Advertisement

Annals of Surgical Oncology

, Volume 18, Issue 2, pp 453–458 | Cite as

Twelve-Month Follow-Up Results of a Trial Utilizing Axxent Electronic Brachytherapy to Deliver Intraoperative Radiation Therapy for Early-Stage Breast Cancer

  • Olga IvanovEmail author
  • Adam Dickler
  • Bennett Y. F. Lum
  • James V. Pellicane
  • Darius S. Francescatti
Breast Oncology

Abstract

Background

Accelerated partial breast irradiation (APBI) is emerging as a valid alternative to whole-breast radiation therapy (WBRT) in breast-conserving therapy (BCT) for early-stage breast cancer. Axxent electronic brachytherapy (EBX) is a form of portable, balloon-based APBI that utilizes an electronic source of kilovoltage irradiation delivery with minimal shielding requirements. As such, EBX becomes a logical and convenient modality for delivery of intraoperative radiation therapy (IORT). We report 1-year results and clinical outcomes of a trial that utilizes EBX to deliver IORT for patients with early-stage breast cancer.

Methods

Eleven patients were enrolled on an institutional review board (IRB)-approved protocol. Inclusion criteria were patient age >45 years, unifocal tumors with infiltrating ductal or ductal carcinoma in situ (DCIS) histology, tumors ≤3 cm, and uninvolved lymph nodes. Preloaded radiation plans were used to deliver radiation prescription dose of 20 Gy to the balloon surface.

Results

The mean time for radiation delivery was 22 min; the total mean procedure time was 1 h 39 min. All margins of excision were negative on final pathology. At mean follow-up of 12 months, overall cosmesis was excellent in 10 of 11 patients. No infection, fat necrosis, desquamation, rib fracture or cancer recurrence has been observed. There was no evidence of fibrosis at last follow-up.

Conclusion

IORT utilizing EBX is emerging as a feasible, well-tolerated alternative to postsurgical APBI. Further research and longer follow-up data on EBX and other IORT methods are needed to establish the clinical efficacy and safety of this treatment.

Keywords

Sentinel Lymph Node Biopsy Accelerate Partial Breast Irradiation Mammographic Finding Retention Suture Lumpectomy Cavity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors wish to thank the patients and their families for participating in this study. The authors would like to acknowledge Leslie Todd for assistance with medical writing.

Disclosures

Olga Ivanov, MD, Bennet Lum, MD, and James Pellicane, MD have nothing to disclose. Adam Dickler, MD is on the Scientific Advisory Board for Xoft, Inc. Darius Francescatti, MD is a Consulting Surgical Medical Director for Xoft, Inc.

References

  1. 1.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRefGoogle Scholar
  2. 2.
    Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002:341:1233–41.CrossRefGoogle Scholar
  3. 3.
    Farrow DC, Hunt WC, Samet JM. Geographic variation in the treatment of localized breast cancer. N Engl J Med. 1992;326:1097–101.PubMedCrossRefGoogle Scholar
  4. 4.
    Dolan JT, Granchi TS, Miller CC, Brunicardi, FC. Low use of breast conservation surgery in medically indigent populations. Am J Surg. 1999;178:470–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Hahn CA, Marks LB, Chen DY, Lind PA, Lind HM, Prosnitz LR. Breast conservation rates –barriers between tertiary care and community practice. Int J Radiat Oncol Biol Phys. 2003;55(5):1196–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005;366(9503):2087–106.PubMedGoogle Scholar
  7. 7.
    Chen PY, Wallace M, Mitchell C, et al. Four-year efficacy, cosmesis, and toxicity using three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76(4):991–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Nelson J, Beitsch P, Vicini F et al. Four-year clinical update from the American Society of Breast Surgeons MammoSite Brachytherapy trial. Am J Surg. 2009;198(1):83–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Dirbas F. Accelerated partial breast irradiation: where do we stand? J Natl Compr Canc Netw. 2009;7(2):215–25.PubMedGoogle Scholar
  10. 10.
    Dickler A, Kirk M, Seif N, et al. A dosimetric comparison of MammoSite high-dose-rate brachytherapy and Xoft Axxent electronic brachytherapy. Brachytherapy. 2007;6:164–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Mehta VK, Algan O, Griem KL, et al. Experience with an electronic brachytherapy technique for intracavitary accelerated partial breast irradiation. Am J Clin Oncol. 2010;33(4):327–35.PubMedCrossRefGoogle Scholar
  12. 12.
    Veronesi U, Orecchia R, Luini A, et al. A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer. 2001;37(17):2178–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Holmes D, Baum M, Joseph D. The targit trial: targeted intraoperative radiation therapy versus conventional postoperative whole breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update). Am J Surg. 2007;194:507–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Baum M, Vaidya J. Targeted intra-operative radiotherapy-TARGIT for early breast cancer. Ann N Y Acad Sci. 2008;1138:132–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Chen Z, King W, Pearcey R, Kerba M, Mickillop W. The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature. Radiother Oncol. 2008;87:3–16.PubMedCrossRefGoogle Scholar
  16. 16.
    Bartelink H. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–87.PubMedCrossRefGoogle Scholar
  17. 17.
    Athas W, Adams-Cameron M, Hunt W, Amir-Fazli A, Key C. Travel distance to radiation therapy and receipt of radio-therapy following breast-conserving surgery. J Natl Cancer Inst. 2000;92:269–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Kurniawan E, Wong M, Windle I. Predictors of surgical margin status in breast-conserving surgery within a breast-screening program. Ann Surg Oncol. 2008;15:2542–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Highes L, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27:5319–24.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Olga Ivanov
    • 1
    Email author
  • Adam Dickler
    • 2
  • Bennett Y. F. Lum
    • 3
  • James V. Pellicane
    • 4
  • Darius S. Francescatti
    • 5
  1. 1.Department of SurgeryLittle Company of Mary HospitalEvergreen ParkUSA
  2. 2.Department of Radiation OncologyLittle Company of Mary HospitalEvergreen ParkUSA
  3. 3.Department of RadiologyLittle Company of Mary HospitalEvergreen ParkUSA
  4. 4.Department of SurgeryVirginia Breast CenterMidlothianUSA
  5. 5.Department of SurgeryRush University Medical CenterChicagoUSA

Personalised recommendations