Intraoperative Radiotherapy For Breast Cancer Research Articles

Evaluating delivered radiation dose in intraoperative radiotherapy for breast cancer using TLD

The extra radiation that it delivers has been questioned by patients, physicians, and the public for early breast cancer patients of intraoperative radiotherapy (IORT). This investigation concerns a left breast Rando phantom with a lumpectomy cavity of 30 cm3 of left breast of Rando phantom made of polymethylmethacrylate (PMMA). Thermoluminescent dosimetry (TLD) was used to evaluate the extra radiation dose or air kerma (kair) rate under IORT from 20 Gy, 50 kV of an Xoft Axxent system. TLDs were first calibrated using 50 kV photons, and then inserted at phantom positions that were close to the positions of the represented organs and tissues. Equivalent doses (DT) delivered to the organ at risks (OAR) were evaluated according to ICRP 103. Entrance surface doses (ESD) or skin doses (Dskin) varied markedly among positions close to the lumpectomy cavity. The dose was 20 Gy at the surface of a balloon applicator and kair varied from 6.40 ± 0.92 Gy down to 1.20 ± 0.30 mGy along the left-right axis of the 17th slice of Rando. These experimental results are compared with those in the literature. The shielding effect of the tungsten-impregnated rubber was also evaluated. This study supports recommendations to patients, relatives, physicians and radiologists concerning IORT.

Feasibility and early toxicity of intraoperative radiotherapy for breast cancer using the papillon + system: First results

Background and PurposeBreast intra operative radiation therapy has been evaluated with different systems delivering 20–21 Gy with treatment times around 30 min. Papillon + TM Contact X-ray machine was designed to produce a 50 kVp beam with a high dose rate ≥ 15 Gy/minute. A pilot study with the first prototype was conducted in Nice. Materials and methodsThe inclusion criteria were age ≥ 60 years, unifocal ductal breast adenocarcinoma ≤ 2.5 cm, grade 1–2. Surgical local excision with sentinel node dissection was performed and the applicator was placed in the tumor bed after excision with a prescribed dose of 20 Gy. The main end point of the study was the doses measured with the Gafchromic films; two were located at the skin surface and two in the excision cavity. Secondary endpoints were early toxicity and relapse free survival. ResultsBetween 10/2018 and 09/2019, 26 patients were included. Mean Gafchromic doseswere 18.8 Gy ± 2 Gy at the south pole, 15.6 Gy ± 2.81 Gy at the equator and 2.5 Gy ± 1.67 Gy at the skin. With a median follow-up time of 12 months, no skin or subcutaneous toxicity > grade 2, no local relapse and no metastasis were observed. ConclusionThis is the first phase II study testing the Papillon + tm system for breast IORT with in vivo dosimetry measurements and reassuring clinical data.

Use of breast MRI to distinguish treatment failure versus new primary tumor following single fraction breast intraoperative radiotherapy for breast cancer (SF-IORT).

e12534 Background: Single-fraction, intraoperative radiation therapy (SF-IORT) can replace whole breast radiotherapy (WBT) in select patients after lumpectomy for breast cancer. By combining histology review with co-registration of breast MRI at diagnosis and following an in-breast tumor recurrence, we sought to characterize IBTR as: missed on initial MRI, treatment failure, or new primary tumor. This has important implications for both breast MRI and understanding the effectiveness of SF-IORT. Methods: We reviewed our IORT database for patients with IBTR. Three radiologists recorded findings on DCE-MRI, mammograms and ultrasound, pathology at initial diagnosis and IBTR, and time to IBTR. Results: 90 women received SF-IORT between 12/6/2002 - 4/10/2019. There were 6 IBTRs (average age at recurrence 63, range 49-71 years). For these 6 patients, initial diagnostic mammograms showed fatty (1), scattered (4) or extremely dense (1) breasts with suspicious masses (4), calcifications (1), or asymmetry (1), average size 1.4 cm: range 0.3 - 2.0 cm. On MRI, background parenchymal enhancement was minimal (2), mild (2), moderate (1), or marked (1), showing a mass (4), mass/distortion (1), or post-biopsy marker/no abnormal enhancement (1). Initial pathology showed 2 IDC, 3 IDC/DCIS, and 1 DCIS, (average size 1.7 cm, range 1.1 - 2.4 cm) with 6/6 ER +, 5/6 PR + and 6 HER2 negative. IDC Ki-67 ranged from 5-25%. 5/6 patients had sentinel lymph node biopsy (SLNB) with 1/5 having a positive SLN. 4/6 received endocrine therapy. One patient declined follow-up mammography. After IORT, IBTR (average size 1.4 cm, range 0.7 - 3.6 cm) was diagnosed by mammography (3), palpable breast lump (2), or palpable axillary lymph node (LN) (1) shown as mass (4), mass/calcifications (1), or abnormal LN (1). IBTR occurred post-SF-IORT an average of 141.7 months, range 88.3 to 195.8 months. 2/6 IBTR occurred near the biopsy cavity. Subsequent surgery included mastectomy (3), re-excision lumpectomy/RT (2), or axillary LN dissection/RT (1) showing 4 IDC, 1 IDC/DCIS, and 1 IDC /ILC (6/6 ER +; 3/6 PR positive; 2 PR weakly positive; and 5 HER2 negative, 1 HER2 equivocal). Ki-67 ranged from 1-70%. Conclusions: 6/90 (6.6%) patients had an IBTR an average of 141.7 months post SF-IORT with 2/6 near the biopsy cavity. Breast MRI reliably screens patients for SF-IORT. Co-registration of imaging can help distinguish true recurrences from new primary tumors.

