Breast Cancer Research and Treatment

, Volume 124, Issue 1, pp 141–151 | Cite as

Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons

  • Umberto Veronesi
  • Roberto Orecchia
  • Alberto Luini
  • Viviana Galimberti
  • Stefano Zurrida
  • Mattia Intra
  • Paolo Veronesi
  • Paolo Arnone
  • Maria Cristina Leonardi
  • Mario Ciocca
  • Roberta Lazzari
  • Pietro Caldarella
  • Nicole Rotmensz
  • Claudia Sangalli
  • Daniele Sances
  • Patrick Maisonneuve
Clinical trial

Abstract

Intraoperative radiotherapy with electrons (ELIOT) after conservative surgery for breast carcinoma was introduced at the IEO in 1999 as a research programme. The results on 1,822 patients treated from January 2000 to December 2008 are reported. Women with unicentric primary breast carcinoma of less than 2.5 cm in the largest diameter were assessed by imaging. All patients were treated with breast-conserving surgery (quadrantectomy). ELIOT was delivered by two mobile linear accelerators immediately after breast resection with a single dose of 21 Gy. Local side effects of ELIOT were mainly liponecrosis (4.2%) and fibrosis (1.8%). After a mean follow-up of 36.1 months, 42 women (2.3%) developed a local recurrence, 24 (1.3%) a new primary ipsilateral carcinomas and 26 (1.4%) distant metastases as first event. Forty-six women died (2.5%), 28 for breast carcinoma and 18 for other causes. Five- and ten-year survivals were, respectively, 97.4 and 89.7%. ELIOT appears a promising feature in early breast cancer treated with breast conserving surgery, reducing the exposure of normal tissues to radiations and shortening the radiation course from 6 weeks to one single session.

