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Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy

  • Epidemiology
  • Published:
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Abstract

Purpose

Mastectomy is the standard procedure in patients with in-breast tumor recurrence (IBTR) or breast cancer after irradiation of the chest due to Hodgkin’s disease. In certain cases a second breast conserving surgery (BCS) in combination with intraoperative radiotherapy (IORT) is possible. To date, data concerning BCS in combination with IORT in pre-irradiated patients are limited. This is the first pooled analysis of this special indication with a mature follow-up of 5 years.

Methods

Patients with IBTR after external beam radiotherapy (EBRT; treated in two centers) for breast cancer were included. Patients with previous EBRT including the breast tissue due to other diseases were also included. IORT was performed with the Intrabeam™-device using low kV X-rays. Clinical data including outcome for all patients and toxicity for a representative cohort (LENT-SOMA scales) were obtained. Statistical analyses were done including Kaplan–Meier estimates for local recurrence, distant metastasis and overall survival.

Results

A total of 41 patients were identified (39 patients with IBTR, 2 with Hodgkin`s disease in previous medical history). Median follow-up was 58 months (range 4–170). No grade 3/4 acute toxicity occurred within 9 weeks. Local recurrence-free survival rate was 89.9% and overall survival was 82.7% at 5 years. Seven patients developed metastasis within the whole follow-up.

Conclusions

BCS in combination with IORT in IBTR in pre-irradiated patients is a feasible method to avoid mastectomy with a low risk of side effects and an excellent local control and good overall survival.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany

    F. Thangarajah, W. Malter & P. Mallmann

  2. Breast Center, University Hospital of Cologne, University of Cologne, Cologne, Germany

    F. Thangarajah & W. Malter

  3. Department of Radiation Oncology, University Hospital of Cologne, University of Cologne, Cologne, Germany

    S. Kunze & S. Marnitz

  4. Department of Radiation Oncology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany

    J. Heilmann, F. Wenz & E. Sperk

Authors
  1. F. Thangarajah
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  2. J. Heilmann
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  3. W. Malter
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  4. S. Kunze
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  5. S. Marnitz
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  6. P. Mallmann
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  7. F. Wenz
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  8. E. Sperk
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Corresponding author

Correspondence to F. Thangarajah.

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Conflict of interest

FT, JH, RS, SK, SM, PM and ES do not have any conflict of interest to declare. WM works as a consultant for Carl Zeiss AG. FW receives research funding from Carl Zeiss AG and works as a consultant for this company.

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Thangarajah, F., Heilmann, J., Malter, W. et al. Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy. Breast Cancer Res Treat 168, 739–744 (2018). https://doi.org/10.1007/s10549-017-4657-y

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  • DOI: https://doi.org/10.1007/s10549-017-4657-y

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