A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated

Veronesi, Umberto; Orecchia, Roberto; Luini, Alberto; Gatti, Giovanna; Intra, Mattia; Zurrida, Stefano; Ivaldi, Giovanni Battista; Tosi, G; Ciocca, Mario; Tosoni, Antonella; Lucia, F. De

doi:10.1016/s0959-8049(01)00285-4

Cited by 263 publications

(145 citation statements)

References 10 publications

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“…Intraoperative radiation therapy (IORT) has been utilized in patients with breast carcinoma to provide an intraoperative boost dose of 9 Gy to the local tumor bed, with IORT followed by additional external beam radiation therapy to the whole breast over the course of 6 weeks. [51][52][53] Investigators utilizing IORT for the boost dose state that directed application of the radiation dose can avoid the problem of a geographic miss and can ensure that the skin is not irradiated and therefore that cosmesis is improved. However, complications (primarily at the skin and the chest wall and ribs) are a major concern and limit the intraoperative dose.…”

Section: Intraoperative Radiation Therapymentioning

confidence: 99%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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Section: Intraoperative Radiation Therapymentioning

confidence: 99%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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“…In this formula, n is the number of fractions and d is the dose/fraction. This equation was used to calculate the BEDs for early and late responses and tumor control for the hypofractionated schedule (five fractions of 6 Gy delivered within 10 days) and two standard schedules (25 fractions of 2 Gy within 5 weeks, considered the standard treatment without a boost [24] and 30 fractions of 2 Gy within 6 weeks-46 Gy to the entire index breast plus a boost of 14 Gy to the tumor cavity, considered the standard treatment with a boost). These calculations assumed that full repair takes place during the >24-h interval between fractions.…”

Section: Justification Of Radiobiologic Dose and Fractionationmentioning

confidence: 99%

“…They delivered electron beams of 3, 5, 7, or 9 MeV. Patients either received an IORT dose of 10-15 Gy after initial quadrantectomy with 1-2-cm clear margins, as an anticipated boost to EBRT, or an IORT dose of 17-21 Gy to the cavity as the only treatment (24).…”

Section: Ireast Rt Protocols Used In Analysismentioning

confidence: 99%

“…In addition, the BEDs were calculated for the low-doserate treatments assuming repair half times of 0.5, 1, 2, or 3 h. The repair kinetics for the tissues associated with acute and late responses, as well as breast carcinoma cells, are likely to fall within this range (48). As for the specific repair half-time appropriate for each effect, evidence has been obtained that sublethal damage repair (24,81) abbreviations: BED = biologically effective dose; Standard 50 = whole breast to 50 Gy in 25 fractions; Standard 60 -whole breast to '6 Gv in 23 fractions plus 14 Gy in 7 fractions to tumor bed (total 60 Gy); Standard 66 = whole breast to 50 Gy in 25 fractions plus 16 Gy n 8 fractions to tumor bed (total, 66 Gy); RTOG = Radiation Therapy Oncology Group; other abbreviations as in Tables 1 and 2. BED values given in Gray. 'Tie formula used to calculate BED mav not yield an accurate value for a single fraction treatment.…”

Section: Bed Valuesmentioning

confidence: 99%

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Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed after Segmental Mastectomy

Formenti¹

2007

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“…Several different methods of APBI have been described, including brachytherapy via multiple catheters placed into the breast parenchyma 9,11 or via a balloon catheter inserted into the lumpectomy cavity, 18,19 localized conformal externalbeam RT, 20 brachytherapy with bead or seed implants, and single-dose intraoperative RT. 21,22 Although multicatheter implants are the best-studied means of APBI, balloon cathether-based brachytherapy has recently received enormous interest because of the ease of insertion and the potential for more uniform delivery of radiation to the breast parenchyma around the lumpectomy cavity. The U.S. Food and Drug Administration (FDA) has cleared a balloon interstitial device (MammoSite RTS; Proxima Therapeutics, Alpharetta, GA) for brachytherapy based on safety and performance data.…”

mentioning

confidence: 99%

Potential applicability of balloon catheter–based accelerated partial breast irradiation after conservative surgery for breast carcinoma

Pawlik

M.S.

Strom

et al. 2004

Cancer

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The evaporation behavior of urea‐water‐solution (UWS) droplet was investigated for application to urea‐selective catalytic reduction (SCR) systems. A number of experiments were performed with single UWS droplet suspended on the tip of a fine quartz fiber. To cover the temperature range of real‐world diesel exhausts, droplet ambient temperature was regulated from 373 to 873 K using an electrical furnace. As a result of this study, UWS droplet revealed different evaporation characteristics depending on its ambient temperature. At high temperatures, it showed quite complicated behaviors such as bubble formation, distortion, and partial rupture after a linear D2‐law period. However, as temperature decreases, these phenomena became weak and finally disappeared. Also, droplet diminishment coefficients were extracted from transient evaporation histories for various ambient temperatures, which yields a quantitative evaluation on evaporation characteristics of UWS droplet as well as provides valuable empirical data required for modeling or simulation works on urea‐SCR systems. © 2009 American Institute of Chemical Engineers AIChE J, 2009

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A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated

Cited by 263 publications

References 10 publications

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed after Segmental Mastectomy

Potential applicability of balloon catheter–based accelerated partial breast irradiation after conservative surgery for breast carcinoma

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