Acute toxicity of intraoperative radiotherapy and external beam-accelerated partial breast irradiation in elderly breast cancer patients

Jacobs, D.; Speijer, G.; Petoukhova, A.; Roeloffzen, Ellen M.A.; Straver, Marieke E.; Marinelli, A.; Fisscher, U.; Zwanenburg, A.G.; Merkus, J. W. S.; Marijnen, Corrie A.M.; Mast, M.; Koper, P.

doi:10.1007/s10549-018-4712-3

Cited by 18 publications

(21 citation statements)

References 34 publications

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“…Nine studies reported results about accelerated partial breast irradiation (APBI): 2 focused on EB APBI ( 23 , 25 ), 2 on intraoperative RT (IORT) ( 13 , 26 ), and 2 on brachytherapy (BRT) ( 8 , 21 ). Jacobs et al compared IORT and EB-APBI ( 18 ), Smith et al compared BRT and EB-RT ( 11 ), and Meattini et al compared WBI and EB-APBI ( 22 ).…”

Section: Resultsmentioning

confidence: 99%

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Radiotherapy in elderly patients with breast cancer: a literature review of acute and late toxicity

Zamagni¹,

Buwenge²,

Ammendolia³

et al. 2020

Transl Cancer Res TCR

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Radiotherapy (RT) induced toxicity in elderly patients is not well documented in the available literature due to the inhomogeneous and fragmentary data. Aim of this study was to review literature data on acute and late toxicity in elderly breast cancer patients treated with RT. The primary endpoint was RT-related acute and late toxicity in elderly breast cancer (BC) patients. The secondary endpoint was RT interruption rate in this patients’ population. All studies reporting RT-related acute and/or late toxicity in elderly women with breast cancer were included. All types of RT settings were included and no restriction was applied regarding other primary/adjuvant associated treatment. A bibliographic search was performed on PubMed. Only articles in English were considered while no chronological limitation was applied. Twenty-two studies were included in this analysis: 12 retrospective, 5 prospective observational trials, 1 phase III trial sub-analysis, and 4 phase I-II trials. Thirteen studies reported results about whole breast irradiation (WBI) delivered by external beams (EB) RT ± boost on the tumor bed. Nine studies reported results about accelerated partial breast irradiation (APBI) based on EB RT (2 studies), intraoperative RT (IORT: 2 studies), and brachytherapy (BRT: 2 studies); three studies compared different treatment techniques. Overall, reported acute grade (G) ≥3 toxicity ranged from 0.0% to 10.5% and late toxicity from 0.0% to 13.0%. RT discontinuation/interruption rates ranged between 0.0% and 2.0%. Acute G ≥3 toxicity rates were 2.0%, 6.7%, and 5.2% with EB-APBI, BRT, and IORT, respectively. Late G ≥3 toxicity with EB-APBI was 2.8%. No late G ≥3 toxicity was recorded in studies reporting on BRT and IORT. With WBI, the overall rates of G ≥3 toxicity were 3.0% (acute) and 1.8% (late). Higher toxicity rates were observed with weekly hypofractionation. None of the studies directly comparing age subgroups found age-related differences. Our findings suggest that RT of breast cancer is well tolerated even in elderly patients with toxicity rates comparable to those of the general population. Given these considerations, RT omission in elderly patients with breast cancer should be carefully evaluated limiting this option to very selected critical patients.

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Section: Resultsmentioning

confidence: 99%

“…Four studies reported data on only acute toxicity ( 13 , 18 , 21 , 24 ) while in 4 studies ( 9 , 11 , 13 , 21 ) RT technique details and/or doses were not described. Toxicity assessment was considered as the primary endpoint only in 5 studies ( 6 , 13 , 23 - 25 ).…”

Section: Resultsmentioning

confidence: 99%

Radiotherapy in elderly patients with breast cancer: a literature review of acute and late toxicity

Zamagni¹,

Buwenge²,

Ammendolia³

et al. 2020

Transl Cancer Res TCR

View full text Add to dashboard Cite

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“…A study by Piotrowski et al suggested that a single IORT could be used as an alternative for 6-7 weeks of PORT [21]. Jacobs et al [22] conducted a study on the toxic reactions of IORT and concluded that, just like EBRT, IORT had toxic reactions tolerable by the patients. Moreover, a recent clinical trial entitled TARGIT-R showed that this therapy had a low wound complications incidence and local recurrence rate [23].…”

Section: Discussionmentioning

confidence: 99%

Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer

et al. 2020

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Background To analyze the clinical efficacy of intraoperative radiotherapy (IORT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer (BC), and to investigate the relationship between its influencing factors and clinical efficacy and prognosis. Methods A total of 73 patients with early-stage BC who underwent IORT after BCS in our hospital were selected in this research. Results Kaplan-Meier survival analysis was used to analyze the related factors of BCS and IORT of disease-free survival (DFS) and overall survival (OS). It was found that only age (χ2 = 14.035, P = 0.003) was statistically positively correlated with the patient’s DFS, and local recurrence and metastasis rate and mortality were higher in patients over 70 years old. Log rank test was used to analyze multiple factors. Only the diameter of the applicator (χ2 = 70.378, P < 0.05) was statistically significant with wound complications, and the larger the diameter, the higher incidence of wound complications. The remaining risk factors did not increase the incidence of wound complications. COX multivariate analysis showed that age was an independent risk factor for DFS rate and the risk factor had no significant effect on the OS rate of patients undergoing IORT after BCS. Conclusions IORT may be a safe form of treatment for the selected patients with early-stage BC, and can achieve satisfactory esthetic effect. Larger applicator diameters may increase the incidence of wound complications. Age is an independent risk factor for DFS in early-stage BC patients undergoing IORT after BCS.

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“…In our study, the incidence of seroma was 6.0% and the infection rate was 5.0%; the infection rate was thus slightly higher than that in the TARGIT-A study (Table 4), but was comparable to the matched patients undergoing BCS over the same period. The wound infection rate arising from IORT varies significantly in the currently available studies, ranging from 2.3% to 13.6% (27)(28)(29). This difference might be attributable to the different radiotherapy equipment and methods used in the studies, and to the effect that variable patient characteristics, surgical procedures, and postoperative therapies might have had on toxicity and side effects.…”

Section: Discussionmentioning

confidence: 99%

Impact of intraoperative radiotherapy on the perioperative period of patients after breast-conserving surgery

Chen

et al. 2020

Gland Surg

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Background: To investigate the effect of intraoperative radiotherapy (IORT) in the perioperative period of patients after breast-conserving surgery (BCS). Methods:The clinical data of 100 patients with early breast cancer undergoing breast-conserving surgery (BCS) followed by treatment with IORT using the Intrabeam system (Carl Zeiss Meditec, Oberkochen,Germany) (BCS + IORT group, n=100) between June 2016 and December 2019 were analyzed and compared with the data of 60 matched patients who only underwent breast-conserving therapy over the same period (BCS group, n=60). The surgical settings and postoperative acute complications between the groups were assessed.Results: There was no significant statistical difference between the groups in terms of age, tumor size, grading, lymph node status, hormone receptor status, and human epidermal growth factor receptor 2 (HER-2) status (P>0.05). The BCS + IORT group had a significantly longer surgery duration (P<0.05), but there was no significant statistical difference in terms of intraoperative blood loss, amount of bleeding, drainage tube removal time, postoperative length of hospitalization, incision suture removal time, or incidence of postoperative complications (P>0.05).Conclusions: IORT using the Intrabeam system safely delivers radiation therapy, is well-tolerated, has acceptable acute toxicity, and does not significant increase the risk of surgery or the incidence of perioperative complications.

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Acute toxicity of intraoperative radiotherapy and external beam-accelerated partial breast irradiation in elderly breast cancer patients

Cited by 18 publications

References 34 publications

Radiotherapy in elderly patients with breast cancer: a literature review of acute and late toxicity

Radiotherapy in elderly patients with breast cancer: a literature review of acute and late toxicity

Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer

Impact of intraoperative radiotherapy on the perioperative period of patients after breast-conserving surgery

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