Abstract
BackgroundTo estimate the proportion of elderly patients (>70 years) with breast cancer eligible for an Exclusive IntraOperative RadioTherapy (E-IORT) and to evaluate their local recurrence-free survival rate.MethodsThis retrospective study examining two cohorts focuses on patients over 70 years old: a multi-centric cohort of 1411 elderly patients and a mono-centric cohort of 592 elderly patients. All patients underwent conservative surgery followed by external radiotherapy for T0-T3 N0-N1 invasive breast cancer, between 1980 and 2008.ResultsWithin each cohort two groups were identified according to the inclusion criteria of the RIOP trial (R group) and TARGIT E study (T group). Each group was divided into two sub-groups, patients eligible (E) or non-eligible (nE) for IORT. The population of patients that were eligible in the TARGIT E study but not in the RIOP trial were also studied in both cohorts. The proportion of patients eligible for IORT was calculated, according to the eligibility criteria of each study. A comparison of the 5-year local or locoregional recurrence-free survival rate between eligible vs non-eligible patients was made.In both cohorts, the proportion of patients eligible according to the RIOP trial’s eligibility criteria was 35.4 and 19.3%, and according to the TARGIT E study criteria was 60.9 and 45.3%.The 5-year locoregional recurrence-free survival rate was not significantly different between RE and RnE groups, TE and TnE groups. In both cohorts RE and (TE-RE) groups were not significantly different.ConclusionsOur results encourage further necessary studies to define and to extend the eligibility criteria for per operative exclusive radiotherapy.
Highlights
To estimate the proportion of elderly patients (>70 years) with breast cancer eligible for an Exclusive IntraOperative RadioTherapy (E-intra-operative radiotherapy (IORT)) and to evaluate their local recurrence-free survival rate
Each group was divided into two sub-groups, separating patients who were eligible for exclusive IORT from those who were not eligible: the RIOP trial with sub-groups R1E and R1nE for the G3S cohort, R2E and R2nE for the cohort 2 and the TARGIT E trial with the subgroups T1E and T1nE for the G3S cohort, T2E and T2nE for the cohort 2
All patients received adjuvant radiotherapy with a whole-breast 50 Gy irradiation completed in most case with a 16 Gy boost to the tumor bed
Summary
To estimate the proportion of elderly patients (>70 years) with breast cancer eligible for an Exclusive IntraOperative RadioTherapy (E-IORT) and to evaluate their local recurrence-free survival rate. Robust publications have shown that in the case of conservative surgery for an invasive cancer, adjuvant whole-breast irradiation in association with a boost to the tumor bed significantly increases recurrence-free survival, without any difference compared to total mastectomy in terms of overall survival [1]. Almost 90% of recurrences in the breast are located in the same quadrant [2] Based on this clinical information, and with the aim of facilitating access to radiotherapy, partial breast irradiation techniques have been developed over the past 20 years; using brachytherapy, external radiotherapy and intraoperative radiotherapy.
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