title: Full-dose intra-operative radiotherapy with electrons (ELIOT) during breast-conserving surgery: experience with 1246 cases.
abstract: BACKGROUND
  Previous studies showed that after breast-conserving surgery for breast cancer, radiotherapy may be applied to the portion of the breast where the primary tumour was removed (partial breast irradiation (PBI), avoiding the irradiation of the whole breast. We developed a procedure of PBI consisting of a single high dose of radiotherapy of 21 Gy with electrons equivalent to 58-60 Gy in fractionated doses, delivered during the surgical session by a mobile linear accelerator, positioned close to the operating table.
  
  
  METHODS
  From July 1999 to December 2006, 1246 patients with primary carcinoma of less than 2.5-cm maximum diameter, mostly over 48 years, were treated with electron intra-operative radiotherapy (ELIOT) at a single dose of 21 Gy.
  
  
  RESULTS
  After a follow-up from 0.3 to 94.7 months (median 26), 24 (1.9%) patients showed a local recurrence and 22 developed distant metastases. Sixteen patients died, seven from breast carcinoma and nine from others causes. The five-year crude survival was 96.5%. Six (0.5%) developed severe breast fibrosis, which resolved in 2-3 years. An additional 40 patients suffered for mild fibrosis. Cosmetic results were good.
  
  
  CONCLUSIONS
  Electron intra-operative radiotherapy is a safe method for treating conservatively operated breasts and avoids the long period of post-operative radiotherapy, greatly improving the quality of life and reduces the cost of radiotherapy. ELIOT markedly reduces the radiation to normal surrounding tissues and deep organs. Results on short- and medium-term toxicity are good. Data on local control are encouraging.
authors.affiliation: Scientific Director, European Institute of Oncology, Milan, Italy. umberto.veronesi@ieo.it
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authors.lastname: Veronesi
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authors.lastname: Orecchia
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authors.lastname: Luini
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authors.lastname: Galimberti
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authors.lastname: Veronesi
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authors.lastname: Leonardi
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authors.lastname: Ciocca
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authors.lastname: Lazzari
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authors.lastname: Rotmensz
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authors.lastname: Sangalli
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authors.lastname: Silva
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authors.lastname: Sances