Intraoperative Radiotherapy for Breast Cancer in Elderly Women

PurposeTo evaluate outcomes and postoperative toxicities after intraoperative radiotherapy (IORT) in elderly women. PopulationWomen older than 65 years, with infiltrating ductal breast cancer ≤3 cm, expressing estrogen receptor (ER+) without Her2 overexpression, and with negative axillary nodes. TreatmentTreatment consisted of partial mastectomy with a sentinel lymph node biopsy (SLNB) procedure; in case of positive SLNB, IORT was cancelled. IORT consisted in a total dose of 20 Gy in 1 fraction delivered at the surface of the applicator with the Intrabeam® technique. ResultsIORT was planned to be administered to a total of 225 patients but was cancelled for 34 patients during surgery. Thus 191 patients were analyzed; mean age was 76 years, with 57 patients (30%) >80 years. Despite inclusion criteria, 15 had lobular carcinoma and 7 were triple negative. With a median follow-up of 40 months, we observed only 1 local recurrence, located in the skin over the initial tumor. The 5-year local relapse rate was 1.7%. A wound healing delay (>15 days) was observed in 21 patients (11%). Sixty-six patients (35%) had postoperative complications, mainly grade 2, resolving within a few days. Two patients needed surgical drainage for local abscesses. Long-term (>1 year) cosmetic outcome was evaluated in 120 patients and was judged excellent or good in 102 (91%). ConclusionIORT can be safely given to elderly women, with a good local control rate and without major toxicities.

Fracture de côte suite à la radiothérapie peropératoire dans le cancer du sein. Cas clinique et expérience locale

Intra-operative radiotherapy for breast cancer has been developed throughout the last two decades. It is already well-established regarding local control and toxicity for intra-operative radiotherapy using electrons as we now have the necessary background knowledge. However, very few data on later toxicity are available for intra-operative radiotherapy using low-energy photons. We report here the case of a 36-year-old woman who experienced rib fracture following intra-operative and external radiotherapy. This patient has been included in the Targit-boost trial. The intra-operative irradiation has been operated with an INTRABEAM device delivering low-energy photons of 50-kV.

Oncologic outcomes and radiation safety of nipple-sparing mastectomy with intraoperative radiotherapy for breast cancer.

Nipple-sparing mastectomy combined with breast reconstruction helps to optimize the contour of the breast after mastectomy. However, the indications for nipple-sparing mastectomy are still controversial. Local radiation to the nipple-areola complex may play some roles in improving the oncological safety of this procedure. From January 2014 to December 2017, 41 consecutive patients who underwent nipple-sparing mastectomy combined with Intrabeam intraoperative radiotherapy to the nipple-areola complex flap and breast reconstruction were enrolled in this prospective study. The prescribed radiation dose at the surface of the spherical applicator was 16Gy. In eight cases, carcinomas were in the central portion of the breast. Partial necrosis of the nipple-areola complex occurred in three cases. Over 90% of patients reported "no or poor sensation" of the nipple-areola complex postoperatively. With a median follow-up time of 26 months, no recurrences or metastases were identified; however, breast-cancer mortality occurred in one patient. Pathologic evaluation of paraffin-embedded sections showed ductal carcinoma in situ in the remaining tissues deep to the nipple-areola complex flap in two patients. Although no further treatment was administered to the nipple-areola complexes postoperatively, no recurrences or metastases were identified 20 months and 24 months later, respectively. Optical microscopy and transmission electron microscopy revealed changes in some normal tissues immediately after Intrabeam intraoperative radiotherapy. Karyopyknosis were observed in gland tissues, and the collagenous fibers became sparse and arranged chaotically. As assessed by thermoluminescence, radiation doses at different sites in the nipple-areola complex flap varied considerably and were about 10Gy at the areola surface. No Intrabeam intraoperative radiotherapy-related acute or chronic radiation injuries of the lung, heart or bone marrow were identified. Our findings indicate that Intrabeam intraoperative radiotherapy during nipple-sparing mastectomy combined with breast reconstruction is safe and feasible. The current study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University (registering order 201750). All participants gave their written informed consent.

