Skip to main content
Top
Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Breast Cancer | Research

Intraoperative radiation therapy for early stage breast cancer

Authors: Vahid Zangouri, Hamid Nasrollahi, Ali Taheri, Majid Akrami, Peyman Arasteh, Seyed Hassan Hamedi, Masoumeh Ghoddusi Johari, Nazanin Karimaghaee, Aliye Ranjbar, Mohammad Yasin Karami, Sedigheh Tahmasebi, Ahmad Mosalaei, Abdolrasoul Talei

Published in: BMC Surgery | Issue 1/2022

Login to get access

Abstract

Background and objective

We report our experiences with Intraoperative radiation therapy (IORT) among breast cancer (BC) patients in our region.

Methods

All patients who received radical IORT from April 2014 on to March 2020 were included in the study. Patient selection criteria included: Age equal or older than 45 years old; All cases of invasive carcinomas (in cases of lobular carcinomas only with MRI and confirmation); Patients who were 45–50 years old with a tumor size of 0–2 cm, 50–55 years old with a tumor size of < 2.5 cm, and those who were ≥ 55 years old with a tumor size of < 3 cm; Invasive tumors only with a negative margin; Negative nodal status (exception in patients with micrometastasis); A positive estrogen receptor status. Primary endpoints included death and recurrence which were assessed using the Kaplan–Meier method.

Results

Overall, 252 patients entered the study. Mean (SD) age of patients was 56.43 ± 7.79 years. In total, 32.9% of patients had a family history of BC. Mean (SD) tumor size was 1.56 ± 0.55 cm. Mean (IQR) follow-up of patients was 36.3 ± 18.7 months. Overall, 8 patients (3.1%) experienced recurrence in follow-up visits (disease-free-survival of 96.1%), among which four (1.5%) were local recurrence, two (0.8%) were regional recurrence and two patients (0.8%) had metastasis. Median (IQR) time to recurrence was 46 (22, 53.7) months among the eight patient who had recurrence. Overall, one patient died due to metastasis in our series. Eleven patients (4.3%) with DCIS in our study received IORT. All these patients had free margins in histopathology examination and none experienced recurrence.

