Abstract MS2-2: Nipple-Sparing Mastectomy with Nipple Areola Intra-Operative Radiotherapy: One Thousand and One Cases of a Five Years Experience at the European Institute of Oncology of Milan (EIO)

Abstract

Abstract Background: in order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for a treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. Methods: In a series of more than 1900 Nipple Sparing Mastectomies (NSM) performed at the European Institute of Oncology (IEO-Milan), 1007 (in which 37 bilateral), were registered from March 2002 to November 2007, for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%. Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 843 patients who received ELIOT and the 208 who underwent delayed one-shot radiotherapy on the days following the operation. Results: The median follow up time was 52 months (range 1.16-100.73) for a minimum follow up of a 6 months for 100% of the patients. The NAC necrosed totally in 40 cases (3,9%) and partially in 66 (6.5%) and was removed in 60 (5.5%). Twenty four infections (2.56%) were observed and 51 (4.85%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 11% of the patients reported a partial sensitivity of the NAC. Of the 31 local recurrences (3%) 21 occurred close to the tumour site or in other quadrant, 7 close to the NAC corresponding to the radiation field and 3 Paget. Overall, 82 cases of metastases (8.1%) and 28 deaths (2.7%) were observed. No significant outcome difference was observed between the 843 patients receiving intraoperative radiotherapy (ELIOT) and 208 patients receiving delayed irradiation. LR rate of a series of 597 NSM with invasive carcinomas was 25 (4.18%) after a follow up of 59 months Our psychological analysis concluded that sixty eight per cent of patients were satisfied with their reconstructed breast and 97% were satisfied with the preservation of the NAC. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr MS2-2.