Efficacy analysis of intraoperative radiotherapy in patients with early-stage breast cancer

Lin Wang, Minmin Zhu, Yuelong Cui, Xudong Zhang, Guowen Li, Lin Wang, Minmin Zhu, Yuelong Cui, Xudong Zhang, Guowen Li

Abstract

Background: To analyze the clinical efficacy of intraoperative radiotherapy (IORT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer (BC), and to investigate the relationship between its influencing factors and clinical efficacy and prognosis.

Methods: A total of 73 patients with early-stage BC who underwent IORT after BCS in our hospital were selected in this research.

Results: Kaplan-Meier survival analysis was used to analyze the related factors of BCS and IORT of disease-free survival (DFS) and overall survival (OS). It was found that only age (χ2 = 14.035, P = 0.003) was statistically positively correlated with the patient's DFS, and local recurrence and metastasis rate and mortality were higher in patients over 70 years old. Log rank test was used to analyze multiple factors. Only the diameter of the applicator (χ2 = 70.378, P < 0.05) was statistically significant with wound complications, and the larger the diameter, the higher incidence of wound complications. The remaining risk factors did not increase the incidence of wound complications. COX multivariate analysis showed that age was an independent risk factor for DFS rate and the risk factor had no significant effect on the OS rate of patients undergoing IORT after BCS.

Conclusions: IORT may be a safe form of treatment for the selected patients with early-stage BC, and can achieve satisfactory esthetic effect. Larger applicator diameters may increase the incidence of wound complications. Age is an independent risk factor for DFS in early-stage BC patients undergoing IORT after BCS.

Keywords: Breast-conserving surgery; Early-stage breast cancer; Influencing factors; Intraoperative radiotherapy.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
DFS curve of influence of age on patients’ survival. DFS: disease-free survival

