BACKGROUND: Intraoperative radiation therapy (IORT) allows delivery of high-dose radiation at the time of lumpectomy, potentially sparing adjuvant daily radiation. A phase 2 study of pre-excision IORT was performed for early-stage breast cancer. METHODS: Patients ≥ 48 years of age with invasive ductal carcinoma, ≤ 3 cm, and clinically node-negative were eligible for this study, which was approved by institutional review board. Ultrasound was used to select electron energy and cone size to cover the tumor plus 1.5- to 2.0-cm lateral margins and 1-cm-deep margins (90% isodose). Fifteen Gy was delivered with a Mobetron irradiator, and immediate needle-localized partial mastectomy followed. Local event results were updated using the Kaplan-Meier method. RESULTS: A total of 53 patients received IORT alone. Median age was 63 years, and median tumor size was 1.2 cm. Of these, 81% were positive for estrogen receptor or progesterone receptor, 11% were positive for human epidermal growth factor receptor 2, and 15% were triple-negative. Also, 42%, 49%, and 9% would have fallen into the Suitable, Cautionary, and Unsuitable groups, respectively, of the American Society of Therapeutic Radiation Oncology consensus statement for accelerated partial breast irradiation. Median follow-up was 69 months. Ipsilateral events occurred in 8 of 53 patients. The 6-year actuarial rate of ipsilateral events was 15% (95% confidence interval = 7%-29%). The crude event rate for Suitable and Cautionary groups was 1 of 22 (5%) and 7 of 26 (27%), respectively. Overall survival was 94.4%, and breast cancer-specific survival was 100%. CONCLUSIONS: The rate of local events in this study is a matter of concern, especially in the Cautionary group. On the basis of these findings, pre-excision IORT, as delivered in this study, may not provide adequate local control for less favorable early-stage breast cancers.
BACKGROUND: Intraoperative radiation therapy (IORT) allows delivery of high-dose radiation at the time of lumpectomy, potentially sparing adjuvant daily radiation. A phase 2 study of pre-excision IORT was performed for early-stage breast cancer. METHODS:Patients ≥ 48 years of age with invasive ductal carcinoma, ≤ 3 cm, and clinically node-negative were eligible for this study, which was approved by institutional review board. Ultrasound was used to select electron energy and cone size to cover the tumor plus 1.5- to 2.0-cm lateral margins and 1-cm-deep margins (90% isodose). Fifteen Gy was delivered with a Mobetron irradiator, and immediate needle-localized partial mastectomy followed. Local event results were updated using the Kaplan-Meier method. RESULTS: A total of 53 patients received IORT alone. Median age was 63 years, and median tumor size was 1.2 cm. Of these, 81% were positive for estrogen receptor or progesterone receptor, 11% were positive for humanepidermal growth factor receptor 2, and 15% were triple-negative. Also, 42%, 49%, and 9% would have fallen into the Suitable, Cautionary, and Unsuitable groups, respectively, of the American Society of Therapeutic Radiation Oncology consensus statement for accelerated partial breast irradiation. Median follow-up was 69 months. Ipsilateral events occurred in 8 of 53 patients. The 6-year actuarial rate of ipsilateral events was 15% (95% confidence interval = 7%-29%). The crude event rate for Suitable and Cautionary groups was 1 of 22 (5%) and 7 of 26 (27%), respectively. Overall survival was 94.4%, and breast cancer-specific survival was 100%. CONCLUSIONS: The rate of local events in this study is a matter of concern, especially in the Cautionary group. On the basis of these findings, pre-excision IORT, as delivered in this study, may not provide adequate local control for less favorable early-stage breast cancers.
Authors: Maria Cristina Leonardi; Patrick Maisonneuve; Mauro Giuseppe Mastropasqua; Anna Morra; Roberta Lazzari; Nicole Rotmensz; Claudia Sangalli; Alberto Luini; Umberto Veronesi; Roberto Orecchia Journal: Int J Radiat Oncol Biol Phys Date: 2012-01-13 Impact factor: 7.038
Authors: Jayant S Vaidya; David J Joseph; Jeffrey S Tobias; Max Bulsara; Frederik Wenz; Christobel Saunders; Michael Alvarado; Henrik L Flyger; Samuele Massarut; Wolfgang Eiermann; Mohammed Keshtgar; John Dewar; Uta Kraus-Tiefenbacher; Marc Sütterlin; Laura Esserman; Helle M R Holtveg; Mario Roncadin; Steffi Pigorsch; Marinos Metaxas; Mary Falzon; April Matthews; Tammy Corica; Norman R Williams; Michael Baum Journal: Lancet Date: 2010-07-10 Impact factor: 79.321
Authors: Timothy J Whelan; Jean-Philippe Pignol; Mark N Levine; Jim A Julian; Robert MacKenzie; Sameer Parpia; Wendy Shelley; Laval Grimard; Julie Bowen; Himu Lukka; Francisco Perera; Anthony Fyles; Ken Schneider; Sunil Gulavita; Carolyn Freeman Journal: N Engl J Med Date: 2010-02-11 Impact factor: 91.245
Authors: Harry Bartelink; Jean-Claude Horiot; Philip M Poortmans; Henk Struikmans; Walter Van den Bogaert; Alain Fourquet; Jos J Jager; Willem J Hoogenraad; S Bing Oei; Carla C Wárlám-Rodenhuis; Marianne Pierart; Laurence Collette Journal: J Clin Oncol Date: 2007-06-18 Impact factor: 44.544
Authors: Bernard Fisher; Stewart Anderson; John Bryant; Richard G Margolese; Melvin Deutsch; Edwin R Fisher; Jong-Hyeon Jeong; Norman Wolmark Journal: N Engl J Med Date: 2002-10-17 Impact factor: 91.245
Authors: Benjamin D Smith; Douglas W Arthur; Thomas A Buchholz; Bruce G Haffty; Carol A Hahn; Patricia H Hardenbergh; Thomas B Julian; Lawrence B Marks; Dorin A Todor; Frank A Vicini; Timothy J Whelan; Julia White; Jennifer Y Wo; Jay R Harris Journal: Int J Radiat Oncol Biol Phys Date: 2009-07-15 Impact factor: 7.038
Authors: Rachel Y Lei; Charles E Leonard; Kathryn T Howell; Phyllis L Henkenberns; Timothy K Johnson; Tracy L Hobart; Shannon P Fryman; Jane M Kercher; Jodi L Widner; Terese Kaske; Dennis L Carter Journal: Breast Cancer Res Treat Date: 2013-07-04 Impact factor: 4.872