Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2023

Open Access 18-07-2023 | Breast Cancer | Breast Oncology

Risk-Adapted Intraoperative Radiation Therapy (IORT) for Breast Cancer: A Novel Analysis

Authors: Melvin J. Silverstein, MD, Brian Kim, MD, Kevin Lin, MD, Shane Lloyd, MD, Lincoln Snyder, MD, Sadia Khan, DO, Katherine Kramme, DO, Peter Chen, MD

Published in: Annals of Surgical Oncology | Issue 10/2023

Login to get access

Abstract

Background

Randomized trials have shown that risk-adapted intraoperative radiation therapy (IORT) after breast-conserving surgery for low-risk breast cancer patients is a safe alternative to whole-breast radiation therapy (WBRT). The risk-adapted strategy allows additional WBRT for predefined high-risk pathologic characteristics discovered on final histopathology. The greater the percentage of patients receiving WBRT, the lower the recurrence rate. The risk-adapted strategy, although important and necessary, can make IORT appear better than it actually is.

Methods

Risk-adapted IORT was used to treat 1600 breast cancers. They were analyzed by the intention-to-treat method and per protocol to better understand the contribution of IORT with and without additional whole-breast treatment. Any ipsilateral breast tumor event was considered a local recurrence.

Results

During a median follow-up period of 63 months, local recurrence differed significantly between the patients who received local treatment and those who received whole-breast treatment. For 1393 patients the treatment was local treatment alone. These patients experienced 79 local recurrences and a 5-year local recurrence probability of 5.95 %. For 207 patients with high-risk final histopathology, additional whole-breast treatment was administered. They experienced two local recurrences and a 5-year local recurrence probability of 0.5 % (p = 0.0009).

Conclusions

Whole-breast treatment works well at reducing local recurrence, and it is a totally acceptable and necessary addition to IORT as part of a risk-adapted program. However, the more whole-breast treatment that is given, the more it dilutes the original plan of simplifying local treatment and the less we understand exactly what IORT contributes to local control as a stand-alone treatment.
Literature
1.
Whelan TJ, Pignol J, Levine MN, Julian JA, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.CrossRefPubMed
2.
Abram WP, Clark J, McAleer, et al. The UK Standardization of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008;9:331–41.
3.
Brunt AM, Haviland J, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395:1613–26.CrossRef
4.
5.
Kunkler IH, Williams L, Jack WJL, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in early breast cancer. N Engl J Med. 2023;388:585–94.CrossRefPubMed
6.
Thompson J, Le J, Hop A, Melnik M, Paulson J, Wright GP. Impact of choosing wisely recommendations on sentinel lymph node biopsy and postoperative radiation rates in women over age 70 years with hormone-positive breast cancer. Ann Surg Oncol. 2021;28:5716–22.CrossRefPubMed
7.
8.
Vaidya JS, Bulsara M, Baum M, 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. BMJ. 2020;370:2836–51.CrossRef
9.
Orecchia R, Veronesi U, Maisonneuve 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;22:597–608.CrossRefPubMed
10.
11.
Veronesi U, Orecchia R, Luini A, et al. Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg. 2005;242:101–6.CrossRefPubMedPubMedCentral
12.
Veronesi U, Orecchia R, Luini A, et al. Intraoperative radiotherapy during breast-conserving surgery: a study on 1822 cases treated with electrons. Breast Cancer Res Treat. 2010;124:141–51.CrossRefPubMed
13.
Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14:1269–77.CrossRefPubMed
14.
Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.CrossRefPubMed
15.
Vaidya JS, Wenz F, Bulsara 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. Lancet. 2014;383:603–13.CrossRefPubMed
16.
Silverstein MJ, Epstein M, Lin K, et al. Intraoperative radiation using low-kilovoltage x-rays for early breast cancer: a single-site trial. Ann Surg Oncol. 2017;24:3082–7.CrossRefPubMed
17.
18.
Silverstein MJ, Epstein M, Chen P, et al. Recurrence and survival rates for 1400 early breast tumors treated with intraoperative radiation therapy (IORT). Ann Surg Oncol. 2022;29:3726–36.CrossRefPubMedPubMedCentral
19.
Correa C, Harris EE, Leonardi MC, et al. Accelerated partial-breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 2017;7:73–9.CrossRefPubMed
20.
Vaidya JS, Bulsara M, Saunders C, 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;6:e200249.CrossRefPubMedPubMedCentral
21.
22.
Valente SA, Tendulkar RD, Cherian S, et al. TARGIT-R (retrospective): 5-Year follow-up evaluation of intraoperative radiation therapy (IORT) for breast cancer performed in North America. Ann Surg Oncol. 2021;28:2512–21.CrossRefPubMed
23.
Meattini I, Marrazzo L, Saieva C, et al. Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer: long-term results of the randomized phase III APBI-IMRT-Florence trial. J Clin Oncol. 2020;38:4175–83.CrossRefPubMed
24.
Jacobs DHM, Mast M, Horeweg N, et al. Accelerated partial-breast irradiation using external beam or intraoperative electron radiation therapy: 5-year oncological outcomes of a prospective cohort study. Int J Radiat Oncol Biol Phys. 2022;113:570–81.CrossRefPubMed
25.
Killander F, Wieslander E, Karlsson P, et al. No increased cardiac mortality or morbidity of radiation therapy in breast cancer patients after breast-conserving surgery: 20-year follow-up of the randomized SweBCGRT trial. Int J Radiat Oncol Biol Phys. 2020;107:701–9.CrossRefPubMed
Metadata
Title
Risk-Adapted Intraoperative Radiation Therapy (IORT) for Breast Cancer: A Novel Analysis
Authors
Melvin J. Silverstein, MD
Brian Kim, MD
Kevin Lin, MD
Shane Lloyd, MD
Lincoln Snyder, MD
Sadia Khan, DO
Katherine Kramme, DO
Peter Chen, MD
Publication date
18-07-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-13897-3

Other articles of this Issue 10/2023

Annals of Surgical Oncology 10/2023 Go to the issue

Breast Oncology

Impact of Postoperative Antibiotic Prophylaxis on Surgical Site Infections Rates After Mastectomy with Drains but Without Immediate Reconstruction: A Multicenter, Double-Blinded, Randomized Control Superiority Trial

ASO Author Reflections

ASO Author Reflections: Patient, Tumor, and Treatment Characteristics Predict Early Versus Late Recurrence in Patients with Invasive Lobular Carcinoma of the Breast

Breast Oncology

Predictors of Early Versus Late Recurrence in Invasive Lobular Carcinoma of the Breast: Impact of Local and Systemic Therapy

ASO Author Reflections

ASO Author Reflections: Axillary Reverse Mapping: Where Do We Go from Here?

Breast Oncology

Timeliness of Breast Diagnostic Imaging and Biopsy in Practice: 15 Years of Collecting, Comparing, and Defining Quality Breast Cancer Care

ASO Visual Abstract

ASO Visual Abstract: Impact of Postoperative, Antibiotic Prophylaxis on Surgical Site Infection Rates After Mastectomy with Drains but Without Immediate Reconstruction—A Multicenter, Double-Blinded, Randomized, Control Superiority Trial