Intraoperative Radiotherapy for Early Breast Cancer

Abstract

The standard treatment for early breast cancer is breast-conserving therapy (BCT) with whole breast external irradiation therapy (WBI), and local control plays crucial role on survival (Clarke et al., 2005). It has been established that there is no significant difference in disease-free or overall survival rates between treatment by mastectomy or by lumpectomy with WBI for women with early breast cancer (Fisher et al., 2002; Veronesi et al., 2002). WBI actually provides statistically significant local control and survival data out to 15 years in favor of WBI compared to none (Clarke, et al., 2005). In actuality many women are still encouraged to proceed to mastectomy, because of the lack of access to radiotherapy centers or the long course of treatment of WBI. On the other hand, local recurrences after BCT with or without WBI arise most in the same quadrant as the primary cancer (Veronesi et al., 2001). The main objective of radiotherapy after BCT is considered to be the destruction of residual cancer cells in the operative field. Partial breast irradiation (PBI) has been tested in clinical trials for selected patients, and these studies have shown adequate local control, minimal toxicity, and good cosmetic appearance (Njeh et al., 2010). Intraoperative radiotherapy (IORT) is one of these PBI methods, which has recently been used in early stage breast cancer. Partial breast radiation therapy administered around the tumor bed has been comparable to WBI in selected patients (Antonucci et al., 2009; Benitez et al., 2007; Vicini et al., 2001; Vicini et al., 2003). Many phase II or III trials evaluating adjuvant IORT are actively accruing patients in the United States (NSABP-B39), Europe, United Kingdom, and Australia (Holmes et al., 2007). The standard treatment for early breast cancer is BCT with WBI, and outside the setting of a clinical trial, use of IORT as well as accelerated partial breast irradiation (APBI) is not yet recommended (Njeh, et al., 2010; Skandarajah et al., 2009). Then, particularly in practice setting, patients’ selection is critical to the successful application of PBI (Polgar et al., 2010; Vicini et al., 2011).