State of the art in breast intraoperative electron radiation therapy after intraoperative ultrasound introduction.


Journal

Radiology and oncology
ISSN: 1581-3207
Titre abrégé: Radiol Oncol
Pays: Poland
ID NLM: 9317213

Informations de publication

Date de publication:
16 May 2021
Historique:
received: 12 11 2020
accepted: 06 04 2021
pubmed: 16 5 2021
medline: 21 9 2021
entrez: 15 5 2021
Statut: epublish

Résumé

Breast intraoperative electron radiation therapy (B-IOERT) can be used in clinical practice both as elective irradiation (partial breast irradiation - APBI) in low risk breast cancer patients, and as an anticipated boost. The procedure generally includes the use of a shielding disk between the residual breast and the pectoralis fascia for the protection of the tissues underneath the target volume. The aim of the study was to evaluate the role of intraoperative ultrasound (IOUS) in improving the quality of B-IOERT. B-IOERT was introduced in Trieste in 2012 and its technique was improved in 2014 with IOUS. Both, needle and IOUS were used to measure target thickness and the latter was used even to check the correct position of the shielding disk. The primary endpoint of the study was the evaluation of the effectiveness of IOUS in reducing the risk of a disk misalignment related to B-IOERT and the secondary endpoint was the analysis of acute and late toxicity, by comparing two groups of patients treated with IOERT as a boost, either measured with IOUS and needle (Group 1) or with needle alone (Group 2). Acute and late toxicity were evaluated by validated scoring systems. From the institutional patients who were treated between June 2012 and October 2019, 109 were eligible for this study (corresponding to 110 cases, as one patients underwent bilateral conservative surgery and bilateral B-IOERT). Of these, 38 were allocated to group 1 and 72 to group 2. The target thickness measured with the IOUS probe and with the needle were similar (mean difference of 0.1 mm, p = 0.38). The percentage of patients in which the shield was perfectly aligned after IOUS introduction increased from 23% to more than 70%. Moreover, patients treated after IOUS guidance had less acute toxicity (36.8% IOUS showed to be accurate in measuring the target depth and decrease the misalignment between collimator and disk. Furthermore there was an absolute decrease in acute toxicity, even though not statistically significant, in the group of women who underwent B-IOERT with IOUS guidance.

Sections du résumé

BACKGROUND BACKGROUND
Breast intraoperative electron radiation therapy (B-IOERT) can be used in clinical practice both as elective irradiation (partial breast irradiation - APBI) in low risk breast cancer patients, and as an anticipated boost. The procedure generally includes the use of a shielding disk between the residual breast and the pectoralis fascia for the protection of the tissues underneath the target volume. The aim of the study was to evaluate the role of intraoperative ultrasound (IOUS) in improving the quality of B-IOERT.
PATIENTS AND METHODS METHODS
B-IOERT was introduced in Trieste in 2012 and its technique was improved in 2014 with IOUS. Both, needle and IOUS were used to measure target thickness and the latter was used even to check the correct position of the shielding disk. The primary endpoint of the study was the evaluation of the effectiveness of IOUS in reducing the risk of a disk misalignment related to B-IOERT and the secondary endpoint was the analysis of acute and late toxicity, by comparing two groups of patients treated with IOERT as a boost, either measured with IOUS and needle (Group 1) or with needle alone (Group 2). Acute and late toxicity were evaluated by validated scoring systems.
RESULTS RESULTS
From the institutional patients who were treated between June 2012 and October 2019, 109 were eligible for this study (corresponding to 110 cases, as one patients underwent bilateral conservative surgery and bilateral B-IOERT). Of these, 38 were allocated to group 1 and 72 to group 2. The target thickness measured with the IOUS probe and with the needle were similar (mean difference of 0.1 mm, p = 0.38). The percentage of patients in which the shield was perfectly aligned after IOUS introduction increased from 23% to more than 70%. Moreover, patients treated after IOUS guidance had less acute toxicity (36.8%
CONCLUSIONS CONCLUSIONS
IOUS showed to be accurate in measuring the target depth and decrease the misalignment between collimator and disk. Furthermore there was an absolute decrease in acute toxicity, even though not statistically significant, in the group of women who underwent B-IOERT with IOUS guidance.

Identifiants

pubmed: 33991470
pii: raon-2021-0023
doi: 10.2478/raon-2021-0023
pmc: PMC8366729
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

333-340

Informations de copyright

© 2021 Cristiana Vidali, Mara Severgnini, Gabriele Bellio, Fabiola Giudici, Vittorino Milan, Zaira Pellin, Sara Savatovic, Serena Scomersi, Gerd Fastner, Antonella Ciabattoni, Marina Bortul, published by Sciendo.

Références

AIOM-AIRTum. [The number of cancer in Italy 2019]. [Italian]. Brescia: Intermedia Editore; 2019. Available at: www.medinews.it
AIOM Linee guida. [Breast neoplasms, 2019]. [Italian]. [internet]. 2019. [cited 2020 Oct 14]. Available at: https://www.aiom.it/linee-guida-aiomneoplasie-della-mammella-2019
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomized trials Lancet 2011; 378: 1707-16. doi: 10.1016/S0140-6736(11)61629-2
doi: 10.1016/S0140-6736(11)61629-2
Hickey BE, James ML, Lehman M, Hider PN, Jeffery M, Francis DP, et al. Fraction size in radiation therapy for breast conservation in early breast cancer. Cochrane Database Syst Rev , 2016; 7: CD003860. doi: 10.1002/14651858.CD003860.pub4.
doi: 10.1002/14651858.CD003860.pub4
Valle LF, Agarwal S, Bickel KE, Herchek HA, Nalepinski DC, Kapadia NS. Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials. Breast Cancer Res Treat 2017; 162: 409-17. doi: 10.1007/ s10549-017-4118-7
doi: 10.1007/s10549-017-4118-7
Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013; 14: 1269-77. doi: 10.1016/S1470-2045(13)70497-2
doi: 10.1016/S1470-2045(13)70497-2
Maluta S, Dall’Oglio S, Goer DA, Marciai N. Intraoperative electron radiotherapy (IOERT) as an alternative to standard whole breast irradiation: only for low-risk subgroups? Breast Care 2014; 9: 102-6. doi: 10.1159/000362392
doi: 10.1159/000362392
Sedlmayer F, Reitsamer R, Wenz F, Sperk E, Fussl C, Kaiser J, et al. Intraoperative radiotherapy (IORT) as boost in breast cancer. Radiat Oncol 2017; 12: 23. doi: 10.1186/s13014-016-0749-9
doi: 10.1186/s13014-016-0749-9
Fastner G, Gaisberger C, Kaiser J, Scherer P, Ciabattoni A, Petoukhova A, et al. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer. Radiother Oncol 2020; 149: 150-15. doi: 10.1016/j.radonc.2020.04.059
doi: 10.1016/j.radonc.2020.04.059
Russo G, Casarino C, Arnetta G, Candiano G, Stefano A, Alongi F, et al. Dose distribution changes with shielding disc misalignments and wrong orientations in breast IOERT: a Monte Carlo-GEANT 4 and experimental study. J Appl Clin Med Phys 2012; 13: 74-92 doi: 10.1120/jacmp.v13i5.3817
doi: 10.1120/jacmp.v13i5.3817
Vidali C, Severgnini M, Urbani M, Toscano L, Perulli A, Bortul M. FMECA application to intraoperative electron beam radiotherapy procedure as a quality method to prevent and reduce patient’s risk in conservative surgery for breast cancer. Front Med 2017; 4: 138 doi: 10.3389/fmed.2017.00138
doi: 10.3389/fmed.2017.00138
Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol 2017; 7: 73-9. doi: 10.1016/j.prro.2016.09.007
doi: 10.1016/j.prro.2016.09.007
Sedlmayer F, Fastner G, Sedlmayer F. Intra-operative electron boost and hypofractionated whole-breast irradiation during breast-conserving treatment (BCT) (HIOB). ClinicalTrials.gov Identifier: NCT01343459 . [internet]. [cited 2020 Oct 13]. Available at: https://clinicaltrials.gov/ct2/show/NCT01343459
Fastner G, Reitsamer R, Urbanski B, Kopp P, Murawa D, Adamczyk B, et al. Toxicity and cosmetic outcome after hypofractionated whole breast irradiation and boost-IOERT in early stage breast cancer (HIOB): first results of a prospective multicenter trial (NCT01343459). Radiother Oncol 2020; 146: 136-42. doi: 10.1016/j.radonc.2020.02.001
doi: 10.1016/j.radonc.2020.02.001
Severgnini M, de Denaro M, Bortul M, Vidali C, Beorchia A. In vivo dosimetry and shielding disk alignment verification by EBT3 GAFCHROMIC film in breast IOERT treatment. J Appl Clin Med Phys 2015; 16: 112-20. doi: 10.1120/jacmp.v16i1.5065
doi: 10.1120/jacmp.v16i1.5065
Ciocca, M, Cantone MC, Veronese I, Cattani F, Pedroli G, Molinelli S, et al. Application of failure mode and effects analysis to intraoperative radiation therapy using mobile electron linear accelerators. Int J Radiat Oncol Biol Phys 2012; 82: e305-11. doi: 10.1016/j.ijrobp.2011.05.010
doi: 10.1016/j.ijrobp.2011.05.010
López-Tarjuelo J, Bouché-Babiloni A, Santos-Serra A, Morillo-Macías V, Calvo FA, Kubyshin Y, et al. Failure mode and effect analysis oriented to risk-reduction interventions in intraoperative electron radiation therapy: the specific impact of patient transportation, automation, and treatment planning availability. Radiother Oncol 2014; 113: 283-9 doi: 10.1016/j. radonc.2014.11.012
