Skip to main content

Advertisement

SpringerLink
Log in

Clinical Efficacy and Side Effects of IORT as Tumor Bed Boost During Breast-Conserving Surgery in Breast Cancer Patients Following Neoadjuvant Chemotherapy

  • Original Article
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Objective

The efficacy of intraoperative radiotherapy (IORT) as boost dose following neoadjuvant chemotherapy (NACT) is not clearly established yet. This trial evaluated the outcome and complications of IORT boost dose after NACT in patients with breast cancer.

Methods and Materials

This study was a single-arm phase II clinical trial conducted at tertiary referral centers including Omid and Imam Reza Educational Hospitals and Pasteur Private Hospital, Mashhad, Iran. Twenty-four women with breast cancer underwent breast-preservation surgery following the neoadjuvant chemotherapy were enrolled. During BCS, a 20 Gy dose was prescribed to the tumor bed using intrabeam system Zeiss followed by 50 Gy/2 Gy whole breast radiotherapy. Patients were followed for complications of treatment and disease recurrence at 2 years.

Results

Toxicity criteria of the RTOG revealed there was only one case of acute toxicity grade 4 as necrosis. During the follow up, two cases of grade III fibrosis were observed. With a median follow up of 29.5 months, one patient died due to cancer with the median survival time of 23.93 months and the 2-year survival rate of 95.5 ± 4.4%. Moreover, one localized relapses in the breast, one recurrent in axillary region and distant metastases, and two distant metastases were diagnosed. The mean free survival was 23.23 months, and the 2-year free survival rate was 87.1%.

Conclusion

The results of this study showed that in the short-term follow up, IORT results in terms of local control, side effects and cosmetic outcome after neoadjuvant chemotherapy in breast cancer patients are acceptable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E et al. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;26(suppl_5):v8-v30.

  2. Kuerer HM. FACS reviewing Early Breast Cancer Trialists' Collaborative Group (EBCTCG). NEJM Journal Watch, Waltham, Massachusetts. 2011 https://www.jwatch.org/oh201111150000004/2011/11/15/benefits-radiotherapy-after-breast-conserving. Accessed 27 May 2019.

  3. Faverly DR, Hendriks JH, Holland R. Breast carcinomas of limited extent: frequency, radiologic-pathologic characteristics, and surgical margin requirements. Cancer. 2001;91(4):647–59.

    Article  CAS  Google Scholar 

  4. Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56(5):979–90.

    Article  CAS  Google Scholar 

  5. Vaidya JS, Tobias JS, Baum M, Keshtgar M, Joseph D, Wenz F, et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol. 2010;5(3):165–73.

    Article  Google Scholar 

  6. Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Eng J Med. 2001;345(19):1378–87. https://doi.org/10.1056/NEJMoa010874.

    Article  CAS  Google Scholar 

  7. Kindts I, Laenen A, Depuydt T, Weltens C. Tumour bed boost radiotherapy for women after breast-conserving surgery. Cochrane Database Syst Rev. 2017;11:Cd011987. https://doi.org/10.1002/14651858.CD011987.pub2.

    Article  PubMed  Google Scholar 

  8. Goyal S, Buchholz TA, Haffty BG. Breast cancer, Early Stage. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady's principles and practice of radiation oncology. 7th ed. Philadelphia, PA: Wolters Kluwer; 2018. p. 1268–1378.

    Google Scholar 

  9. Moran MS, Truong P. Breast cancer, Locally advanced, part 2. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady's principles and practice of radiation oncology. 7th ed. Philadelphia, PA: Wolters Kluwer; 2018. p. 1395–1418.

    Google Scholar 

  10. Shiloh RY, Mahal BA, Wong S, Khan A, Bellon JR. Breast cancer, Locally advanced, part 1. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady's principles and practice of radiation oncology. 7th ed. Philadelphia, PA: Wolters Kluwer; 2018. p. 1379–1394.

    Google Scholar 

  11. Jalali R, Singh S, Budrukkar A. Techniques of tumour bed boost irradiation in breast conserving therapy: current evidence and suggested guidelines. Acta Oncol. 2007;46(7):879–92. https://doi.org/10.1080/02841860701441798.