Conclusion

Inhere we reported our experience with the use of IORT in a region where facilities for IORT are limited using our modified criteria for patient selection.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lei J, Wang Y, Bi Z, Xue S, Ou B, Liu K. Intraoperative radiotherapy (IORT) versus whole-breast external beam radiotherapy (EBRT) in early stage breast cancer: results from SEER database. 2020;38(1):85–92. Lei J, Wang Y, Bi Z, Xue S, Ou B, Liu K. Intraoperative radiotherapy (IORT) versus whole-breast external beam radiotherapy (EBRT) in early stage breast cancer: results from SEER database. 2020;38(1):85–92.
2.
go back to reference Harris EER, Small W Jr. Intraoperative radiotherapy for breast cancer. Front Oncol. 2017;7:317.CrossRef Harris EER, Small W Jr. Intraoperative radiotherapy for breast cancer. Front Oncol. 2017;7:317.CrossRef
3.
go back to reference Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. The Lancet. 2014;383(9917):603–13.CrossRef Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. The Lancet. 2014;383(9917):603–13.CrossRef
4.
go back to reference Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14(13):1269–77.CrossRef Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14(13):1269–77.CrossRef
5.
go back to reference Talei A, Tahmasebi S, Akrami M, Zangouri V, Rezaianzadeh A, Arasteh P, et al. The Shiraz Breast Cancer Registry (SBCR): study design and primary reports. Pers Med. 2018;15(6):471–9.CrossRef Talei A, Tahmasebi S, Akrami M, Zangouri V, Rezaianzadeh A, Arasteh P, et al. The Shiraz Breast Cancer Registry (SBCR): study design and primary reports. Pers Med. 2018;15(6):471–9.CrossRef
6.
go back to reference Merdad AA, Bahadur YA, Fawzy EE, Hassouna AH, Eltaher MM, Alghaithy ZK, et al. Phase II study on the use of intraoperative radiotherapy in early breast cancer. Saudi Med J. 2013;34(11):1133–8.PubMed Merdad AA, Bahadur YA, Fawzy EE, Hassouna AH, Eltaher MM, Alghaithy ZK, et al. Phase II study on the use of intraoperative radiotherapy in early breast cancer. Saudi Med J. 2013;34(11):1133–8.PubMed
8.
go back to reference Bodmer A, Feller A, Bordoni A, Bouchardy C, Dehler S, Ess S, et al. Breast cancer in younger women in Switzerland 1996–2009: a longitudinal population-based study. The Breast. 2015;24(2):112–7.CrossRef Bodmer A, Feller A, Bordoni A, Bouchardy C, Dehler S, Ess S, et al. Breast cancer in younger women in Switzerland 1996–2009: a longitudinal population-based study. The Breast. 2015;24(2):112–7.CrossRef
9.
go back to reference Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 2017;7(2):73–9.CrossRef Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 2017;7(2):73–9.CrossRef
10.
go back to reference Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, et al. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. 2020;370. Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, et al. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. 2020;370.
11.
go back to reference Orecchia R, Veronesi U, Maisonneuve P, Galimberti VE, Lazzari R, Veronesi P, et al. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-centre, randomised, phase 3 equivalence trial. Lancet Oncol. 2021;22(5):597–608.CrossRef Orecchia R, Veronesi U, Maisonneuve P, Galimberti VE, Lazzari R, Veronesi P, et al. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-centre, randomised, phase 3 equivalence trial. Lancet Oncol. 2021;22(5):597–608.CrossRef
12.
go back to reference Fastner G, Gaisberger C, Kaiser J, Scherer P, Ciabattoni A, Petoukhova A, et al. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer. 2020;149:150–7. Fastner G, Gaisberger C, Kaiser J, Scherer P, Ciabattoni A, Petoukhova A, et al. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer. 2020;149:150–7.
13.
go back to reference Abi-Raad R, Boutrus R, Wang R, Niemierko A, Macdonald S, Smith B, et al. Patterns and risk factors of locoregional recurrence in T1–T2 node negative breast cancer patients treated with mastectomy: implications for postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2011;81(3):e151–7.CrossRef Abi-Raad R, Boutrus R, Wang R, Niemierko A, Macdonald S, Smith B, et al. Patterns and risk factors of locoregional recurrence in T1–T2 node negative breast cancer patients treated with mastectomy: implications for postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2011;81(3):e151–7.CrossRef
14.
