title: Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery.
abstract: OBJECTIVE
  The current standard treatment for early breast cancer includes conservative surgery followed by entire breast radiotherapy (RT). Recent study findings show that most local recurrences are in the scar tissue area suggesting that whole-breast RT may not always be necessary. If the volume of breast tissue to be irradiated is limited, RT may be performed intraoperatively. Intraoperative RT delivered with electrons at the total isodose of 2100 rad (21 Gy) could in principle substitute the currently used radiation course of external RT after breast-conserving surgery in selected cases.
  
  
  METHODS
  We report our findings on intraoperative RT using a specially designed mobile linear accelerator delivering 4 energy levels of electrons (3, 5, 7, and 9 MeV) via a head maneuvered by a robot arm. We applied this technique to 237 patients with breast cancer (mean age, 59 years; age range, 33-80 years) with tumors smaller than 2 cm in maximum diameter (T1); most underwent wide resection and an axillary sentinel node biopsy.
  
  
  RESULTS
  After a median follow-up of 19 months (range, 7-33 months), the rate of posttreatment complications is very low. Four patients (1.7%) developed breast fibrosis-mild in 3 patients and severe in 1 patient-that resolved in 24 months. Three patients (1.4%) developed ipsilateral breast cancer-2 (1.0%) contralateral breast cancer, 1 (0.5%) supraclavicular node metastasis, and 1 (0.5%) distant metastases.
  
  
  CONCLUSIONS
  Intraoperative RT with electron beams reduces irradiation to the skin, subcutaneous tissue, and contralateral breast and lung. It appears to be a promising method for irradiating conservatively treated breasts and it avoids the long period of postoperative RT that may not be easily accessible to all patients.
authors: Office of the Scientific Director, Milan, Italy. umberto.veronesi@ieo.it
authors: Umberto
authors: U
authors: Veronesi
authors: Giovanna
authors: G
authors: Gatti
authors: Alberto
authors: A
authors: Luini
authors: Mattia
authors: M
authors: Intra
authors: Mario
authors: M
authors: Ciocca
authors: Daniele
authors: D
authors: Sanchez
authors: Stefano
authors: S
authors: Zurrida
authors: Salvador
authors: S
authors: Navarro
authors: Roberto
authors: R
authors: Orecchia
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016896:Treatment Outcome