ASO Author Reflections: The Strengths and Weaknesses of Intraoperative Radiotherapy for Early Breast Cancer and Ipsilateral Tumor Recurrence

Excerpt

In the American Society for Radiation Oncology statement, use of intraoperative radiotherapy (IORT) and accelerated partial breast irradiation (APBI) has been allowed for specific criteria (“suitable group” and “cautionary group”), with caution and concern, outside a clinical trial.1 According to the updated statement,2 electron beam IORT (ELIOT) should be restricted to women with suitable group criteria because of the reported increased risk for ipsilateral breast tumor recurrence (IBTR).3 In clinical trials of selected patients, APBI has shown adequate local control, minimal toxicity, and good cosmetic appearance.3,4 The IORT procedure has been promoted to prospective trials analyzing tolerance for increased IORT doses, which would lead to the use of 21 Gy, although no data exist on Asian breast cancer patients. After a phase 1/2 study to identify the recommended dose and evaluate the feasibility of using a device in the operating room,5,6 a feasibility study was performed in an institution that has no irradiation device in the operating room.7 For standardization, a phase 2 study using multiple devices was performed. …