Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays

Radiation Oncology

Marc Sütterlin²  Sven Kehl²  Frederik Wenz¹  Elena Sperk¹  Simone Romero²  Sebastian Berlit²  Benjamin Tuschy² 

[1] Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany;Department of Gynaecology and Obstetrics, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

关键词: Morbidity;    Short term complications;    Breast cancer;    Intrabeam;    Intraoperative radiotherapy;   

Others  :  1154136
DOI  :  10.1186/1748-717X-8-95

 received in 2012-09-20, accepted in 2013-04-18,  发布年份 2013

【 摘 要 】

Background

To assess postoperative complications, clinical outcome and histological findings in patients undergoing intraoperative radiotherapy with low energy x-rays for early breast cancer.

Methods

We retrospectively analysed data of 208 women who underwent intraoperative irradiation during breast conserving surgery (BCS) between 2002 and 2007. Demographic, clinical and surgical parameters as well as short-term complications within the first postoperative week and histological findings were evaluated. Toxicities were assessed using the CTC/EORTC Score.

Results

Postoperative complications were rare and the immediate toxicity low, without any grade 3/4 acute toxicity. The most frequent postoperative side effects were suggillation (24%) and palpable seroma (17.3%). In 78.6% of the axillary seroma and in 25% of the breast seroma a needle aspiration was inevitable. Erythema grade I-II of the breast was found in 27 women (13%); whereas in 7 patients (3.4%), mastitis was confirmed. In 57.7% of the cases, the pathological assessment revealed ductal invasive breast cancer and tumour size ranged between 0.1 and 4.5 cm (mean = 1.6 cm).

Conclusion

IORT using Intrabeam^® during BCS is safe, although it is associated with postoperative adverse events such as seroma. These should be mentioned and explained to women in detail during the preoperative discussion. This explicitly clinical description is useful for daily clinical practice; especially for giving a detailed analysis of the postoperative side effects during preoperative counselling.

【 授权许可】

   
2013 Tuschy et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Ruano-Ravina A, Cantero-Munoz P, Eraso Urien A: Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review. Cancer Lett 2011, 313:15-25.
• [2]Blank E, Kraus-Tiefenbacher U, Welzel G, Keller A, Bohrer M, Sutterlin M, Wenz F: Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays. Ann Surg Oncol 2010, 17(Suppl 3):352-358.
• [3]Herskind C, Steil V, Kraus-Tiefenbacher U, Wenz F: Radiobiological aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X rays for early-stage breast cancer. Radiat Res 2005, 163:208-215.
• [4]Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W: Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010, 376:91-102.
• [5]Welzel G, Hofmann F, Blank E, Kraus-Tiefenbacher U, Hermann B, Sutterlin M, Wenz F: Health-related quality of life after breast-conserving surgery and intraoperative radiotherapy for breast cancer using low-kilovoltage X-rays. Ann Surg Oncol 2010, 17(Suppl 3):359-367.
• [6]Sperk E, Welzel G, Keller A, Kraus-Tiefenbacher U, Gerhardt A, Sutterlin M, Wenz F: Late radiation toxicity after intraoperative radiotherapy (IORT) for breast cancer: results from the randomized phase III trial TARGIT A. Breast Cancer Res Treat 2012, 135:253-260.
• [7]Intra M, Leonardi C, Luini A, Veronesi P, Gennari R, Gatti G, Ciocca M, Soteldo J, Bassi F, Venturino M: Full-dose intraoperative radiotherapy with electrons in breast surgery: broadening the indications. Arch Surg 2005, 140:936-939.
• [8]Kraus-Tiefenbacher U, Bauer L, Kehrer T, Hermann B, Melchert F, Wenz F: Intraoperative radiotherapy (IORT) as a boost in patients with early-stage breast cancer – acute toxicity. Onkologie 2006, 29:77-82.
• [9]Mussari S, Sabino Della Sala W, Busana L, Vanoni V, Eccher C, Zani B, Menegotti L, Tomio L: Full-dose intraoperative radiotherapy with electrons in breast cancer. First report on late toxicity and cosmetic results from a single-institution experience. Strahlenther Onkol 2006, 182:589-595.
• [10]Veronesi U, Orecchia R, Luini A, Galimberti V, Gatti G, Intra M, Veronesi P, Leonardi MC, Ciocca M, Lazzari R: Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg 2005, 242:101-106.
• [11]O'Grady NP, Barie PS, Bartlett JG, Bleck T, Carroll K, Kalil AC, Linden P, Maki DG, Nierman D, Pasculle W, Masur H: Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 2008, 36:1330-1349.
• [12]Kraus-Tiefenbacher U, Scheda A, Steil V, Hermann B, Kehrer T, Bauer L, Melchert F, Wenz F: Intraoperative radiotherapy (IORT) for breast cancer using the Intrabeam system. Tumori 2005, 91:339-345.
• [13]Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, Garusi C, De Lorenzi F, Martella S, Bosco R: Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 2009, 114:97-101.
• [14]Sedlmayer F, Fastner G, Merz F, Deutschmann H, Reitsamer R, Menzel C, Ciabattoni A, Petrucci A, Hager E, Willich N: IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: results of an ISIORT pooled analysis. Strahlenther Onkol 2007, 183(Spec No 2):32-34.
• [15]Ivaldi GB, Leonardi MC, Orecchia R, Zerini D, Morra A, Galimberti V, Gatti G, Luini A, Veronesi P, Ciocca M: Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast-conserving surgery in premenopausal women. Int J Radiat Oncol Biol Phys 2008, 72:485-493.
• [16]Joseph DJ, Bydder S, Jackson LR, Corica T, Hastrich DJ, Oliver DJ, Minchin DE, Haworth A, Saunders CM: Prospective trial of intraoperative radiation treatment for breast cancer. ANZ J Surg 2004, 74:1043-1048.
• [17]Kraus-Tiefenbacher U, Welzel G, Brade J, Hermann B, Siebenlist K, Wasser KS, Schneider FS, Sutterlin M, Wenz F: Postoperative seroma formation after intraoperative radiotherapy using low-kilovoltage X-rays given during breast-conserving surgery. Int J Radiat Oncol Biol Phys 2010, 77:1140-1145.