title: Factors predictive of failure to complete planned intraoperative breast radiation using the intrabeam® system.
abstract: OBJECTIVE
  Intraoperative radiation therapy (IORT) is a form of breast irradiation that is delivered in a single session at the time of partial mastectomy. In up to 10% of patients, planned IORT is not completed; this leads to wasted resources and decreased patient satisfaction. Our objective was to evaluate factors associated with failure to complete planned IORT.
  
  
  METHODS
  An IRB-approved review of planned IORT cases from 2011 to 2015 was conducted. Eligibility criteria included: age ≥60, invasive ductal or mammary carcinoma, tumor <3.0 cm, ER positive, and clinically node negative. Discontinuation of planned IORT was at the discretion of the breast surgical and radiation oncologists.
  
  
  RESULTS
  Twenty-one (15%) of one hundred and forty-five planned IORT cases were not completed. Reasons for failure to complete IORT included inadequate applicator to skin distance (n = 15, 71%), altered wire localization findings the day of surgery (n = 4, 19%), equipment failure (n = 1, 5%), and hemodynamic instability (n = 1, 5%). Significant surgeon variability was associated with failure to complete planned IORT (P < 0.001).
  
  
  CONCLUSIONS
  Insufficient skin-to-applicator spacing is the most common reason for failure to complete IORT. In this series, higher volume surgeons completed a greater proportion of IORT cases, suggesting a learning curve to patient selection or intraoperative technique. J. Surg. Oncol. 2016;114:930-932. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Dossett
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Abbott
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Weihong
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Loretta
authors.initials: L
authors.lastname: Loftus
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Marie Catherine
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.|Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Roberto
authors.initials: R
authors.lastname: Diaz
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000532:radiotherapy* / Q000601:surgery; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D006801:Humans; D007430:Intraoperative Care / Q000706:statistics & numerical data*; D059032:Learning Curve; D015412:Mastectomy, Segmental; D019300:Medical Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
keywords: APBI; IORT; breast cancer