Intraoperative radiation therapy for breast cancer-Immediate and 30-month oncological outcomes.
early breast cancer
electronic brachytherapy
intraoperative radiation
radiation
recurrence score
targeted radiotherapy
Journal
The breast journal
ISSN: 1524-4741
Titre abrégé: Breast J
Pays: United States
ID NLM: 9505539
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
12
03
2019
revised:
28
10
2019
accepted:
21
11
2019
pubmed:
27
12
2019
medline:
22
6
2021
entrez:
27
12
2019
Statut:
ppublish
Résumé
There is growing evidence that intraoperative radiation therapy (IORT) may be a viable option in selected patients with early breast cancer. This study reports our 4-year experience with IORT. The perioperative outcome and imaging data of all patients who underwent IORT for early breast cancer at a tertiary medical center in 2014-2018 were retrospectively retrieved. The cohort included 158 patients aged 52-84 years (mean 68) with stage I (n = 137) or II (n = 21) breast cancer. Mean applicator size was 4.13 cm; IORT added a mean of 29 minutes to the operative time. Minor wound infections (n = 18, 11.4%) requiring antibiotics and drainage were the only postoperative complication. In 25 patients (15%), postoperative mammography demonstrated a seroma (n = 22) or fat necrosis (n = 3). The risk of wound infection or a new postoperative imaging finding was unrelated to patient age, operative time, tumor size, or comorbid diabetes or obesity. After a mean of 30 months' follow-up, none of the patients who met the institutional criteria for IORT had local recurrence, regardless of age, histology, tumor grade, KI67 proliferation index, pathologic stage, Recurrence Score, or additional whole-breast irradiation or adjuvant treatment. Patients for whom a Recurrence Score was determined (n = 55, 35%) had a significantly higher tumor grade, pathologic stage, and whole-breast irradiation/adjuvant chemotherapy rate than the remaining patients. IORT may be a safe alternative to traditional external beam radiation in well-selected patients with early breast cancer, with few minor complications and good 30-month outcome.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
946-951Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Vaidya JS, Tobias JS, Baum M, et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol. 2004;5:165-173.
Clark RM, Wilkinson RH, Mahoney LJ, Reid JG, Macdonald WD. Breast cancer: a 21 year experience with conservative surgery and radiation. Int J Radiat Oncol Biol Phys. 1982;8:967-979.
Veronesi U, Luini A, Del Vecchio M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993;328:1587-1591.
Clark RM, McCulloch PB, Levine MN, et al. Randomized clinical trial to assess the effectiveness of breast irra±diation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992;84:683-689.
Fisher ER, Anderson S, Redmond C, Fisher B. Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP protocol B-06. Semin Surg Oncol. 1992;8:161-166.
Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376(9735):91-102.
Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14(13):1269-1277.
Silverstein MJ, Fastner G, Maluta S, et al. Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 2-TARGIT. Ann Surg Oncol. 2014;21(12):3793-3799.
Silverstein MJ, Fastner G, Maluta S, et al. Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 1-ELIOT. Ann Surg Oncol. 2014;21(12):3787-3792.
Rakhra S, Bethke K, Strauss J, et al. Risk factors leading to complications in early-stage breast cancer following breast-conserving surgery and intraoperative radiotherapy. Ann Surg Oncol. 2017;24(5):1258-1261.
May M, Chin C, Hirji S, et al. Comparing preoperative imaging modalities in patient selection for breast intraoperative radiotherapy. J Surg Oncol. 2018;118(6):959-965.
Paudel N, Bethke KP, Wang LC, Strauss JB, Hayes JP, Donnelly ED. Impact of breast MRI in women eligible for breast conservation surgery and intra-operative radiation therapy. Surg Oncol. 2018;27(1):95-99.
Elsberger B, Romsauerova A, Vinnicombe S, et al. Comparison of mammographic findings after intraoperative radiotherapy or external beam whole breast radiotherapy. Eur J Surg Oncol. 2014;40(2):163-167.
Wasser K, Ruch M, Brade J, et al. Do structural changes in the tumour bed after intraoperative radiotherapy (IORT) of breast cancer complicate the evaluation of mammograms in a long-term follow-up? Eur J Radiol. 2012;81(3):e255-e259.
Oppong BA, Sen Gupta S, Gary M, et al. 21-gene recurrence assay in patients receiving intraoperative radiotherapy: are “favourable” characteristics a surrogate for low recurrence? Gland Surg. 2017;6(6):675-681.
Smith B, Buchholz TA. Correspondence- intraoperative radiotherapy for early breast cancer. Lancet. 2010;374:1141.
Anthony Z. Letters regarding the TERGIT A trial: the editor's introduction. Int J Radiat Oncol Biol Phys. 2015;92:951-962.
Vaidya JS, Wenz F, Bulsara M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 2014;383(9917):603-613.
Ivanov O, Dickler A, Lum BY, Pellicane JV, Francescatti DS. Twelve-month follow-up results of a trial utilizing Axxent electronic brachytherapy to deliver intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol. 2011;18(2):453-458.
Veronesi U, Orecchia R, Luini A, et al. Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast Cancer Res Treat. 2010;124(1):141-151.
Takanen S, Gambirasio A, Gritti G, et al. Breast cancer electron intraoperative radiotherapy: assessment of preoperative selection factors from a retrospective analysis of 758 patients and review of literature. Breast Cancer Res Treat. 2017;165(2):261-271.
Lai HW, Liu LC, Ouyang F, et al. Multi-center study on patient selection for and the oncologic safety of intraoperative radiotherapy (IORT) with the Xoft Axxent® eBx® System for the management of early stage breast cancer in Taiwan. PLoS One. 2017;12(11):e0185876.