Intraoperative Radiotherapy
Brest experience in intraoperative radiotherapy for breast cancer
Abstract
Purpose: Targeted intraoperative radiotherapy (TARGIT) of an early breast cancer is a novel and promising treatment approach. For carefully selected patients, it permits to omit external beam breast radiotherapy (EBRT) and thus reduce the treatment duration. Moreover it offers an excellent precision without risk of tumour site miss and normal tissue sparing. Various techniques of intraoperative radiotherapy (IORT) are available. The first technique being tested in randomised trial was the TARGIT using a device developed by clinical academics in collaboration with the industry, Intrabeam® system that consists of a small low-energy X-ray generator. Strict criteria for TARGIT eligibility need to be respected, i.e., age ≥45 years and invasive ductal carcinoma that is unifocal on conventional imaging ≤3.5 cm, without gross lymph node involvement.
Methods: Our inclusion criteria were significantly stricter than those of the TARGIT-A trial and we only included patients ≥55 years with unifocal ductal invasive carcinoma of grade 1 or 2, tumour size ≤2 cm (based upon clinical and ultrasound evaluation), significant expression of hormone receptors (≥10%), no ErbB-2 expression. Intrabeam® system has been established within Regional University Hospital in Brest on April 2011. Between Mai 2011 and September 2013, 74 female patients were scheduled for TARGIT of an early stage breast cancer. Patients submitted a breast-conserving surgery (BCS) and sentinel lymph node (SLN) search. In case of respect of inclusion criteria patients benefited of TARGIT using a spherical applicator of a diameter depending upon the tumour and breast size. A total dose of 20 Gy was prescribed to the surface of the applicator and delivered into the surgical cavity. If any unfavorable histological modification appeared in the final pathological examination, a further EBRT needed to be done with a dose of 46-50 Gy. Patients were evaluated clinically 3-4 weeks post-operatively and possible side effects were documented.
Results: Sixty five patients received TARGIT. For 66% of them, the TARGIT was the only radiation treatment. For 33% also a complementary EBRT was required and thus the TARGIT has replaced the boost, only. Among the first side effects observed induration of surgical bed, radiation dermatitis, seroma, and delayed healing were the most frequent ones that have appeared in 20%, 14%, 12.5%, and 12.5% of patients, respectively.
Conclusions: Intraoperative irradiation during BCS is a feasible and promising alternative to conventional external fractionated radiotherapy. Strict eligibility criteria need to be taken into account before TARGIT is proposed to the patients. At present, only women with an early-stage breast cancer with low risk of recurrence can be candidates for this treatment modality.
Methods: Our inclusion criteria were significantly stricter than those of the TARGIT-A trial and we only included patients ≥55 years with unifocal ductal invasive carcinoma of grade 1 or 2, tumour size ≤2 cm (based upon clinical and ultrasound evaluation), significant expression of hormone receptors (≥10%), no ErbB-2 expression. Intrabeam® system has been established within Regional University Hospital in Brest on April 2011. Between Mai 2011 and September 2013, 74 female patients were scheduled for TARGIT of an early stage breast cancer. Patients submitted a breast-conserving surgery (BCS) and sentinel lymph node (SLN) search. In case of respect of inclusion criteria patients benefited of TARGIT using a spherical applicator of a diameter depending upon the tumour and breast size. A total dose of 20 Gy was prescribed to the surface of the applicator and delivered into the surgical cavity. If any unfavorable histological modification appeared in the final pathological examination, a further EBRT needed to be done with a dose of 46-50 Gy. Patients were evaluated clinically 3-4 weeks post-operatively and possible side effects were documented.
Results: Sixty five patients received TARGIT. For 66% of them, the TARGIT was the only radiation treatment. For 33% also a complementary EBRT was required and thus the TARGIT has replaced the boost, only. Among the first side effects observed induration of surgical bed, radiation dermatitis, seroma, and delayed healing were the most frequent ones that have appeared in 20%, 14%, 12.5%, and 12.5% of patients, respectively.
Conclusions: Intraoperative irradiation during BCS is a feasible and promising alternative to conventional external fractionated radiotherapy. Strict eligibility criteria need to be taken into account before TARGIT is proposed to the patients. At present, only women with an early-stage breast cancer with low risk of recurrence can be candidates for this treatment modality.
