Intraoperative Radiation Therapy Versus Whole Breast Radiation for Early-Stage Breast Cancer Treatment in Rural Appalachia

Background Intraoperative radiation therapy (IORT) is an alternate accelerated form of radiation following breast-conserving surgery (BCS). Lack of data regarding long-term outcomes has limited adoption. We report our experience with IORT in patients undergoing BCS versus whole breast radiation therapy (WBRT). Methods Retrospective review of patients undergoing BCS with IORT versus WBRT (2012-2017). Inclusion: low grade, T1-2N0M0, estrogen receptor/progesterone receptor positive, and Her2-negative infiltrating ductal carcinomas. IORT was delivered as a single fraction of radiation (20 Gy) intraoperatively. Outcomes were compared using Fisher’s test for discrete variables or Wilcoxon signed-rank test for continuous variables. Kaplan-Meier method was used to estimate disease-free survival (DFS). Results Fifty-one patients (44%) received IORT, and 66 (56%) received WBRT. There was no difference in age, tumor size, receptor status, or in-breast recurrence (1.9% vs 0%, all P > .05). Length of follow-up was longer in the WBRT group due to time to inception of IORT (mean ± SD: 44 ± 8.1 vs 73 ± 13 months, P < .001). There was no difference in DFS between the 2 groups (HR 2.5; P = .44). IORT patients experienced delay to BCS (mean ± SD: 38 ± 12.7 vs 27 ± 12.2 days, P < .001) likely due to coordination of care. Analysis demonstrated IORT patients would have traveled a mean distance of 20 miles to the closest WBRT center (range 1-70, miles) for a mean travel time of 31 minutes (range 4-90, minutes) per WBRT treatment. Discussion IORT produces noninferior oncologic outcomes and decreased skin toxicity compared with WBRT. It can be convenient for patients in rural regions with limited health care access.

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Surgical and Oncologic Outcomes With Intraoperative Radiation Therapy for Early Breast Cancer

The American Surgeon ◽

10.1177/00031348211047499 ◽

2021 ◽

pp. 000313482110474

Author(s):

Orli Friedman-Eldar ◽

Christina Layton ◽

Iago De Castro Silva ◽

Mecker G Moller ◽

Ahkeel Allen ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Early Stage ◽

Oncologic Outcomes ◽

Intraoperative Radiation Therapy ◽

Perioperative Outcomes ◽

Wound Complications ◽

Intraoperative Radiation ◽

Areola Complex

Background For selected patients with early-stage breast cancer (BC), intraoperative radiation therapy (IORT) has emerged as a convenient alternative to standard whole breast irradiation (WBI). We report a single institution experience with IORT in terms of oncologic outcomes, toxicities, and cosmesis. Methods Clinicopathological and perioperative outcomes of patients who underwent IORT for early-stage BC at a public hospital from 2017 to 2020 were retrospectively retrieved. Toxicity was categorized to acute or chronic based on 6 months post-IORT cutoff. Results 85 patients underwent IORT and had complete data, aged 49‐85 years (mean 62). Intraoperative radiation therapy added 23 minutes on average to the total operative time. Final stage was 0, I, and II in 40%, 58.9%, and 1.1% of patients, respectively. Mean tumor size was 0.8 cm (range .1-2.1), with ductal histology comprising 94% of cases. Surgical margins were positive in 2 patients, and adjuvant WBI was required in 5 patients. After a median follow‐up of 17 months (range 3-41), none of the patients had local recurrence and no mortality was recorded. Early wound complications included wound dehiscence (n = 1), seroma/hematoma (n = 15), and re-operation with loss of nipple-areola complex (n = 1). Chronic skin toxicities were reported in 10 (12%) patients and good or excellent cosmetic outcome was reported in 93% of patients. Conclusions Utilizing IORT among low-risk early BC patients may be a safe and more convenient alternative to traditional WBI, with low toxicity rate, acceptable cosmetic results, and good oncologic outcomes at 17 months. Longer follow-up and further prospective controlled studies are needed to confirm these findings.