    Article  PubMed  Google Scholar 

  12. Van Limbergen E. Indications and technical aspects of brachytherapy in breast conserving treatment of breast cancer. Cancer/Radiothérapie. 2003;7(2):107–20. https://doi.org/10.1016/S1278-3218(03)00015-5.

    Article  Google Scholar 

  13. Sedlmayer F, Reitsamer R, Wenz F, Sperk E, Fussl C, Kaiser J, et al. Intraoperative radiotherapy (IORT) as boost in breast cancer. Radiat Oncol. 2017;12(1):23. https://doi.org/10.1186/s13014-016-0749-9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nairz O, Deutschmann H, Kopp M, Wurstbauer K, Kametriser G, Fastner G, et al. A dosimetric comparison of IORT techniques in limited-stage breast cancer. Strahlenther Onkol. 2006;182(6):342–8. https://doi.org/10.1007/s00066-006-1580-2.

    Article  PubMed  Google Scholar 

  15. Fastner G, Hauser-Kronberger C, Moder A, Reitsamer R, Zehentmayr F, Kopp P, et al. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery. Strahlenther Onkol. 2016;192(1):1–7. https://doi.org/10.1007/s00066-015-0895-2.

    Article  PubMed  Google Scholar 

  16. Kolberg H-C, Lövey G, Akpolat-Basci L, Stephanou M, Fasching P, Untch M, et al. Targeted intraoperative radiotherapy tumour bed boost during breast-conserving surgery after neoadjuvant chemotherapy—a subgroup analysis of hormone receptor-positive HER2-negative breast cancer. Breast Care (Basel). 2017;12(5):318–23. https://doi.org/10.1159/000479424.

    Article  Google Scholar 

  17. Kolberg HC, Loevey G, Akpolat-Basci L, Stephanou M, Fasching PA, Untch M, et al. Targeted intraoperative radiotherapy tumour bed boost during breast conserving surgery after neoadjuvant chemotherapy in HER2 positive and triple negative breast cancer. Rev Recent Clin Trials. 2017;12(2):93–100. https://doi.org/10.2174/1574887112666170201142458.

    Article  CAS  PubMed  Google Scholar 

  18. Zur M, Shai A, Leviov M, Bitterman A, Shiloni E, Ben Yosef R, et al. Short-term complications of intra-operative radiotherapy for early breast cancer. J Surg Oncol. 2016;113(4):370–3. https://doi.org/10.1002/jso.24157.

    Article  PubMed  Google Scholar 

  19. Cracco S, Semprini G, Cattin F, Gregoraci G, Zeppieri M, Isola M, et al. Impact of intraoperative radiotherapy on cosmetic outcome and complications after oncoplastic breast surgery. Breast J. 2015;21(3):285–90. https://doi.org/10.1111/tbj.12402.

    Article  PubMed  Google Scholar 

  20. Cedolini C, Bertozzi S, Seriau L, Londero AP, Concina S, Moretti E, et al. Feasibility of concervative breast surgery and intraoperative radiation therapy for early breast cancer: a single-center, open, non-randomized, prospective pilot study. Oncol Rep. 2014;31(4):1539–46. https://doi.org/10.3892/or.2014.3018.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chua BH, Henderson MA, Milner AD. Intraoperative radiotherapy in women with early breast cancer treated by breast-conserving therapy. ANZ J Surg. 2011;81(1–2):65–9. https://doi.org/10.1111/j.1445-2197.2010.05431.x.

    Article  PubMed  Google Scholar 

  22. Fazilat-Panah D, Vakili Ahrari Roudi S, Keramati A, Fanipakdel A, Sadeghian M, Homaei-Shandiz F, et al. Changes in cytokeratin during neoadjuvant chemotherapy of breast cancer: a prospective study. Iran J Pathol. 2020;1:12–24. https://doi.org/10.30699/ijp.2020.116238.2261.

