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Abstract
PurposeTo present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes.Materials and methodsEighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits.ResultsThirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group.ConclusionIORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.
Highlights
Breast cancer has a high incidence, representing 11.6% of all neoplasms in all countries [1]
The results of randomized studies have shown that conservative surgery and radiotherapy are as effective as mastectomy in terms of local control [2, 3], and conservative treatment even can offer better survival rate [4]
Patients were given a post-lumpectomy radiation therapy dose before the completion of their surgery using an Intrabeam® system (Carl Zeiss Meditec, Oberkochen, Germany) that utilizes a point source of X-rays of 50 kV energy that provides the dose by means of a spherical applicator that allows effective irradiation at 1–1.5 cm depth
Summary
Breast cancer has a high incidence, representing 11.6% of all neoplasms in all countries [1]. The results of randomized studies have shown that conservative surgery and radiotherapy are as effective as mastectomy in terms of local control [2, 3], and conservative treatment even can offer better survival rate [4]. Whole-breast irradiation (WBI) reduces ipsilateral recurrence [5], but can produce skin toxicity and fibrosis, especially when boosting the tumor bed [6]. Accelerated partial breast irradiation (APBI) focuses irradiation only to tumor bed with margin, as recurrences occur more frequently in this area [7] and allows shorter treatment duration while sparing healthy tissue. Several randomized trials comparing APBI to WBI demonstrated similar tumor control after 5 years in selected patients [8].
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