Intraoperative radiation therapy as part of breast conserving therapy of early breast cancer—Results of one-year follow-up

Wareńczak-Florczak, Żaneta; Roszak, A.; Bratos, K.; Milecki, Piotr; Karczewska-Dzionk, A.; Wlodarczyk, H.

doi:10.1016/j.rpor.2012.10.007

Cited by 10 publications

(10 citation statements)

References 11 publications

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“…A total of 88% of postwhole breast irradiation patients had no edema, and this result was comparable to other reports . Electron‐based IORT combined with whole breast irradiation resulted in comparable number of patients without breast edema, although the observation time was 1 year . In the UK IMPORT trial, as in our IORT only group, there were only a few cases of edema in the APBI arm .…”

Section: Discussionsupporting

confidence: 87%

“…Grade 2 pain was reported more frequently in other studies (6.9% and 10%), whereas in our group only one (1.2%) patient reported it. Wareńczak‐Florczak reported comparable results to ours with electron‐based intraoperative irradiation . Coles et al showed comparable number of patients with no pain post‐APBI irradiation, but more patients (45.7%) reported pain postballoon brachytherapy …”

Section: Discussionsupporting

confidence: 72%

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Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Falco¹,

Masojć²,

Rolla³

et al. 2020

Breast J

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Introduction: Intraoperative radiotherapy (IORT) based on low-kV photons may be an option for early breast cancer patients. Following Targit trial results some of those patients should undergo whole breast irradiation (WBRT) additionally. Material and methods:Since April 2010, IORT has been applied to early breast cancer patients. One hundred and fifty patients were prospectively followed up and examined to evaluate the side effects (pain, fibrosis, breast edema, telangiectasias). We present the results 3 years post-treatment. WBRT was given to 82 (54.7%) patients. Results:Tumor cavity fibrosis grade II and more was observed in 18 (12%) patients, as grade III only in 2 (1.33%) patients. Breast tissue fibrosis outside tumor cavity grade II was observed only in 2 (1.33%) patients. Breast edema was present in 10 (6.66%) patients. WBRT administration led to increased frequency of higher grade tumor cavity fibrosis (P < .0001), breast fibrosis (P < .0001), breast edema (P = .003), and occurrence of telangiectasias (P = .03), with no influence on pain reported by patients.In case of WBRT, tumor location (P = .026) and size of the irradiated breast (P = .015) were independent risk factors for higher degree of breast fibrosis, as seroma evacuation 6 months post-WBRT (P = .036) was the only independent risk factor for higher level of tumor cavity fibrosis in multiple regression. Conclusions:The cosmetic result after IORT is good and comparable to other accelerated partial breast irradiation techniques. Administration of WBRT post-IORT in breast cancer patients increases the level of fibrotic changes, breast edema and telangiectasias 3 years post-treatment, but with no influence on pain. K E Y W O R D Sbreast cancer, breast edema, fibrosis, intraoperative radiotherapy, pain, side effects, telangiectasias, whole breast radiotherapy

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 72%

Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Falco¹,

Masojć²,

Rolla³

et al. 2020

Breast J

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“…Following the two large clinical trial studies on IORT other centers have further reported their institutional experiences with IORT in early stage BC (12)(13)(14). Among which chowdhry et al (15) from the Massachusetts General Hospital reported on 109 patient who received IORT.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative radiation therapy for early stage breast cancer: experiences from Iran

