Skip to main content
SpringerLink
Log in

A Systematic Review of Intraoperative Radiotherapy in Early Breast Cancer

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

A systematic review was undertaken to assess the safety and efficacy of intraoperative radiotherapy (IORT) in early breast cancer compared with breast conserving surgery with postoperative radiotherapy. Literature databases were searched up to March 2002 inclusive. IORT studies of any design and breast conserving therapy randomised controlled trials with sample sizes greater than 500 patients (with at least one arm of breast conserving therapy (BCT)) and systematic reviews on BCT published since 1992, were included for comparison. Seven unique IORT studies were located; one randomised controlled trial, one study with a concurrent control group and five case series. Minor postoperative complications were reported following IORT. Short-term results were similar for both treatment modalities in terms of local recurrence, disease-free and overall survival. However, the current evidence base is poor, making definitive assessment on IORT very difficult. Further research is required to clarify several issues such as identification of the most appropriate subgroups of patients for IORT, a comparison of the currently available mobile IORT technologies, establishing whether IORT is most appropriate as a boost replacement dose or replacement for all postoperative radiotherapy, the examination of how biological repair processes may differ between the two treatment modalities and determining precisely where local recurrences originate with respect to the original tumour site.

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

Similar content being viewed by others

References

  1. Early Breast Cancer Trialists' Collaborative Group: Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 355: 1757-1770, 2000

    Google Scholar 

  2. Baum M, Houghton J: Contribution of randomised controlled trials to understanding and management of early breast cancer. Br Med J 319: 568–571, 1999

    Google Scholar 

  3. Beck C: On external roentgen treatment of internal structures. NY Med J 89: 621–622, 1919

    Google Scholar 

  4. Cosgrove GR, Hochberg FH, Zervas NT, Pardo FS, Valenzuela RF, Chapman P: Interstitial irradiation of brain tumours using a miniature radiosurgery device: initial experience. Neurosurgery 40: 518–525, 1997

    Google Scholar 

  5. Hu KS, Harrison LB: Results and complications of surgery combined with intra-operative radiation therapy for the treatment of locally advanced or recurrent cancers in the pelvis. Sem Surg Oncol 18: 269–278, 2000

    Google Scholar 

  6. Battle JA, Dubois JB, Merrick HW, Dobelbower RR: IORT for breast cancer. In: Gunderson LL, Willett C, Harrison L, Calvo F (eds) Intraoperative Irradiation: Techniques and Results. Humana Press, Totowa, NJ, USA, 1999, pp 521-526

    Google Scholar 

  7. Merrick III HW, Battle JA, Padgett BJ, Dobelbower Jr RR: IORT for early breast cancer: a report on long-term results. Front Radiat Ther Oncol 31: 126–130, 1997

    Google Scholar 

  8. Baum M: Intraoperative radiotherapy following local excision for early breast cancer. (From website: www.photoelectron.com: accessed: 22 September 2000)

  9. Thomson E, Vaidya JS, Tobias JS, Baum M, Houghton J, Keshtgar MR: Targeted intraoperative radiotherapy (Targit) for breast cancer: a randomised trial. In: Proceedings of the Radiological Society of North America's 87th Scientific Assembly and Annual Meeting, 25–30 November 2001, Paper No. 234 in Session C02, Chicago, Illinois, USA

  10. Veronesi U, Orrechia R, Luini A, Gatti G, Intra M, Veronesi P: Focalised intraoperative irradiation after conservative surgery for early-stage breast cancer. Br J 10(Suppl. 3): 84–89, 2001

    Google Scholar 

  11. Vaidya JS, Baum M, Tobias JS, D'Souza D, Naidu S, Morgan S: Targeted intraoperative radiotherapy (TARGIT): a novel approach to local treatment of early breast cancer. Br J Surg (Suppl.) 87(S1): 68–69, 2000

    Google Scholar 

  12. Bartelink H: Commentary on the paper: a preliminary report of intraoperative radiotherapy (IORT) in limited stage breast cancers that are conservatively treated: a critical review of an innovative approach. Eur J Cancer 37: 2143–2146, 2001

    Google Scholar 

  13. Vaidya J: Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann Oncol 12: 1075–1080, 2001

    Google Scholar 

  14. Veronesi U, Orrechia R, Luini A, Gatti G, Intra M, Veronesi P: A preliminary report of intraoperative radiotherapy (IORT) in limited stage breast cancers that are conservatively treated. Eur J Cancer 37: 2178–2183, 2001

    Google Scholar 

  15. National Health and Research Council of Australia (NHMRC): How to Use the Evidence: Assessment and Application of Scientific Evidence. 2000, p 8

  16. Fortuna G, Ciccone V, Palloni T, Siniscalchi A, Ciabattoni A: Randomised study on IORT for T1–T2 breast cancer. Proceedings from the International Congress of Radiation Oncologists (ICRO), Melbourne, Australia, 2001

