Full-Dose Intraoperative Radiotherapy Research Articles

P161 - Full dose Intraoperative Radiotherapy in the conservative treatment of breast cancer: a single institution experience

P161 - Full dose Intraoperative Radiotherapy in the conservative treatment of breast cancer: a single institution experience

Accelerated partial breast irradiation with intraoperative electrons: Using GEC–ESTRO recommendations as guidance for patient selection

PurposeTo evaluate outcomes among early-stage breast cancer patients after conservative surgery and full-dose intraoperative radiotherapy electrons (ELIOT) by applying the Groupe Européen de Curiethérapie–European Society for Therapeutic Radiology and Oncology (GEC–ESTRO) recommendations for partial breast irradiation (APBI). Materials and MethodsOne-thousand eight-hundred and twenty-two patients were stratified into the three GEC–ESTRO categories of “good candidates”, “possible candidates” and “contraindication” in order to assess outcomes. ResultsAll the 1822 cases except 7 could be classified according to GEC–ESTRO groups: 573 patients met the criteria to be included in the “good candidates” group, 468 patients in the “possible candidates” group and 767 patients in the “contraindication” group. Median and mean follow-up length was 3.5years (range 0–10.5years) and 3.8years (SD 2.2), respectively.The 5-year rate of in-breast tumor reappearances for “good candidates”, “possible candidates” and “contraindication” groups were 1.9%, 7.4% and 7.7%, respectively (p 0.001). While the regional node relapse showed no difference, the rate of distant metastases was significantly different in the “contraindication” group compared to the other two categories, having a significant impact on survival. ConclusionsAmong the ELIOT population, the GEC–ESTRO recommendations enabled the selection of the good candidates with a low rate of local recurrence, but failed to differentiate the “possible candidates” and the “contraindication” groups.

2 oral: Full Dose Intraoperative Radiotherapy with Electrons(IORT) During Breast Conserving Surgery- Experiencewith 1246 Cases at the European Institute of Oncology

2 oral: Full Dose Intraoperative Radiotherapy with Electrons(IORT) During Breast Conserving Surgery- Experiencewith 1246 Cases at the European Institute of Oncology

Full Dose Intraoperative Radiotherapy With Electrons (ELIOT) During Breast Conserving Surgery - Experience with 1246 Cases

Background:Previous studies showed that after breast-conserving surgery for breast cancer, radiotherapy may be applied to the portion of the breast where the primary tumour was removed (partial breast irradiation (PBI), avoiding the irradiation of the whole breast. We developed a procedure of PBI consisting of a single high dose of radiotherapy of 21 Gy with electrons equivalent to 58–60 Gy in fractionated doses, delivered during the surgical session by a mobile linear accelerator, positioned close to the operating table.Patients and methods:From July 1999 to December 2006, 1246 patients with primary carcinoma of less than 2.5-cm maximum diameter, mostly over 48 years, were treated with electron intra-operative radiotherapy (ELIOT) at a single dose of 21 Gy.Results:After a follow-up from 0.3 to 94.7 months (median 26), 24 (1.9%) patients showed a local recurrence and 22 developed distant metastases. Sixteen patients died, seven from breast carcinoma and nine from others causes. The five-year crude survival was 96.5%. Six (0.5%) developed severe breast fibrosis, which resolved in 2–3 years. An additional 40 patients suffered for mild fibrosis. Cosmetic results were good.Conclusions:Electron intra-operative radiotherapy is a safe method for treating conservatively operated breasts and avoids the long period of post-operative radiotherapy, greatly improving the quality of life and reduces the cost of radiotherapy. ELIOT markedly reduces the radiation to normal surrounding tissues and deep organs. Results on short- and medium-term toxicity are good. Data on local control are encouraging.

Full-dose intra-operative radiotherapy with electrons (ELIOT) during

Full-dose intra-operative radiotherapy with electrons (ELIOT) during

P85 Full-dose intraoperative radiotherapy with electrons, (ELIOT) in breast surgery: new frontiers

P85 Full-dose intraoperative radiotherapy with electrons, (ELIOT) in breast surgery: new frontiers

Full-Dose Intraoperative Radiotherapy With Electrons in Breast Surgery: Broadening the Indications

Full-Dose Intraoperative Radiotherapy With Electrons in Breast Surgery: Broadening the Indications

Full-Dose Intraoperative Radiotherapy with Electrons in Breast Cancer

Full-Dose Intraoperative Radiotherapy with Electrons in Breast Cancer

Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: A lesson learned by over 1000 procedures

At the European Institute of Oncology (EIO) in Milan, full-dose intraoperative radiotherapy with electrons (ELIOT) after breast conservative surgery (BCS) for limited-stage invasive unifocal breast cancer in postmenopausal women has been extensively investigated since 1999.1

2–45 Full-Dose Intraoperative Radiotherapy With Electrons in Breast Surgery

2–45 Full-Dose Intraoperative Radiotherapy With Electrons in Breast Surgery

Full-Dose Intraoperative Radiotherapy With Electrons in Breast Surgery

Although postoperative fractionated radiotherapy (PFR) remains the standard method for conservative treatment of breast carcinomas, widespread experience in the use of full-dose intraoperative radiotherapy with electrons (ELIOT) merits its application in novel clinical situations, although long-term results of ongoing clinical trials have not been fully reported. Retrospective case series. Division of breast surgery in a comprehensive cancer center. From June 1999 to September 2003 ELIOT was used as the sole radiotherapy in 355 patients with unifocal invasive carcinoma who were candidates for breast-conserving surgery and most of whom were participating in an ongoing institutional trial. In a group of patients in whom PFR was not considered safe or feasible (because of previous mantle field irradiation for Hodgkin disease, cosmetic breast augmentation, severe cardiopathy, large hypertrophic scarring from skin burns, vitiligo, and geographic or social obstacles), ELIOT was performed outside of the ongoing trial. No particular adverse effects, unusual acute reactions, late sequelae, and local or systemic events were noted in these patients after a mean follow-up of 27.3 months. In appropriated selected patients, when it is critical to perform PFR after breast-conserving therapy, a single dose of ELIOT may be considered to avoid mastectomy, reduce potential treatment toxicity, improve quality of life, and resolve logistic problems. The long-term results of ongoing clinical trials will further delineate patients in whom ELIOT may replace PFR.