Keywords

Breast cancer Intraoperative radiotherapy Conserving surgery 

References

  1. 1.
    Veronesi U, Saccozzi R, Del Vecchio M et al (1981) Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. New Engl J Med 305:6–11CrossRefPubMedGoogle Scholar
  2. 2.
    Veronesi U, Luini A, Del Vecchio M et al (1993) Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Eng J Med 328:1587–1590CrossRefGoogle Scholar
  3. 3.
    Veronesi U, Marubini E, Mariani L et al (2001) Radiotherapy after breastconserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 12:997–1003CrossRefPubMedGoogle Scholar
  4. 4.
    Whelan TJ, Pignol JP, Levine MN et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362(6):513–520CrossRefPubMedGoogle Scholar
  5. 5.
    START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EG et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9(4):331–341CrossRefPubMedGoogle Scholar
  6. 6.
    Kirova YM, Campana F, Savignoni A et al (2009) Institut Curie Breast Cancer Study Group. Breast-conserving treatment in the elderly long-term results of adjuvant hypofractionated and normofractionated radiotherapy. Int J Radiat Oncol Biol Phys 75(1):76–81PubMedGoogle Scholar
  7. 7.
    Bernier J, Viale G, Orecchia R et al (2006) Partial irradiation of the breast: old challenges, new solutions. Breast 15:466–475CrossRefPubMedGoogle Scholar
  8. 8.
    Orecchia R, Fossati P (2007) Partial breast irradiation: ready for routine? Breast 16(Suppl 2):S89–S297CrossRefPubMedGoogle Scholar
  9. 9.
    Vicini FA, Beitsch PD, Quiet CA et al (2005) First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer 104(6):1138–1148CrossRefPubMedGoogle Scholar
  10. 10.
    Orecchia R, Jereczek-Fossa BA, Ciocca M et al (2007) Intraoperative radiotherapy for locally advanced prostate cancer: treatment technique and ultrasound-based analysis of dose distribution. Anticancer Res 27:3471–3476PubMedGoogle Scholar
  11. 11.
    Tepper JE, Cohen AM, Wood WC et al (1986) Intraoperative electron beam radiotherapy in the treatment of unresectable rectal cancer. Arch Surg 121:421–423PubMedGoogle Scholar
  12. 12.
    Wood WC, Shipley WU, Gunderson LL et al (1982) Intraoperative irradiation for unresectable pancreatic carcinoma. Cancer 49:1272–1275CrossRefPubMedGoogle Scholar
  13. 13.
    Veronesi U, Orecchia R, Luini A et al (2001) A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer 37:2178–2183CrossRefPubMedGoogle Scholar
  14. 14.
    Veronesi U, Gatti G, Luini A et al (2003) Full-dose intraoperative radiotherapy with electrons during breast conserving surgery. Arch Surg 138:1253–1256CrossRefPubMedGoogle Scholar
  15. 15.
    Veronesi U, Orecchia R, Luini A et al (2005) Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery. Experience with 590 cases. Ann Surg 242:101–106CrossRefPubMedGoogle Scholar
  16. 16.
    Veronesi U, Gatti G, Luini A et al (2003) Intraoperative radiotherapy for breast cancer: technical notes. Breast J 9:106–112CrossRefPubMedGoogle Scholar
  17. 17.
    Ciocca M, Orecchia R, Garibaldi C et al (2003) In vivo dosimetry using radiochromic films during intraoperative electron beam radiation therapy in early-stage breast cancer. Radiother Oncol 69:285–289CrossRefPubMedGoogle Scholar
  18. 18.
    Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer: the value of histological grade in breast cancer. Histopathology 19:403–410CrossRefPubMedGoogle Scholar
  19. 19.
    Rosen PP, Oberman HA (1993) Tumors of the mammary gland. In: Atlas of tumor pathology, 3rd ser., fasc. 7. Armed Forces Institute of Pathology, Washington, DC, pp 135–156Google Scholar
  20. 20.
    Viale G, Regan MM, Mastropasqua MG et al (2008) Predictive value of tumor Ki-67 expression in two randomized trials of adjuvant chemoendocrine therapy for node-negative breast cancer. J Natl Cancer Inst 100:207–212CrossRefPubMedGoogle Scholar
  21. 21.
    Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 16:1227–1232CrossRefGoogle Scholar
  22. 22.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-five-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 8:1233–1241CrossRefGoogle Scholar
  23. 23.
    Nguyen PL, Taghian AG, Katz MS et al (2008) Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 26:2373–2378CrossRefPubMedGoogle Scholar
  24. 24.
    Kim KJ, Huh SJ, Yang JH et al (2005) Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol 35:126–133CrossRefPubMedGoogle Scholar
  25. 25.
    Veronesi U, Paganelli G, Viale G et al (2006) Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of randomised controlled study. Lancet Oncol 7(12):983–990CrossRefPubMedGoogle Scholar
  26. 26.
    Ribeiro GG, Magee B, Swindell R et al (1993) The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol 5:278–283CrossRefGoogle Scholar
  27. 27.
    Reitsamer R, Peintinger F, Kopp M et al (2004) Local recurrence rates in breast cancer patients treated with intraoperative electron-boost radiotherapy versus postoperative external-beam electron-boost irradiation. A sequential intervention study. Strahlenther Onkol 180:38–44CrossRefPubMedGoogle Scholar
