P0016 A novel approach of intrabeam intraoperative radiotherapy for nipple-sparing mastectomy with breast reconstruction

Abstract

Background Despite the advancement and increasing use of breast-conserving surgery, mastectomies, including nipple-sparing mastectomy (NSM), are still carried out in a portion of breast cancer patients. However, the role of NSM is still controversial, mainly owing to the oncological safety of the nipple-areola complex (NAC). Intrabeam (Carl Zeiss, Germany) is the most widely used mobile intraoperative radiotherapy (IORT) device to date. This pilot study aims to broaden the application of Intrabeam system for breast cancer, investigating the feasibility of Intrabeam IORT in NSM with breast reconstruction. Methods From December 2012 to June 2013, seven female patients with breast cancer were enrolled in the study. NSM with or without axillary dissection was performed first. After confirming the presence of a negative retroareolar frozen section and that there was no local bleeding of the NAC, Intrabeam IORT was carried out, with a single dose of 16 Gy, followed by breast reconstruction. The complications and short-term outcomes were assessed. Findings The median radiation time was 13 min 14 s. One patient complained of mild pain in the radiation field on the skin in the first 2 weeks. All seven patients were followed up for a median of 7 months. No acute radiation injury with symptoms (heart, lung, or haematological system), NAC necrosis, local recurrence, or metastasis was observed. Although every patient had reduction in NAC sensitivity, the contours of the breasts (including the NAC) were satisfactory. Interpretation Intrabeam IORT may be a feasible and convenient approach for NSM with breast reconstruction in patients with breast cancer.