Zangouri

Nasrollahi

Taheri

et al. 2020

Preprint

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Background and objective Currently no definite guideline exists on the use of intraoperative radiation therapy (IORT) among patients with early stage BC. We report our experiences with IORT among breast cancer (BC) patients in our region.Methods All patient who received radical IORT from April 2014 on to March 2020 were included in the study. Patient selection criteria were as followed: age equal or older than 45 years old; all cases of invasive carcinomas, moreover in lobular carcinomas only after MRI and confirmation, and in cases with ductal carcinoma in-situ (DCIS) only those with low, intermediate grade, tumor size of equal or less than 2.5cm and a margin of 2-3mm; those between 45 and 50 years old with a tumor size of 0-2cm, those between 50 and 55 years old with a tumor size of 2-2.5cm, and those ≥55 years old with a tumor size of 2.5-3cm; those with invasive tumors a negative margin and in cases of DCIS a margin of 3mm; a negative nodal status (exception in patients with micrometastasis); and a positive estrogen receptor status. Results Overall, 252 patients entered the study. Mean (SD) age of patients was 56.43±7.79 years. In total, 32.9% of patients had a family history of BC. Mean tumor size was 1.56±0.55 cm. Median (IQR) follow-up of patients was 24 (13, 36) months. Overall, 6 patients (2.4%) experienced recurrence in follow-up visits, among which three (1.2%) were local recurrence, two (0.8%) were regional recurrence and one patients (0.4%) had metastasis.Median (IQR) time to recurrence was 23 (13, 36) among the six patient who had recurrence. Overall, 11 patients (4.3%) with DCIS in our study received IORT. All these patients had free margins in histopathology examination. None of these patients experience recurrence.Conclusion For the first time, we categorized patients according to age and tumor size and older patients with larger tumor sizes were considered appropriate candidates for IORT. Our series showed a successful experience with the use of IORT in a region where facilities for IORT are limited using our modified criteria for patient selection.

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“…Histopathological studies on selected women for conservative surgery of the breast have demonstrated that it's improbable that the microscopic extension of the malignant cells reaches more than 1 cm [15] therefore local recurrence very probably develops from the cells that surround the primary tumor and not from additional cancer foci, this suggests that the primary target that requires adjuvant treatment with radiotherapy following a lumpectomy (with negative margins) it's probably limited by a 2 cm area around the borders of the cavity [16]- [18]. Taking that into account to avoid risks of recurrence for single dose treatments we deliver a dose of 20 Gy prescribed at 2 mm, that for instance for a 3.5 cm diameter applicator will deliver a 6.9 Gy at a depth of 1 cm, plus the margins given at the lumpectomy it broadens the area of treatment to include the volume desired.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Radiation Therapy (INTRABEAM) Experience at the Mastology Unit Leopoldo Aguerrevere Clinic

Muñoz¹,

Hany²,

Cosson³

et al. 2015

JCT

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Introduction: External radiation therapy has been the fundamental pillar when treating breast cancer. Partial radiation therapy and intraoperative radiation treatment have created modifications that allow the irradiation of the breast to be performed at the surgical act delivering a single large fraction or a "boost" dose directly at the tumor bed. We will discuss patients treated with INTRABEAM (Carl Zeiss Surgical Oberkochen, Germany) at the "Mastology Unit at Leopoldo Aguerrevere Clinic". Materials and Methods: The selection of patients is crucial for the success of the treatment, same protocol of treatment has been applied to every patient at the surgical act. Since September 2013 until February 2015, we have treated a total of 148 patients with the INTRABEAM unit, we will discuss the 114 patients treated by the team at the "Mastology Unit at Leopoldo Aguerrevere Clinic" with ages between 31 and 87 years in which 46% were single treatments and 54% were treated as a "boost" for external radiation therapy. Results: The procedure has been well tolerated with only a 17% of transient fibrosis and a 12% of seromas. We have had none mayor complications like dehiscence of the wound or necrosis of the borders. Conclusion: With this preliminary presentation, we would like to demonstrate that the technique and protocol used at our mastology unit with the intraoperative radiation treatment is safe and has many advantages to the patients including better comfort, cost-effective and with results comparable to external radiotherapy.

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Intraoperative radiation therapy as part of breast conserving therapy of early breast cancer—Results of one-year follow-up

Abstract: Due to its exceptional physical and radiobiological properties, intraoperative radiation therapy can be a good alternative to other methods of boosting dose to the post-operative site in management of low stage breast cancer, enabling a precise therapy to the tumour bed.

Cited by 10 publications

References 11 publications

Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Intraoperative radiation therapy for early stage breast cancer: experiences from Iran

Intraoperative Radiation Therapy (INTRABEAM) Experience at the Mastology Unit Leopoldo Aguerrevere Clinic

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