The POLO (Partially Omitted Lobe) approach to safely treat in-breast recurrence after intraoperative radiotherapy with electrons

2021 ◽  
Author(s):  
Maria Cristina Leonardi ◽  
Andriana Kouloura ◽  
Damaris Patricia Rojas ◽  
Mattia Zaffaroni ◽  
Mattia Intra ◽  
...  
Keyword(s):  
Intraoperative Radiotherapy ◽  
Intensity Modulated Radiotherapy ◽  
Severe Toxicity ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy ◽  
Integrated Boost ◽  
Prescription Dose ◽  
Dose Constraints ◽  
Reduction Of Radiation Dose ◽  
Breast Recurrence

Objectives: The aim of this study is to evaluate feasibility of salvage 4-week hypofractionated whole breast radiotherapy (WBRT) in patients with in-breast recurrence after receiving intraoperative radiotherapy with electrons (IOERT) for primary breast cancer (BC). Methods: BC patients who had repeated quadrantectomy underwent modified WBRT with intensity-modulated radiotherapy using Helical Tomotherapy to underdose the IOERT region. This approach, called POLO (Partially Omitted Lobe), excluded the IOERT volume from receiving the full prescription dose. Results: Nine patients were treated with this approach, receiving 45 Gy in 20 fractions. A simultaneous integrated boost of 2.5 Gy in 20 fractions was delivered in 6/9 patients. Dose constraints and planning objectives were reported. No severe toxicity was reported while local control and overall survival were 100%. Conclusion: The POLO approach is technically feasible and capable to achieve a significant reduction of radiation dose delivered to the previous treated IOERT area. Advances in knowledge: The study demonstrates the technical and dosimetric feasibility of conservative salvage whole breast radiotherapy, while sparing the area already treated with IORT, in patients with in-breast recurrence.

Workload of breast image-guided intensity-modulated radiotherapy delivered with TomoTherapy

2019 ◽  
Vol 106 (6) ◽  
pp. 518-523
Author(s):  
Rosalinda Ricotti ◽  
Eleonora Miglietta ◽  
Maria Cristina Leonardi ◽  
Federica Cattani ◽  
Samantha Dicuonzo ◽  
...  
Keyword(s):  
Treatment Time ◽  
Intensity Modulated Radiotherapy ◽  
Breast Radiotherapy ◽  
Overall Treatment Time ◽  
Postmastectomy Radiotherapy ◽  
Intensity Modulated ◽  
Breast Image ◽  
Whole Breast Radiotherapy ◽  
Integrated Boost ◽  
Workflow Efficiency

Objective: To report treatment times (door to door) of adjuvant treatments of breast cancer (BC) with intensity-modulated radiotherapy (IMRT). Methods: Treatment times of 62 patients with BC on the TomoTherapy Hi-Art System were collected for the analysis. Patients underwent either locoregional radiotherapy (postmastectomy radiotherapy [PMRT]) with helical modality (TomoHelical) or whole breast radiotherapy (RT) with simultaneous integrated boost (WBRT-SIB) with direct modality (TomoDirect). Door-to-door time was broken down into different steps, which were crucial to RT session. Results: A total of 594 treatment fractions were monitored. Median treatment time was 22.4 minutes (17.2–30.8) for PMRT and 14.4 minutes (10.9–23.5) for WBRT-SIB. The mean beam-on time accounted for 61.36% of the overall treatment time for PMRT compared to 57% for WBRT-SIB. The beam-on time was a much more time-consuming process. Conclusion: This treatment times analysis on the use of IMRT for BC might be useful to organize and improve the workflow efficiency in RT facilities.

