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The efficacy of IORT (intraoperative radiotherapy) for early advanced breast cancer depending on the time delay of external beam irradiation (EXRT) post conservative breast surgery (CBS)
Affiliations- Dept. Radiotherapy, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Div. Research Programmes, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Dept. Radiotherapy and Chemotherapy I, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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Abstract
Introduction. The following study focuses on the efficacy of the IORT (14.4 izoGy2.0) as part of conservative surgery with adjuvant EXRT (50 Gy in 25 fractions) for low risk 109 early breast cancer patients and 106 intermediate or nonlinear high risk patients with adjuvant chemoradiation or chemotherapy followed by the EXRT.
Material and methods. The accumulation of the rates of local recurrences (LR) and distant metastases (DM) are characterized by nonlinear but two-phase curves.
Results. During the first 5 years, 67% of all LR, and only 43% of all DM occurred, and between the 8th and 10th years the LR curve steeply increases by 25% and the DM by 48%.
Conclusion. This suggest that a 5-year follow-up is too short and should be extended to 10 years. Among the analyzed prognostic factors, the time interval (TI) between IORT and adjuvant EXRT has occurred the major prognostic risk factor. If the TI is extended over 60 days (delayed EXRT), the LR and the DM risk undergoes a3–10 fold increase. Concurrent CH-EXRT significantly lowers local and distant failures, compared with delayed EXRT after completing CHT. Therefore, delayed EXRT completely ruins the expected efficacy of the IORT.
Abstract
Introduction. The following study focuses on the efficacy of the IORT (14.4 izoGy2.0) as part of conservative surgery with adjuvant EXRT (50 Gy in 25 fractions) for low risk 109 early breast cancer patients and 106 intermediate or nonlinear high risk patients with adjuvant chemoradiation or chemotherapy followed by the EXRT.
Material and methods. The accumulation of the rates of local recurrences (LR) and distant metastases (DM) are characterized by nonlinear but two-phase curves.
Results. During the first 5 years, 67% of all LR, and only 43% of all DM occurred, and between the 8th and 10th years the LR curve steeply increases by 25% and the DM by 48%.
Conclusion. This suggest that a 5-year follow-up is too short and should be extended to 10 years. Among the analyzed prognostic factors, the time interval (TI) between IORT and adjuvant EXRT has occurred the major prognostic risk factor. If the TI is extended over 60 days (delayed EXRT), the LR and the DM risk undergoes a3–10 fold increase. Concurrent CH-EXRT significantly lowers local and distant failures, compared with delayed EXRT after completing CHT. Therefore, delayed EXRT completely ruins the expected efficacy of the IORT.
Keywords
IORT; early breast cancer; delayed adjuvant EXRT
About this articleTitle
The efficacy of IORT (intraoperative radiotherapy) for early advanced breast cancer depending on the time delay of external beam irradiation (EXRT) post conservative breast surgery (CBS)
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Research paper (original)
Pages
133-138
Published online
2021-03-12
Page views
553
Article views/downloads
515
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2021;71(3):133-138.
Keywords
IORT
early breast cancer
delayed adjuvant EXRT
Authors
Agata Celejewska
Bogusław Maciejewski
Jerzy Wydmański
Krzysztof Składowski
References (21)- Abe M, Takahashi M. Intraoperative Radiation Therapy. Procc IIIrd Int. Symp on Intraoperative Radiation Therapy. Philadelphia and Pergamon Press 1991.
- Vaidya JS, Wenz F, Bulsara M, et al. TARGIT trialists' group. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 2014; 383(9917): 603–613.
- Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013; 14(13): 1269–1277.
- Reitsamer R, Sedlmayer F, Kopp M, et al. The Salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations. Int J Cancer. 2006; 118(11): 2882–2887.
- Herskind C, Steil V, Kraus-Tiefenbacher U, et al. Radiobiological aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X rays for early-stage breast cancer. Radiat Res. 2005; 163(2): 208–215.
- Herskind C, Griebel J, Kraus-Tiefenbacher U, et al. Sphere of equivalence--a novel target volume concept for intraoperative radiotherapy using low-energy X rays. Int J Radiat Oncol Biol Phys. 2008; 72(5): 1575–1581.
- Herdskind C, Wenz F. Radiobiological aspects of intraoperative tumour-bed irradiation with low-energy X-rays (LEX-IORT). Trans Cancer Res. 2014; 3: 3–17.
- Veronesi U, Luini A, Del Vecchio M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993; 328(22): 1587–1591.
- Bartelink H, Horiot JC, Poortmans P, et al. European Organization for Research and Treatment of Cancer Radiotherapy and Breast Cancer Groups. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001; 345(19): 1378–1387.
- Vrieling C, van Werkhoven E, Maingon P, et al. European Organisation for Research and Treatment of Cancer, Radiation Oncology and Breast Cancer Groups, EORTC Radiation Oncology and Breast Cancer Groups, European Organisation for Research and Treatment of Cancer Radiation Oncology and Breast Cancer Groups. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015; 16(1): 47–56.
- Kraus-Tiefenbacher U, Bauer L, Scheda A, et al. Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer. 2007; 7: 178.
- 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(16): 1227–1232.
- Bartelink H, Horiot JC, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007; 25(22): 3259–3265.
- Holland R, Veling S, Mravunac M, et al. Histologic multifocality of tis, T1–2 breast carcinomas implications for clinical trials of breast-conserving surgery. Cancer. 1985; 56(5): 979–990, doi: 10.1002/1097-0142(19850901)56:5<979::aid-cncr2820560502>3.0.co;2-n.
- Clarke M, Collins R, Darby S, et al. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 366(9503): 2087–2106.
- van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000; 92(14): 1143–1150.
- Clark RM, McCulloch PB, Levine MN, et al. Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992; 84(9): 683–689.
- Fastner G, Gaisberger C, Kaiser J, et al. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer. Radiother Oncol. 2020; 149: 150–157.
- Bellon JR, Come SE, Gelman RS, et al. Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial. J Clin Oncol. 2005; 23(9): 1934–1940.
- Vaidya JS, Bulsara M, Baum M, et al. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. BMJ. 2020; 370: m2836.
- Vaidya J, Bulsara M, Saunders C, et al. Effect of Delayed Targeted Intraoperative Radiotherapy vs Whole-Breast Radiotherapy on Local Recurrence and Survival. JAMA Oncol. 2020; 6(7): e200249.