Advertisement

In Vivo Intraoperative Radiotherapy: A Novel Approach to Radiotherapy for Early Stage Breast Cancer

Abstract

Introduction

Intraoperative radiotherapy (IORT) has the potential to eliminate the access problems associated with standard 6-week post-operative external beam radiotherapy for patients with breast cancer. However, accurate delivery of the IORT dose for breast cancer has been problematic due to difficulty estimating the tumor bed after tumor removal and tissue reapproximation. We are investigating the feasibility of partial breast irradiation using a single fraction of IORT delivered to the tumor in vivo prior to surgical resection.

Methods

In a trial, approved by the University of North Carolina School of Medicine Institutional Review Board, patients ≥55 years old with infiltrating ductal carcinoma without an extensive intraductal component with an overall tumor size ≤3.0 cm receive a single dose of IORT in place of standard post-operative radiotherapy.

Results

All patients undergo preoperative ultrasonography to define the target volume. In a standard operating room, the tumor is exposed through a standard partial mastectomy incision. IORT is then delivered using a mobile, self-shielded, magnetron-driven X-band linear accelerator (Intraop Corp, Santa Clara, CA, USA). 15 Gy is delivered to the 90% isodose line covering the tumor with a 1 cm margin anterior–posterior and 2 cm margins laterally. After IORT, partial mastectomy is performed in the usual manner.

Conclusions

IORT for breast cancer, delivered to the exposed tumor in vivo, is feasible and allows accurate estimation of the tumor bed. Further follow-up is ongoing to determine the efficacy of this approach.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

References

  1. 1.

    Athas WF, Adams-Cameron M, Hunt WC, Amir-Fazli A, Key CR. Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst 2000;92(3):269–71

  2. 2.

    Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 1996;88(11):716–26

  3. 3.

    Dirbas FM, Jeffrey SS, Goffinet DR. The evolution of accelerated, partial breast irradiation as a potential treatment option for women with newly diagnosed breast cancer considering breast conservation. Cancer Biother Radiopharm 2004;19(6):673–5

  4. 4.

    Mandelblatt JS, Hadley J, Kerner JF, Schulman KA, Gold K, Dunmore-Griffith J, Edge S, Guadagnoli E, Lynch JJ, Meropol NJ, Weeks JC, Winn R. Patterns of breast carcinoma treatment in older women: patient preference and clinical and physical influences. Cancer 2000;89(3):561–73

  5. 5.

    Morrow M, White J, Moughan J, Owen J, Pajack T, Sylvester J, Wilson JF, Winchester D. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol 2001;19(8):2254–62

  6. 6.

    Nattinger AB, Hoffmann RG, Kneusel RT, Schapira MM. Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery. Lancet 2000;356(9236):1148–53

  7. 7.

    Nattinger AB, Kneusel RT, Hoffmann RG, Gilligan MA. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst 2001;93(17):1344–6

  8. 8.

    Vaidya JS, Tobias JS, Baum M, Wenz F, Kraus-Tiefenbacher U, D’Souza D, Keshtgar M, Massarut S, Hilaris B, Saunders C, Joseph D. TARGeted intraoperative radiotherapy (TARGIT): an innovative approach to partial-breast irradiation. Semin Radiat Oncol 2005;15(2):84–91

  9. 9.

    Veronesi U, Gatti G, Luini A, Intra M, Orecchia R, Borgen P, Zelefsky M, McCormick B, Sacchini V. Intraoperative radiation therapy for breast cancer: technical notes. Breast J 2003;9(2):106–12

  10. 10.

    Veronesi U, Orecchia R, Luini A, Galimberti V, Gatti G, Intra M, Veronesi P, Leonardi MC, Ciocca M, Lazzari R, Caldarella P, Simsek S, Silva LS, Sances D. Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg 2005;242(1):101–6

Download references

Author information

Correspondence to Karyn B. Stitzenberg.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video File (MPG 97630576 kb)

Video File (MPG 97630576 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Stitzenberg, K.B., Klauber-Demore, N., Chang, X.S. et al. In Vivo Intraoperative Radiotherapy: A Novel Approach to Radiotherapy for Early Stage Breast Cancer. Ann Surg Oncol 14, 1515–1516 (2007). https://doi.org/10.1245/s10434-006-9152-3

Download citation

Keywords

  • Breast Cancer
  • Natl Cancer Inst
  • Isodose Line
  • Partial Mastectomy
  • Partial Breast Irradiation