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Oncologic outcomes and radiation safety of nipple-sparing mastectomy with intraoperative radiotherapy for breast cancer

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Abstract

Background

Nipple-sparing mastectomy combined with breast reconstruction helps to optimize the contour of the breast after mastectomy. However, the indications for nipple-sparing mastectomy are still controversial. Local radiation to the nipple–areola complex may play some roles in improving the oncological safety of this procedure.

Methods

From January 2014 to December 2017, 41 consecutive patients who underwent nipple-sparing mastectomy combined with Intrabeam intraoperative radiotherapy to the nipple–areola complex flap and breast reconstruction were enrolled in this prospective study. The prescribed radiation dose at the surface of the spherical applicator was 16 Gy.

Results

In eight cases, carcinomas were in the central portion of the breast. Partial necrosis of the nipple–areola complex occurred in three cases. Over 90% of patients reported “no or poor sensation” of the nipple–areola complex postoperatively. With a median follow-up time of 26 months, no recurrences or metastases were identified; however, breast-cancer mortality occurred in one patient. Pathologic evaluation of paraffin-embedded sections showed ductal carcinoma in situ in the remaining tissues deep to the nipple–areola complex flap in two patients. Although no further treatment was administered to the nipple–areola complexes postoperatively, no recurrences or metastases were identified 20 months and 24 months later, respectively. Optical microscopy and transmission electron microscopy revealed changes in some normal tissues immediately after Intrabeam intraoperative radiotherapy. Karyopyknosis were observed in gland tissues, and the collagenous fibers became sparse and arranged chaotically. As assessed by thermoluminescence, radiation doses at different sites in the nipple–areola complex flap varied considerably and were about 10 Gy at the areola surface. No Intrabeam intraoperative radiotherapy-related acute or chronic radiation injuries of the lung, heart or bone marrow were identified.

Conclusions

Our findings indicate that Intrabeam intraoperative radiotherapy during nipple-sparing mastectomy combined with breast reconstruction is safe and feasible.

Trial registration

The current study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University (registering order 201750). All participants gave their written informed consent.

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Abbreviations

NSM:

Nipple-sparing mastectomy

NAC:

Nipple–areola complex

IORT:

Intraoperative radiotherapy

EBRT:

External beam radiotherapy

RTOG:

Radiation Therapy Oncology Group

HE:

Hematoxylin and eosin

TEM:

Transmission electron microscope

DCIS:

Ductal carcinoma in situ

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Acknowledgements

This work was supported by the Medical and Health Technology Project of Guangzhou Municipal Health Bureau (Grant number 20161A010078); the translational medicine and research program of the First Affiliated Hospital of Guangzhou Medical University (Grant numbers 201516-gyfyy and 20054002-gyfyy); the Health and Family Planning Technology Project of Guangzhou Municipal Health and Family Planning Bureau (Grant number 20181A011060).

Author information

Author notes

  1. Lingxiao Pan and Changsheng Ye are co-first authors.

Authors and Affiliations

  1. Department of Breast Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China

    Lingxiao Pan, Lun Chen, Wei Tang, Xiaoshen Zhang, Jin Gao, Xigang Ye, Weige Tan & Wenbo Zheng

  2. Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China

    Lingxiao Pan & Changsheng Ye

  3. Department of Radiotherapy, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China

    Rui Wu

  4. Department of Radiation Oncology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China

    Minghui Wan

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  1. Lingxiao Pan
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Correspondence to Minghui Wan or Wenbo Zheng.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pan, L., Ye, C., Chen, L. et al. Oncologic outcomes and radiation safety of nipple-sparing mastectomy with intraoperative radiotherapy for breast cancer. Breast Cancer 26, 618–627 (2019). https://doi.org/10.1007/s12282-019-00962-7

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