IORT for breast cancer
First year experience with IORT for breast cancer at the Geneva University Hospitals
Abstract
Purpose: The Breast Centre at the Geneva University Hospitals implemented guidelines for breast cancer intraoperative radiotherapy (IORT) in 2012. The present study evaluates early breast and skin toxicities observed during the first year of the implementation.
Material and methods: From February 2012 to January 2013, 52 women received IORT for primary breast cancer treated with conservative surgery. IORT was delivered with the Intrabeam® system. The prescribed dose was 20 Gy at the applicator’s surface. No further radiation was to be given according to the following criteria: age ≥50 years old, histopathology of invasive ductal, mucinous, tubular, medullar or colloid carcinoma, unifocal tumor, absence of lymphovascular invasion (LVI), absence of extensive in situ component, tumor size ≤30 mm, pathological nodal status pN0 by sentinel node biopsy or pN1mi by axillary dissection, and clear resection margins ≥2 mm. If the criteria were not met, additional whole breast radiotherapy (WBRT) to an equivalent dose of 50 Gy in 2-Gy fractions was to be given post-operatively. Toxicity grades were based on LENT-SOMA scoring tables.
Results: IORT was given as exclusive radiation therapy in 34 (65%) patients, whereas 18 (35%) patients received an additional hypofractionated WBRT of 40-47.25 Gy in 15-21 fractions, one of whom further received after IORT-WBRT an additional electron boost of 13.5 Gy to the tumor bed in 6 fractions. At 1-month post-IORT, no heart toxicity was recorded. Six (11.5%) patients presented grade 2 lung symptoms. Breast/skin most frequent toxicities were seroma, grade 3 in 13 of 52 (25%) patients. One patient had a wound dehiscence requiring suture, and one patient had hematoma after immediate bilateral breast reconstruction with implants. Regarding the 18 patients who received additional WBRT, subsequent reevaluation after the WBRT found no heart toxicity, grade 1 lung symptoms in 1 (5%) patient, and grade 3 breast and skin toxicity in 2 (11%) patients (1 persistent seroma and 1 skin dryness). The breast and skin toxicity observed in patients after additional WBRT was not significantly increased as compared with the toxicity earlier observed after IORT, P=0.631.
Conclusions: Early evaluation of IORT found mild to moderate breast and skin toxicity. Toxicity was not significantly increased in patients receiving additional WBRT.
Material and methods: From February 2012 to January 2013, 52 women received IORT for primary breast cancer treated with conservative surgery. IORT was delivered with the Intrabeam® system. The prescribed dose was 20 Gy at the applicator’s surface. No further radiation was to be given according to the following criteria: age ≥50 years old, histopathology of invasive ductal, mucinous, tubular, medullar or colloid carcinoma, unifocal tumor, absence of lymphovascular invasion (LVI), absence of extensive in situ component, tumor size ≤30 mm, pathological nodal status pN0 by sentinel node biopsy or pN1mi by axillary dissection, and clear resection margins ≥2 mm. If the criteria were not met, additional whole breast radiotherapy (WBRT) to an equivalent dose of 50 Gy in 2-Gy fractions was to be given post-operatively. Toxicity grades were based on LENT-SOMA scoring tables.
Results: IORT was given as exclusive radiation therapy in 34 (65%) patients, whereas 18 (35%) patients received an additional hypofractionated WBRT of 40-47.25 Gy in 15-21 fractions, one of whom further received after IORT-WBRT an additional electron boost of 13.5 Gy to the tumor bed in 6 fractions. At 1-month post-IORT, no heart toxicity was recorded. Six (11.5%) patients presented grade 2 lung symptoms. Breast/skin most frequent toxicities were seroma, grade 3 in 13 of 52 (25%) patients. One patient had a wound dehiscence requiring suture, and one patient had hematoma after immediate bilateral breast reconstruction with implants. Regarding the 18 patients who received additional WBRT, subsequent reevaluation after the WBRT found no heart toxicity, grade 1 lung symptoms in 1 (5%) patient, and grade 3 breast and skin toxicity in 2 (11%) patients (1 persistent seroma and 1 skin dryness). The breast and skin toxicity observed in patients after additional WBRT was not significantly increased as compared with the toxicity earlier observed after IORT, P=0.631.
Conclusions: Early evaluation of IORT found mild to moderate breast and skin toxicity. Toxicity was not significantly increased in patients receiving additional WBRT.