Intraoperative Radiotherapy for Breast Cancer.

Intraoperative radiotherapy (IORT) for early stage breast cancer is a technique for partial breast irradiation. There are several technologies in clinical use to perform breast IORT. Regardless of technique, IORT generally refers to the delivery of a single dose of radiation to the periphery of the tumor bed in the immediate intraoperative time frame, although some protocols have performed IORT as a second procedure. There are two large prospective randomized trials establishing the safety and efficacy of breast IORT in early stage breast cancer patients with sufficient follow-up time on thousands of women. The advantages of IORT for partial breast irradiation include: direct visualization of the target tissue ensuring treatment of the high-risk tissue and eliminating the risk of marginal miss; the use of a single dose coordinated with the necessary surgical excision thereby reducing omission of radiation and the selection of mastectomy for women without access to a radiotherapy facility or unable to undergo several weeks of daily radiation; favorable toxicity profiles; patient convenience and cost savings; radiobiological and tumor microenvironment conditions which lead to enhanced tumor control. The main disadvantage of IORT is the lack of final pathologic information on the tumor size, histology, margins, and nodal status. When unexpected findings on final pathology such as positive margins or positive sentinel nodes predict a higher risk of local or regional recurrence, additional whole breast radiation may be indicated, thereby reducing some of the convenience and low-toxicity advantages of sole IORT. However, IORT as a tumor bed boost has also been studied and appears to be safe with acceptable toxicity. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses. It may also be very useful in specific situations, such as prior to oncoplastic reconstruction to improve accuracy of adjuvant radiation delivery, or when used as a boost in higher risk patients to improve tumor control. Ongoing international clinical trials are studying these uses and follow-up data are accumulating on completed studies.

Outcomes of Intraoperative Radiotherapy for Breast Cancer: Experience from a Multidisciplinary Breast Oncology Program at an NCI Designated Cancer Center

Outcomes of Intraoperative Radiotherapy for Breast Cancer: Experience from a Multidisciplinary Breast Oncology Program at an NCI Designated Cancer Center

Design, construction and performance evaluation of the target tissue thickness measurement system in intraoperative radiotherapy for breast cancer

Intraoperative electron radiation therapy (IOERT), which uses electron beams for irradiating the target directly during the surgery, has the advantage of delivering a homogeneous dose to a controlled layer of tissue. Since the dose falls off quickly below the target thickness, the underlying normal tissues are spared. In selecting the appropriate electron energy, the accuracy of the target tissue thickness measurement is critical. In contrast to other procedures applied in IOERT, the routine measurement method is considered to be completely traditional and approximate. In this work, a novel mechanism is proposed for measuring the target tissue thickness with an acceptable level of accuracy. An electronic system has been designed and manufactured with the capability of measuring the tissue thickness based on the recorded electron density under the target. The results indicated the possibility of thickness measurement with a maximum error of 2mm for 91.35% of data. Aside from system limitation in estimating the thickness of 5mm phantom, for 88.94% of data, maximum error is 1mm.

Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT

ObjectiveTo quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks' course of external beam whole...

Short-term complications of intra-operative radiotherapy for early breast cancer.