  28. 28.
    Giraud P, Simon L, Saliou M et al (2005) Respiratory gated radiotherapy: the 4D radiotherapy. Bull Cancer 92:83–89PubMedGoogle Scholar
  29. 29.
    Vicini FA, Sharpe M, Kestin L et al (2002) Optimizing breast cancer treatment efficacy with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 54:1336–1344CrossRefPubMedGoogle Scholar
  30. 30.
    Wallner P, Arthur D, Bartelink H et al (2004) Workshop Participants. Commentary. Workshop on Partial Breast Irradiation: State of the art and the science, Bethesda, MD, December 8–10, 2002. J Natl Cancer Inst 96:175–184CrossRefPubMedGoogle Scholar
  31. 31.
    Smith BD, Arthur DW, Buchholz TA et al (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 74:987–1001PubMedGoogle Scholar
  32. 32.
    Antonucci JV, Wallace M, Goldstein NS et al (2009) Differences in patterns of failure in patients treated with accelerated partial breast irradiation versus whole-breast irradiation: a matched-pair analysis with 10-year follow-up. Int J Radiat Oncol Biol Phys 74:447–452PubMedGoogle Scholar
  33. 33.
    Polgar C, Major T, Fodor J et al (2010) Accelerated partial-breat irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol 94:274–279CrossRefPubMedGoogle Scholar
  34. 34.
    Finsterer H (1915) Zur therapie inoperable magen—und Darmkarzinome mit freilegund und nachfolgender Rontgenbestrahlung. Strahlentherapie 6:205–213Google Scholar
  35. 35.
    Abe M, Takahashi M (1981) Intraoperative radiotherapy: the Japanese experience. Int J Radiat Oncol Biol Phys 7:863–868PubMedGoogle Scholar
  36. 36.
    Vaidya JS, Baum M, Tobias JS et al (2001) Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann Oncol 12:1075–1080CrossRefPubMedGoogle Scholar
  37. 37.
    Holmes DR, Baum M, Joseph D (2007) The TARGIT trial: targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update). Am J Surg 194:507–510CrossRefPubMedGoogle Scholar
  38. 38.
    Sindelar WF, Johnstone PA, Hoekstra H (1999) Normal tissue tolerance to IORT: The NCI experimental studies. In: Gunderson LL, Willett CG, Harrison LB et al (eds) Intraoperative irradiation: techniques and results. Humana Press, Totowa, pp 131–146Google Scholar
  39. 39.
    Rietjens M, De Lorenzi F, Veronesi P et al (2006) Breast conservative treatment in association with implant augmentation and intraoperative radiotherapy. J Plast Reconstr Aesthet Surg 59(5):532–555CrossRefPubMedGoogle Scholar
  40. 40.
    Athas WF, Adams-Cameron M, Hunt WC et al (2000) Travel distance to radiation therapy and receipt of radiotherapy following breast conserving therapy. J Natl Cancer Inst 92:269–271CrossRefPubMedGoogle Scholar
  41. 41.
    Fietkau R (2000) Effects of the time interval between surgery and radiotherapy on the treatment results. Strahlenther Onkol 176:452–457CrossRefPubMedGoogle Scholar
  42. 42.
    Recht A, Come SE, Henderson IC et al (1996) The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med 334:1356–1361CrossRefPubMedGoogle Scholar
  43. 43.
    Hershman DL, Wang X, McBride R et al (2006) Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival. Int J Radiat Oncol Biol Phys 65:1353–1360PubMedGoogle Scholar
  44. 44.
    Mikeljevic JS, Haward R, Johnston C et al (2004) Trends in postoperative radiotherapy delay and the effect on survival in breast cancer patients treated with conservation surgery. Br J Cancer 90:1343–1348CrossRefPubMedGoogle Scholar
  45. 45.
    Bellon JR, Come SE, Gelman RS et al (2005) Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial. J Clin Oncol 23:1934–1940CrossRefPubMedGoogle Scholar
  46. 46.
    Mariani L, Salvadori B, Marubini E et al (1998) Ten year results of a randomised trial comparing two conservative treatment strategies for small size breast cancer. Eur J Cancer 34:1156–1162CrossRefPubMedGoogle Scholar
  47. 47.
    Chism DB, Freedman GM, Li T et al (2006) Re-excision of margins before breast radiation-diagnostic or therapeutic? Int J Radiat Oncol Biol Phys 65:1416–1421PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Umberto Veronesi
    • 1
  • Roberto Orecchia
    • 2
    • 3
  • Alberto Luini
    • 4
    • 3
  • Viviana Galimberti
    • 4
  • Stefano Zurrida
    • 4
    • 3
  • Mattia Intra
    • 4
  • Paolo Veronesi
    • 4
    • 3
  • Paolo Arnone
    • 4
  • Maria Cristina Leonardi
    • 2
  • Mario Ciocca
    • 5
  • Roberta Lazzari
    • 2
  • Pietro Caldarella
    • 4
  • Nicole Rotmensz
    • 6
  • Claudia Sangalli
    • 3
  • Daniele Sances
    • 7
  • Patrick Maisonneuve
    • 6
  1. 1.European Institute of OncologyMilanItaly
  2. 2.Division of RadiotherapyEuropean Institute of OncologyMilanItaly
  3. 3.University of Milan School of MedicineMilanItaly
  4. 4.Division of SenologyEuropean Institute of OncologyMilanItaly
  5. 5.Division of Nuclear MedicineEuropean Institute of OncologyMilanItaly
  6. 6.Division of Epidemiology and BiostatisticsEuropean Institute of OncologyMilanItaly
  7. 7.Division of AnaesthesiologyEuropean Institute of OncologyMilanItaly

Personalised recommendations