Single-fraction intraoperative radiotherapy for breast cancer: early cosmetic results.
OBJECTIVE
To evaluate the cosmetic outcome of patients treated with wide local excision and intraoperative radiotherapy for early-stage breast cancer.


METHODS
A total of 50 women were treated on a pilot study to evaluate the feasibility of intraoperative radiotherapy at wide local excision. The eligibility criteria included age >60, tumor size </=2.0 cm, clinically negative lymph nodes, and biopsy-established diagnosis. After wide local excision, a custom breast applicator was placed in the excision cavity, and a dose of 20 Gy was prescribed to a depth of 1 cm. After 18 patients were treated, the dose was constrained laterally to 18 Gy. The cosmetic outcome was evaluated by photographs at baseline and at 6 and 12 months postoperatively. Four examiners graded the photographs for symmetry, edema, discoloration, contour, and scarring. The grades were evaluated in relationship to the volume of irradiated tissue, tumor location, and dose at the lateral aspects of the cavity.


RESULTS
The median volume of tissue receiving 100% of the prescription dose was 47 cm(3) (range, 20-97 cm(3)). Patients with </=47 cm(3) of treated tissue had better cosmetic outcomes than did the women who had >47 cm(3) of treated tissue. Women who had received 18 Gy at the lateral aspects of their cavities had better cosmetic outcomes than did women who had received 20 Gy at the lateral aspects. When comparing the 6- and 12-month results, the scores remained stable for 63%, improved for 17%, and worsened for 20%.


CONCLUSIONS
Intraoperative radiotherapy appears feasible for selected patients. A favorable cosmetic outcome appears to be related to a smaller treatment volume. The cosmetic outcome is acceptable, although additional follow-up is necessary.
Beal
Kathryn
K
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. BealK@MSKCC.org
McCormick
Beryl
B
Zelefsky
Michael J
MJ
Borgen
Patrick
P
Fey
Jane
J
Goldberg
Jessica
J
Cohen
Gilad N
GN
Sacchini
Virgilio
V
D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology / Q000528:radiation effects*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D004954:Esthetics; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D047368:Tumor Burden / Q000528:radiation effects