go back to reference Scala LM, Hu K, Urken ML, Jacobson AS, Persky MS, Tran TN, et al. Intraoperative high‐dose‐rate radiotherapy in the management of locoregionally recurrent head and neck cancer. 2013;35(4):485-92. Scala LM, Hu K, Urken ML, Jacobson AS, Persky MS, Tran TN, et al. Intraoperative high‐dose‐rate radiotherapy in the management of locoregionally recurrent head and neck cancer. 2013;35(4):485-92.
15.
go back to reference Holman FA, Haddock MG, Gunderson LL, Kusters M, Nieuwenhuijzen GA, van den Berg HA, et al. Results of intraoperative electron beam radiotherapy containing multimodality treatment for locally unresectable T4 rectal cancer: a pooled analysis of the Mayo Clinic Rochester and Catharina Hospital Eindhoven. 2016;7(6):903. Holman FA, Haddock MG, Gunderson LL, Kusters M, Nieuwenhuijzen GA, van den Berg HA, et al. Results of intraoperative electron beam radiotherapy containing multimodality treatment for locally unresectable T4 rectal cancer: a pooled analysis of the Mayo Clinic Rochester and Catharina Hospital Eindhoven. 2016;7(6):903.
16.
go back to reference Roeder F, Lehner B, Saleh-Ebrahimi L, Hensley FW, Ulrich A, Alldinger I, et al. Intraoperative electron radiation therapy combined with external beam radiation therapy and limb sparing surgery in extremity soft tissue sarcoma: a retrospective single center analysis of 183 cases. 2016;119(1):22–9. Roeder F, Lehner B, Saleh-Ebrahimi L, Hensley FW, Ulrich A, Alldinger I, et al. Intraoperative electron radiation therapy combined with external beam radiation therapy and limb sparing surgery in extremity soft tissue sarcoma: a retrospective single center analysis of 183 cases. 2016;119(1):22–9.
17.
go back to reference Sole CV, Calvo FA, Polo A, Cambeiro M, Gonzalez C, Desco M, et al. Intraoperative electron-beam radiation therapy for pediatric Ewing sarcomas and rhabdomyosarcomas: long-term outcomes. 2015;92(5):1069-76. Sole CV, Calvo FA, Polo A, Cambeiro M, Gonzalez C, Desco M, et al. Intraoperative electron-beam radiation therapy for pediatric Ewing sarcomas and rhabdomyosarcomas: long-term outcomes. 2015;92(5):1069-76.
18.
go back to reference Arians N, Foerster R, Rom J, Uhl M, Roeder F, Debus J, et al. Outcome of patients with local recurrent gynecologic malignancies after resection combined with intraoperative electron radiation therapy (IOERT). 2016;11(1):1–10. Arians N, Foerster R, Rom J, Uhl M, Roeder F, Debus J, et al. Outcome of patients with local recurrent gynecologic malignancies after resection combined with intraoperative electron radiation therapy (IOERT). 2016;11(1):1–10.
19.
go back to reference Habl G, Uhl M, Hensley F, Pahernik S, Debus J, Röder FJRO. Intraoperative electron radiation therapy (IOERT) in patients with locally recurrent renal cell carcinoma. 2013;8(1):1–6. Habl G, Uhl M, Hensley F, Pahernik S, Debus J, Röder FJRO. Intraoperative electron radiation therapy (IOERT) in patients with locally recurrent renal cell carcinoma. 2013;8(1):1–6.
20.
go back to reference Krengli M, Terrone C, Ballarè A, Loi G, Tarabuzzi R, Marchioro G, et al. Intraoperative radiotherapy during radical prostatectomy for locally advanced prostate cancer: technical and dosimetric aspects. 2010;76(4):1073-7. Krengli M, Terrone C, Ballarè A, Loi G, Tarabuzzi R, Marchioro G, et al. Intraoperative radiotherapy during radical prostatectomy for locally advanced prostate cancer: technical and dosimetric aspects. 2010;76(4):1073-7.
21.
go back to reference Keane FK, Wo JY, Ferrone CR, Clark JW, Blaszkowsky LS, Allen JN, et al. Intraoperative radiotherapy in the era of intensive neoadjuvant chemotherapy and chemoradiotherapy for pancreatic adenocarcinoma. 2018;41(6):607-12. Keane FK, Wo JY, Ferrone CR, Clark JW, Blaszkowsky LS, Allen JN, et al. Intraoperative radiotherapy in the era of intensive neoadjuvant chemotherapy and chemoradiotherapy for pancreatic adenocarcinoma. 2018;41(6):607-12.
22.
go back to reference Zhang Q, Tey J, Peng L, Yang Z, Xiong F, Jiang R, et al. Adjuvant chemoradiotherapy with or without intraoperative radiotherapy for the treatment of resectable locally advanced gastric adenocarcinoma. 2012;102(1):51-5. Zhang Q, Tey J, Peng L, Yang Z, Xiong F, Jiang R, et al. Adjuvant chemoradiotherapy with or without intraoperative radiotherapy for the treatment of resectable locally advanced gastric adenocarcinoma. 2012;102(1):51-5.
23.