  17. Dubois JB, Hay M, Gely S, Saint-Aubert B, Rouanet P, Pujol H: IORT in breast carcinomas. Front Radiat Ther Oncol 31: 131–137, 1997

    Google Scholar 

  18. Early Breast Cancer Trialists' Collaborative Group: Radiotherapy for early breast cancer. Cochrane Database of Systematic Reviews, Issue 4, 2002

  19. Proulx GM, Hurd T, Lee RJ, Stomper PC, Podgorsak MB, Edge SB: Intraoperative radiation therapy (IORT) to the tumor bed only for breast cancer: technique and outcome. Rad Oncol 35: 35–41, 2001

    Google Scholar 

  20. Romestaing P, Lehingue Y, Carrie C, Coquard R, Montbarbon X, Ardiet JM: Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol 15: 963–968, 1997

    Google Scholar 

  21. Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den BW, Barillot: Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345: 1378–1387, 2001

    Google Scholar 

  22. Odantini R, Mazzitelli R, Bellia SR, Di Pietro A, al Sayyad S, Capua A: Intraoperative electron radiotherapy (IOERT) in the QUART sequence: a phase I study. Chirurgia Italiana 53: 349–354, 2001

    Google Scholar 

  23. Fisher B, Anderson S: Conservative surgery for the management of invasive and noninvasive carcinoma of the breast. World J Surg 18: 63–69, 1994

    Google Scholar 

  24. Fisher B, Wickerham DL, Deutsch M, Anderson S, Redmond C, Fisher ER: Breast tumor recurrence following lumpectomy with and without breast irradiation: an overview of recent NSABP findings. Sem Surg Oncol 8: 153–160, 2001

    Google Scholar 

  25. Fisher ER, Anderson S, Tan-Chiu E, Fisher B, Eaton L, Wolmark N: Fifteen-year prognostic discriminants for invasive breast carcinoma: National Surgical Adjuvant Breast and Bowel Project Protocol-06. Cancer 91(Suppl. 8): 1679–1687, 2001

    Google Scholar 

  26. Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW: Danish randomised trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. J Nat Cancer Inst 11: 19–25, 1992

    Google Scholar 

  27. Bartelink H: Locoregional recurrence after mastectomy or breast conserving therapy: analysis of clinical prognostic factors and results of salvage therapy in a randomized EORTC trial. Int J Rad Oncol Biol Phys 24(Suppl. 1): 220, 1992

    Google Scholar 

  28. Van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G: Randomised clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer: EORTC 10801 trial. J Nat Cancer Inst Monogram 11: 15–18, 1992

    Google Scholar 

  29. Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D: Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Nat Cancer Inst 92: 1143–1150, 2000

    Google Scholar 

  30. Magee B: Prognostic factors for breast recurrence after conservative breast surgery and radiotherapy: results from a randomised trial. Radiother Oncol 39: 223–227, 1996

    Google Scholar 

  31. Mariani L, Salvadori B, Marubini E, Conti AR, Rovini D, Cusumano F: Ten year results of a randomised trial comparing two conservative treatment strategies for small size breast cancer. Eur J Cancer 34: 1156–1162, 1998

    Google Scholar 

  32. Veronesi U, Salvadori B, Luini A, Greco M, Saccozzi R, del Vecchio M: Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1973 patients. Eur J Cancer 31A: 1574–1579, 1995

    Google Scholar 

  33. Clark RM, Whelan T, Levine M, Roberts R, Willan A, McCulloch P: Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for nodenegative breast cancer: an update. Ont Clin Oncol Group. J Nat Cancer Inst 88: 1659–1664, 1996

    Google Scholar 

  34. Whelan TJ, Julian J, Wright J, Jadad AR, Levine M: Does locoregional radiation therapy improve survival in breast cancer: a meta-analysis. J Clin Oncol 18: 1220–1229, 2000

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. ASERNIP-S, Royal Australian College of Surgeons, PO Box 688, North Adelaide, 5006, South Australia, Australia

    Astrid Cuncins-Hearn & Guy Maddern

  2. University Department of Surgery, Royal Perth Hospital, Perth, Western Australia, Australia

    Christobel Saunders

  3. Department of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia

    David Walsh & Guy Maddern

  4. Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Martin Borg

  5. The Breast Centre, Calvary Clinic, Bruce, ACT, Australia

    John Buckingham

  6. Christchurch Colorectal Unit, Christchurch Hospital, Christchurch, New Zealand

    Frank Frizelle

Authors
  1. Astrid Cuncins-Hearn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christobel Saunders
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Borg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Buckingham
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Frizelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guy Maddern
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guy Maddern.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cuncins-Hearn, A., Saunders, C., Walsh, D. et al. A Systematic Review of Intraoperative Radiotherapy in Early Breast Cancer. Breast Cancer Res Treat 85, 271–280 (2004). https://doi.org/10.1023/B:BREA.0000025411.77758.1e

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:BREA.0000025411.77758.1e

Search

Navigation