title: Accelerated partial breast irradiation: a review and description of an early North American surgical experience with the intrabeam delivery system.
abstract: BACKGROUND
  Targeted intraoperative radiation therapy (IORT) as an alternative to whole breast irradiation (WBI) has been described for patients with early-stage breast cancer. The randomized phase III TARGiT trial demonstrated similar recurrence rates to WBI and a lower overall toxicity profile on short-term follow-up. We report on our early North American surgical experience using the Intrabeam radiotherapy delivery system and review the current literature.
  
  
  METHODS
  Prospectively gathered estrogen receptor-positive, clinically node-negative patients with invasive breast cancer < 3 cm receiving IORT using the Intrabeam system were reviewed. IORT-related effects and early postoperative outcome were assessed. A literature review was also performed.
  
  
  RESULTS
  Forty-two patients (median age 71 years) underwent lumpectomy, sentinel lymph node (SLN) biopsy, and concurrent IORT from January 2011 to July 2011. Ninety-one percent of patients had invasive ductal histology with a median tumor size of 1.0 cm. This review highlights the patient selection criteria, describes commercially available accelerated partial breast irradiation (APBI) treatment options, and discusses outcomes for the variety of APBI techniques currently utilized in clinical practice as well as an institutional review of our early surgical experience using the Intrabeam radiotherapy delivery system.
  
  
  CONCLUSIONS
  While a variety of APBI techniques are currently available for clinical use, our early North American operative experience with IORT shows it is well tolerated with low morbidity. Delivery of IORT adds moderate operative time and may require creating subcutaneous tissue fl aps. The addition of WBI may be necessary in situations for positive residual margins or microscopic nodal disease in patients who do not undergo additional surgery.
authors.affiliation: Comprehensive Breast Program, Department of Women's Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
authors.forename: Jeremiah L
authors.initials: JL
authors.lastname: Deneve
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hoefer
authors.forename: Eleanor E R
authors.initials: EE
authors.lastname: Harris
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D009656:North America; D011446:Prospective Studies