title: Breast-conserving surgery and intraoperative electron radiotherapy in early breast cancer: experience at the Rambam Health Care Campus.
abstract: BACKGROUND
  Local recurrences after breast-conserving surgery occur mostly at the site of the primary carcinoma. The main objective of postoperative radiotherapy is sterilization of residual cancer cells. Whole-breast radiotherapy is the standard of care, but its utility has recently been challenged in favor of radiotherapy limited to the area at highest risk of recurrence. Intraoperative electron radiotherapy (IOeRT) is an innovative technique for accelerated partial breast irradiation (APBI) that is applied to selected patients affected by early breast cancer.
  
  
  OBJECTIVE
  To describe our experience with IOeRT at the Rambam Health Care Campus in Haifa since we began utilizing this modality in 2006.
  
  
  METHODS
  From April 2006 to September 2010, 31 patients affected by unifocal invasive duct breast carcinoma < or = 2 cm diameter received wide local resection followed by intraoperative radiotherapy with electrons. Patients were evaluated for early and late complications, and other events, 1 month after surgery and every 3 months thereafter for the duration of the first 2 years.
  
  
  RESULTS
  After a mean follow-up of 36 months, seven patients developed mild breast fibrosis and three suffered from mild postoperative infection. Rib fractures were observed in four patients before routine lead shielding was initiated. Additional whole-breast irradiation was given to four patients. None of the patients developed local recurrences or other ipsilateral cancers. Similarly, no contralateral cancers or distant metastases were observed.
  
  
  CONCLUSIONS
  Intraoperative electron radiotherapy may be an alternative to external beam radiation therapy in an appropriate selected group of early-stage breast cancer patients. However, long-term results of clinical trials are required to better evaluate the indications and utility of this technique in the management of breast cancer.
authors.affiliation: Department of Surgery, Rambam Health Care Campus affiliated with Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel. d_hershko@rambam.health.gov.il
authors.forename: Dan
authors.initials: D
authors.lastname: Hershko
authors.forename: Roxolyana
authors.initials: R
authors.lastname: Abdah-Bortnyak
authors.forename: Alexander
authors.initials: A
authors.lastname: Nevelsky
authors.forename: Eliahu
authors.initials: E
authors.lastname: Gez
authors.forename: Georgeta
authors.initials: G
authors.lastname: Fried
authors.forename: Abraham
authors.initials: A
authors.lastname: Kuten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D018365:Neoplasm, Residual / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome