Abstract
IntroductionPatients who have undergone mantle radiotherapy for Hodgkin's disease (HD) are at increased risk of developing breast cancer. In such patients, breast conserving surgery (BCS) followed by breast irradiation is generally considered contraindicated owing to the high cumulative radiation dose. Mastectomy is therefore recommended as the first option treatment in these women.MethodsSix patients affected by early breast cancer previously treated with mantle radiation for HD underwent BCS associated with full-dose intraoperative radiotherapy with electrons (ELIOT).ResultsA total dose of 21 Gy (prescribed at 90% isodose) in five cases and 17 Gy (at 100% isodose) in one case were delivered directly to the mammary gland without acute complications and with good cosmetic results. After an average of 30.8 months of follow up, no late sequelae were observed and the patients are free of disease.ConclusionIn patients previously irradiated for HD, ELIOT can avoid repeat irradiation of the whole breast, permit BCS and decrease the number of avoidable mastectomies.
Highlights
Patients who have undergone mantle radiotherapy for Hodgkin's disease (HD) are at increased risk of developing breast cancer
In order to avoid a dangerously high total cumulative dose of radiotherapy to the whole breast, soft tissues of the thoracic wall, lung and heart, without rejecting the possibility of breast conserving surgery (BCS), we evaluated the potential of performing full-dose intraoperative radiotherapy with electrons
ELIOT was well tolerated in all patients without any unusual acute reactions
Summary
Patients who have undergone mantle radiotherapy for Hodgkin's disease (HD) are at increased risk of developing breast cancer In such patients, breast conserving surgery (BCS) followed by breast irradiation is generally considered contraindicated owing to the high cumulative radiation dose. The risk of developing breast cancer after radiotherapy for Hodgkin's disease (HD) is well documented and is attributed to the incidental inclusion of portions of the breast in the portals used to irradiate the mediastinum with or without infraclavicular/axillary regions [1,2] This increased risk depends on several patient and treatment factors, including radiation dose, radiation treatment field and age at treatment [3]. Few studies have been published whereby alternative therapies to mastectomy have been employed; they describe local excision alone, or interstitial brachytherapy and local excision followed by local field external beam radiotherapy [7,8,9,10].
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