A new option for early breast cancer patients previously irradiated for Hodgkin's disease: intraoperative radiotherapy with electrons (ELIOT)

IntroductionPatients who have undergone mantle radiotherapy for Hodgkin's disease (HD) are at increased risk of developing breast cancer. In such patients, breast conserving surgery (BCS) followed by breast irradiation is generally considered contraindicated owing to the high cumulative radiation dose. Mastectomy is therefore recommended as the first option treatment in these women.MethodsSix patients affected by early breast cancer previously treated with mantle radiation for HD underwent BCS associated with full-dose intraoperative radiotherapy with electrons (ELIOT).ResultsA total dose of 21 Gy (prescribed at 90% isodose) in five cases and 17 Gy (at 100% isodose) in one case were delivered directly to the mammary gland without acute complications and with good cosmetic results. After an average of 30.8 months of follow up, no late sequelae were observed and the patients are free of disease.ConclusionIn patients previously irradiated for HD, ELIOT can avoid repeat irradiation of the whole breast, permit BCS and decrease the number of avoidable mastectomies.

Full-Dose Intraoperative Radiotherapy With Electrons During Breast-Conserving Surgery

Previous studies show that local recurrences after breast-conserving treatment occur in the site of the primary tumor. The need for postoperative radiotherapy on the whole breast is challenged in favor of radiotherapy limited to the area of the breast at high risk of recurrence. The new mobile linear accelerators easily moved close to the operating table to allow the full-dose irradiation during surgery. From July 1999 to December 2003, 590 patients affected by unifocal breast carcinoma up to a diameter of 2.5 cm received wide resection of the breast followed by intraoperative radiotherapy with electrons (ELIOT). Most patients received 21 Gy intraoperatively, biologically equivalent to 58 to 60 Gy in standard fractionation. Patients were evaluated 1, 3, 6, and 12 months after surgery, and thereafter every 6 months, to look for early, intermediate, late complications, and other events. After a follow-up from 4 to 57 months (mean, 24 months; median, 20 months), 19 patients (3.2%) developed breast fibrosis, mild in 18, severe in 1, which resolved within 24 months. Three patients (0.5%) developed local recurrences, 3 patients ipsilateral carcinomas in other quadrants and other 5 patients contralateral breast carcinoma. One patient (0.2%) died of distant metastases. ELIOT is a safe method for treating conservatively operated breasts, avoids the long period of postoperative radiotherapy, and reduces drastically the cost of radiotherapy. ELIOT reduces radiation to normal tissues and organs. Results on short-term and middle-term toxicity up to 5 years of follow-up are good. Data on local control are encouraging.

Intraoperative Radiotherapy during Breast Conserving Surgery in Patients Previously Treated with Radiotherapy for Hodgkin's Disease

Women who have received radiotherapy for Hodgkin's disease have an increased risk of developing breast cancer. Breast-conserving surgery followed by breast irradiation is generally considered to be contraindicated in such patients owing to the high cumulative radiation dose to the breast. Mastectomy is therefore recommended as the preferred treatment option in these women. We report 3 patients affected by breast cancer who had previously been treated with mantle radiation for Hodgkin's disease and on whom breast-conserving surgery and full-dose intraoperative radiotherapy with electrons (ELIOT) were performed. A total dose of 17 Gy (prescribed at 100% isodose) in one case and 21 Gy (at the 90% isodose) in two cases was delivered directly to the mammary gland without acute complications and with good cosmetic results. In women previously irradiated for Hodgkin's disease, ELIOT could avoid repeat irradiation of the whole breast, thereby permitting conservative surgical treatment.

Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery.

The current standard treatment for early breast cancer includes conservative surgery followed by entire breast radiotherapy (RT). Recent study findings show that most local recurrences are in the scar tissue area suggesting that whole-breast RT may not always be necessary. If the volume of breast tissue to be irradiated is limited, RT may be performed intraoperatively. Intraoperative RT delivered with electrons at the total isodose of 2100 rad (21 Gy) could in principle substitute the currently used radiation course of external RT after breast-conserving surgery in selected cases. We report our findings on intraoperative RT using a specially designed mobile linear accelerator delivering 4 energy levels of electrons (3, 5, 7, and 9 MeV) via a head maneuvered by a robot arm. We applied this technique to 237 patients with breast cancer (mean age, 59 years; age range, 33-80 years) with tumors smaller than 2 cm in maximum diameter (T1); most underwent wide resection and an axillary sentinel node biopsy. After a median follow-up of 19 months (range, 7-33 months), the rate of posttreatment complications is very low. Four patients (1.7%) developed breast fibrosis-mild in 3 patients and severe in 1 patient-that resolved in 24 months. Three patients (1.4%) developed ipsilateral breast cancer-2 (1.0%) contralateral breast cancer, 1 (0.5%) supraclavicular node metastasis, and 1 (0.5%) distant metastases. Intraoperative RT with electron beams reduces irradiation to the skin, subcutaneous tissue, and contralateral breast and lung. It appears to be a promising method for irradiating conservatively treated breasts and it avoids the long period of postoperative RT that may not be easily accessible to all patients.