title: The Salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations.
abstract: Aim of this study is to show that ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery can be reduced by proper surgery and modern radiotherapy techniques. Three hundred and seventy eight women with stage I or II breast cancer had breast conserving surgery and received 51-56.1 Gy of postoperative radiation to the whole breast in 1.7 Gy fractions, but patients received different boost strategies. Group 1 (n = 188) received electron boost radiation of 12 Gy subsequent to the irradiation to the whole breast, group 2 (n = 190) received intraoperative electron boost radiation of 9 Gy directly to the tumor bed, followed by whole breast irradiation. After a median follow up period of 81.0 months in group 1 and a median follow up period of 51.1 months in group 2, 12 IBTRs (6.4%) could be observed in group 1 and no IBTR could be observed in group 2 (0.0%). The 5-year actuarial rates of IBTR were 4.3% (95% CI, 1.9-8.3%) and 0.0% (95% CI, 0.0-1.9%), respectively (p = 0.0018). The 5-year actuarial rates of distant recurrence were 8.6% (95% CI, 4.9-13.5%) and 4.2% (95% CI, 1.8-8.2%), respectively (p = 0.08). The 5 year disease-free survival rates were 90.9% (95% CI, 85.8-94.7%) in group 1 and 95.8% (95% CI, 91.8-98.2%) in group 2 (p = 0.064). Immediate IORT-boost and whole breast irradiation yields excellent local control at 5 years, and was associated with a statistically significant decreased rate of IBTR compared with a similar cohort of patients treated with whole breast irradiation and conventional electron boost.
authors.affiliation: Breast Center Salzburg, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria. r.reitsamer@salk.at
authors.forename: Roland
authors.initials: R
authors.lastname: Reitsamer
authors.forename: Felix
authors.initials: F
authors.lastname: Sedlmayer
authors.forename: Michael
authors.initials: M
authors.lastname: Kopp
authors.forename: Gerhard
authors.initials: G
authors.lastname: Kametriser
authors.forename: Christian
authors.initials: C
authors.lastname: Menzel
authors.forename: Heinz
authors.initials: H
authors.lastname: Deutschmann
authors.forename: Olaf
authors.initials: O
authors.lastname: Nairz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hitzl
authors.forename: Florentia
authors.initials: F
authors.lastname: Peintinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018572:Disease-Free Survival; D004583:Electrons; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007430:Intraoperative Care; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D016896:Treatment Outcome