go back to reference Yu W, Lin Z, Ju Z-J, Li X-R, Zhang Y-J, Kong Q-L, et al. Intraoperative radiation therapy delivered prior to lumpectomy for early-stage breast cancer: a single institution study. Am J Cancer Res. 2015;5(7):2249–57.PubMedPubMedCentral Yu W, Lin Z, Ju Z-J, Li X-R, Zhang Y-J, Kong Q-L, et al. Intraoperative radiation therapy delivered prior to lumpectomy for early-stage breast cancer: a single institution study. Am J Cancer Res. 2015;5(7):2249–57.PubMedPubMedCentral
24.
go back to reference Wareńczak-Florczak Z, Roszak A, Bratos K, Milecki P, Karczewska-Dzionk A, Włodarczyk H. Intraoperative radiation therapy as part of breast conserving therapy of early breast cancer-results of one-year follow-up. Rep Pract Oncol Radiother. 2013;18(2):107–11.CrossRef Wareńczak-Florczak Z, Roszak A, Bratos K, Milecki P, Karczewska-Dzionk A, Włodarczyk H. Intraoperative radiation therapy as part of breast conserving therapy of early breast cancer-results of one-year follow-up. Rep Pract Oncol Radiother. 2013;18(2):107–11.CrossRef
25.
go back to reference Morlino A, La Torre G, Lapadula L, Cammarota A. IORT in breast cancer. Our experience of the first patients treated. Ann Ital Chir. 2017;88:253–7.PubMed Morlino A, La Torre G, Lapadula L, Cammarota A. IORT in breast cancer. Our experience of the first patients treated. Ann Ital Chir. 2017;88:253–7.PubMed
26.
go back to reference Chowdhry VK, Bushey JA, Kwait RM, Goldberg S, Ritchie J, Ji Y-L, et al. Intraoperative radiation therapy as part of planned monotherapy for early-stage breast cancer. J Radiat Oncol. 2018;7(2):167–73.CrossRef Chowdhry VK, Bushey JA, Kwait RM, Goldberg S, Ritchie J, Ji Y-L, et al. Intraoperative radiation therapy as part of planned monotherapy for early-stage breast cancer. J Radiat Oncol. 2018;7(2):167–73.CrossRef
27.
go back to reference Akrami M, Arasteh P, Mokhtari M, Tahmasebi S, Zangouri V, Hosseini S, et al. Does metaplastic breast carcinoma demonstrate a different clinicopathological behavior in our region: the Shiraz Breast Cancer Registry. Breast J. 2018;25. Akrami M, Arasteh P, Mokhtari M, Tahmasebi S, Zangouri V, Hosseini S, et al. Does metaplastic breast carcinoma demonstrate a different clinicopathological behavior in our region: the Shiraz Breast Cancer Registry. Breast J. 2018;25.
28.
go back to reference Akrami M, Sepahdar A, Arasteh P, Tahmasebi S, Zangouri V, Askari A, et al. Do site and type of metastasis in breast cancer show a changing pattern with increased age? A cross comparison of clinicopathological characteristics between age groups. World J Surg Oncol. 2018;16. Akrami M, Sepahdar A, Arasteh P, Tahmasebi S, Zangouri V, Askari A, et al. Do site and type of metastasis in breast cancer show a changing pattern with increased age? A cross comparison of clinicopathological characteristics between age groups. World J Surg Oncol. 2018;16.
29.
go back to reference Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast cancer before age 40 years. Semin Oncol. 2009;36(3):237–49.CrossRef Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast cancer before age 40 years. Semin Oncol. 2009;36(3):237–49.CrossRef
30.
go back to reference Merlo DF, Ceppi M, Filiberti R, Bocchini V, Znaor A, Gamulin M, et al. Breast cancer incidence trends in European women aged 20–39 years at diagnosis. Breast Cancer Res Treat. 2012;134(1):363–70.CrossRef Merlo DF, Ceppi M, Filiberti R, Bocchini V, Znaor A, Gamulin M, et al. Breast cancer incidence trends in European women aged 20–39 years at diagnosis. Breast Cancer Res Treat. 2012;134(1):363–70.CrossRef
31.
go back to reference Vaidya JS, Bulsara M, Saunders C, Flyger H, Tobias JS, Corica T, et al. Effect of delayed targeted intraoperative radiotherapy vs whole-breast radiotherapy on local recurrence and survival: long-term results from the TARGIT-a randomized clinical trial in early breast cancer. JAMA Oncol. 2020:e200249-e. Vaidya JS, Bulsara M, Saunders C, Flyger H, Tobias JS, Corica T, et al. Effect of delayed targeted intraoperative radiotherapy vs whole-breast radiotherapy on local recurrence and survival: long-term results from the TARGIT-a randomized clinical trial in early breast cancer. JAMA Oncol. 2020:e200249-e.
Metadata
Title
Intraoperative radiation therapy for early stage breast cancer
Authors
Vahid Zangouri
Hamid Nasrollahi
Ali Taheri
Majid Akrami
Peyman Arasteh
Seyed Hassan Hamedi
Masoumeh Ghoddusi Johari
Nazanin Karimaghaee
Aliye Ranjbar
Mohammad Yasin Karami
Sedigheh Tahmasebi
Ahmad Mosalaei
Abdolrasoul Talei
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-021-01427-5

Other articles of this Issue 1/2022

BMC Surgery 1/2022 Go to the issue