title: A novel approach of INTRABEAM intraoperative radiotherapy for nipple-sparing mastectomy with breast reconstruction.
abstract: BACKGROUND
  Despite the advancement and increasing use of breast-conserving surgery, mastectomies, including nipple-sparing mastectomy (NSM), are still carried out in a portion of breast cancer patients. However, the role of NSM is still controversial, mainly because of concern about the oncologic safety of the nipple-areola complex (NAC). INTRABEAM (Carl Zeiss, Oberkochen, Germany) is the most widely used mobile intraoperative radiotherapy (IORT) device to date. This pilot study aims to broaden the application of the INTRABEAM system for breast cancer, investigating the feasibility of INTRABEAM IORT in NSM with breast reconstruction.
  
  
  METHODS
  From December 2012 to June 2013, 7 female patients with breast cancer were enrolled in the study. NSM with or without axillary dissection was performed first. After confirming negative retroareolar frozen section results and no poor local bleeding in the NAC, INTRABEAM IORT was carried out with a single dose of 16 Gy, followed by breast reconstruction. The complications and short-term outcomes were assessed.
  
  
  RESULTS
  The median radiation time was 13 minutes 14 seconds in the 7 cases. One patient complained of mild pain in the radiation field on the skin in the first 2 weeks. All 7 patients were followed for a median of 7 months. No acute radiation injury with symptoms (heart, lung, or hematologic system), NAC necrosis, local recurrence, or metastasis was observed. Although every patient had reduction in NAC sensitivity, the contours of the breasts (including the NAC) were satisfactory.
  
  
  CONCLUSIONS
  INTRABEAM IORT may be a feasible and convenient approach for NSM with breast reconstruction in patients with breast cancer.
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Lingxiao
authors.initials: L
authors.lastname: Pan
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China. Electronic address: wenbo_zheng@163.com.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Zheng
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Xigang
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Lun
authors.initials: L
authors.lastname: Chen
authors.affiliation: Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
authors.forename: Yaohua
authors.initials: Y
authors.lastname: Ke
authors.affiliation: Department of Radiation Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Wan
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Tang
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Jin
authors.initials: J
authors.lastname: Gao
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Xiaoshen
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000295:instrumentation* / Q000379:methods
keywords: Breast cancer; Breast reconstruction; Intraoperative radiotherapy; Mastectomy; Nipple sparing