scholarly journals Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Wolfram Malter ◽  
Verena Kirn ◽  
Lisa Richters ◽  
Claudius Fridrich ◽  
Birgid Markiefka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Early Breast Cancer ◽  
Breast Surgery ◽  
Intraoperative Radiotherapy ◽  
Local Therapy ◽  
Breast Conserving Surgery ◽  
Resection Margins ◽  
X Rays ◽  
Oncoplastic Breast Surgery

Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than “tumor not touching ink” leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT) can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy) in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer.

scholarly journals Effect of intraoperative radiotherapy on wound healing in breast cancer patient post breast conserving surgery, KSUMC, Riyadh, Saudi Arabia: Case series and review of literature.

2019 ◽  
Vol 6 (06) ◽  
pp. 4505-4510
Author(s):  
Dr. Maha Alamodi Alghamdi ◽  
Abdulaziz Saleh Altwjri ◽  
Abdullah Alsuhaibani ◽  
Abdulaziz Alsaif
Keyword(s):  
Breast Cancer ◽  
Hormone Receptor ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
Breast Conserving Surgery ◽  
Hormone Receptor Status ◽  
Wound Complications ◽  
External Beam ◽  
X Rays ◽  
Receptor Status

Intraoperative radiotherapy during breast-conserving surgery is being studied as an alternative to 6 weeks of external beam radiotherapy (EBRT) for low-risk women; it can be delivered using electrons (intraoperative electron radiotherapy, IOERT) or 50-kV X-rays. Intraoperative radiation therapy (IORT) may pose a risk for wound complications.  Between March 2018 and June 2018, 5 breast cancer patients, all eligible for breast conserving surgery (BCS), were treated at the King Saud Medical city with IORT using the IOERT. Complete data sets for age, stage (T, N, and M), and histology and hormone receptor status were available in 5 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favourable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E “elderly”, risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology. Consecutive patients operated on with the same surgical technique and given IORT were included. Wound complications were evaluated.

scholarly journals Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial

BMJ ◽  
2020 ◽  
pp. m2836 ◽  
Author(s):  
Jayant S Vaidya ◽  
Max Bulsara ◽  
Michael Baum ◽  
Frederik Wenz ◽  
Samuele Massarut ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Single Dose ◽  
Local Recurrence ◽  
Early Breast Cancer ◽  
External Beam Radiotherapy ◽  
Breast Cancer Mortality ◽  
Intraoperative Radiotherapy ◽  
Term Survival ◽  
Free Survival

AbstractObjectiveTo determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer.DesignProspective, open label, randomised controlled clinical trial.Setting32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada.Participants2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT).InterventionsRandom allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients).Main outcome measuresNon-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes.ResultsBetween 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival (hazard ratio 1.13, 95% confidence interval 0.91 to 1.41, P=0.28), mastectomy-free survival (0.96, 0.78 to 1.19, P=0.74), distant disease-free survival (0.88, 0.69 to 1.12, P=0.30), overall survival (0.82, 0.63 to 1.05, P=0.13), and breast cancer mortality (1.12, 0.78 to 1.60, P=0.54). Mortality from other causes was significantly lower (0.59, 0.40 to 0.86, P=0.005).ConclusionFor patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality. TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned.Trial registrationISRCTN34086741, NCT00983684.

Intraoperative radiotherapy in early breast cancer: 400 consecutive patients in one institution.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1108-1108
Author(s):  
Mariana Steiner ◽  
Michele Leviov ◽  
Arie Biterman ◽  
Eitan Shiloni ◽  
Jehudit Goldman
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
Systemic Disease ◽  
Intraoperative Radiotherapy ◽  
Local Therapy ◽  
Low Risk ◽  
Morbidity Rate ◽  
Breast Cancer Patients

1108 Background: From 2006 we offer intraoperative radiotherapy as the only post lumpectomy breast irradiation as an alternative to the standard post-operative WBRT in low risk early breast cancer patients (age > 60, invasive ductal carcinoma < 2 cm and clinically negative axilla). Younger patients (>50) or patients with tumors up to 3.5 cm or other histologies are treated too if they are not candidate for standard local therapy. In patients found to have high risk tumor characteristics at final pathology, additional local breast therapy is considered. Methods: Intrabeam System is used administering 20 Gy at the surface of surgical cavity. Results: 400 patients were treated. Their median age was 70 years (55-90). Median clinical tumor size was 12 mm (5-30). 14.5% had mild to moderate local complications: 6.5% wound infection, 5.8% complicated seromas, 1.7% bleeding or hematoma and 0.5% small skin necrosis. 6.2% experienced major complications: 2.5% required surgical intervention, 2% had late healing (> 90 days), 1% required IV antibiotics and 0.7% had grade III RTOG fibrosis. Median pathologic size was 14 mm (1-40). Pathologic free margins > 1mm were obtained in 98.8% of patients. 15.5 % were found to have axillary l-nodes involved (11% one node only), 12% of patients had adverse unexpected breast pathologic findings (7.5% EDCIS or LVI) and 11% had additional local therapy, most of them WBRT. Median follow up is 30 months (1-76) in the whole group and 43 months (3-76) in the first 200 patients treated. Seven ipsilateral breast failures (1.7%) and one axillary recurrence were observed, all had radical local therapy. Four patients developed systemic disease (1%), one of them with simultaneous breast recurrence and one had contralateral breast cancer. Conclusions: We conclude that intraoperative radiotherapy using the Intrabeam system is feasible and may offer an alternative to whole breast RT in low risk breast cancer patients. Clinically significant local morbidity rate is low and self limiting. Longer follow up is needed to evaluate final results and late toxicity.

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