IORT is becoming an accepted radiotherapy technique for treatment of early breast cancer. Data regarding the early complications of breast IORT are lacking. Assess the nature and risk factors for early complications of breast conserving surgery (BCS) and intraoperative radiotherapy (IORT) with INTRABEAM®. IORT with INTRABEAM® was administered to breast cancer patients in Carmel Medical Center as part of an institutional clinical registry project. Three hundred and ninety five patients treated during 2006-2013 were included. Clinical and treatment data and data regarding complications documented within 1 year of surgery were collected. The association between clinical and treatment variables and risk of complications was assessed. Complications were documented in 108 (27.3%) of patients. Grade III or IV complications were found in 5% of patients. Infections were diagnosed in 43 (10.8%) patients, seroma in 40 (10.1%), wound dehiscence in 32 (8.1%), and bleeding and hematomas in 11(2.8%). Two patients had a small size skin necrosis. Sixteen patients with a seroma had a secondary complication. All complications resolved. Diabetes mellitus and use of anticoagulants were associated with an increased risk of wound dehiscence and bleeding, respectively. IORT for breast cancer is safe in appropriately selected patients. Careful surgical technique and postoperative care is prudent. J. Surg. Oncol. 2016;113:370-373. © 2016 Wiley Periodicals, Inc.

Experience with intraoperative radiotherapy for breast cancer: the Geneva University Hospital's experience.

Background Breast conserving surgery along with adjuvant radiotherapy is effective in terms of local control and survival for earlystage breast cancer (1).External beam radiotherapy (EBRT) following breast conserving surgery has been shown to improve survival by preventing local recurrence,in the Early Breast Cancer Trialists' Collaborative Group meta-analysis (2).Standard radiotherapy typically requires numerous fractions over a 3-5 week period and is performed weeks or months after surgery or chemotherapy.Partial breast irradiation (PBI) techniques,including intraoperative radiotherapy (IORT),have been investigated in the last decades (3,4).

Calcifications and tungsten deposits after breast-conserving surgery and intraoperative radiotherapy for breast cancer

AimTo describe the presence of atypical calcifications on post-operative mammography after breast-conserving surgery (BCS) and intraoperative radiotherapy (IORT). Materials and methodsWe retrospectively include all patients followed after BCS and IORT for breast cancer (n=271). All follow-up mammograms at 6 months after surgery were retrospectively evaluated by two board-certified radiologists. The radiologists had to notify the presence or the absence of atypical calcifications. ResultsFive patients had on follow-up mammography the presence of atypical calcifications. Two patients had a stereotactic breast biopsy. The pathologic examination showed the presence of small tungsten particles located in the breast parenchyma. ConclusionThe presence of atypical calcifications after BCS and IORT, presenting as multiple, scattered, round calcifications, should be rated as BIRADS 2 and do not require biopsy. They corresponded on tungsten deposits.

SU‐E‐T‐412: Evaluation of Tungsten‐Based Functional Paper for Attenuation Device in Intraoperative Radiotherapy for Breast Cancer

Purpose:Intraoperative radiotherapy (IORT) with an electron beam is one of the accelerated partial breast irradiation methods that have recently been used in early‐stage breast cancer. A protective acrylic resin‐copper disk is inserted between the breast tissue and the pectoralis muscle to minimize the dose received by the posterior structures. However, a problem with this protective disk is that the surgical incision must be larger than the field size because the disk is manufactured from stiff and unyielding materials. The purpose of this study was to assess the applicability of a new tungsten‐based functional paper (TFP) as an alternative to the existing protective disk in IORT.Methods:The newly introduced TFP (Toppan Printing Co., Ltd., Tokyo, JP) is anticipated to become a useful device that is lead‐free, light, flexible, and easily processed. The radiation shielding performance of TFP was verified by experimental measurements and Monte Carlo (MC) simulations using PHITS code. The doses transmitted through the protective disk or TFP were measured on a Mobetron mobile accelerator. The same geometries were then reproduced, and the dose distributions were simulated by the MC method.Results:The percentages of transmitted dose relative to the absence of the existing protective disk were lower than 2% in both the measurements and MC simulations. In the experimental measurements, the percentages of transmitted dose for a 9 MeV electron beam were 48.1, 2.3, and 0.6% with TFP thicknesses of 1.9, 3.7, and 7.4 mm, respectively. The percentages for a 12 MeV were 76.0, 49.3, 20.0, and 5.5% with TFP thicknesses of 1.9, 3.7, 7.4, and 14.8 mm, respectively. The results of the MC simulation showed a slight dose increase at the incident surface of the TFP caused by backscattered radiation.Conclusion:The results indicate that a small‐incision procedure may be possible by the use of TFP.

Eligibility criteria for intraoperative radiotherapy for breast cancer: study employing 12,025 patients treated in two cohorts.

BackgroundWe wished to estimate the proportion of patients with breast cancer eligible for an exclusive targeted intraoperative radiotherapy (TARGIT) and to evaluate their survival without local recurrence.MethodsWe undertook a retrospective study examining two cohorts. The first cohort was multicentric (G3S) and contained 7580 patients. The second cohort was monocentric (cohort 2) comprising 4445 patients. All patients underwent conservative surgery followed by external radiotherapy for invasive breast cancer (T0–T3, N0–N1) between 1980 and 2005. Within each cohort, two groups were isolated according to the inclusion criteria of the TARGIT A study (T group) and RIOP trial (R group).In the multicentric cohort (G3S) eligible patients for TARGIT A and RIOP trials were T1E and R1E subgroups, respectively. In cohort number 2, the corresponding subgroups were T2E and R2E. Similarly, non-eligible patients were T1nE, R1nE and T2nE, and R2nE.The eligible groups in the TARGIT A study that were not eligible in the RIOP trial (TE–RE) were also studied. The proportion of patients eligible for TARGIT was calculated according to the criteria of each study. A comparison was made of the 5-year survival without local or locoregional recurrence between the TE versus TnE, RE versus RnE, and RE versus (TE–RE) groups.ResultsIn G3S and cohort 2, the proportion of patients eligible for TARGIT was, respectively, 53.2% and 33.9% according the criteria of the TARGIT A study, and 21% and 8% according the criteria of the RIOP trial. Survival without five-year locoregional recurrence was significantly different between T1E and T1nE groups (97.6% versus 97% [log rank =0.009]), R1E and R1nE groups (98% versus 97.1% [log rank =0.011]), T2E and T2nE groups (96.6% versus 93.1% [log rank <0. 0001]) and R2E and R2nE groups (98.6% versus 94% [log rank =0.001]). In both cohorts, no significant difference was found between RE and (TE–RE) groups.ConclusionsAlmost 50% of T0-2 N0 patients could be eligible for TARGIT.

Intraoperative radiotherapy for breast cancer.

Intra-operative radiotherapy (IORT) as a treatment for breast cancer is a relatively new technique that is designed to be a replacement for whole breast external beam radiotherapy (EBRT) in selected women suitable for breast-conserving therapy. This article reviews twelve reasons for the use of the technique, with a particular emphasis on targeted intra-operative radiotherapy (TARGIT) which uses X-rays generated from a portable device within the operating theatre immediately after the breast tumour (and surrounding margin of healthy tissue) has been removed. The delivery of a single fraction of radiotherapy directly to the tumour bed at the time of surgery, with the capability of adding EBRT at a later date if required (risk-adaptive technique) is discussed in light of recent results from a large multinational randomised controlled trial comparing TARGIT with EBRT. The technique avoids irradiation of normal tissues such as skin, heart, lungs, ribs and spine, and has been shown to improve cosmetic outcome when compared with EBRT. Beneficial aspects to both institutional and societal economics are discussed, together with evidence demonstrating excellent patient satisfaction and quality of life. There is a discussion of the published evidence regarding the use of IORT twice in the same breast (for new primary cancers) and in patients who would never be considered for EBRT because of their special circumstances (such as the frail, the elderly, or those with collagen vascular disease). Finally, there is a discussion of the role of the TARGIT Academy in developing and sustaining high standards in the use of the technique.

Brest experience in intraoperative radiotherapy for breast cancer

Purpose: Targeted intraoperative radiotherapy (TARGIT) of an early breast cancer is a novel and promising treatment approach. For carefully selected patients, it permits to omit external beam breast radiotherapy (EBRT) and thus reduce the treatment duration. Moreover it offers an excellent precision without risk of tumour site miss and normal tissue sparing. Various techniques of intraoperative radiotherapy (IORT) are available. The first technique being tested in randomised trial was the TARGIT using a device developed by clinical academics in collaboration with the industry, Intrabeam® system that consists of a small low-energy X-ray generator. Strict criteria for TARGIT eligibility need to be respected, i.e., age ≥45 years and invasive ductal carcinoma that is unifocal on conventional imaging ≤3.5 cm, without gross lymph node involvement. Methods: Our inclusion criteria were significantly stricter than those of the TARGIT-A trial and we only included patients ≥55 years with unifocal ductal invasive carcinoma of grade 1 or 2, tumour size ≤2 cm (based upon clinical and ultrasound evaluation), significant expression of hormone receptors (≥10%), no ErbB-2 expression. Intrabeam® system has been established within Regional University Hospital in Brest on April 2011. Between Mai 2011 and September 2013, 74 female patients were scheduled for TARGIT of an early stage breast cancer. Patients submitted a breast-conserving surgery (BCS) and sentinel lymph node (SLN) search. In case of respect of inclusion criteria patients benefited of TARGIT using a spherical applicator of a diameter depending upon the tumour and breast size. A total dose of 20 Gy was prescribed to the surface of the applicator and delivered into the surgical cavity. If any unfavorable histological modification appeared in the final pathological examination, a further EBRT needed to be done with a dose of 46-50 Gy. Patients were evaluated clinically 3-4 weeks post-operatively and possible side effects were documented. Results: Sixty five patients received TARGIT. For 66% of them, the TARGIT was the only radiation treatment. For 33% also a complementary EBRT was required and thus the TARGIT has replaced the boost, only. Among the first side effects observed induration of surgical bed, radiation dermatitis, seroma, and delayed healing were the most frequent ones that have appeared in 20%, 14%, 12.5%, and 12.5% of patients, respectively. Conclusions: Intraoperative irradiation during BCS is a feasible and promising alternative to conventional external fractionated radiotherapy. Strict eligibility criteria need to be taken into account before TARGIT is proposed to the patients. At present, only women with an early-stage breast cancer with low risk of recurrence can be candidates for this treatment modality.

