Feasibility of concervative breast surgery and intraoperative radiation therapy for early breast cancer: A single-center, open, non-randomized, prospective pilot study

Cedolini,Carla; Bertozzi,Serena; Seriau,Luca; Londero,Ambrogio P.; Concina,Serena; Moretti,Eugenia; Padovani,Renato; Pasqualucci,Alberto; Ceschia,Tino; Risaliti,Andrea

doi:10.3892/or.2014.3018

Feasibility of concervative breast surgery and intraoperative radiation therapy for early breast cancer: A single-center, open, non-randomized, prospective pilot study

Authors:
- Carla Cedolini
- Serena Bertozzi
- Luca Seriau
- Ambrogio P. Londero
- Serena Concina
- Eugenia Moretti
- Renato Padovani
- Alberto Pasqualucci
- Tino Ceschia
- Andrea Risaliti
View Affiliations

Affiliations: Clinic of Surgery, University of Udine, I-33100 Udine, Italy, Clinic of Obstetrics and Gynecology, University of Udine, I-33100 Udine, Italy, Department of Medical Physics, AOU ‘Santa Maria della Misericordia’, I-33100 Udine, Italy, Department of Surgical and Biomedical Sciences, University of Perugia, I-06123 Perugia, Italy, Department of Radiotherapy, AOU ‘Santa Maria della Misericordia’, I-33100 Udine, Italy
Published online on: February 11, 2014 https://doi.org/10.3892/or.2014.3018
Pages: 1539-1546
Copyright: © Cedolini et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Intraoperative radiotherapy (IORT) consists of an accelerated, single-dose, partial breast irradiation, performed immediately after breast conservative surgery. In the present study, we report the results of our feasibility protocol study using IORT between 2005 and 2009. We analyzed the data from a single-center, open, non-randomized, prospective pilot study including patients who underwent breast conservative surgery for invasive breast cancer between January 2005 and December 2009 at our Clinic of Surgery. Patients were divided based on IORT performance and stratified by age (≥48 or <48 years). Data were analyzed using R (version 2.15.2), considering a level of significance at p<0.05. Among the 247 eligible patients, 81 accepted the IORT protocol. Intraoperative IORT feasibility was 95.1% (77/81). In 71.4% (55/77) of the cases no postoperative complication was registered. Concerning local recurrence and overall survival, no significant difference was observed between women who underwent the IORT protocol or standard treatment. Among the patients aged <48 years, no local recurrence was noted after IORT protocol, and among women aged ≥48, local recurrences developed later in patients treated with IORT than with standard treatment. IORT represents a feasible and promising technique for the treatment of early breast cancer, with low morbidity, and beneficial aesthetic and oncologic results. Further studies are required in order to extend the inclusion criteria and offer IORT to a larger number of breast cancer patients.

