Targeted intraoperative radiotherapy tumour bed boost during breast-conserving surgery after neoadjuvant chemotherapy

Zielgerichtete intraoperative Strahlentherapie als vorgezogener Boost im Rahmen der brusterhaltenden Operation nach neoadjuvanter Chemotherapie

Abstract

Introduction

The use of targeted intraoperative radiotherapy (TARGIT-IORT) as a tumour bed boost during breast-conserving surgery (BCS) for breast cancer has been reported since 1998. We present its use in patients undergoing breast conservation following neoadjuvant therapy (NACT).

Method

In this retrospective study involving 116 patients after NACT we compared outcomes of 61 patients who received a tumour bed boost with IORT during lumpectomy versus 55 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Local recurrence-free survival (LRFS), disease-free survival (DFS), distant disease-free survival (DDFS), breast cancer mortality (BCM), non-breast cancer mortality (NBCM) and overall mortality (OS) were compared.

Results

Median follow up was 49 months. The differences in LRFS, DFS and BCM were not statistically significant. The 5‑year Kaplan–Meier estimate of OS was significantly better by 15% with IORT: IORT 2 events (96.7%, 95%CI 87.5–99.2), EBRT 9 events (81.7%, 95%CI 67.6–90.1), hazard ratio (HR) 0.19 (0.04–0.87), log rank p = 0.016, mainly due to a reduction of 10.1% in NBCM: IORT 100%, EBRT 89.9% (77.3–95.7), HR (not calculable), log rank p = 0.015. The DDFS was as follows: IORT 3 events (95.1%, 85.5–98.4), EBRT 12 events (69.0%, 49.1–82.4), HR 0.23 (0.06–0.80), log rank p = 0.012.

Conclusion

IORT during lumpectomy after neoadjuvant chemotherapy as a tumour bed boost appears to give results that are not worse than external beam radiotherapy boost. These data give further support to the inclusion of such patients in the TARGIT-B (boost) randomised trial that is testing whether IORT boost is superior to EBRT boost.

Zusammenfassung

Einleitung

Die intraoperative Radiotherapie (TARGIT-IORT) als vorgezogener Boost im Rahmen der brusterhaltenden Therapie (BET) ist seit 1998 Gegenstand der wissenschaftlichen Diskussion. Wir präsentieren Daten zum Einsatz der IORT bei der BET nach neoadjuvanter Therapie (NACT).

Methode

In diese retrospektive Analyse wurden 116 Patientinnen nach NACT eingeschlossen. Verglichen wurden 61 Patientinnen, die während der Lumbektomie einen Boost als IORT erhalten hatten, mit 55 Patientinnen, die in den vergangenen 13 Monaten mit einem externen Boost (EBRT) behandelt worden waren. Bei allen 116 Patientinnen wurde postoperativ eine Granzbrustbestrahlung durchgeführt. Verglichen wurden lokales rezidivfreies (LRFS), krankheitsfreies (DFS) und fernmetastasenfreies Überleben (DDFS) sowie Brustkrebs- (BCM), nichtbrustkrebsbezogene (NBCM) und Gesamtmortalität (OS).

Ergebnisse

Das mediane Follow-up betrug 49 Monate. Die Unterschiede bezüglich LRFS, DFS und BCM waren statistisch nicht signifikant. Die 5‑Jahres-Kaplan-Meier-Schätzung für das OS ergab einen signifikanten Vorteil von 15 % für die IORT: IORT 2 Ereignisse (96,7 %, 95%-KI 87,5–99,2), EBRT 9 Ereignisse (81,7 %, 95%-KI 67,6–90,1), Hazard Ratio (HR) 0,19 (0,04–0,87), Log Rank p = 0,016, vor allem durch eine Reduktion von 10,1 % bei der NBCM: IORT 100 %, EBRT 89,9 % (77,3–95,7), HR (nicht berechenbar), Log Rank p = 0,015. Des Weiteren zeigte sich eine signifikante Verbesserung beim DDFS: IORT 3 Ereignisse (95,1 %, 85,5–98,4), EBRT 12 Ereignisse (69,0 %, 49,1–82,4), HR 0,23 (0,06–0,80), Log Rank p = 0,012.

Schlussfolgerung

Die IORT im Rahmen der Lumpektomie nach NACT als Tumorbett-Boost ist der EBRT nicht unterlegen. Diese Daten unterstreichen die Wichtigkeit der Rekrutierung in die randomisierte TARGIT-B-(Boost-)Studie, die untersucht, ob der IORT- dem EBRT-Boost überlegen ist.

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Correspondence to Hans‑Christian Kolberg MD.

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Conflict of interest

L. Akpolat-Basci, M. Stephanou, and M. Untch state that they have no competing interests. H.-C. Kolberg reports personal fees from Carl Zeiss meditec, TEVA, Theraclion, Novartis, Amgen, Janssen, GSK, LIV Pharma, and Genomic Health outside the submitted work. G. Loevey reports personal fees from Carl Zeiss meditec outside the submitted work. P.A. Fasching reports personal fees from Roche, TEVA, Pfizer, and Genomic Health and grants and personal fees from Novartis and from Amgen outside the submitted work. C. Liedtke reports personal fees from Celgene, TEVA, Pierre Fabre, Novartis, Amgen, Eisai, GSK, Roche, and Genomic Health outside the submitted work. M. Bulsara reports grants and personal fees from Carl Zeiss meditec outside the submitted work. J.S. Vaidya reports grants from Photoelectron corporation 1996–1999, personal fees from Carl Zeiss, non-financial support and other from Carl Zeiss, during the conduct of the study; personal fees from Carl Zeiss meditec, non-financial support and other from Carl Zeiss meditec outside the submitted work.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Kolberg, H., Loevey, G., Akpolat-Basci, L. et al. Targeted intraoperative radiotherapy tumour bed boost during breast-conserving surgery after neoadjuvant chemotherapy. Strahlenther Onkol 193, 62–69 (2017). https://doi.org/10.1007/s00066-016-1072-y

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Keywords

  • External boost
  • Neoadjuvant therapy
  • Tumor bed boost
  • Breast cancer
  • Intraoperative radiotherapy

Schlüsselwörter

  • Externer Boost
  • Neoadjuvante Therapie
  • Tumorbett-Boost
  • Brustkrebs
  • Intraoperative Strahlentherapie