Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer

Overview

Journal Breast Care (Basel)

Publisher Karger

Date 2018 Aug 3

PMID 30069175

Citations 15

Authors

Julia Kaiser

Roland Reitsamer

Peter Kopp

Christoph Gaisberger

Michael Kopp

Thorsten Fischer

Franz Zehentmayr

Felix Sedlmayer

Gerd Fastner

Affiliations

Soon will be listed here.

Abstract

IOERT (intraoperative electron radiotherapy) in breast cancer is used either as a boost (10-12 Gy) followed by whole breast irradiation (WBI) or as full-dose partial breast irradiation (PBI, 20-24 Gy) during breast-conserving surgery. IOERT has the longest evidence of all IORT techniques. When administered as a boost, excellent low local recurrence rates were observed in long-term follow-up >5 years. Even in high-risk groups like triple-negative or locally advanced breast cancers, IOERT contributes to long-term local control rates of more than 90%. For selected low-risk groups, IOERT as PBI with 21 Gy seems to be a viable treatment alternative to standard WBI. IOERT has been shown to be advantageous for several reasons: Geographic misses are avoided due to direct visualization of the tumor bed; thus, a high single dose is delivered with utmost precision to small volumes, completely sparing the skin and ensuring good long-term cosmetic outcome. Furthermore, high single doses seem to induce biological mechanisms with verifiable antitumor capability in in-vitro cell-line studies. In addition, IOERT markedly shortens the overall treatment time both in combination with (now mostly hypofractionated) WBI or as a PBI in selected low-risk constellations.

Citing Articles

A Novel Treatment Planning Design for Intraoperative Electron Radiation Therapy (IOERT) using an Electronic Board.

Pouyanrad Z, Shamsaei Zafarghandi M, Setayeshi S J Biomed Phys Eng. 2024; 14(2):119-128.

PMID: 38628890 PMC: 11016823. DOI: 10.31661/jbpe.v0i0.2109-1405.

Long-term results of breast cancer patients who received IOERT as boost during BCS: A single-institution retrospective analysis.

Gunay S, Gokcek B, Kandemir O, Akan A, Yalcin O Turk J Surg. 2023; 39(2):115-120.

PMID: 38026906 PMC: 10681109. DOI: 10.47717/turkjsurg.2023.5978.

Evaluating the induced photon contamination by different breast IOERT shields using Monte Carlo simulation.

Baghani H, Robatjazi M J Appl Clin Med Phys. 2023; 24(11):e14098.

PMID: 37461859 PMC: 10647956. DOI: 10.1002/acm2.14098.

Delivery of intensity-modulated electron therapy by mechanical scanning: An algorithm study.

Ma P, Tian Y, Li M, Niu C, Song Y, Dai J Front Oncol. 2022; 12:1063577.

PMID: 36505866 PMC: 9730234. DOI: 10.3389/fonc.2022.1063577.

Early Outcome, Cosmetic Result and Tolerability of an IOERT-Boost Prior to Adjuvant Whole-Breast Irradiation.

Jazmati D, Bolke E, Halfmann K, Tamaskovics B, Ruckhaberle E, Fehm T Cancers (Basel). 2022; 14(15).

PMID: 35892894 PMC: 9332060. DOI: 10.3390/cancers14153636.

References

Correa C, Harris E, Leonardi M, Smith B, Taghian A, Thompson A . Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Pract Radiat Oncol. 2016; 7(2):73-79. DOI: 10.1016/j.prro.2016.09.007. View

Belletti B, Vaidya J, DAndrea S, Entschladen F, Roncadin M, Lovat F . Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res. 2008; 14(5):1325-32. DOI: 10.1158/1078-0432.CCR-07-4453. View

Ollila D, Klauber-DeMore N, Tesche L, Kuzmiak C, Pavic D, Goyal L . Feasibility of breast preserving therapy with single fraction in situ radiotherapy delivered intraoperatively. Ann Surg Oncol. 2006; 14(2):660-9. DOI: 10.1245/s10434-006-9154-1. View