View Figures

View References

1	Arthur DW and Vicini FA: Accelerated partial breast irradiation as a part of breast conservation therapy. J Clin Oncol. 23:1726–1735. 2005. View Article : Google Scholar : PubMed/NCBI
2	Athas WF, Adams-Cameron M, Hunt WC, Amir-Fazli A and Key CR: Travel distance to radiation therapy and receipt of radiotherapy following breast conservative surgery. J Natl Cancer Inst. 92:269–271. 2000. View Article : Google Scholar : PubMed/NCBI
3	Voogd AC, van Tienhoven G, Peterse HL, et al: Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Cancer. 85:437–446. 1999. View Article : Google Scholar
4	Kennedy MJ and Abeloff MD: Management of locally recurrent breast cancer. Cancer. 71:2395–2409. 1993. View Article : Google Scholar : PubMed/NCBI
5	Cajucom CC, Tsangaris TN, Nemoto T, Driscoll D, Penetrante RB and Holyoke ED: Results of salvage mastectomy for local recurrence after breast conservative surgery without radiation therapy. Cancer. 71:1774–1779. 1993. View Article : Google Scholar : PubMed/NCBI
6	Cionini L, Pacini P, Marzano S, Distante V, Cardona G and Bianchi S: Exclusive brachytherapy after conservative surgery in cancer of the breast. Lyon Chir. 89:1281993.
7	Del Frate C, Borghese L, Cedolini C, et al: Role of pre-surgical breast MRI in the management of invasive breast carcinoma. Breast. 16:469–481. 2007.PubMed/NCBI
8	Wasif N, Maggard M, Ko C, et al: Underuse of axillary dissection for the management of sentinel node micrometastases in breast cancer. Arch Surg. 145:161–166. 2010. View Article : Google Scholar : PubMed/NCBI
9	Lyman G, Giuliano A, Somerfield M, et al: American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 23:7703–7720. 2005. View Article : Google Scholar : PubMed/NCBI
10	Joseph KA, El-Tamer M, Komenaka I, Troxel A, Ditkoff BA and Schnabel F: Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis. Arch Surg. 139:648–651. 2004. View Article : Google Scholar : PubMed/NCBI
11	Lemanski C, Azria D, Gourgon-Bourgade S, et al: Intraoperative radiotherapy in early-stage breast cancer: results of the montpellier phase II trial. Int J Radiat Oncol Biol Phys. 76:698–703. 2010. View Article : Google Scholar : PubMed/NCBI
12	Wasser K, Schoeber C, Kraus-Tiefenbacher U, et al: Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer. Eur Radiol. 17:1865–1874. 2007. View Article : Google Scholar : PubMed/NCBI
13	Della Sala SW, Pellegrini M, Bernardi D, et al: Mammographic and ultrasonographic comparison between intraoperative radiotherapy (IORT) and conventional external radiotherapy (RT) in limited-stage breast cancer, conservatively treated. Eur J Radiol. 59:222–230. 2006.
14	Reitsamer R, Peintinger F, Kopp M, Menzel C, Kogelnik HD and Sedlmayer F: Local recurrence rates in breast cancer patients treated with intraoperative electron-boost radiotherapy versus postoperative external-beam electron-boost irradiation. A sequential intervention study. Strahlenther Onkol. 180:38–44. 2004. View Article : Google Scholar
15	Reitsamer R, Peintinger F, Sedlmayer F, et al: Intraoperative radiotherapy given as a boost after breast conservative surgery in breast cancer patients. Eur J Cancer. 38:1607–1610. 2002. View Article : Google Scholar : PubMed/NCBI
16	Vaidya JS, Baum M, Tobias JS, et al: Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost. Int J Radiat Oncol Biol Phys. 66:1335–1338. 2006. View Article : Google Scholar : PubMed/NCBI
17	Ivaldi GB, Leonardi MC, Orecchia R, et al: Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast conservative surgery in premenopausal women. Int J Radiat Oncol Biol Phys. 72:485–493. 2008. View Article : Google Scholar
18	Mussari S, Sabino Della Sala W, Busana L, et al: Full-dose intraoperative radiotherapy with electrons in breast cancer. First report on late toxicity and cosmetic results from a single-institution experience. Strahlenther Onkol. 182:589–595. 2006. View Article : Google Scholar : PubMed/NCBI
19	Veronesi U, Orecchia R, Luini A, et al: Full-dose intraoperative radiotherapy with electrons during breast conservative surgery: experience with 590 cases. Ann Surg. 242:101–106. 2005. View Article : Google Scholar : PubMed/NCBI
20	Veronesi U, Orecchia R, Luini A, et al: Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast Cancer Res Treat. 124:141–151. 2010. View Article : Google Scholar : PubMed/NCBI
21	Sperk E, Welzel G, Keller A, Kraus-Tiefenbacher U, Gerhardt A, Sütterlin M and Wenz F: Late radiation toxicity after intraoperative radiotherapy (IORT) for breast cancer: results from the randomized phase III trial TARGIT A. Breast Cancer Res Treat. 135:253–260. 2012. View Article : Google Scholar : PubMed/NCBI
22	Vanderwalde NA, Jones EL, Kimple RJ, Moore DT, Klauber-Demore N, Sartor CI and Ollila DW: Phase 2 study of pre-excision single-dose intraoperative radiation therapy for early-stage breast cancers: six-year update with application of the ASTRO accelerated partial breast irradiation consensus statement criteria. Cancer. 119:1736–1743. 2013.
23	Farrow DC, Hunt WC and Samet JM: Geographic variation in the treatment of localized breast cancer. N Engl J Med. 326:1097–1101. 1992. View Article : Google Scholar : PubMed/NCBI
24	Kotwall CA, Covington DL, Rutledge R, Churchill MP and Meyer AA: Patient, hospital, and surgeon factors associated with breast conservation surgery. A statewide analysis in North Carolina. Ann Surg. 224:419–429. 1996. View Article : Google Scholar : PubMed/NCBI
25	Samet JM, Hunt WC and Farrow DC: Determinants of receiving breast conservative surgery. The Surveillance, Epidemiology, and End Results Program, 1983–1986. Cancer. 73:2344–2351. 1994.PubMed/NCBI