Comparison of the Oncological Efficacy Between Intraoperative Radiotherapy With Whole-Breast Irradiation for Early Breast Cancer: A Meta-Analysis

He, Lin; Zhou, Ji; Qi, Yuhong; He, Dawei; Yuan, Canliang; Chang, Hao; Wang, Qiming; Li, Gaiyan; Shao, Qing

doi:10.3389/fonc.2021.759903

Cited by 4 publications

(4 citation statements)

References 56 publications

(96 reference statements)

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“…After five years of follow-up, local recurrence was 3.96% vs. 1.05%. However, after median nine-year long-term follow-up, the rates of local recurrence-free survival, mastectomy-free survival, distant disease-free survival, and overall survival were the same IORT: intraoperative radiotherapy; PBRT: partial breast radiation therapy; EBRT: external-beam radiation therapy; %: percentage Table 5 summarizes the results from meta-analysis or data mining analysis [42][43][44][45]. The data establish the safety and equivalency of outcomes between IORT-based PBRT and WBRT outside of the randomized clinical trial settings.…”

Section: Targit-related Studies Using Intraoperative Radiotherapy-bas...mentioning

confidence: 99%

“…It segregated them into two groups based on whether they received IORT or EBRT after surgery. The results indicate that there is no difference between cancer-specific survival and overall survival 3 Yin Mi used a propensity score matching based on the SEER database[44], published in 2022, to investigate the overall survival and BCS outcomes of IORT compared to no RT in low-risk EBC. The study enrolled approximately 20,000 patients diagnosed with earlystage breast cancer between 2010 and 2019.…”

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confidence: 99%

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Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts

Vijayakumar¹,

Nittala²,

Buddala³

et al. 2023

Cureus

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Breast conservation therapy (BCT) (usually a lumpectomy plus radiotherapy (RT)) has become a standard alternative to radical mastectomy in early-stage breast cancers with equal, if not higher, survival rates. The established standard of the RT component of the BCT had been about six weeks of Monday through Friday external beam RT to the whole breast (WBRT). Recent clinical trials have shown that partial breast radiation therapy (PBRT) to the region surrounding the lumpectomy cavity with shorter courses can result in equal local control, survival, and slightly improved cosmetic outcomes. Intraoperative RT (IORT) wherein RT is administered at the time of operation for BCT to the lumpectomy cavity as a single-fraction RT is also considered PBRT. The advantage of IORT is that weeks of RT are avoided. However, the role of IORT as part of BCT has been controversial. The extreme views go from “I will not recommend to anyone” to “I can recommend to all early-stage favorable patients.” These divergent views are due to difficulty in interpreting the clinical trial results. There are two modalities of delivering IORT, namely, the use of low-energy 50 kV beams or electron beams. There are several retrospective, prospective, and two randomized clinical trials comparing IORT versus WBRT. Yet, the opinions are divided. In this paper, we try to bring clarity and consensus from a highly broad-based multidisciplinary team approach. The multidisciplinary team included breast surgeons, radiation oncologists, medical physicists, biostatisticians, public health experts, nurse practitioners, and medical oncologists. We show that there is a need to more carefully interpret and differentiate the data based on electron versus low-dose X-ray modalities; the randomized study results have to be extremely carefully dissected from biostatistical points of view; the importance of the involvement of patients and families in the decision making in a very transparent and informed manner needs to be emphasized; and the compromise some women may be willing to accept between 2-4% potential increase in local recurrence (as interpreted by some of the investigators in IORT randomized studies) versus mastectomy. We conclude that, ultimately, the choice should be that of women with detailed facts of the pros and cons of all options being presented to them from the angle of patient/family-focused care. Although the guidelines of various professional societies can be helpful, they are only guidelines. The participation of women in IORT clinical trials is still needed, and as genome-based and omics -based fine-tuning of prognostic fingerprints evolve, the current guidelines need to be revisited. Finally, the use of IORT can help rural, socioeconomically, and infrastructure-deprived populations and geographic regions as the convenience of single-fraction RT and the possibility of breast preservation are likely to encourage more women to choose BCT than mastectomy. This option can also likely lead to more wom...

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Section: Targit-related Studies Using Intraoperative Radiotherapy-bas...mentioning

confidence: 99%

mentioning

confidence: 99%

Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts

Vijayakumar¹,

Nittala²,

Buddala³

et al. 2023

Cureus

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“…While several studies and meta‐analyses have shown promising results of PBI in suitable low‐risk breast cancer patients, 17,18 two recently published cohort studies and a randomized clinical trial reported higher than expected rates of IBTR in patients treated with electron beam IORT 19–21 . No effects were reported on distant metastasis rates, nor on cancer‐specific or overall survival 20,22,23 …”

Section: Introductionmentioning

confidence: 99%

“…[19][20][21] No effects were reported on distant metastasis rates, nor on cancer-specific or overall survival. 20,22,23 The aim of this study was to report our data on a large series of IBTR after electron beam IORT and to identify possible risk factors for IBTR in patients with suitable low-risk breast cancer. 24 2 | MATERIALS AND METHODS…”

Section: Introductionmentioning

confidence: 99%

Breast conserving surgery with intraoperative electron beam radiation therapy for low‐risk breast cancer: Five‐year follow‐up of 306 patients

de Jonge,

Schipper,

Walstra

et al. 2024

Intl Journal of Cancer

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Recent studies have reported a higher than expected risk of ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) and a single dose of electron beam intra‐operative radiotherapy (IORT). This finding was the rationale to perform a retrospective single center cohort study evaluating the oncologic results of consecutive patients treated with BCS and IORT. Women were eligible if they had clinical low‐risk (N0, ≤2 cm unifocal, Bloom and Richardson grade 1–2), estrogen receptor‐positive and human‐epidermal‐growth‐factor‐receptor‐2‐negative breast cancer. Prior to BCS, pN0 status was determined by sentinel lymph node biopsy. Data on oncologic follow‐up were analyzed. Between 2012 and 2019, 306 consecutive patients were treated and analyzed, with a median age of 67 (50–86) years at diagnosis. Median follow‐up was 60 (8–120) months. Five‐year cumulative risk of IBTR was 13.4% (95% confidence interval [CI] 9.4–17.4). True in field recurrence was present in 3.9% of the patients. In 4.6% of the patients, the IBRT was classified as a local recurrence due to seeding of tumor cells in the cutis or subcutis most likely related to percutaneous biopsy. In 2.9% of the patients, the IBRT was a new outfield primary tumor. Three patients had a regional lymph node recurrence and two had distant metastases as first event. One breast cancer‐related death was observed. Estimated 5‐year overall survival was 89.8% (95% CI 86.0–93.6). In conclusion, although some of IBTR cases could have been prevented by adaptations in biopsy techniques and patient selection, BCS followed by IORT was associated with a substantial risk of IBTR.

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Intraoperative radiotherapy versus no radiotherapy for early stage low-risk breast cancer patients undergoing breast-conserving surgery: a propensity score matching study based on the SEER database

Zuo

Cao

et al. 2022

Clin Transl Oncol

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Comparison of the Oncological Efficacy Between Intraoperative Radiotherapy With Whole-Breast Irradiation for Early Breast Cancer: A Meta-Analysis

Cited by 4 publications

References 56 publications

Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts

Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts

Breast conserving surgery with intraoperative electron beam radiation therapy for low‐risk breast cancer: Five‐year follow‐up of 306 patients

Intraoperative radiotherapy versus no radiotherapy for early stage low-risk breast cancer patients undergoing breast-conserving surgery: a propensity score matching study based on the SEER database

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