title: Our intraoperative boost radiotherapy experience and applications.
abstract: OBJECTIVE
  To present our experience since November 2013, and case selection criteria for intraoperative boost radiotherapy (IObRT) that significantly reduces the local recurrence rate after breast conserving surgery in patients with breast cancer.
  
  
  METHODS
  Patients who were suitable for IObRT were identified within the group of patients who were selected for breast conserving surgery at our breast council. A MOBETRON (mobile linear accelerator for IObRT) was used for IObRt during surgery.
  
  
  RESULTS
  Patients younger than 60 years old with <3 cm invasive ductal cancer in one focus (or two foci within 2 cm), with a histologic grade of 2-3, and a high possibility of local recurrence were admitted for IObRT application. Informed consent was obtained from all participants. Lumpectomy and sentinel lymph node biopsy was performed and advancement flaps were prepared according to the size and inclination of the conus following evaluation of tumor size and surgical margins by pathology. Distance to the thoracic wall was measured, and a radiation oncologist and radiation physicist calculated the required dose. Anesthesia was regulated with slower ventilation frequency, without causing hypoxia. The skin and incision edges were protected, the field was radiated (with 6 MeV electron beam of 10 Gy) and the incision was closed. In our cases, there were no major postoperative surgical or early radiotherapy related complications.
  
  
  CONCLUSIONS
  The completion of another stage of local therapy with IObRT during surgery positively effects sequencing of other treatments like chemotherapy, hormonotherapy and radiotherapy, if required. IObRT increases disease free and overall survival, as well as quality of life in breast cancer patients.
authors.affiliation: Clinic of Breast and Endocrin Surgery, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Günay
authors.affiliation: Clinic of Oncology, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey.
authors.forename: Ömür
authors.initials: Ö
authors.lastname: Alan
authors.affiliation: Clinic of Breast and Endocrin Surgery, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Yalçın
authors.affiliation: Clinic of Anesthesiology and Reanimation, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey.
authors.forename: Aygen
authors.initials: A
authors.lastname: Türkmen
authors.affiliation: Clinic of Oncology, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey.
authors.forename: Nihal
authors.initials: N
authors.lastname: Dizdar
keywords: Breast cancer; boost radiotherapy; intraoperative radiotherapy; local recurrence