Dubois J, Hay M, Gely S, Saint-Aubert B, Rouanet P, Pujol H . IORT in breast carcinomas. Front Radiat Ther Oncol. 1997; 31:131-7. DOI: 10.1159/000061160. View

Fastner G, Reitsamer R, Ziegler I, Zehentmayr F, Fussl C, Kopp P . IOERT as anticipated tumor bed boost during breast-conserving surgery after neoadjuvant chemotherapy in locally advanced breast cancer--results of a case series after 5-year follow-up. Int J Cancer. 2014; 136(5):1193-201. DOI: 10.1002/ijc.29064. View

Reitsamer R, Sedlmayer F, Kopp M, Kametriser G, Menzel C, Deutschmann H . The Salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations. Int J Cancer. 2005; 118(11):2882-7. DOI: 10.1002/ijc.21727. View

Merrick 3rd H, Battle J, Padgett B, Dobelbower Jr R . IORT for early breast cancer: a report on long-term results. Front Radiat Ther Oncol. 1997; 31:126-30. DOI: 10.1159/000061177. View

Fowler J . The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol. 1989; 62(740):679-94. DOI: 10.1259/0007-1285-62-740-679. View

Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M . Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011; 378(9804):1707-16. PMC: 3254252. DOI: 10.1016/S0140-6736(11)61629-2. View

10.

Whelan T, Kim D, Sussman J . Clinical experience using hypofractionated radiation schedules in breast cancer. Semin Radiat Oncol. 2008; 18(4):257-64. DOI: 10.1016/j.semradonc.2008.04.008. View

11.

Bartelink H . Commentary on the paper "A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated". A critical review of an innovative approach. Eur J Cancer. 2001; 37(17):2143-6. DOI: 10.1016/s0959-8049(01)00284-2. View

12.

Van Limbergen E, van der Schueren E, Van Tongelen K . Cosmetic evaluation of breast conserving treatment for mammary cancer. 1. Proposal of a quantitative scoring system. Radiother Oncol. 1989; 16(3):159-67. DOI: 10.1016/0167-8140(89)90016-9. View

13.

Fastner G, Sedlmayer F, Merz F, Deutschmann H, Reitsamer R, Menzel C . IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: long term results of an ISIORT pooled analysis. Radiother Oncol. 2013; 108(2):279-86. DOI: 10.1016/j.radonc.2013.05.031. View

14.

Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C . Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013; 14(13):1269-77. DOI: 10.1016/S1470-2045(13)70497-2. View

15.

Leonardi M, Maisonneuve P, Mastropasqua M, Morra A, Lazzari R, DellAcqua V . Accelerated partial breast irradiation with intraoperative electrons: using GEC-ESTRO recommendations as guidance for patient selection. Radiother Oncol. 2012; 106(1):21-7. DOI: 10.1016/j.radonc.2012.10.018. View

16.

Ivaldi G, Leonardi M, Orecchia R, Zerini D, Morra A, Galimberti V . Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast-conserving surgery in premenopausal women. Int J Radiat Oncol Biol Phys. 2008; 72(2):485-93. DOI: 10.1016/j.ijrobp.2007.12.038. View

17.

Sedlmayer F, Sautter-Bihl M, Budach W, Dunst J, Fastner G, Feyer P . DEGRO practical guidelines: radiotherapy of breast cancer I: radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol. 2013; 189(10):825-33. PMC: 3825416. DOI: 10.1007/s00066-013-0437-8. View

18.

Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J . Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2014; 16(1):47-56. DOI: 10.1016/S1470-2045(14)71156-8. View

19.

Faverly D, Hendriks J, Holland R . Breast carcinomas of limited extent: frequency, radiologic-pathologic characteristics, and surgical margin requirements. Cancer. 2001; 91(4):647-59. DOI: 10.1002/1097-0142(20010215)91:4<647::aid-cncr1053>3.0.co;2-z. View

20.

Agrawal R, Aird E, Barrett J, Barrett-Lee P, Bentzen S, Bliss J . The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008; 371(9618):1098-107. PMC: 2277488. DOI: 10.1016/S0140-6736(08)60348-7. View