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Stefanelli A, Farina E, Mastella E, Fabbri S, Turra A, Bonazza S, De Troia A, Radica MK, Carcoforo P. Full-Dose Intraoperative Electron Radiotherapy for Early Breast Cancer: Evidence from a Single Center's Experience. Cancers (Basel) 2023; 15:3239. [PMID: 37370849 DOI: 10.3390/cancers15123239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
To evaluate the clinical response rate and cosmetic outcome after full-dose intraoperative electron radiotherapy (IOERT) in early breast cancer (BC) treated with conserving surgery. Inclusion criteria were: >60 years old, clinical tumor size ≤2 cm, luminal A carcinoma, patological negative lymph nodes, excluded lobular carcinoma histology. IOERT was delivered with a dose of 21 Gy at 90% isodose. Clinical, cosmetic and/or instrumental follow-up were performed 45 days after IOERT, 6 months after the first check, and every 12 months thereafter. Acute and late toxicities were assessed with the CTCAE v.4.03 and EORTC-RTOG scales, respectively. Cosmetic outcome was evaluated using the Harvard/NSABO/RTOG Breast Cosmesis Grading Scale. Overall, 162 consecutive patients were included in this analysis (median follow-up: 54 months, range: 1-98 months). The overall response rate was 97.5% (CI 95%: 0.93-0.99%). Locoragional relapse occurred in 2.5% of patients. No patient showed distant metastases. No patient showed radiation-related acute complications, with 3.7% showing late G2-3 toxicity. Only 3.7% of patients showed poor cosmetic results. Our data confirmed that IOERT is a feasible and valid therapeutic option in low-risk BC patients treated with lumpectomy. A low local recurrence rate combined with good cosmetic results validates the settings of our operative method in routinely clinical practice.
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Affiliation(s)
- Antonio Stefanelli
- Department of Radiation Oncology, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Eleonora Farina
- Department of Radiation Oncology, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Edoardo Mastella
- Department of Medical Physics, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Sara Fabbri
- Department of Medical Physics, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Alessandro Turra
- Department of Medical Physics, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Simona Bonazza
- Department of Surgery, University Hospital of Ferrara, 44121 Ferrara, Italy
| | | | | | - Paolo Carcoforo
- Department of Surgery, University Hospital of Ferrara, 44121 Ferrara, Italy
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Mosiun JA, See MH, Teoh LY, Danaee M, Lai LL, Ng CH, Yip CH, Teh MS, Taib NAM, Bustam A, Malik RA, Saad M, Jamaris S, Ung NM. Comparison of Clinical Outcomes Between Low- and High-Risk Groups of Early Breast Cancer Patients Treated with Intraoperative Radiotherapy in Addition to External Beam Radiation: A Multi-Centre Prospective Study. World J Surg 2023; 47:201-208. [PMID: 36305952 DOI: 10.1007/s00268-022-06753-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is a paucity of data on the use of intraoperative radiotherapy (IORT) with low-energy X-rays in Malaysian women with early breast cancer. The aim of this study is to evaluate the clinical, cosmetic, and patient-reported outcomes in low- and high-risk early breast cancer patients treated with breast conserving surgery (BCS) and IORT. METHODOLOGY Patients suitable for BCS who were treated with IORT between January 2016 and June 2019 from three centres were analysed. They were divided into low-risk and high-risk groups based on the risk of recurrence according to the TARGeted Intraoperative radioTherapy (TARGIT) A and B study criteria. Outcomes of interest included local recurrence, wound complications, and radiation toxicity, with a subset analysed for cosmetic and patient-reported outcomes. RESULTS Within a median follow-up of 31 months, there were 104 and 211 patients in the low- and high-risk groups, respectively. No significant difference was observed in local recurrence rates (low-risk, 1.0% vs. high-risk, 1.4%; p = 1.000). Both cohorts exhibited low frequencies of severe wound complications ranging between 1.4 and 1.9%. No major radiation toxicities were reported in either group. In the subgroup analysis, low-risk patients had significantly better mean scores in the subscales of inframammary fold and scar. Based on the BREAST-Q patient-reported outcomes questionnaire, seven out of nine parameters were scored similarly between both groups with no significant difference. CONCLUSION This study showed that the use of IORT in both low- and high-risk early breast cancers is efficacious and safe with low recurrence rates and an acceptable toxicity profile.
