One-step intraoperative radiotherapy optimizes conservative treatment of breast cancer with advantages in quality of life and work resumption

Sorrentino, Luca; Fissi, S.; Meaglia, Ilaria; Bossi, Daniela; Caserini, Ottavia; Mazzucchelli, Serena; Truffi, Marta; Albasini, Sara; Fatis, Paola Tabarelli de; Liotta, M.; Ivaldi, Giovanni Battista; Corsi, Fabio

doi:10.1016/j.breast.2018.04.004

Cited by 13 publications

(26 citation statements)

References 31 publications

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“…Contrary to other observations, we did not observe a significant impact of the time interval between administration of IORT and whole breast irradiation on fibrosis level . IORT used as a single modality treatment offers a low risk of breast tissue fibrosis outside the tumor cavity on a level comparable with other APBI modalities, that is, intraoperative electron irradiation or external beam radiotherapy . Whole breast irradiation leads to an increased incidence of breast fibrosis, but with a low incidence of grade 2‐3 as in other studies .…”

Section: Discussioncontrasting

confidence: 99%

Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Falco¹,

Masojć²,

Rolla³

et al. 2020

Breast J

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Introduction: Intraoperative radiotherapy (IORT) based on low-kV photons may be an option for early breast cancer patients. Following Targit trial results some of those patients should undergo whole breast irradiation (WBRT) additionally. Material and methods:Since April 2010, IORT has been applied to early breast cancer patients. One hundred and fifty patients were prospectively followed up and examined to evaluate the side effects (pain, fibrosis, breast edema, telangiectasias). We present the results 3 years post-treatment. WBRT was given to 82 (54.7%) patients. Results:Tumor cavity fibrosis grade II and more was observed in 18 (12%) patients, as grade III only in 2 (1.33%) patients. Breast tissue fibrosis outside tumor cavity grade II was observed only in 2 (1.33%) patients. Breast edema was present in 10 (6.66%) patients. WBRT administration led to increased frequency of higher grade tumor cavity fibrosis (P < .0001), breast fibrosis (P < .0001), breast edema (P = .003), and occurrence of telangiectasias (P = .03), with no influence on pain reported by patients.In case of WBRT, tumor location (P = .026) and size of the irradiated breast (P = .015) were independent risk factors for higher degree of breast fibrosis, as seroma evacuation 6 months post-WBRT (P = .036) was the only independent risk factor for higher level of tumor cavity fibrosis in multiple regression. Conclusions:The cosmetic result after IORT is good and comparable to other accelerated partial breast irradiation techniques. Administration of WBRT post-IORT in breast cancer patients increases the level of fibrotic changes, breast edema and telangiectasias 3 years post-treatment, but with no influence on pain. K E Y W O R D Sbreast cancer, breast edema, fibrosis, intraoperative radiotherapy, pain, side effects, telangiectasias, whole breast radiotherapy

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Section: Discussioncontrasting

confidence: 99%

Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Falco¹,

Masojć²,

Rolla³

et al. 2020

Breast J

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“…Three small series reported earlier on postoperative complications after low‐energy X‐ray IORT as a boost 9,10,24 . Tuschy et al 10 demonstrated hematoma rates (24%) to be most prevalent, similar to our findings, the latter nonetheless occurring to a much lesser extent (2.6%), probably because of the possible underestimation we assume.…”

Section: Discussionsupporting

confidence: 89%

“…Further, Kraus‐Tiefenbaucher et al 9 studied the rates of seroma formation in 73 patients undergoing BCS and IORT as a boost and demonstrating that it was similarly occurring after IORT as it was after BCS without IORT. Sorrentino et al 24 demonstrated an overall risk for the development of complications of 1.22 compared to EBRT, albeit not significant ( P = .478).…”

