Abstract
Background and purposeWe investigated the acute toxicity of accelerated partial breast irradiation using external beam (EB-APBI) or intraoperative radiotherapy (IORT) techniques in elderly breast cancer patients.Materials and methodsWomen ≥ 60 years with unifocal breast tumors of ≤ 30 mm were eligible for this prospective multi-center cohort study. IORT was applied with electrons following lumpectomy (23.3 Gy). EB-APBI was delivered using 3D-CRT or IMRT in 10 daily fractions of 3.85 Gy within 6 weeks after surgery. Acute toxicity was scored using the CTCAE v3.0 at 3 months after treatment. Patient-reported symptoms were analyzed using visual analogue scales (VAS) for pain and fatigue (scale 0–10), and single items from the EORTC QLQ-C30 and Breast Cancer questionnaires.ResultsIn total, 267 (IORT) and 206 (EB-APBI) patients were available for toxicity analysis. More patients experienced ≥ grade 2 CTCAE acute toxicity in the IORT group (10.4% IORT and 4.9% EB-APBI; p = 0.03); grade 3 toxicity was low (3.3% IORT and 1.5% EB-APBI; ns); and no grade 4 toxicity occurred. EB-APBI patients experienced less fatigue direct postoperatively (EORTC p < 0.00, VAS p < 0.00). After 3 months only pain, according to the VAS scale, was significantly worse in the EB-APBI group (p < 0.00).ConclusionAcute toxicity after IORT and EB-APBI treatment is acceptable.
Highlights
Adjuvant whole breast irradiation (WBI) has shown to prevent local recurrence when administered as part of breast conserving therapy (BCT) for early-stage breast cancer patients [1,2,3]
In 3/269, tumors were proven by preoperative biopsy but no residual tumor burden was found in the lumpectomy specimen (IORT)
By evaluating a prospective cohort of early breast cancer patients treated with two different types of Accelerated partial breast irradiation (APBI), we provide an overview of acute toxicity for the two techniques
Summary
Adjuvant whole breast irradiation (WBI) has shown to prevent local recurrence when administered as part of breast conserving therapy (BCT) for early-stage breast cancer patients [1,2,3]. Accelerated partial breast irradiation (APBI) encompasses the irradiation of solely the tumor bed, as recurrences most often occur in this area. This allows a higher dose per fraction and a shorter treatment duration while sparing healthy tissue. We investigated the acute toxicity of accelerated partial breast irradiation using external beam (EB-APBI) or intraoperative radiotherapy (IORT) techniques in elderly breast cancer patients. Acute toxicity was scored using the CTCAE v3.0 at 3 months after treatment. More patients experienced ≥ grade 2 CTCAE acute toxicity in the IORT group (10.4% IORT and 4.9% EB-APBI; p = 0.03); grade 3 toxicity was low (3.3% IORT and 1.5% EB-APBI; ns); and no grade 4 toxicity occurred. Conclusion Acute toxicity after IORT and EB-APBI treatment is acceptable
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