhibited by 1/3 or less of volume breast), while 19/226 (8.4%) had a score 3 (asymmetry greater than 1/3 of breast volume). These findings remained unchanged at the following examinations. No breast oedema, discoloration at site or scar prominence were observed. Discussion: IOERT has significant advantages compared to other post-operative APBI approaches. The surgical re-approximation of the tumor bed, combined with the high quality of electron beam radiation, generates substantially more uniform dose distributions. IOERT offers the advantage of an excellent delineation of the tumor bed under visual control and high sparing of normal tissue, including the skin. IOERT delivers a very high biologically dose at the time of the surgery, when residual tumor cells are more rapidly proliferating. IOERT is insensitive to chemotherapy sequencing since all of the radiation is given during the surgery. IOERT offers low-risk women the possibility of a one-day procedure to treat their cancer and preserve their breast. The results of our study are very encouraging compared with other series with IOERT or APBI. The absolute recurrence rate of 0.4% and the recurrence rate per year of 0.2% of the present study are lower compared to the ones from the largest series with IOERT ever published (3.6% and 1.2%, respectively) (1). Conclusion: APBI using a single dose of IOERT can be delivered safely in women with early, low risk breast cancer. A longer follow-up is needed to ascertain its efficacy compared to that of the current standard treatment of whole breast irradiation. References 1. Veronesi U, Orecchia R, Luini A, et al. Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast Cancer Res Treat 2010; 124:141–151. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-08.

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