Proven Cancer Indications: Breast (Single-Fraction APBI)

Summary/Conclusion

Recently, interest has also grown in intraoperative radiation therapy (IORT), which treats the partial breast with a single dose of radiation using either low-energy x-rays or electrons, most commonly delivered at the time of surgery. These different modalities are likely to have certain tradeoffs with regard to their effectiveness and toxicity profiles, although these tradeoffs have yet to be completely described in the existing literature.

Summary/Conclusion

Authors AnnaPetoukhova, IrisRüssel, JulienneNijst-Brouwers, Kovan Wingerden, Jaapvan Egmond, DaphneJacobs, AndreasMarinelli, Joostvan der Sijp, PeterKoper, HenkStruikmans  Purpose The purpose of this study was to compare the delivered dose to the expected intraoperative radiation therapy (IORT) dose with in vivo dosimetry. For IORT using electrons in accelerated partial breast irradiation, this is especially relevant since a high dose is delivered in a single fraction. Methods For … Continued

Summary/Conclusion

These findings support the recent guidelines from the American Society for Radiation Oncology (ASTRO) supporting the use of electron IORT for low-risk patients.

Summary/Conclusion

After breast conservation surgery, SF or HfB may be an option for patients with early-stage breast cancer compared to conventional external beam radiotherapy.

Summary/Conclusion

In our current practice we consider the following preoperative factors to select patients suitable for IORT: age > 50 years, absence of lobular histology, tumor size ≤ 2 cm, pN0 or pNmic, according to APBI consensus statement, including also ki67 ≤ 20%, non triple negative receptor status and G1-G2

Summary/Conclusion

Background In conservative breast surgery, the achievement of a satisfactory cosmetic result could be challenging; oncoplastic techniques may be helpful in many cases. A comparative analysis was performed among 3 groups of patients undergoing oncoplastic techniques plus external radiation therapy or intraoperative radiotherapy (IORT) and breast conservative surgery plus external radiation therapy; long-term oncologic results … Continued

Summary/Conclusion

The preoperative diagnostic work-up must be comprehensive and the selection process must be rigorous for this therapeutic approach reserved for small ductal unifocal cancers. After 23.3 months median follow-up, the clinical results of IOERT for selected patients are encouraging for locoregional recurrence rate and toxicity rates. The satisfaction of our patients in terms of quality of life was extremely high.

Summary/Conclusion

Although the rate of IBTR was within pre-specified equivalence margin, the rate was significantly greater than with EBRT, and overall survival did not differ between the groups. Improved selection of patients should reduce the rate of IBTR with IOERT.

Summary/Conclusion

APBI using a single dose of IOERT can be delivered safely in women with early, low-risk breast cancer in carefully selected patients.

Summary/Conclusion

The 5-year rate of ipsilateral breast recurrence for ASTRO suitable, cautionary and unsuitable groups were 1.5%, 4.4% and 8.8% (p = 0.0003)…the ASTRO recommendations offer useful guidance to judge the appropriateness of APBI using ELIOT.