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

Annals of Surgical Oncology volume 25, pages 137–147 (2018)Cite this article

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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Authors and Affiliations

  1. Center for Cancer Prevention and Treatment, St. Joseph Hospital, 1010 W. La Veta, Suite 675, Orange, CA, 92868, USA

    Jay K. Harness MD, FACS

  2. Decision Driver Analytics/Translational Technologies International, LLC, Asheville, NC, USA

    Kalatu Davies PhD, Christina Via MPH, Elizabeth Brooks PhD & April Zambelli-Weiner PhD

  3. Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA

    Chirag Shah MD

  4. Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, MI, USA

    Frank Vicini MD

Authors
  1. Jay K. Harness MD, FACS
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  2. Kalatu Davies PhD
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  3. Christina Via MPH
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  5. April Zambelli-Weiner PhD
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  6. Chirag Shah MD
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  7. Frank Vicini MD
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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