Full-Dose Intraoperative Radiotherapy with Electrons in Breast Cancer

Mussari, S.; Sala, Walter Sabino della; Busana, Lucia; Vanoni, Valentina; Eccher, Claudio; Zani, Bruno; Menegotti, L.; Tomio, L.

doi:10.1007/s00066-006-1559-z

Cited by 56 publications

(9 citation statements)

References 48 publications

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“…With regard to efficacy, the incidence of LR in this cohort was low and acceptable. Moreover, complications due to local toxicity were scarce, and this form of IORT led to a favorable impact on body image, as already observed by other authors [ 51 ]. Also, when oncoplastic maneuvers are required, including immediate breast reconstruction with prostheses, they are feasible and safe [ 19 , 21 ].…”

Section: Discussionsupporting

confidence: 69%

Intraoperative Full-Dose of Partial Breast Irradiation with Electrons Delivered by Standard Linear Accelerators for Early Breast Cancer

Barros

Hanna

Carvalho

et al. 2014

International Journal of Breast Cancer

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Purpose. To assess feasibility, efficacy, toxicity, and cosmetic results of intraoperative radiotherapy (IORT) with electrons delivered by standard linear accelerators (Linacs) during breast conserving surgeries for early infiltrating breast cancer (BC) treatment. Materials and Methods. A total of 152 patients with invasive ductal carcinoma (T ≤ 3.0 cm) at low risk for local relapses were treated. All had unicentric lesions by imaging methods and negative sentinel node. After a wide local excision, 21 Gy were delivered on the parenchyma target volume with electron beams. Local recurrences (LR), survival, toxicity, and cosmetic outcomes were analyzed. Results. The median age was 58.3 years (range 40–85); median follow-up was 50.7 months (range 12–101.5). There were 5 cases with LR, 2 cases with distant metastases, and 2 cases with deaths related to BC. The cumulative incidence rates of LR, distant metastases, and BC death were 3.2%, 1.5%, and 1.5%, respectively. Complications were rare, and the cosmetic results were excellent or good in most of the patients. Conclusions. IORT with electrons delivered by standard Linacs is feasible, efficient, and well tolerated and seems to be beneficial for selected patients with early infiltrating BC.

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Section: Discussionsupporting

confidence: 69%

Intraoperative Full-Dose of Partial Breast Irradiation with Electrons Delivered by Standard Linear Accelerators for Early Breast Cancer

Barros

Hanna

Carvalho

et al. 2014

International Journal of Breast Cancer

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“…Excellent results were described for boost patients with 20-25% G1-2 and less than 2% G3 reactions [7,29,30,31]. After full-dose IORT, 80% G1, 30% G2, and up to 6% G3 ratings have been reported [32,33,34]. …”

Section: Clinical Resultsmentioning

confidence: 93%

Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer

et al. 2018

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IOERT (intraoperative electron radiotherapy) in breast cancer is used either as a boost (10-12 Gy) followed by whole breast irradiation (WBI) or as full-dose partial breast irradiation (PBI, 20-24 Gy) during breast-conserving surgery. IOERT has the longest evidence of all IORT techniques. When administered as a boost, excellent low local recurrence rates were observed in long-term follow-up >5 years. Even in high-risk groups like triple-negative or locally advanced breast cancers, IOERT contributes to long-term local control rates of more than 90%. For selected low-risk groups, IOERT as PBI with 21 Gy seems to be a viable treatment alternative to standard WBI. IOERT has been shown to be advantageous for several reasons: Geographic misses are avoided due to direct visualization of the tumor bed; thus, a high single dose is delivered with utmost precision to small volumes, completely sparing the skin and ensuring good long-term cosmetic outcome. Furthermore, high single doses seem to induce biological mechanisms with verifiable antitumor capability in in-vitro cell-line studies. In addition, IOERT markedly shortens the overall treatment time both in combination with (now mostly hypofractionated) WBI or as a PBI in selected low-risk constellations.

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“…As to late reactions, cumulative incidences of fibrosis/sclerosis within the IORT volumes were slightly different according to the treatment concept: for boost patients, tolerance was excellent with incidences of 20–25% G1-2 and less than 2% G3-reactions [6, 8, 41, 42]. Following full-dose IORT, reported rates amounted up to 80% G1, 30% G2, and up to 6% G3-sequelae [43–45]. …”

Section: Clinical Resultsmentioning

confidence: 99%

Intraoperative radiotherapy (IORT) as boost in breast cancer

et al. 2017

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The term IORT (intraoperative radiotherapy) is currently used for various techniques that show huge differences in dose delivery and coverage of the tissue at risk. The largest evidence for boost IORT preceding whole breast irradiation (WBI) originates from intraoperative electron treatments (IOERT) with single doses around 10 Gy. At median follow-up periods at 6 years, outstandingly low local recurrence rates of less than 1% are observed. Higher local relapse rates were described for G3 tumors and triple negative breast cancers as well as for IORT following primary systemic treatment for locally advanced tumors. Even there, long term (>5y) local tumor control rates mostly beyond 95% were maintained. Compared to other boost methods, an intraoperative treatment has evident advantages in terms of precision (by avoiding a “spatial and/or temporal miss”), cosmetic outcome and patient comfort. Direct visualisation of a tumor bed during surgery guarantees for an accurate dose delivery, which has additionally gained importance in times of primary reconstruction techniques after lumpectomy, since IORT is performed before breast tissue including parts of the tumor bed is mobilized for plastic purposes. As a consequence of direct tissue exposure without distension by hematoma/seroma, IORT allows for small treatment volumes and complete skin sparing, both having a positive effect on late tissue tolerance and, hence, cosmetic appearance. Boost IORT marginally prolongs the surgical procedure, while significantly shortening postoperative radiotherapy. Its combination with external beam radiotherapy to the whole breast (WBI) is currently tested in two multicentric prospective trials: as kV-IORT in the multicentric TARGIT-B (oost) study, and as IOERT in the HIOB trial (3 weeks hypofractionated WBI preceded by IORT electron boost).

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Full-Dose Intraoperative Radiotherapy with Electrons in Breast Cancer

Cited by 56 publications

References 48 publications

Intraoperative Full-Dose of Partial Breast Irradiation with Electrons Delivered by Standard Linear Accelerators for Early Breast Cancer

Intraoperative Full-Dose of Partial Breast Irradiation with Electrons Delivered by Standard Linear Accelerators for Early Breast Cancer

Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer

Intraoperative radiotherapy (IORT) as boost in breast cancer

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