First year experience with IORT for breast cancer at the Geneva University Hospitals

Purpose: The Breast Centre at the Geneva University Hospitals implemented guidelines for breast cancer intraoperative radiotherapy (IORT) in 2012. The present study evaluates early breast and skin toxicities observed during the first year of the implementation. Material and methods: From February 2012 to January 2013, 52 women received IORT for primary breast cancer treated with conservative surgery. IORT was delivered with the Intrabeam ® system. The prescribed dose was 20 Gy at the applicator’s surface. No further radiation was to be given according to the following criteria: age ≥50 years old, histopathology of invasive ductal, mucinous, tubular, medullar or colloid carcinoma, unifocal tumor, absence of lymphovascular invasion (LVI), absence of extensive in situ component, tumor size ≤30 mm, pathological nodal status pN0 by sentinel node biopsy or pN1mi by axillary dissection, and clear resection margins ≥2 mm. If the criteria were not met, additional whole breast radiotherapy (WBRT) to an equivalent dose of 50 Gy in 2-Gy fractions was to be given post-operatively. Toxicity grades were based on LENT-SOMA scoring tables. Results: IORT was given as exclusive radiation therapy in 34 (65%) patients, whereas 18 (35%) patients received an additional hypofractionated WBRT of 40-47.25 Gy in 15-21 fractions, one of whom further received after IORT-WBRT an additional electron boost of 13.5 Gy to the tumor bed in 6 fractions. At 1-month post-IORT, no heart toxicity was recorded. Six (11.5%) patients presented grade 2 lung symptoms. Breast/skin most frequent toxicities were seroma, grade 3 in 13 of 52 (25%) patients. One patient had a wound dehiscence requiring suture, and one patient had hematoma after immediate bilateral breast reconstruction with implants. Regarding the 18 patients who received additional WBRT, subsequent reevaluation after the WBRT found no heart toxicity, grade 1 lung symptoms in 1 (5%) patient, and grade 3 breast and skin toxicity in 2 (11%) patients (1 persistent seroma and 1 skin dryness). The breast and skin toxicity observed in patients after additional WBRT was not significantly increased as compared with the toxicity earlier observed after IORT, P=0.631. Conclusions: Early evaluation of IORT found mild to moderate breast and skin toxicity. Toxicity was not significantly increased in patients receiving additional WBRT.

Intraoperative radiotherapy for breast cancer: the lasting effects of a fleeting treatment.

In well-selected patients who choose to pursue breast conservation therapy (BCT) for early-stage breast cancer, partial breast irradiation (PBI) delivered externally or intraoperatively, may be a viable alternative to conventional whole breast irradiation. Two large, contemporary randomized trials have demonstrated breast intraoperative radiotherapy (IORT) to be noninferior to whole breast external beam radiotherapy (EBRT) when assessing for ipsilateral breast tumor recurrence in select patients. Additionally, IORT and other PBI techniques are likely to be more widely adopted in the future because they improve patient convenience by offering an accelerated course of treatment. Coupled with these novel techniques for breast radiotherapy (RT) are distinct toxicity profiles and unique cosmetic alterations that differ from conventional breast EBRT and have the potential to impact disease surveillance and patient satisfaction. This paper will review the level-one evidence for treatment efficacy as well as important secondary endpoints like RT toxicity, breast cosmesis, quality of life, patient satisfaction, and surveillance mammography following BCT with IORT.

Intraoperative radiotherapy for breast cancer

Intraoperative radiotherapy for breast cancer