Top

Published in:

Open Access 01-12-2014 | Research

A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer

Authors: Elena Sperk, Daniela Astor, Anke Keller, Grit Welzel, Axel Gerhardt, Benjamin Tuschy, Marc Sütterlin, Frederik Wenz

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

Since the results from the randomized TARGIT A trial were published, intraoperative radiotherapy (IORT) is used more often. IORT can be provided as accelerated partial breast irradiation (APBI) or as a boost. The definition of suitable patients for IORT as APBI differs between different national societies (e.g. ESTRO and ASTRO) and different inclusion criteria of trials and so does the eligibility of patients. This analysis identifies eligible patients for IORT according to available consensus statements and inclusion criteria of the ongoing TARGIT trials.

Methods

Between 01/03 – 12/09, 1505 breast cancer cases were treated at the breast cancer center at the University Medical Center Mannheim. Complete data sets for age, stage (T, N, and M), histology and hormone receptor status were available in 1108 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favorable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E “elderly”, risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology, phase II: ≥70 years, IDC, T1, N0, any hormone receptor status, M0; TARGIT C “consolidation”, risk adapted radiotherapy, phase IV: ≥50 years, IDC, T1, N0, positive hormone receptor status, M0; TARGIT BQR “boost quality registry”: every age, every histology, T1-2 (max. 3.5 cm), any hormone receptor status, N0/+, M0/+.

Results

Out of the 1108 cases, 379 cases (34.2%) were suitable for IORT as APBI regarding the ESTRO and 175 (15.8%) regarding the ASTRO consensus statements. 82 (7.4%) patients were eligible for the TARGIT E trial, 258 (23.3%) for the TARGIT C trial and 671 (60.6%) for the TARGIT BQR registry. According to the consensus statements of ASTRO (45.1%) and ESTRO (41.4%) about half of the eligible patients were treated with IORT as APBI. From the eligible patients fulfilling the criteria for IORT boost (35%) about one third was eventually treated.

Conclusions

Patient selection for IORT should be restrictive. For IORT as APBI the TARGIT trials are even more restrictive including patients than the ESTRO and ASTRO consensus statements.

Available only for authorised users

Shah C, Badiyan S, Ben Wilkinson J, Vicini F, Beitsch P, Keisch M, Arthur D, Lyden M: Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American society of breast surgeons MammoSite(®) breast brachytherapy registry trial. Ann Surg Oncol 2013,20(10):3279-3285.CrossRefPubMed

Polgár C, Fodor J, Major T, Sulyok Z, Kásler M: Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol 2013,108(2):197-202.CrossRefPubMed

Pashtan IM, Recht A, Ancukiewicz M, Brachtel E, Abi-Raad RF, D’Alessandro HA, Levy A, Wo JY, Hirsch AE, Kachnic LA, Goldberg S, Specht M, Gadd M, Smith BL, Powell SN, Taghian AG: External beam accelerated partial-breast irradiation using 32 gy in 8 twice-daily fractions: 5-year results of a prospective study. Int J Radiat Oncol Biol Phys 2012,84(3):e271-e277.PubMedCentralCrossRefPubMed

Lemanski C, Azria D, Gourgou-Bourgade S, Ailleres N, Pastant A, Rouanet P, Fenoglietto P, Dubois JB, Gutowski M: Electrons for intraoperative radiotherapy in selected breast-cancer patients: late results of the Montpellier phase II trial. Radiat Oncol 2013,8(1):191.PubMedCentralCrossRefPubMed

Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, Luini A, Veronesi P, Galimberti V, Zurrida S, Leonardi MC, Lazzari R, Cattani F, Gentilini O, Intra M, Caldarella P, Ballardini B: Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013,14(13):1269-1277.CrossRefPubMed

Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W, Keshtgar M, Dewar J, Kraus-Tiefenbacher U, Sütterlin M, Esserman L, Holtveg HM, Roncadin M, Pigorsch S, Metaxas M, Falzon M, Matthews A, Corica T, Williams NR, Baum M: Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010,376(9735):91-102. Erratum in: Lancet. 2010, 376(9735): 90CrossRefPubMed

Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, Flyger HL, Massarut S, Alvarado M, Saunders C, Eiermann W, Metaxas M, Sperk E, Sütterlin M, Brown D, Esserman L, Roncadin M, Thompson A, Dewar JA, Holtveg HM, Pigorsch S, Falzon M, Harris E, Matthews A, Brew-Graves C, Potyka I, Corica T, Williams NR, Baum M, on behalf of the TARGIT trialists’ group: 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. Lancet 2014,383(9917):603-613. Erratum in: Lancet 2014, 383(9917): 602CrossRefPubMed

Sperk E, Welzel G, Keller A, Kraus-Tiefenbacher U, Gerhardt A, Sütterlin M, Wenz F: Late radiation toxicity after intraoperative radiotherapy (IORT) for breast cancer: results from the randomized phase III trial TARGIT A. Breast Cancer Res Treat 2012,135(1):253-260.CrossRefPubMed

Neumaier C, Elena S, Grit W, Yasser AM, Uta KT, Anke K, Axel G, Marc S, Frederik W: TARGIT-E(lderly)–prospective phase II study of intraoperative radiotherapy (IORT) in elderly patients with small breast cancer. BMC Cancer 2012, 12: 171.PubMedCentralCrossRefPubMed

10.

S3 (2012) interdisziplinäre S3-leitlinie für die diagnostik, therapie und nachsorge des mammakarzinoms, langversion 3.0, aktualisierung 2012, AWMF-Register-Nummer: 032 – 045OL. http://www.awmf.org/uploads/tx_szleitlinien/032-045OL_k_S3__Brustkrebs_Mammakarzinom_Diagnostik_Therapie_Nachsorge_2012-07.pdf

11.

Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, Fietkau R, Haase W, Harms W, Souchon R, Wenz F, Sauer R, Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO): DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 2013,189(10):825-833.PubMedCentralCrossRefPubMed

12.

Polgár C, Van Limbergen E, Pötter R, Kovács G, Polo A, Lyczek J, Hildebrandt G, Niehoff P, Guinot JL, Guedea F, Johansson B, Ott OJ, Major T, Strnad V, GEC-ESTRO breast cancer working group: Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the groupe européen de curie thérapie-european society for therapeutic radiology and oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010,94(3):264-273.CrossRefPubMed

13.

Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, Julian TB, Marks LB, Todor DA, Vicini FA, Whelan TJ, White J, Wo JY, Harris JR: Accelerated partial breast irradiation consensus statement from the American society for radiation oncology (ASTRO). Int J Radiat Oncol Biol Phys 2009,74(4):987-1001.CrossRefPubMed

14.

Kraus-Tiefenbacher U, Steil V, Bauer L, Melchert F, Wenz F: A novel device for intraoperative radiotherapy (IORT). Onkologie 2003, 26: 596-598.CrossRefPubMed

15.

Tuschy B, Berlit S, Nasterlack C, Tomé K, Blank E, Wenz F, Sütterlin M: Intraoperative radiotherapy of early breast cancer using low-kilovoltage x-rays – reasons for omission of planned intraoperative irradiation. Breast J 2013,19(3):325-328.CrossRefPubMed

16.

Leonardi MC, Maisonneuve P, Mastropasqua MG, Morra A, Lazzari R, Dell’Acqua V, Ferrari A, Rotmensz N, Sangalli C, Luini A, Veronesi U, Orecchia R: Accelerated partial breast irradiation with intraoperative electrons: using GEC-ESTRO recommendations as guidance for patient selection. Radiother Oncol 2013,106(1):21-27.CrossRefPubMed

17.

Leonardi MC, Maisonneuve P, Mastropasqua MG, Morra A, Lazzari R, Rotmensz N, Sangalli C, Luini A, Veronesi U, Orecchia R: How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? a retrospective analysis of patients treated at the European institute of oncology. Int J Radiat Oncol Biol Phys 2012,83(3):806-813.CrossRefPubMed

18.

Tuschy B, Berlit S, Romero S, Sperk E, Wenz F, Kehl S, Sütterlin M: Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays. Radiat Oncol 2013, 8: 95.PubMedCentralCrossRefPubMed

19.

Kraus-Tiefenbacher U, Bauer L, Kehrer T, Hermann B, Melchert F, Wenz F: Intraoperative radiotherapy (IORT) as a boost in patients with early-stage breast cancer – acute toxicity. Onkologie 2006,29(3):77-82.CrossRefPubMed

20.

Wenz F, Welzel G, Keller A, Blank E, Vorodi F, Herskind C, Tomé O, Sütterlin M, Kraus-Tiefenbacher U: Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer. Breast 2008,17(6):617-622.CrossRefPubMed

21.

Blank E, Kraus-Tiefenbacher U, Welzel G, Keller A, Bohrer M, Sütterlin M, Wenz F: Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays. Ann Surg Oncol 2010,17(Suppl 3):352-358.CrossRefPubMed

22.

Welzel G, Boch A, Sperk E, Hofmann F, Kraus-Tiefenbacher U, Gerhardt A, Suetterlin M, Wenz F: Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A. Radiat Oncol 2013,8(1):9.PubMedCentralCrossRefPubMed

23.

Welzel G, Hofmann F, Blank E, Kraus-Tiefenbacher U, Hermann B, Sütterlin M, Wenz F: Health-related quality of life after breast-conserving surgery and intraoperative radiotherapy for breast cancer using low-kilovoltage X-rays. Ann Surg Oncol 2010,17(Suppl 3):359-367.CrossRefPubMed

24.

Aziz MH, Schneider F, Clausen S, Blank E, Herskind C, Afzal M, Wenz F: Can the risk of secondary cancer induction after breast conserving therapy be reduced using intraoperative radiotherapy (IORT) with low-energy x-rays? Radiat Oncol 2011, 6: 174.PubMedCentralCrossRefPubMed

25.

Alvarado MD, Mohan AJ, Esserman LJ, Park CC, Harrison BL, Howe RJ, Thorsen C, Ozanne EM: Cost-effectiveness analysis of intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol 2013,20(9):2873-2880.CrossRefPubMed

26.

Blank E, Willich N, Fietkau R, Popp W, Schaller-Steiner J, Sack H, Wenz F: Evaluation of time, attendance of medical staff, and resources during radiotherapy for breast cancer patients: the DEGRO-QUIRO trial. Strahlenther Onkol 2012,188(2):113-119.CrossRefPubMed

Title: A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer
Authors: Elena Sperk
Daniela Astor
Anke Keller
Grit Welzel
Axel Gerhardt
Benjamin Tuschy
Marc Sütterlin
Frederik Wenz
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-154

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

Integrating microRNA and mRNA expression profiles in response to radiation-induced injury in rat lung

Clinical outcome of hypofractionated breath-hold image-guided SABR of primary lung tumors and lung metastases

BAY 87–2243, a novel inhibitor of hypoxia-induced gene activation, improves local tumor control after fractionated irradiation in a schedule-dependent manner in head and neck human xenografts

Chemoradiation with capecitabine and mitomycin-C for stage I-III anal squamous cell carcinoma

Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis

A retrospective analysis of survival and prognostic factors after stereotactic radiosurgery for aggressive meningiomas