A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer

Abstract

BackgroundSince the results from the randomized TARGIT A trial were published, intraoperative radiotherapy (IORT) is used more often. IORT can be provided as accelerated partial breast irradiation (APBI) or as a boost. The definition of suitable patients for IORT as APBI differs between different national societies (e.g. ESTRO and ASTRO) and different inclusion criteria of trials and so does the eligibility of patients. This analysis identifies eligible patients for IORT according to available consensus statements and inclusion criteria of the ongoing TARGIT trials.MethodsBetween 01/03 – 12/09, 1505 breast cancer cases were treated at the breast cancer center at the University Medical Center Mannheim. Complete data sets for age, stage (T, N, and M), histology and hormone receptor status were available in 1108 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favorable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E “elderly”, risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology, phase II: ≥70 years, IDC, T1, N0, any hormone receptor status, M0; TARGIT C “consolidation”, risk adapted radiotherapy, phase IV: ≥50 years, IDC, T1, N0, positive hormone receptor status, M0; TARGIT BQR “boost quality registry”: every age, every histology, T1-2 (max. 3.5 cm), any hormone receptor status, N0/+, M0/+.ResultsOut of the 1108 cases, 379 cases (34.2%) were suitable for IORT as APBI regarding the ESTRO and 175 (15.8%) regarding the ASTRO consensus statements. 82 (7.4%) patients were eligible for the TARGIT E trial, 258 (23.3%) for the TARGIT C trial and 671 (60.6%) for the TARGIT BQR registry. According to the consensus statements of ASTRO (45.1%) and ESTRO (41.4%) about half of the eligible patients were treated with IORT as APBI. From the eligible patients fulfilling the criteria for IORT boost (35%) about one third was eventually treated.ConclusionsPatient selection for IORT should be restrictive. For IORT as APBI the TARGIT trials are even more restrictive including patients than the ESTRO and ASTRO consensus statements.

miR-15b/16-2 Regulates Factors That Promote p53 Phosphorylation and Augments the DNA Damage Response following Radiation in the Lung

“…Acute radiation pneumonitis and chronic radiation fibrosis represent common consequences of radiation exposure in the setting of treatment of various cancers (22), including non-small cell lung cancer, small cell lung cancer (23), breast cancer (24), esophageal cancer (25), mediastinal tumors (26), and head and neck tumors (27). Although the underlying biology of radiation-induced injury to the lung is becoming increasingly known, few actionable targets exist for the purposes of therapy.…”

“…E, HBECs were transfected with scramble and silencer-miR-15b and incubated for 24 h. Cells were then treated with IR (4 Gy) and incubated for another 24 h. Total RNA was extracted, cDNA was synthesized, and qRT-PCR was performed with miR-15b primer (*, p Ͻ 0.001). 24 h after transfection, cells were exposed to IR and incubated for another 24 h. Total proteins were extracted, and the presence of Wip1, total and phosphorylated ATM, total and phosphorylated Chek1, MDM2, phospho-p53, ␥-H2AX, Rad51, and cleaved PARP was assessed by Western blot analysis (Fig. 6A).…”

The Dosimetric Characteristics and Potential Limitation in Clinical Application of a Low Energy Photon Intra-Operative Radiotherapy System

“…Vaidya JS et al have reported in TARGIT A, a phase III clinical trial that for patients with early breast cancer <2 cm the tumor local control rate of IORT is not inferior to external beam radiotherapy after breast conserving surgery; external beam radiotherapy should be considered for patients with tumor of 2 -3 cm or with poorer prognostic factors [6]. Sperk E et al have reported that patient selection for IORT should be restrictive when provided as accelerated partial breast irradiation (APBI) [4].…”

“…Dedicated IORT device commercially available includes Mobetron ® MeV electron beam system [1] (Intra Op Medical Corporation, California, USA), NOVAC™ 7 system (New Radiant Technology SpA, Italy) and the INTRABEAM ® 50 kV X-ray device (Carl Zeiss Medical Company, Germany). Since the results from the randomized TARGIT A trial were published, IORT has been applied for locally advanced or recurrent rectal cancer [2], superficial cutaneous malignancies [3] and as full dose partial breast irradiation (PBI) or as a boost after whole-breast radiatherapy (WBI) in early stage breast cancer [4] [5]. Vaidya J.S.…”

Accelerated Partial Breast Irradiation in Clinical Practice

“…This development was supported by novel insights into breast cancer tumor biology. The concept of accelerated partial breast irradiation (APBI) was rigorously tested in several large-scale clinical studies [4,5,6,7], and has now entered clinical guidelines (for a summary, see [8,9]). The current article reviews some of the underlying biological concepts, summarizes the results of the practice-changing clinical trials and tries to give an overview on the current status of ongoing additional clinical studies.…”