doi: 10.1016/j.radonc.2014.11.012
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341-6. doi: 10.1016/0360-3016(95)00060-C
doi: 10.1016/0360-3016(95)00060-C
Rubin P, Constine LS, Fajardo LF, Phillips TF, Wasserman TH. RTOG Late Effects Working Group. Overview of late effects of normal tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 1995; 31: 1041-2. doi: 10.1016/0360-3016(95)00057-6
doi: 10.1016/0360-3016(95)00057-6
Valdivieso-Casique MF, Rodríguez R, Rodríguez-Bescós S, Lardíes D, Guerra P, Ledesma MJ, et al. RADIANCE − a planning software for intra-operative radiation therapy. Transl Cancer Res 2015; 4: 196-209. doi: 10.3978/j. issn.2218-676X.2015.04.05
doi: 10.3978/j.issn.2218-676X.2015.04.05
Fastner G, Sedlmayer F, Merz F, Deutschmann H, Reitsamer R, Menzel C, et al. IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: long term results of an ISIORT pooled analysis. Radiother Oncol 2013; 108: 279-86. doi: 10.1016/j.radonc.2013.05.031
doi: 10.1016/j.radonc.2013.05.031
Kaiser J, Reitsamer R, Kopp P, Gaisberger C, Kopp M, Fischer T, et al. Intraoperative electron radiotherapy (IOERT) in the treatment of primary breast cancer. Breast Care 2018; 13: 162-7. doi: 10.1159/000489637
doi: 10.1159/000489637
Merrick HW 3rd, Hager E, Dobelbower RR Jr. Intraoperative radiation therapy for breast cancer. Surg Oncol Clin N Am 2003; 12: 1065-78. doi: 10.1016/s1055-3207(03)00098-x
doi: 10.1016/s1055-3207(03)00098-x
Lemanski C, Azria D, Thezenas S, Gutowski M, Saint-Aubert B, Rouanet P, et al. Intraoperative radiotherapy given as a boost for early breast cancer: long-term clinical and cosmetic results. Int J Radiat Oncol Biol Phys 2006; 64: 1410-5. doi: 10.1016/j.ijrobp.2005.10.025
doi: 10.1016/j.ijrobp.2005.10.025
Wong WW, Pockaj BA, Vora SA, Halyard MY, Gray RJ, Schild SE. Six-year outcome of a prospective study evaluating tumor bed boost with intraoperative electron irradiation followed by whole-breast irradiation for early-stage breast cancer. Breast J 2014; 20: 125-30. doi:10.1111/tbj.12235
doi: 10.1111/tbj.12235
Konig L, Lang K, Heil J, Golatta M, Major G, Krug D, et al. Acute toxicity and early oncological outcomes after intraoperative electron radiotherapy (IOERT) as boost followed by whole breast cancer patients – first clinical results from a single center. Front Oncol 2019; 9: 384. doi: 10.3389/ fonc.2019.00384
doi: 10.3389/fonc.2019.00384
Ivaldi GB, Leonardi MC, Orecchia R, Zerini D, Morra A, Galimberti V, et al. Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast-conserving surgery in premenopausal women. Int J Radiat Oncol Biol Phys 2008; 72: 485-93. doi: 10.1016/j.ijrobp.2007.12.038
doi: 10.1016/j.ijrobp.2007.12.038
Bhandari T, Babaran W, Forouzannia A, Williams V, Harness J, Carpenter M, et al. A prospective phase I comparison of toxicity and cosmesis outcomes of single-fraction IORT and hypofractionated radiotherapy with IORT boost in early-stage breast cancer. Brachytherapy 2017; 16: 1232-1238.e2. doi: 10.1016/j.brachy.2017.09.002
doi: 10.1016/j.brachy.2017.09.002

Auteurs

Cristiana Vidali (C)

Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.

Mara Severgnini (M)

Department of Medical Physics, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy.

Gabriele Bellio (G)

Department of Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina Trieste, Trieste Italy.

Fabiola Giudici (F)

Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Vittorino Milan (V)

Department of Radiation Oncology, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy.

Zaira Pellin (Z)

Department of Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina Trieste, Trieste Italy.

Sara Savatovic (S)

Department of Physics, University of Trieste, Trieste, Italy.

Serena Scomersi (S)

Department of Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina Trieste, Trieste Italy.

Gerd Fastner (G)

Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria.

Antonella Ciabattoni (A)

Department of Radiotherapy, San Filippo Neri Hospital, ASL Roma1, Rome, Italy.

Marina Bortul (M)

Department of Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina Trieste, Trieste Italy.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH