Intraoperative radiation therapy delivered prior to lumpectomy for early-stage breast cancer: a single institution study.
OBJECTIVE
To evaluate the safety, cosmesis, and clinical outcome of intraoperative electron radiation therapy (IOERT) delivered prior to lumpectomy for early-stage breast cancer.


METHODS
From December 2008 to March 2012, 75 breast cancer patients (ages 34-66 years) were treated with IOERT during breast conservative surgery. IOERT was delivered using a mobile linear accelerator. Suitable energy and applicator size were chosen to ensure coverage of the tumor with anterior and posterior margins of 1 cm and lateral margins of 2 cm. Patients with sentinel node metastases or younger than 40 years received 8 Gy as boost followed by post-operative external beam radiation therapy of 50 Gy/25F; the others had 15 Gy, prescribed to the 90% isodose depth. Adjuvant treatment consisted of chemotherapy (55 patients), hormonal therapy (59 patients), or combined chemotherapy and hormonal therapy (41 patients). The safety, cosmesis, and short-term outcome were evaluated.


RESULTS
Median follow-up was 54 months (range: 30-66 months). Two (2.7%) patients developed post-surgical hematoma. Six (8.0%) patients developed mild breast fibrosis. Eight (10.7%) patients suffered from local pain. One (1.2%) patient experienced a post-operative infection. Sixteen (21.3%) patients developed Grade 1 pulmonary fibrosis. Forty-three (57.3%) patients had an excellent cosmetic result and 23 (30.7%) had a good cosmetic result. Three patients had an ipsilateral breast recurrence, with an actual 3-year local recurrence rate of 4.0%. One patient had an ipsilateral axillary recurrence, resulting in a 3-year regional recurrence rate of 1.3%. No distant metastases or deaths were observed. The 3-year disease free survival was 94.6%.


CONCLUSIONS
Intraoperative electron radiation therapy delivered prior to lumpectomy is safe and feasible for selected patients with early-stage breast cancer. Early side effects, cosmesis and short-term efficacy are acceptable, but a longer follow-up is needed for evaluation of late side effects and long-term outcome.
Department of Radiotherapy, Chinese PLA General Hospital Beijing 100853, China.
Wei
W
Yu
Department of Medical Oncology, Chinese PLA General Hospital Beijing 100853, China.
Zhi
Z
Lin
Department of Radiotherapy, Chinese PLA General Hospital Beijing 100853, China.
Zhong-Jian
ZJ
Ju
Department of General Surgery, Chinese PLA General Hospital Beijing 100853, China.
Xi-Ru
XR
Li
Department of General Surgery, Chinese PLA General Hospital Beijing 100853, China.
Yan-Jun
YJ
Zhang
Department of Oncological Surgery, Chinese PLA General Hospital Beijing 100853, China.
Qing-Long
QL
Kong
Department of Radiotherapy, Chinese PLA General Hospital Beijing 100853, China.
Han-Shun
HS
Gong
Department of General Surgery, Chinese PLA General Hospital Beijing 100853, China.
Jian-Dong
JD
Wang
Department of Radiotherapy, Chinese PLA General Hospital Beijing 100853, China.
Lin
L
Ma
IOERT; Intraoperative radiotherapy; breast cancer; intraoperative electron radiation therapy; whole breast radiation therapy