Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy

Thangarajah, Fabinshy; Heilmann, J.; Malter, Wolfram; Kunze, Sabine; Marnitz, Simone; Mallmann, Peter; Wenz, Frederik; Sperk, Elena

doi:10.1007/s10549-017-4657-y

Cited by 23 publications

(11 citation statements)

References 19 publications

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“…The average rate of 3 rd IBTE-free survival for patients treated with IORT is about 95%, ranged between 89.7% and 100%, for recent but low-powered studies [ [24] , [25] , [26] , [27] ] ( Table 2 ). Four small series (published between 2007 and 2017) reported the use of IORT in case of SCT.…”

Section: Resultsmentioning

confidence: 99%

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Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques

2020

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Aim To address the different partial breast re-irradiation techniques available in the context of second conservative treatment (SCT), as an alternative to salvage mastectomy, for 2nd ipsilateral breast tumor event (IBTE) and summarize their respective oncological and toxicity outcomes. Material and methods A literature search was made based on MeSH/PubMed, including papers from 1995 to 2019. Each article was described according to the main irradiation technique, fractionation, oncological results and grade 3 toxicities related to the salvage conservative treatment. Results Twenty-two articles were identified, reporting the outcomes of over 1 000 patients. MIB Brachytherapy was the most used re-irradiation technique in case of SCT, with a median 3rdIBTE-FS rate of 88% and summed up grade 3 toxicities of 6%. As for IORT, the average rate of 3rdIBTE-FS was about Finally, external beam partial re-irradiation was recently tested in this indication with encouraging results in terms of tolerance. Conclusion When presenting a 2ndIBTE, a SCT can safely be proposed to carefully selected and well-informed patients, as an alternative to salvage mastectomy. MIB appears to be the first intention and most robust choice. IORT, external beam radiotherapy and balloon brachytherapy are interesting alternatives but have only been tested in small series. Further investigations are required and their use should be limited to clinical trial only.

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Section: Resultsmentioning

confidence: 99%

“…[ 27 ] 2017 30 47 Electron beam 18 92.3 91.2 21 Thangarajah F et al. [ 24 ] 2018 41 58 50 kV X-rays 20 89.7 82 0 # pts: number of patients; MFU: median follow-up; 3 rd IBTE-FS: third ipsilateral breast tumor event free survival rate; OS: overall survival; ≥ G3 tox. : grade 3 and higher toxicity rate.…”

Section: Resultsmentioning

confidence: 99%

Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques

2020

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“…Comparable results were showed in smaller BT patient cohorts [26,30,31,34] and in patients treated with other types of adjuvant irradiation. SBCS and IORT presented LC and OS of 91-100% and 82-94%, respectively [41,42,43,44,45,46], whereas a second EBRT after SBCS provided LC of 76.9-100% and OS of 62.5-100% [49,50,51,52,53].…”

Section: Discussionmentioning

confidence: 95%

“…The conservative approach can be proposed after careful evaluation of surgical feasibility, which must consider the IBTR dimension, size, focality, and the breast size in order to achieve cosmetically acceptable results. Several authors have described the use of adjuvant breast reirradiation with brachytherapy (BT) [26,27,28,29,30,31,32,33,34,35,36,37,38,39,40], intraoperative radiation therapy (IORT) [41,42,43,44,45,46], proton beam radiotherapy [47,48], or EBRT with or without concurrent hyperthermia to increase local control rate [49,50,51,52,53,54].…”

Section: Purposementioning

confidence: 99%

High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study

Vavassori

Riva

Cavallo

et al. 2020

jcb

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To evaluate clinical results of catheter-based interstitial high-dose-rate (HDR) brachytherapy (BT) as adjuvant treatment in previously irradiated recurrent breast cancer. Material and methods: Between January 2011 and September 2015, 31 consecutive patients with histologically confirmed recurrent breast cancer after conservative surgery and conventional whole breast radiotherapy, were retreated with a second conservative surgical resection and reirradiated with adjuvant interstitial HDR-BT. None of the brachytherapy implant was performed during the quadrantectomy procedure. A dose of 34 Gy in 10 fractions, 2 fractions per day, with a minimal interval of 6 hours was delivered. Results: At the time of the implant, the median age of patients was 59.7 years (range, 39.3-74.9 years). The median time from first treatment until BT for local recurrence was 11.9 years (range, 2.5-27.8 years). The median interval between salvage surgery and BT was 3.6 months (range, 1-8.2 months). No acute epidermitis or soft tissue side effects higher than grade 2 were recorded, with good cosmetic results in all patients. Most of the patients presented grade 1-2 late side effects. Only one patient developed grade 3 liponecrosis. After a median follow-up of 73.7 months (range, 28.8-102.4 months), the overall survival and cancer specific survival were 87.1% and 90.3%, respectively; 5-year local control and 5-year progression-free survival rate were 90.3% and 83.9%, respectively. Conclusions: Our preliminary analysis showed that HDR-BT is a feasible treatment for partial breast reirradiation offering very low complications rate and fast procedure. Higher patients' cohort is warranted in order to define the role of this treatment modality in the breast conservative management of local recurrence.

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“…In punkto Re-BET nach Re-Radiatio gilt, dass sie zur Rezidiv-Reduktion und Vermeidung der Salvage-Mastektomie in Erwägung gezogen werden kann. Ganz aktuell behandelt eine Arbeit in Breast-Cancer-Research-and-Treatment [9] den Einsatz der intraoperativen Radiotherapie bei brusterhaltender Operation nach vorangegangener, externer Strahlentherapie. Ziel ist es, die Mastektomie zu vermeiden.…”

Section: Re-bestrahlung Nach Re-betunclassified

Senologie-Kongress 2018

2018

TumorDiagn u Ther

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Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy

Abstract: BCS in combination with IORT in IBTR in pre-irradiated patients is a feasible method to avoid mastectomy with a low risk of side effects and an excellent local control and good overall survival.

Cited by 23 publications

References 19 publications

Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques

Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques

High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study

Senologie-Kongress 2018

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