Electron Beam Intraoperative Radiotherapy (ELIOT) in Pregnant Women with Breast Cancer: From in Vivo Dosimetry to Clinical Practice

Background: The aim of this study was to confirm our preliminary results with in vivo dosimetry in non-pregnant breast cancer patients receiving electron beam intraoperative radiotherapy (ELIOT) and to report on the first treatment in a pregnant woman. Patients and Methods: Following our previous experience, 5 non-pregnant patients receiving ELIOT to the tumor bed after breast-conserving surgery (BCS) were studied with thermoluminescent dosimeters positioned in the subdiaphragmatic region, within the uterus, and in the ovarian region. In December 2011, the first pregnant breast cancer patient underwent BCS and ELIOT (21 Gy at 90% isodose) during the 15th week of gestation. Results: The mean dose to the subdiaphragmatic external region in the 5 non-pregnant patients was 5.57 mGy, while pelvic measurements were below 1 mGy. The actual dosimetry of the pregnant patient showed a mean subdiaphragmatic dose of 4.34 mGy, a mean suprapubic dose of 1.64 mGy, and mean ovarian doses of 1.48 mGy (right-sided) and 1.44 mGy (left-sided). The expected dose to the fetus was estimated as 0.84 mGy (0.004% of the prescribed dose). Conclusion: ELIOT as an anticipated boost to the breast could be considered in pregnant women in the early second trimester, postponing whole-breast irradiation after delivery.

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Is Electron Beam Intraoperative Radiotherapy (ELIOT) Safe in Pregnant Women with Early Breast Cancer? In Vivo Dosimetry to Assess Fetal Dose

Annals of Surgical Oncology ◽

10.1245/s10434-008-0172-z ◽

2009 ◽

Vol 16 (1) ◽

Cited By ~ 17

Author(s):

Viviana Galimberti ◽

Mario Ciocca ◽

Maria Cristina Leonardi ◽

Vanna Zanagnolo ◽

Baratella Paola ◽

...

Keyword(s):

Breast Cancer ◽

Electron Beam ◽

Pregnant Women ◽

Early Breast Cancer ◽

Intraoperative Radiotherapy ◽

In Vivo Dosimetry ◽

Fetal Dose

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In vivo dosimetry and acute toxicity in breast cancer patients undergoing intraoperative radiotherapy as boost

Radiation Oncology Journal ◽

10.3857/roj.2017.00150 ◽

2017 ◽

Vol 35 (2) ◽

pp. 121-128 ◽

Cited By ~ 9

Author(s):

Jason Joon Bock Lee ◽

Jinhyun Choi ◽

Sung Gwe Ahn ◽

Joon Jeong ◽

Ik Jae Lee ◽

...

Keyword(s):

Breast Cancer ◽

Acute Toxicity ◽

Cancer Patients ◽

Intraoperative Radiotherapy ◽

In Vivo Dosimetry ◽

Breast Cancer Patients

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Intraoperative radiotherapy given as a boost after breast-conserving surgery in breast cancer patients

European Journal of Cancer ◽

10.1016/s0959-8049(02)00116-8 ◽

2002 ◽

Vol 38 (12) ◽

pp. 1607-1610 ◽

Cited By ~ 44

Author(s):

R. Reitsamer ◽

F. Peintinger ◽

F. Sedlmayer ◽

M. Kopp ◽

C. Menzel ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Intraoperative Radiotherapy ◽

Breast Conserving Surgery ◽

Breast Cancer Patients

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OC-0487: In vivo dosimetry using MOSFET and radiochromic films in intraoperative radiotherapy for breast cancer treatment

Radiotherapy and Oncology ◽

10.1016/s0167-8140(15)32793-6 ◽

2013 ◽

Vol 106 ◽

pp. S189-S190

Author(s):

F. Cavagnetto ◽

L. Ferri ◽

S. Agostinelli ◽

M. Gusinu ◽

M. Guenzi ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Treatment ◽

Intraoperative Radiotherapy ◽

Breast Cancer Treatment ◽

In Vivo Dosimetry ◽

Radiochromic Films

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Targeted intraoperative radiotherapy tumor bed boost during breast conserving surgery after neoadjuvant chemotherapy in hormone receptor positive HER2 negative breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12090 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12090-e12090 ◽

Cited By ~ 1

Author(s):

Hans-Christian Kolberg ◽

Gyoergy Loevey ◽

Leyla Akpolat-Basci ◽

Miltiades Stephanou ◽

Peter A. Fasching ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Hormone Receptor ◽

Intraoperative Radiotherapy ◽

Breast Conserving Surgery ◽

Tumor Bed ◽

Hormone Receptor Positive ◽

Whole Breast Radiotherapy ◽

Tumor Bed Boost

e12090 Background: Targeted intraoperative radiotherapy (TARGIT – IORT) as a tumor bed boost during breast conserving surgery is an established option for women with early breast cancer. In a previous study our group could show a beneficial effect of TARGIT-IORT on overall survival after neoadjuvant chemotherapy compared to an external boost in an unselected cohort. In this study we present an analysis of the hormone receptor positive HER2 negative subgroup. Methods: In this non-randomized cohort study involving 46 hormone receptor positive HER2 negative patients after NACT we compared outcomes of 21 patients who received a tumour bed boost with IORT (TARGIT-IORT) during lumpectomy versus 25 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Disease free survival (DFS) and overall survival (OS) were compared. Results: There were no statistical differences between the two groups regarding tumor size, grading, nodal status and pCR rates. Median follow up was 49 months. Whereas DFS was not significantly different between the groups the 5-year Kaplan-Meier estimate of OS was significantly better by 21% with IORT: TARGIT-IORT 0 events 100%, EBRT 5 events 79%, log rank p = 0.028. Conclusions: Although our results have to be interpreted with caution due to a possible selection bias and the small numbers, we could show that the improved OS as previously demonstrated in our dataset for TARGIT-IORT during lumpectomy after neoadjuvant chemotherapy as a tumor bed boost compared to an external beam radiotherapy boost is driven by the hormone receptor positive HER2 negative subgroup. These data give further support to the inclusion of such patients in the TARGIT-B (Boost) randomised trial that is testing whether IORT boost is superior to EBRT boost and to the analysis of subgroups based on tumor biology in this trial.

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