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The TARGIT trial: targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update)

The American Journal of Surgery ◽

10.1016/j.amjsurg.2007.06.018 ◽

2007 ◽

Vol 194 (4) ◽

pp. 507-510 ◽

Cited By ~ 55

Author(s):

Dennis R. Holmes ◽

Michael Baum ◽

David Joseph

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Invasive Breast Cancer ◽

Early Stage ◽

Breast Conserving Surgery ◽

Intraoperative Radiation Therapy ◽

Breast Radiotherapy ◽

Intraoperative Radiation ◽

Whole Breast Radiotherapy

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Comparison of heart dose in early-stage left-sided breast cancers treated with intraoperative radiation therapy or whole-breast irradiation with deep inspiratory breath hold

Brachytherapy ◽

10.1016/j.brachy.2018.06.003 ◽

2018 ◽

Vol 17 (5) ◽

pp. 831-836 ◽

Cited By ~ 4

Author(s):

Clayton Alonso ◽

Einsley Janowski ◽

Bruce Libby ◽

Shayna Showalter

Keyword(s):

Radiation Therapy ◽

Early Stage ◽

Intraoperative Radiation Therapy ◽

Breath Hold ◽

Whole Breast Irradiation ◽

Breast Cancers ◽

Breast Irradiation ◽

Intraoperative Radiation ◽

Heart Dose

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Intraoperative radiation therapy for early stage breast cancer: experiences from Iran

10.21203/rs.3.rs-57682/v1 ◽

2020 ◽

Author(s):

Vahid Zangouri ◽

Hamid Nasrollahi ◽

Ali Taheri ◽

Majid Akrami ◽

Peyman Arasteh ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Patient Selection ◽

Tumor Size ◽

Ductal Carcinoma ◽

Early Stage ◽

Intraoperative Radiation Therapy ◽

Study Patient ◽

Intraoperative Radiation

Abstract Background and objective Currently no definite guideline exists on the use of intraoperative radiation therapy (IORT) among patients with early stage BC. We report our experiences with IORT among breast cancer (BC) patients in our region.Methods All patient who received radical IORT from April 2014 on to March 2020 were included in the study. Patient selection criteria were as followed: age equal or older than 45 years old; all cases of invasive carcinomas, moreover in lobular carcinomas only after MRI and confirmation, and in cases with ductal carcinoma in-situ (DCIS) only those with low, intermediate grade, tumor size of equal or less than 2.5cm and a margin of 2-3mm; those between 45 and 50 years old with a tumor size of 0-2cm, those between 50 and 55 years old with a tumor size of 2-2.5cm, and those ≥55 years old with a tumor size of 2.5-3cm; those with invasive tumors a negative margin and in cases of DCIS a margin of 3mm; a negative nodal status (exception in patients with micrometastasis); and a positive estrogen receptor status. Results Overall, 252 patients entered the study. Mean (SD) age of patients was 56.43±7.79 years. In total, 32.9% of patients had a family history of BC. Mean tumor size was 1.56±0.55 cm. Median (IQR) follow-up of patients was 24 (13, 36) months. Overall, 6 patients (2.4%) experienced recurrence in follow-up visits, among which three (1.2%) were local recurrence, two (0.8%) were regional recurrence and one patients (0.4%) had metastasis.Median (IQR) time to recurrence was 23 (13, 36) among the six patient who had recurrence. Overall, 11 patients (4.3%) with DCIS in our study received IORT. All these patients had free margins in histopathology examination. None of these patients experience recurrence.Conclusion For the first time, we categorized patients according to age and tumor size and older patients with larger tumor sizes were considered appropriate candidates for IORT. Our series showed a successful experience with the use of IORT in a region where facilities for IORT are limited using our modified criteria for patient selection.

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