Intraoperative Period and Breast Cancer: Review

Abstract

Intraoperative radiation therapy in breast cancer (IORT) delivers a concentrated dose of radiation therapy to a tumor bed during surgery. IORT offers some of the following advantages with typically fewer complications like; maximum effect, sparing healthy tissues and organs, to help the patients finish treatment and get back to their normal activities. The goal of IORT is to improve local tumor control and survival rates for patients with breast cancer. IORT can both be performed with electron beams (ELIOT) and X-rays. Two main randomised trials testing intraoperative partial breast radiotherapy are TARGIT trial and the ELIOT (intraoperative radiotherapy with electrons) trial, but the techniques are fundamentally different. Whereas TARGIT delivers radiation from within the undisturbed tumour bed, for ELIOT, the mammary gland is mobilised, a prepectoral lead shield is inserted, the edges of the tumour bed are apposed, and radiation is delivered from without. Key words: Intraoperative period, breast cancer, treatment IntroductionCurrently, breast cancer is one of the leading causes of cancer in women. Nevertheless, there are rapid developments and changes in the diagnosis, treatment and follow-up methods of this disease. Today breast cancer can be diagnosed at earlier stages, with a chance for cure with limited surgery, and the patients have improved quality of life. Today, based on recent studies, the type of breast cancer surgery that led to complete loss of the breast has been replaced by breast-conserving surgery (BCS) in all appropriate patients (1-4). According to the results from large multicenter studies on early breast cancer, there were no significant differences in terms of disease-free survival and overall survival between mastectomy, and BCS and whole breast radiotherapy (RT). Therefore, conserving surgery and whole breast irradiation has been accepted as the standard treatment in early breast cancer, and it has been reported that local control also plays an important role on survival. One of the most feared clinical situations in the treatment of breast cancer, especially after BCS, is local recurrence (LR) at the site of operation. Undoubtedly, one of the most important ways to avoid this dreaded complication is application of RT to the tumor itself and around the tumor bed. Most of the LRs usually occur at the same quadrant with the tumor area that has been operated, due to the microscopic tumor remaining after BCS. A number of risk factors have been identified for the occurrence of LR, including large tumor size, high tumor grade, young patient age, lymph node involvement, and presence of tumor deposit close to surgical resection margin (5,6). There is a decrease in LR rates due to earlier diagnosis of breast cancer patients, high quality standards in pathological examinations, better individual treatment planning, and increased awareness on breast cancer. The focus of the discussion regarding the causes of LR and the developments leading to decreased LR rates is centered around mostly the...

First Experience of Intra-Operative Radiation Therapy (IORT) during Kyphoplasty in Patients Diagnosed with Spinal Metastasis in Iran

“…With increasing utilization of e-IORT in 1980, x-ray orthovoltage was used to decrease radiation protection cost in IORT. Nevertheless, due to decreased appropriate uniformity, high bony radiation dose and prolonged procedure interval, the technology lost its popularity [29]. However, in recent years, mobile IORT with low voltage (about 20 to 50 kV) such as INTRABEAM (Carl Zeiss AG, Germany) and electronic brachytherapy system Axxent (Fremont, California Xoft Inc.) gained significant popularity in IORT field [30].…”