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Comparison of Clinical Outcomes Between Low- and High-Risk Groups of Early Breast Cancer Patients Treated with Intraoperative Radiotherapy in Addition to External Beam Radiation: A Multi-Centre Prospective Study

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Abstract

Background

There is a paucity of data on the use of intraoperative radiotherapy (IORT) with low-energy X-rays in Malaysian women with early breast cancer. The aim of this study is to evaluate the clinical, cosmetic, and patient-reported outcomes in low- and high-risk early breast cancer patients treated with breast conserving surgery (BCS) and IORT.

Methodology

Patients suitable for BCS who were treated with IORT between January 2016 and June 2019 from three centres were analysed. They were divided into low-risk and high-risk groups based on the risk of recurrence according to the TARGeted Intraoperative radioTherapy (TARGIT) A and B study criteria. Outcomes of interest included local recurrence, wound complications, and radiation toxicity, with a subset analysed for cosmetic and patient-reported outcomes.

Results

Within a median follow-up of 31 months, there were 104 and 211 patients in the low- and high-risk groups, respectively. No significant difference was observed in local recurrence rates (low-risk, 1.0% vs. high-risk, 1.4%; p = 1.000). Both cohorts exhibited low frequencies of severe wound complications ranging between 1.4 and 1.9%. No major radiation toxicities were reported in either group. In the subgroup analysis, low-risk patients had significantly better mean scores in the subscales of inframammary fold and scar. Based on the BREAST-Q patient-reported outcomes questionnaire, seven out of nine parameters were scored similarly between both groups with no significant difference.

Conclusion

This study showed that the use of IORT in both low- and high-risk early breast cancers is efficacious and safe with low recurrence rates and an acceptable toxicity profile.

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Acknowledgements

The authors acknowledge and thank the following persons for their support in this study: Madam Azleen Binti Mohd Zain, Miss Faizah Binti Ahmad and Madam Anis Suhana Ahmad from the Medical Physics Unit of the University of Malaya Medical Centre (UMMC). The assistance from staff of the breast cancer resource centre Pn Zarinah bt Abdul Rahman in University Malaya Medical Centre for their contribution and assistance in this research project.

Funding

This study was not funded by any grant.

Author information

Authors and Affiliations

  1. Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    J. A. Mosiun, Mee-Hoong See, Li-Ying Teoh, Mei-Sze Teh, Nur Aishah Md Taib & Suniza Jamaris

  2. Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Mahmoud Danaee

  3. Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Lee-Lee Lai

  4. Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500, Petaling Jaya, Selangor, Malaysia

    Ng Char-Hong

  5. Ramsay Sime Darby Health Care, Jalan SS 12/1A, Subang Jaya, Malaysia

    Cheng-Har Yip

  6. Universiti Malaya Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Malaysia

    Nur Aishah Md Taib

  7. Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Anita Bustam, Rozita Abdul Malik, Marniza Saad & Ngie-Min Ung

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  1. J. A. Mosiun
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Correspondence to Mee-Hoong See.

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The other authors declare that they have no competing interests.

Ethical approvel

Data of the study was from Institution Breast Cancer Registry which was approved by the University of Malaya Medical Centre’s Medical Ethics Committee UMMC MECID. NO: 2018716-6489 and conformed to the Declaration of Helsinki 1975. This study has been registered with the National Medical Research Register (NMRR-21-1405-59293).

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Mosiun, J.A., See, MH., Teoh, LY. et al. Comparison of Clinical Outcomes Between Low- and High-Risk Groups of Early Breast Cancer Patients Treated with Intraoperative Radiotherapy in Addition to External Beam Radiation: A Multi-Centre Prospective Study. World J Surg 47, 201–208 (2023). https://doi.org/10.1007/s00268-022-06753-0

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