title: Cosmetic outcomes for accelerated partial breast irradiation before surgical excision of early-stage breast cancer using single-dose intraoperative radiotherapy.
abstract: OBJECTIVE
  Determine cosmetic outcome and toxicity profile of intraoperative radiation delivered before tumor excision for patients with early-stage breast cancer.
  
  
  METHODS
  Patients age 48 or older with ultrasound-visible invasive ductal cancers <3 cm and clinically negative lymph nodes were eligible for treatment on this institutional review board-approved Phase II clinical trial. Treatment planning ultrasound was used to select an electron energy and cone size sufficient to cover the tumor plus a 1.5- to 2.0-cm circumferential margin laterally and a 1-cm-deep margin with the 90% isodose line. The dose was prescribed to a nominal 15 Gy and delivered using a Mobetron electron irradiator before tumor excision by segmental mastectomy. Physician- and patient-assessed cosmetic outcome and patient satisfaction were determined by questionnaire.
  
  
  RESULTS
  From March 2003 to July 2007, 71 patients were treated with intraoperative radiation therapy. Of those, 56 patients were evaluable, with a median follow-up of 3.1 years (minimum 1 year). Physician and patient assessment of cosmesis was "good or excellent" (Radiation Therapy Oncology Group cosmesis scale) in 45/56 (80%) and 32/42 (76%) of all patients, respectively. Eleven patients who received additional whole breast radiation had similar rates of good or excellent cosmesis: 40/48 (83%) and 29/36 (81%), respectively). Grade 1 or 2 acute toxicities were seen in 4/71 (6%) patients. No Grade 3 or 4 toxicities or serious adverse events have been seen.
  
  
  CONCLUSIONS
  Intraoperative radiotherapy delivered to an in situ tumor is feasible with acceptable acute tolerance. Patient and physician assessment of the cosmetic outcome is good to excellent.
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Kimple
authors.forename: Nancy
authors.initials: N
authors.lastname: Klauber-DeMore
authors.forename: Cherie M
authors.initials: CM
authors.lastname: Kuzmiak
authors.forename: Dag
authors.initials: D
authors.lastname: Pavic
authors.forename: Jun
authors.initials: J
authors.lastname: Lian
authors.forename: Chad A
authors.initials: CA
authors.lastname: Livasy
authors.forename: Laura
authors.initials: L
authors.lastname: Esler
authors.forename: Dominic T
authors.initials: DT
authors.lastname: Moore
authors.forename: Carolyn I
authors.initials: CI
authors.lastname: Sartor
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D047368:Tumor Burden; D014463:Ultrasonography
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