PO-1135 Ultra-hypofractionated whole breast radiotherapy with integrated boost for early breast cancer

2021 ◽  
Vol 161 ◽  
pp. S942-S943
Author(s):  
A. Montero ◽  
R. Ciervide ◽  
M. Garcia-Aranda ◽  
B. Alvarez ◽  
A. Prado ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy ◽  
Integrated Boost

Acute side effects of intraoperative electron radiotherapy of breast cancer.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 112-112
Author(s):  
Edwin Boelke ◽  
Wilfried Budach ◽  
Wolfgang Janni ◽  
Karin Zwiefel ◽  
Freddy-Joel Njanang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Acute Toxicity ◽  
Intraoperative Radiotherapy ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
European Organization ◽  
Whole Breast Radiotherapy ◽  
Acute Side Effects

112 Background: Intraoperative boost irradiation as part of breast-conserving therapy is a perfect method to adequately capture the high risk tumor relapse area. The most homogeneous dose distribution is achieved with electrons. Intraoperative radiotherapy (IOERT) as a boost for breast cancer releases a high single dose of radiation to the breast tissue; therefore acute toxicity is of particular attention. To date there is only inadequate information available on breast cancer patients treated with IORT using electrons applied as a boost. We therefore analyzed the acute toxicity after radiotherapy with 10 Gy as a boost with a minimum follow-up of 3 months. Methods: A total of 69 patients treated with IOERT (10Gy with 5, 7 and 9 MeV electrons) with a dedicated robotic linac (NOVAC 7, New Radiant Technology, Aprilia, Italy) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT, 50.4 Gy; 1.8 Gy per fraction) were included in this study. All patients underwent a retrospective follow-up (median, 8 months; range 1-17 months) regarding acute side effects within the first three months. Toxicities were documented using the common toxicity criteria (CTC 4.0 of the European Organization for Research and Treatment of Cancer). Results: The IOERT was well tolerated. As a side effect there was one patient with seroma. Two patients developed chronic pain in the irradiated breast. Two patients developed a secondary wound healing. The remaining patients did not develop any grade 3 or 4 side effects. The observed toxicity rates were not influenced by age, tubus size, electron energy or systemic therapy. Conclusions: After IOERT of the breast using electrons we did not find any unexpected acute toxicity rates.

scholarly journals Intraoperative Radiotherapy Is Not a Better Alternative to Whole Breast Radiotherapy as a Therapeutic Option for Early-Stage Breast Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Linwei Wang ◽  
Min Sun ◽  
Shuailong Yang ◽  
Yuanyuan Chen ◽  
Tian Li
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Intraoperative Radiotherapy ◽  
Recurrence Risk ◽  
Early Stage Breast Cancer ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy

ObjectiveIntraoperative radiotherapy (IORT) in early-stage breast cancer has been studied over the years. However, it has not been demonstrated whether IORT is more suitable as a therapeutic option for early-stage breast cancer than whole breast radiotherapy (WBRT). Therefore, we performed a meta-analysis to compare the efficacy and safety of IORT to those of WBRT as therapeutic options for early-stage breast cancer patients receiving breast-conserving surgery (INPLASY2020120008).MethodsPubMed, Embase, and Cochrane Library databases were searched from inception to October 2021. Computerized and manual searches were adopted to identify eligible randomized control trials from online databases. Risk ratio (RR) and 95% confidence intervals (CI) were calculated by random-effect models to assess the relative risk. Potential publication bias was quantified by Begg’s and Egger’s tests.ResultsBased on our inclusion criteria, 10 randomized control trials involving 5,698 patients were included in this meta-analysis. This meta-analysis showed that the IORT group was associated with a higher local recurrence risk (RR = 2.111, 95% CI, 1.130–3.943, p = 0.0191), especially in the long-term follow-up subgroup or published after 2020 subgroup or Caucasian subgroup (RR = 2.404, 95% CI, 1.183–4.885, p = 0.0154). Subgroup analysis showed that the IORT group had a higher recurrence risk than the WBRT group in the polycentric randomized controlled trial subgroup (RR = 1.213, 95% CI, 1.030–1.428, p = 0.0204). Pooled analysis showed that there was no statistically significant difference in overall survival, recurrence-free survival, distant metastasis-free survival, and cancer-specific survival between IORT and WBRT groups. Additionally, the risk of skin toxicity was reduced, but the incidences of fat toxicity, edema, and scar calcification were significantly increased in the patients who underwent IORT in comparison to those who underwent WBRT.ConclusionThis meta-analysis revealed that IORT was not a better alternative to WBRT. More large-scale and well-designed clinical trials with longer follow-up periods are encouraged to further investigate the value of IORT.Systematic Review Registrationhttps://inplasy.com/inplasy-2020-12-0008/.

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