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Meta-Analysis of Local Invasive Breast Cancer Recurrence After Electron Intraoperative Radiotherapy

Abstract

Background

Electron intraoperative radiotherapy (IORT) can be used during breast conserving surgery to treat early-stage invasive breast cancer. Using data from current clinical and observational studies, this study aimed to assess the impact of single-fraction electron IORT on local recurrence rates.

Methods

Studies on single-fraction electron IORT during breast conserving surgery were identified through a search of PubMed and Google Scholar, as well as through secondary referencing. Local recurrence rate was the main outcome of interest. A meta-analysis of proportions using a binomial distribution to model the within-study variability and a random effects model was conducted to estimate a pooled local recurrence rate. To estimate a 5-year recurrence rate, a single-sample Poisson-normal model was applied to model the probability of events occurring during a fixed period (60 months).

Results

The study identified 13 publications. The analysis demonstrated a pooled monthly local recurrence rate of 0.02% per person-month (95% confidence interval CI 0.00–0.06%) for the studies with a follow-up period shorter than 5 years, 0.03% per person-month (95% CI 0.02–0.06%) for studies with a follow-up period of 5 years or longer, and 0.02% per person-month (95% CI 0.01–0.04%) overall. Based on this model, the predicted 5-year local recurrence rate was 2.7% (range 1.9–3.7%).

Conclusions

According to the published literature, the rate of breast cancer local recurrence after electron IORT was 0.02% per person-month, with an adjusted 5-year recurrence rate of 2.7%. These findings support the recent guidelines from the American Society for Radiation Oncology (ASTRO) supporting the use of electron IORT for low-risk patients.

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Acknowledgment

This study was funded by IntraOp Medical.

Disclosure

Decision Driver Analytics was a paid consultant to IntraOp Medical, and Jay K. Harness, MD, was a speaker for IntraOp Medical.

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Corresponding author

Correspondence to Jay K. Harness MD, FACS.

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Harness, J.K., Davies, K., Via, C. et al. Meta-Analysis of Local Invasive Breast Cancer Recurrence After Electron Intraoperative Radiotherapy. Ann Surg Oncol 25, 137–147 (2018). https://doi.org/10.1245/s10434-017-6130-x

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  • DOI: https://doi.org/10.1245/s10434-017-6130-x

Keywords

  • Electron IORT
  • Intraoperative Radiotherapy (IORT)
  • Breast Cancer
  • American Society For Radiation Oncology (ASTRO)
  • Breast-conserving Surgery