Breast cancer radiotherapyIORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: Long term results of an ISIORT pooled analysis
Section snippets
Patients and methods
A pooled analysis has been performed among 7 member institutions of the ISIORT-Europe (Table 1). Each institution conducted its own prospective program on breast boost IOERT preceding WBI in agreement with the requirements of their local ethic’s committees’ or internal review boards. All patients gave informed consent.
Data of 1235 consecutive patients were collected, with the vast majority treated between 10/98 and 10/05, and a smaller cohort of 50 patients from Montpellier dating back to the
Statistics
Univariate and multivariate Cox proportional hazards regression models were used to estimate the influence of patients’ or tumor characteristics on the risk of local recurrence for a 95% confidence level. SPSS (IBM PSWA Statistics 18, version 18.0.3) was used to perform the analyses [12].
Results
As of March 2009, a median follow up period of 72.4 months (range 0.8–239) was reached. The quality of follow-up was high, with lacking information for more than one year of only 107 patients (9.6%), the latter group still providing a median FU-time of 67.5 months (3.8–208.6). At the time of analysis, 951 patients were alive without evidence of breast disease.
110 patients had developed metastases, 106 patients have died, thereof 47 from breast cancer and 13 from other malignancies. The actuarial
Discussion
Frozen section histology as first estimation of resection margins [16] shows a specificity of 84% [17] and was in our study available in 79% of all cases. Final histopathological assessment might reveal discrepancies toward frozen section especially for in-situ tumor, leading to re-excisions in a second operation as necessary. In our series, this caused the vast majority of the 10% second resection rate. As to invasive components, frozen sections gave precise intraoperative informations on
Conclusion
IOERT during BCS as preceding boost strategy has possible advantages in terms of precision, patient comfort and in theory, also a potential beneficial influence on late cosmesis. Long term results provide outstanding in-breast tumor control rates in every risk group.
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Cited by (79)
Intraoperative radiation therapy in the management of early stage breast cancer
2023, BrachytherapyCitation Excerpt :Multiple studies have evaluated IORT for boost; a prospective series comes from Vaidya et al. who evaluated 299 patients treated with a low-energy IORT boost during breast conserving surgery (BCS), followed by 45–50 Gy WBI. At 60.5 months, the IBTR rate was 1.73%, which is consistent with additional series (25-27). TARGIT-B is a multi-center, prospective study that is currently ongoing with the primary outcome being local tumor control with secondary outcomes including site of relapse in the breast, survival, toxicities, and quality of life (28).
The Role of Intraoperative Radiation in Early-stage Breast Cancer
2021, Clinical Breast CancerESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer
2020, Radiotherapy and OncologyCitation Excerpt :Information on outcome after IORT-boost with electrons (IOERT-Boost) is available from various cohort analyses, with the largest deriving from a pooled analysis of the International Society of Intraoperative Radiation Therapy (ISIORT) Europe (Table 2). In these unselected retrospective studies, boost-IOERT plus WBI consistently resulted in high in-breast control rates, with observered 6- and 10-year local recurrence rates (LRR) of 0.8% and 2.7% respectively [19,20]. In a matched-pair design study, 188 patients who received a boost with external beam electrons (6x2Gy) were compared to 190 patients after IOERT-boost.
On the need of in vivo verifications as quality control for intraoperative electron radiotherapy in breast cancer
2024, Clinical and Translational OncologyEvaluating the induced photon contamination by different breast IOERT shields using Monte Carlo simulation
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On behalf of the ISIORT Europe.