Cosmetic Outcomes for Accelerated Partial Breast Irradiation Before Surgical Excision of Early-Stage Breast Cancer Using Single-Dose Intraoperative Radiotherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 79; no. 2; pp. 400 - 407
• Main Authors: Kimple, Randall J., M.D., Ph.D, Klauber-DeMore, Nancy, M.D, Kuzmiak, Cherie M., D.O, Pavic, Dag, M.D, Lian, Jun, Ph.D, Livasy, Chad A., M.D, Esler, Laura, B.A, Moore, Dominic T., M.P.H, Sartor, Carolyn I., M.D, Ollila, David W., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2011; Elsevier
• Subjects: Accelerated partial breast irradiation; Acute toxicity; Aged; Aged, 80 and over; Biological and medical sciences; BODY; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - radiotherapy; Carcinoma, Ductal, Breast - surgery; CLINICAL TRIALS; Combined Modality Therapy - methods; Cosmetics; DISEASES; Energy; Female; Follow-Up Studies; Geriatrics; GLANDS; Gynecology. Andrology. Obstetrics; Hematology, Oncology and Palliative Medicine; Humans; Intraoperative Period; Intraoperative radiation; Invasiveness; Inventories; Lymph nodes; Mammary gland diseases; MAMMARY GLANDS; Mastectomy, Segmental - methods; Medical sciences; MEDICINE; Middle Aged; NEOPLASMS; NUCLEAR MEDICINE; Oncology; ORGANS; Patient Satisfaction; Prospective Studies; Radiation; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; SURGERY; TESTING; THERAPY; TOXICITY; Treatment Outcome; Tumor Burden; Tumors; Ultrasonography; Ultrasound; Accelerated partial breast irradiation; Intraoperative radiation; Breast cancer; Breast disease; Prognosis; Malignant tumor; Radiotherapy; Mammary gland diseases; Treatment; Surgery; Irradiation; Breast; Mammary gland; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.10.032

Purpose Determine cosmetic outcome and toxicity profile of intraoperative radiation delivered before tumor excision for patients with early-stage breast cancer. Methods and Materials Patients age 48 or older with ultrasound-visible invasive ductal cancers <3 cm and clinically negative lymph nodes were eligible for treatment on this institutional review board—approved Phase II clinical trial. Treatment planning ultrasound was used to select an electron energy and cone size sufficient to cover the tumor plus a 1.5- to 2.0-cm circumferential margin laterally and a 1-cm-deep margin with the 90% isodose line. The dose was prescribed to a nominal 15 Gy and delivered using a Mobetron electron irradiator before tumor excision by segmental mastectomy. Physician- and patient-assessed cosmetic outcome and patient satisfaction were determined by questionnaire. Results From March 2003 to July 2007, 71 patients were treated with intraoperative radiation therapy. Of those, 56 patients were evaluable, with a median follow-up of 3.1 years (minimum 1 year). Physician and patient assessment of cosmesis was “good or excellent” (Radiation Therapy Oncology Group cosmesis scale) in 45/56 (80%) and 32/42 (76%) of all patients, respectively. Eleven patients who received additional whole breast radiation had similar rates of good or excellent cosmesis: 40/48 (83%) and 29/36 (81%), respectively). Grade 1 or 2 acute toxicities were seen in 4/71 (6%) patients. No Grade 3 or 4 toxicities or serious adverse events have been seen. Conclusion Intraoperative radiotherapy delivered to an in situ tumor is feasible with acceptable acute tolerance. Patient and physician assessment of the cosmetic outcome is good to excellent.