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Affiliation(s)
- J A Mosiun
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mee-Hoong See
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Li-Ying Teoh
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Lee-Lee Lai
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Char-Hong Ng
- Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500, Petaling Jaya, Selangor, Malaysia
| | - Cheng-Har Yip
- Ramsay Sime Darby Health Care, Jalan SS 12/1A, Subang Jaya, Malaysia
| | - Mei-Sze Teh
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Md Taib
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Universiti Malaya Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Anita Bustam
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Marniza Saad
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Suniza Jamaris
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ngie-Min Ung
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Guillerm SO, Bourstyn E, Itti R, Cahen-Doidy L, Quéro L, Labidi M, Marchand E, Lorphelin H, Giacchetti S, Cuvier C, Espié M, Teixeira L, Hennequin C. Intraoperative Radiotherapy for Breast Cancer in Elderly Women. Clin Breast Cancer 2021; 22:e109-e113. [PMID: 34154928 DOI: 10.1016/j.clbc.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/18/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate outcomes and postoperative toxicities after intraoperative radiotherapy (IORT) in elderly women. POPULATION Women older than 65 years, with infiltrating ductal breast cancer ≤3 cm, expressing estrogen receptor (ER+) without Her2 overexpression, and with negative axillary nodes. TREATMENT Treatment consisted of partial mastectomy with a sentinel lymph node biopsy (SLNB) procedure; in case of positive SLNB, IORT was cancelled. IORT consisted in a total dose of 20 Gy in 1 fraction delivered at the surface of the applicator with the Intrabeam® technique. RESULTS IORT was planned to be administered to a total of 225 patients but was cancelled for 34 patients during surgery. Thus 191 patients were analyzed; mean age was 76 years, with 57 patients (30%) >80 years. Despite inclusion criteria, 15 had lobular carcinoma and 7 were triple negative. With a median follow-up of 40 months, we observed only 1 local recurrence, located in the skin over the initial tumor. The 5-year local relapse rate was 1.7%. A wound healing delay (>15 days) was observed in 21 patients (11%). Sixty-six patients (35%) had postoperative complications, mainly grade 2, resolving within a few days. Two patients needed surgical drainage for local abscesses. Long-term (>1 year) cosmetic outcome was evaluated in 120 patients and was judged excellent or good in 102 (91%). CONCLUSION IORT can be safely given to elderly women, with a good local control rate and without major toxicities.
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Affiliation(s)
- S Ophie Guillerm
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Edwige Bourstyn
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Ramona Itti
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Laurence Cahen-Doidy
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Laurent Quéro
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Mouna Labidi
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Eva Marchand
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Henri Lorphelin
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Sylvie Giacchetti
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Caroline Cuvier
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Marc Espié
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Luis Teixeira
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Christophe Hennequin
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France.
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Ramdas Y, Benn CA, van Heerden M. First Intraoperative Radiation Therapy Center in Africa: First 2 Years in Operation, Including COVID-19 Experiences. JCO Glob Oncol 2020; 6:1696-1703. [PMID: 33156717 PMCID: PMC7713533 DOI: 10.1200/go.20.00258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is a shortage of radiation therapy service centers in low- to middle-income countries. TARGIT–intraoperative radiation therapy (IORT) may offer a viable alternative to improve radiation treatment efficiency and alleviate hospital patient loads. The Breast Care Unit in Johannesburg became the first facility in Africa to offer TARGIT-IORT, and the purpose of this study was to present a retrospective review of patients receiving IORT at this center between November 2017 and May 2020. PATIENTS AND METHODS Patient selection criteria were based mainly on the latest American Society of Radiation Oncology guidelines. Selection criteria included early-stage breast carcinoma (luminal A) and luminal B with negative upfront sentinel lymph node biopsy that negated external-beam radiation therapy (EBRT). Patient characteristics, reasons for choosing IORT, histology, and use of oncoplastic surgery that resulted in complications were recorded. RESULTS One hundred seven patients successfully received IORT/TARGIT-IORT. Mean age was 60.8 years (standard deviation, 9.3 years). A total of 73.8% of patients presented with luminal A, 15.0% with luminal B, and 5.6% with triple-negative cancer. One patient who presented with locally advanced breast cancer (T4N2) opted for IORT as a boost in addition to planned EBRT. Eighty-seven patients underwent wide local excision (WLE) with mastopexy, and 12 underwent WLE with parenchymal. Primary reasons for selecting IORT/TARGIT-IORT were distance from the hospital (43.9%), choice (40.2%), and age (10.3%). CONCLUSION This retrospective study of IORT/TARGIT-IORT performed in Africa confirms its viability, with low complication rates and no detrimental effects with breast conservation, resulting in positive acceptance and the potential to reduce Oncology Center patient loads. Limitations of the study include the fact that only short-term data on local recurrence were available. Health and socioeconomic value models must still be addressed in the African setting.