References

    1. Chen WQ, Zheng RS. Incidence, mortality and survival analysis of breast cancer in China. Chin J Clin Oncol. 2015;42:668–74.
    1. Li YH, Zhang LH, Chen X. Research progress of breast-conserving surgery combined with intraoperative radiotherapy for early breast cancer. Chin J Endocr Surg. 2018;12:85–8.
    1. Reintgen C, Reintgen D, Solin LJ. Advances in local regional treatment for patients with early target breast cancer: a review of the field. Clinic Breast Cancer. 2010;10:180–7. doi: 10.3816/CBC.2010.n.025.
    1. Noël G, Mazeron JJ. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Cancer Radiather. 2001;5:92–4. doi: 10.1016/S1278-3218(00)00058-5.
    1. Reitsamer R, Sedlmayer F, Kopp M, Kametriser G, Menzel C, Glueck S, et al. Concepts and techniques of intraoperative radiotherapy (IORT) for breast cancer. Breast Cancer. 2008;15:40–6. doi: 10.1007/s12282-007-0001-4.
    1. Leonardi MC, Maisonneuve P, Mastropasqua MG, Cattani F, Fanetti G, Morra A, et al. Comparison of treatment outcome between invasive lobular and ductal carcinomas in patients receiving partial breast irradiation with intraoperative electrons. Int J Radiat Oncol Biol Phys. 2017;99:173–81. doi: 10.1016/j.ijrobp.2017.04.033.
    1. Fastner G, Reitsamer R, Sedlmayer F. Partial breast irradiation with intraoperative electrons versus conventional external whole breast irradiation for early breast cancer. Results of the ELIOT trial. Strahlenther Onkol. 2014;190:422–4. doi: 10.1007/s00066-014-0556-x.
    1. Livi L, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51:451–63. doi: 10.1016/j.ejca.2014.12.013.
    1. Yin WB, Gu XZ. Radiation oncology. Beijing: Pecking Union Medical College Press; 2002. pp. 1059–87.
    1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) Darby S, McGale P, Correa C, Taylor C, Arriagada R, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16. doi: 10.1016/S0140-6736(11)60993-8.
    1. Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 2017;7:73–9. doi: 10.1016/j.prro.2016.09.007.
    1. Wickberg A, Holmberg L, Adami HO, Magnuson A, Villman K, Liljegren G. Sector resection with or without postoperative radiotherapy for stage I breast cancer: 20⁃year results of a randomized trial. J Clin Oncol. 2014;32:791⁃7.
    1. Williams NR, Pigott KH, Brew-Graves C, Keshtgar MR. Intraoperative radiotherapy for breast cancer. Gland Surg. 2014;3:109–19.
    1. Holmes DR. Intraoperative radiotherapy in breast conserving surgery. J Surg Oncol. 2014;110:68–74. doi: 10.1002/jso.23620.
    1. Wallace M, Ye H, Wobb J, Jawad MS, Dekhne N, Brabbins DS. Accelerated partial-breast irradiation (APBI) versus whole-breast irradiation (WBI) in treatment of the biological subtypes of breast cancer:an analysis of comparative effectiveness. J Clin Oncol. 2015;33:45.
    1. Subhedar P, Olcese C, Patil S, Morrow M, Van Zee KJ. Decreasing recurrence rates for ductal carcinoma in situ: analysis of 2996 women treated with breast⁃conserving surgery over 30 years. Ann Surg Oncol. 2015;22:3273–81. doi: 10.1245/s10434-015-4740-8.
    1. Meattini I, Saieva C, Miccinesi G, Desideri I, Francolini G, Scotti V, et al. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: health-related quality of life final analysis from the Florence phase 3 trial. Eur J Cancer. 2017;76:17–26. doi: 10.1016/j.ejca.2017.01.023.
    1. Harat A, Harat M, Makarewicz R. Whole breast irradiation vs. APBI using multicatheter brachytherapy in early breast cancer-simulation of treatment costs based on phase 3 trial data. J Contemp Brachyther. 2016;8:505–11. doi: 10.5114/jcb.2016.64919.
    1. Lemanski C, Bourgier C, Draghici R, Thezenas S, Morel A, Rouanet P, et al. Intraoperative partial irradiation for highly selected patients with breast cancer: Results of the INTRAOBS prospective study. Cancer Radiother. 2020;24:114–9. doi: 10.1016/j.canrad.2020.01.007.
    1. Grobmyer SR, Lightsey JL, Bryant CM, Shaw C, Yeung A, Bhandare N, et al. Low-kilovoltage, single-dose intraoperative radiation therapy for breast cancer:resuits and impact on a multidisciplinary breast cancer program. J Am Coll Surg. 2013;216:617–23. doi: 10.1016/j.jamcollsurg.2012.12.038.
    1. Piotrowski I, Kulcenty K, Wichtowski M, Murawa D, Suchorska W. Intraoperative radiotherapy of breast cancer and its biological effects. Breast Care. 2017;12:109–13. doi: 10.1159/000454673.
    1. Jacobs DHM, Speijer G, Petoukhova AL, Roeloffzen EMA, Straver M, Marinelli A, et al. Acute toxicity of intraoperative radiotherapy and external beam-accelerated partial breast irradiation in elderly breast cancer patients. Breast Cancer Res Treat. 2018;169:549–59. doi: 10.1007/s10549-018-4712-3.
    1. Valente SA, Tendulkar RD, Cherian S, O’Rourke C, Greif JM, Bailey L, et al. TARGIT-R (Retrospective): North American experience with intraoperative radiation using low-kilovoltage X-rays for breast cancer. Ann Surg Oncol. 2016;23:2809–15. doi: 10.1245/s10434-016-5240-1.
    1. Hanna GG, Kirby AM. Intraoperative radiotherapy in early stage breast cancer: potential indications and evidence to date. Br J Radiol. 2015;88:20140686. doi: 10.1259/bjr.20140686.
    1. Zeidan YH, Habib JG, Ameye L, Paesmans M, de Azambuja E, Gelber RD, et al. Postmastectomy radiation therapy in women with T1⁃T2 tumors and 1 to 3 positive lymph nodes: analysis of the breast international group 02⁃98 trial. Int J Radiat Oncol Biol Phys. 2018;101:316–24. doi: 10.1016/j.ijrobp.2018.01.105.
    1. Rakhra S, Bethke K, Strauss J, Hayes JP, Hansen N, Khan SA, et al. Risk factors leading to complications in early-stage breast cancer following breast-conserving surgery and intraoperative radiotherapy. Ann Surg Oncol. 2017;24:1258–61. doi: 10.1245/s10434-016-5679-0.
    1. Wenz F, Welzel G, Blank E, Hermann B, Steil V, Sütterlin M, et al. Intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage X-rays: the first 5 years of experience with a novel approach. Int J Radiat Oncol Biol Phys. 2010;77:1309–14. doi: 10.1016/j.ijrobp.2009.06.085.

Source: PubMed

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