Early Invasive Cancer and Partial Intraoperative Electron Radiation Therapy of the Breast: Experience of the Jules Bordet Institute

Abstract

Objectives. The aim of this prospective phase II study is to evaluate the treatment of early-stage breast cancer (T1 N0) with intraoperative electron radiation therapy (IOERT) in terms of local control, early complications, and cosmesis. Patients and Methods. From February 2010 to February 2012, 200 patients underwent partial IOERT of the breast. Inclusion criteria were unifocal invasive ductal carcinoma, age ≥40 years, histological tumour size ≤20 mm, and no lymph node involvement. A 21 Gy dose was prescribed over the 90% isodose line in the tumour bed. Median follow-up is 23.3 months (7–37). Results. Acute toxicity was not frequent (Grade 1: 4.5%, Grade 2: 1%). The cosmetic result was considered to be very good or good in 92.5%. One ipsi lateral out-quadrant recurrence at 18 months was observed. The crude and actuarial local recurrence rates after median follow-up were 0.5% and 0.9%, respectively. Conclusion. The preoperative diagnostic work-up must be comprehensive and the selection process must be rigorous for this therapeutic approach reserved for small ductal unifocal cancers. After a 23.3-month median follow-up time, the clinical results of IOERT for selected patients are encouraging for the locoregional recurrence and the toxicity rates. The satisfaction of our patients in terms of quality of life was extremely high.

The impact of breast MRI workup on tumor size assessment and surgical planning in patients with early breast cancer

“…This finding is lower than those of previous studies that reported a 53%‐57% rate of concordance for MRI . The 5 mm cutoff that was used in these previous studies corresponds to a stage migration in T1 breast tumors (T1a, T1b, T1c) and could represent a substantial discordance in the treatment plan, especially for IORT patient selection . A 2 mm cutoff of tumor size seems to be much more reasonable for the BIT to better estimate preoperative staging.…”

“…In our clinic, breast MRI is generally performed to rule out multifocal and/or multicentric disease in patients with TS up to 2 cm prior to intraoperative radiation therapy (IORT) …”

Eficacia, efectividad y seguridad de la radioterapia intraoperatoria en carcinoma de mama

“…Figura 1. Diagrama de flujo para la identificación y selección de estudios sobre RIO Los resultados estéticos son evaluados por 6 estudios 35,38,[50][51][52][53] y la calidad de vida percibida por las mujeres en uno de los estudios seleccionados 50 . La seguridad del personal sanitario es abordada en uno de los estudios seleccionados 54 , y la evaluación económica de la RIO por tres 6,55,56 .…”

“…Se han seleccionado 21 estudios para la descripción y análisis de la seguridad de la RIO 10,11,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] , uno específico sobre la aparición de cicatrices hipertróficas 42 , otro sobre seguridad cardíaca 43 , dos estudios que abordan el correcto posicionamiento del emisor de radiaciones 46,47 y dos estudios que debaten la aparición de segundas neoplasias 44,45 .…”

Commissioning, clinical implementation, and performance of the Mobetron 2000 for intraoperative radiation therapy

“…When the resection leaves behind a thin region of unresected tumor cells (either microscopic or macroscopic), the use of intraoperative high‐dose‐rate brachytherapy (IORT‐HDR), low energy photons, or megavoltage electrons can provide a therapeutic dose to the tumor bed while minimizing damage to distal tissues. Accordingly, IORT has found several clinical applications using a number of different delivery devices for sites such as sarcomas,1, 2, 3 breast,4, 5 recurrent head and neck cancer,6 pancreatic cancer,7 locally advanced and recurrent GYN tumors,8 rectal cancers,9, 10 and genitourinary cancers 11…”