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Affiliation(s)
- Yastira Ramdas
- Breast Care Unit, Netcare Milpark Hospital, Johannesburg, South Africa
| | - Carol-Ann Benn
- Breast Care Unit, Netcare Milpark Hospital, Johannesburg, South Africa
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Low Expression of DDX60 Gene Might Associate with the Radiosensitivity for Patients with Breast Cancer. JOURNAL OF ONCOLOGY 2020; 2020:8309492. [PMID: 32765606 PMCID: PMC7387961 DOI: 10.1155/2020/8309492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022]
Abstract
DEXD/H box helicase 60 (DDX60) is a new type of DEAD-box RNA helicase, which is induced to express after virus infection. It might involve in antiviral immunity by promoting RIG-I-like receptor-mediated signal transduction. In addition, previous studies had shown that the expression of DDX60 is related to cancer, but there was still a lack of relevant research in breast cancer. In this study, we used the information of patients with breast cancer in the TCGA database for statistical analysis and found that the breast cancer patients with low expression of DDX60 exhibited radiosensitivity. Comparing the radiotherapy groups with the nonradiotherapy groups, for patients with low expression of DDX60, the adjusted hazard ratio (HR) values for radiotherapy were 0.244 (0.064–0.921) and 0.199 (0.062–0.646) in the training and validation datasets, with the p values 0.040 and 0.007, respectively. However, for patients with high expression of DDX60, the adjusted hazard ratio (HR) values were 3.582 (0.627–20.467) and 2.421 (0.460–12.773), with the p values 0.054 and 0.297, respectively. These results suggested that the expression of DDX60 might strongly associate with individualized radiosensitivity in patients with breast cancer.
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Elfgen C, Güth U, Gruber G, Birrer S, Bjelic-Radisic V, Fleisch M, Tausch CJ. Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient's perspective. Breast Cancer 2020; 27:1107-1113. [PMID: 32488732 PMCID: PMC7567708 DOI: 10.1007/s12282-020-01114-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022]
Abstract
Purpose When ipsilateral breast-tumor recurrence (IBTR) following breast-conserving surgery (BCS) occurs, the cure of a potentially life-threatening disease is the main goal. If, however, this is diagnosed early, prognosis is still good and patient-reported outcomes become more important. Despite the fact that many patients would prefer a further BCS, international breast cancer guidelines still recommend mastectomy, mainly because previous radiation implies limited options. Our comparative study evaluates the long-term quality-of-life and outcome in patients with IBTR who received BCS plus intraoperative radiotherapy (IORT) versus mastectomy. Methods Patients with IBTR were retrospectively divided into three groups according to the local treatment: group 1 (n = 26) was treated with BCS + IORT; group 2 (n = 35) received a standard mastectomy; group 3 (n = 52) had a mastectomy with subsequent reconstruction. Outcomes were analyzed after a mean follow-up of 5 years after IBTR. Quality-of-life was evaluated by the validated questionnaire BREAST-Q in 50 patients who fulfilled the inclusion criteria. Results Quality-of-life scores varied within the groups, ranging from 51.4 to 91.3 (out of 100 points). We observed satisfactory scores in all items, with no statistical difference within the groups. Disease-free survival of all groups did not statistically differ, and overall mortality was very low (0.9%). The postinterventional complication rate was lower after BCS (19.2% versus 34.3% after mastectomy and 30.8% after mastectomy with reconstruction). Conclusion For patients with previous surgery and radiation who demand a second BCS in the recurrent situation, this surgical technique can be offered in combination with IORT. Our long-term results imply oncological safety, lower complication rate, and good patient satisfaction.
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Affiliation(s)
- Constanze Elfgen
- Breast Centre Zurich, Seefeldstrasse 214, 8008, Zurich, Switzerland. .,University of Witten-Herdecke, Witten, Germany.
| | - U Güth
- Breast Centre Zurich, Seefeldstrasse 214, 8008, Zurich, Switzerland
| | - G Gruber
- Institute of Radiooncology, Hirslanden Hospital Zurich, Zurich, Switzerland
| | - S Birrer
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - V Bjelic-Radisic
- University of Witten-Herdecke, Witten, Germany.,Institute of Gynecology and Obstetrics, Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - M Fleisch
- University of Witten-Herdecke, Witten, Germany.,Institute of Gynecology and Obstetrics, Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - C J Tausch
- Breast Centre Zurich, Seefeldstrasse 214, 8008, Zurich, Switzerland
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