Accelerated partial breast irradiation: Preliminary experience with the IntraBeam System

Abstract

11581 Local failure after breast conserving surgery (BCS) and breast radiation usually occurs at the tumor site. This has increased interest in accelerated partial breast irradiation (APBI), because better local control should be achieved if radiation is delivered directly to the tumor bed. The interstitial catheter and Mammosite balloon brachytherapy procedures require multiple visits to the radiation center and another procedure to remove the devices. Veronesi’s intraoperative radiotherapy technique (IORT) and the Mobetron require a special operating room (OR), expensive equipment, and are not very mobile. The IntraBeam IORT system is ideal for APBI. It is inexpensive, safe, easy to use, mobile and can be used in any standard OR. The system also can be used at multiple sites. The photon radiation unit, control console, and applicators all fit easily in cases, requiring only a stand at another site. This makes the system versatile and cost effective. It is convenient for the patient because it requires no further surgery or visits to the radiation center. The procedure is very practical for the community setting. We have performed the procedure to compliment BCS in 54 patients, 49 as part of the original surgery, while 5 had re-exploration of the previous segmental mastectomy site. Because of the final pathology, 3 patients had total mastectomies and 8 went on to have total breast irradiation. When total breast radiation is required, the IntraBeam IORT serves as the radiation boost. There have been no serious surgical or radiation complications, however, most patients developed seromas, managed by aspiration. There were no wound infections. One patient had re-excision of the segmental mastectomy site after 22 months because of severe induration. The pathology report was only radiation fibrosis and fat necrosis. Patient satisfaction has been great and there have been no local recurrences. However, our follow-up is not long enough to determine the true efficacy of preventing local recurrence. No significant financial relationships to disclose.