title: Risk Factors Leading to Complications in Early-Stage Breast Cancer Following Breast-Conserving Surgery and Intraoperative Radiotherapy.
abstract: OBJECTIVE
  The aim of this study was to evaluate outcomes after breast-conserving surgery (BCS) and intraoperative radiotherapy (IORT), and to identify risk factors associated with complications.
  
  
  METHODS
  We evaluated patients with early-stage breast cancer treated from January 1, 2011 to January 31, 2014 with BCS and IORT at a single institution. The presence of breast cancer recurrences, complications, or fat necrosis were assessed at subsequent follow-up visits using physical examination and breast imaging.
  
  
  RESULTS
  Overall, 113 patients, of whom three were undergoing bilateral treatments, were identified. The median length of time for IORT was 29 min and 36 s (range 15:50-59:00). Fifteen patients received additional external beam radiotherapy (EBRT), and the median follow-up was 40.3 months (range 1.6-58.3) for all patients. To date, one biopsy-proven ipsilateral recurrence has been noted (0.9%), for which the patient elected to undergo a mastectomy. Nine patients were found to have wound complications (7.7%) and two had fat necrosis (1.7%) on follow-up. Of all the evaluated risk factors, only applicator size (p < 0.01) had a statistically significant association with an increase in complications.
  
  
  CONCLUSIONS
  With a short follow-up, IORT appears to be a safe treatment modality for a select group of patients, leading to a reasonable increase in operating room time and complication rates following BCS. The utilization of larger applicators at the time of IORT was associated with an increase in wound complications and fat necrosis.
authors.affiliation: Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Sunpreet
authors.initials: S
authors.lastname: Rakhra
authors.affiliation: Department of Surgery, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Bethke
authors.affiliation: Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Strauss
authors.affiliation: Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Hayes
authors.affiliation: Department of Surgery, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Hansen
authors.affiliation: Department of Surgery, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Seema A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Northwestern University Cancer Biostatistics Core, Chicago, IL, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Helenowski
authors.affiliation: Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. edonnel2@nm.org.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Donnelly
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects* / Q000295:instrumentation; D012307:Risk Factors