Section: Discussionmentioning

confidence: 94%

Oncological outcome, postoperative complications, and mammographic changes after intraoperative radiotherapy with electrons (IOERT) as a boost in a large single‐institution cohort of breast cancer patients

et al. 2020

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Advantages of using intraoperative radiotherapy with electrons (IOERT) as a boosting modality in breast‐conserving therapy include the direct visualization of the tumor bed, a reduced skin dose, and patient convenience. We report oncological outcome, postoperative complication rate, and mammographic changes on follow‐up imaging in women treated at our institution with IOERT as a boost modality in breast‐conserving therapy for early‐stage breast carcinoma. Between January 2007 and June 2018, 763 consecutive patients were enrolled. During breast‐conserving surgery, an IOERT boost of 9 Gy was applied, followed by whole breast irradiation (WBI). At a median follow‐up of 62.2 months (range: 0.5‐135), 13 in‐breast recurrences were observed, yielding a local tumor control rate of 98.4% at 5 years. In multivariable analysis, high tumor grading was predictive for local recurrence (HR = 5.6; 95%CI: 1.19‐26.2). A total of 27 (3.5%) patients developed any kind of postoperative complication. None of the tumor characteristics nor any of the IOERT technical parameters were predictive for development of a postoperative complication. On follow‐up imaging, 145 patients with mammographic changes BIRADS score ≥3 were found of which 50.3% required a biopsy. Only 17 patients had positive biopsies; none of the IOERT parameters were predictive for false‐positive imaging. A 9 Gy IOERT boost combined with postoperative WBI provided outstanding local control rates, was well‐tolerated, with limited postoperative complications. However, radiologists must be aware of a presumable higher prevalence of mammographic changes after IORT as a boost.

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“…A previous study suggested one-step IORT is associated with an advantage in work resumption. 27 This is particularly relevant in a state such as Kansas with concerns surrounding rural patients’ access to treatment. Among the 18% of EBRT patients in this study who chose not to receive adjuvant EBRT after surgery, the average age was 65.7 years.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative Radiation Therapy versus Whole Breast External Beam Radiotherapy: A Comparison of Patient-Reported Outcomes

Leatherman

Nicholas²,

Cusick³

et al. 2021

kjm

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Introduction. This project sought to compare patient-reported outcomes between patients who received intra-operative radiation therapy (IORT) and those who qualified for IORT but received whole-breast external beam radiation therapy (EBRT) following breast-conserving surgery (BCS). Methods. Three scales from the BREAST-Q Breast Cancer BCT Module Version 2.0 questionnaire were used to collect patient-reported outcomes regarding post-operative physical well-being of the chest, post-operative satisfaction with breast cosmesis and post-operative adverse effects of radiation. Results. Patients who received EBRT travelled farther on average than patients who received IORT to complete treatment. Respondents who received IORT reported better physical well-being of the chest than those who received EBRT. Regression reveals that the respondent’s age was the determining factor in the difference between IORT and EBRT post-operative physical well-being scores, where younger patients report poorer well-being. There was no difference in patient-reported outcomes regarding post-operative satisfaction with breast cosmesis or adverse effects of radiation. Conclusions. This study suggests that patients who received IORT report better physical well-being of the chest than patients who received EBRT. There appears to be a relationship between age and physical well-being of chest. This study suggests that there is no difference in patient-reported outcomes concerning post-operative satisfaction with breast cosmesis or post-operative adverse effects of radiation between patients who received IORT and those who received EBRT.

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One-step intraoperative radiotherapy optimizes conservative treatment of breast cancer with advantages in quality of life and work resumption

Cited by 13 publications

References 31 publications

Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Analysis of breast cosmetic effects 3 years after breast‐conserving surgery and intraoperative radiotherapy with and without adjuvant whole breast irradiation

Oncological outcome, postoperative complications, and mammographic changes after intraoperative radiotherapy with electrons (IOERT) as a boost in a large single‐institution cohort of breast cancer patients

Intra-operative Radiation Therapy versus Whole Breast External Beam Radiotherapy: A Comparison of Patient-Reported Outcomes

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