    Article  Google Scholar 

  23. National Comprehensive Cancer Network. Breast Cancer (Version 3.2019). 2019. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed June 10, 2019.

  24. Fanipakdel A, Seilanian Toussi M, Rezazadeh F, Mohamadian Roshan N, Javadinia SA. Overexpression of cancer-testis antigen melanoma-associated antigen A1 in lung cancer: a novel biomarker for prognosis, and a possible target for immunotherapy. J Cell Physiol. 2019;234(7):12080–6. https://doi.org/10.1002/jcp.27884.

    Article  CAS  PubMed  Google Scholar 

  25. Javadinia SA, Shahidsales S, Fanipakdel A, Joudi-Mashhad M, Mehramiz M, Talebian S, et al. Therapeutic potential of targeting the Wnt/β-catenin pathway in the treatment of pancreatic cancer. J Cell Biochem. 2019;120(5):6833–40. https://doi.org/10.1002/jcb.27835.

    Article  CAS  Google Scholar 

  26. Javadinia SA, Shahidsales S, Fanipakdel A, Mostafapour A, Joudi-Mashhad M, Ferns GA, et al. The esophageal cancer and the PI3K/AKT/mTOR signaling regulatory micrornas: a novel marker for prognosis, and a possible target for immunotherapy. Curr Pharm Des. 2018;24(39):4646–51. https://doi.org/10.2174/1381612825666190110143258.

    Article  CAS  PubMed  Google Scholar 

  27. Javadinia SA, Gholami A, Joudi Mashhad M, Ferns GA, Shahidsales S, Avan A, et al. Anti-tumoral effects of low molecular weight heparins: a focus on the treatment of esophageal cancer. J Cell Physiol. 2018;233(10):6523–9. https://doi.org/10.1002/jcp.26613.

    Article  CAS  PubMed  Google Scholar 

  28. Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet (London, England). 2014;383(9917):603–13. https://doi.org/10.1016/s0140-6736(13)61950-9.

    Article  Google Scholar 

  29. Veronesi U, Orecchia R, Luini A, Galimberti V, Zurrida S, Intra M, et al. Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast Cancer Res Treat. 2010;124(1):141–51.

    Article  Google Scholar 

  30. Fastner G, Reitsamer R, Ziegler I, Zehentmayr F, Fussl C, Kopp P, et al. 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. 2015;136(5):1193–201. https://doi.org/10.1002/ijc.29064.

    Article  CAS  PubMed  Google Scholar 

  31. Spaich S, Tuschy B, Sperk E, Wenz F, Sütterlin M. Initial experience of intraoperative radiotherapy as tumour bed boost after neoadjuvant chemotherapy in breast cancer patients. Transl Cancer Res. 2017;6(2):416–23.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank staffs of Reza Radiotherapy & Oncology Center of Mashhad.

Funding

This work was supported by the Mashhad University of Medical Sciences [Grant numbers 950995, 2017].

Author information

Authors and Affiliations

  1. Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Fatemeh Homaei Shandiz, Azar Fanipakdel, Mohammad Naser Forghani, Elyar Mousapour Shahi, Alireza Keramati & Mohammad Moein Babaei

  2. Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran

    Seyed Alireza Javadinia

  3. Cancer Research Center, Babol University of Medical Sciences, Babol, Iran

    Danial Fazilat-Panah

Authors
  1. Fatemeh Homaei Shandiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Azar Fanipakdel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad Naser Forghani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seyed Alireza Javadinia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elyar Mousapour Shahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alireza Keramati
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Danial Fazilat-Panah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohammad Moein Babaei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Seyed Alireza Javadinia or Alireza Keramati.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Homaei Shandiz, F., Fanipakdel, A., Forghani, M.N. et al. Clinical Efficacy and Side Effects of IORT as Tumor Bed Boost During Breast-Conserving Surgery in Breast Cancer Patients Following Neoadjuvant Chemotherapy. Indian J Gynecol Oncolog 18, 46 (2020). https://doi.org/10.1007/s40944-020-00389-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-020-00389-5

Keywords

Search

Navigation