Intraoperative radiotherapy in previously augmented patients with early-stage breast cancer.

Abstract

186 Background: Breast conservation therapy (BCT) is the preferred treatment for early stage breast cancer (ESBC), providing equivalent survival to mastectomy with improved quality of life (QOL). Nevertheless, previously augmented women (PAW) with ESBC are often denied access to BCT due to potential complications arising from capsular contracture from exposure to whole breast radiation therapy (WBRT). Instead of BCT, PAW are commonly advised to undergo total, skin-sparing, or nipple-sparing mastectomy with or without breast reconstruction to eliminate the need for WBRT. These more extensive procedures alter the form and function of the breast, increase the risk of perioperative morbidity, prolong postoperative recovery, and add incremental costs. Intraoperative radiotherapy (IORT) emerged as a strategy for delivering breast radiotherapy that preserves the option of BCT in PAW with ESBC. IORT confines the effects of radiotherapy to the quadrant of the breast and to the portion of the prosthesis in proximity to the cancer. Since IORT is administered at the time of BCT, it permits insertion of a radiation barrier to further shield the prosthesis from effects of radiotherapy. Methods: We present several examples of PAW who underwent BCT combined with IORT for the treatment of ESBC. Results: Four women with an average age of 51.8 years (range: 47-57) were treated with BCT and IORT for ESBC using the Intrabeam System (Carl Zeiss-Meditec, Inc., Oberkochen, GE). All women had either saline (SA), silicone (SI), or combination retropectoral implants (RP). All pathological margins were clear and IORT was administered without complications. Average follow-up was 26 months (range: 1-72 months). None experienced a recurrence and breast cosmesis was acceptable in all women. Conclusions: IORT preserves the option of BCT in PAW by reducing the impact of radiotherapy on the breast. This radiotherapy approach eliminates the physical burden, impact on QOL, and cost of more extensive breast procedures. Consequently, IORT should be considered a preferred treatment for PAW facing a diagnosis of ESBC. [Table: see text]