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Strahlenther Onkol. 2017 Jan;193(1):62-69. doi: 10.1007/s00066-016-1072-y. Epub 2016 Nov 17.

Targeted intraoperative radiotherapy tumour bed boost during breast-conserving surgery after neoadjuvant chemotherapy.

Author information

1
Department of Gynecology and Obstetrics, Marienhospital Bottrop gGmbH, Josef-Albers-Str. 70, 46236, Bottrop, Germany. hans-christian.kolberg@mhb-bottrop.de.
2
BORAD, Bottrop, Germany.
3
Department of Gynecology and Obstetrics, Marienhospital Bottrop gGmbH, Josef-Albers-Str. 70, 46236, Bottrop, Germany.
4
University of Erlangen, Erlangen, Germany.
5
Helios Klinikum Berlin-Buch, Berlin, Germany.
6
University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany.
7
University of Notre Dame, Fremantle, Australia.
8
University College, London, UK.

Abstract

INTRODUCTION:

The use of targeted intraoperative radiotherapy (TARGIT-IORT) as a tumour bed boost during breast-conserving surgery (BCS) for breast cancer has been reported since 1998. We present its use in patients undergoing breast conservation following neoadjuvant therapy (NACT).

METHOD:

In this retrospective study involving 116 patients after NACT we compared outcomes of 61 patients who received a tumour bed boost with IORT during lumpectomy versus 55 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Local recurrence-free survival (LRFS), disease-free survival (DFS), distant disease-free survival (DDFS), breast cancer mortality (BCM), non-breast cancer mortality (NBCM) and overall mortality (OS) were compared.

RESULTS:

Median follow up was 49 months. The differences in LRFS, DFS and BCM were not statistically significant. The 5‑year Kaplan-Meier estimate of OS was significantly better by 15% with IORT: IORT 2 events (96.7%, 95%CI 87.5-99.2), EBRT 9 events (81.7%, 95%CI 67.6-90.1), hazard ratio (HR) 0.19 (0.04-0.87), log rank p = 0.016, mainly due to a reduction of 10.1% in NBCM: IORT 100%, EBRT 89.9% (77.3-95.7), HR (not calculable), log rank p = 0.015. The DDFS was as follows: IORT 3 events (95.1%, 85.5-98.4), EBRT 12 events (69.0%, 49.1-82.4), HR 0.23 (0.06-0.80), log rank p = 0.012.

CONCLUSION:

IORT during lumpectomy after neoadjuvant chemotherapy as a tumour bed boost appears to give results that are not worse than external beam radiotherapy boost. These data give further support to the inclusion of such patients in the TARGIT-B (boost) randomised trial that is testing whether IORT boost is superior to EBRT boost.

KEYWORDS:

Breast cancer; External boost; Intraoperative radiotherapy; Neoadjuvant therapy; Tumor bed boost

PMID:
27858093
DOI:
10.1007/s00066-016-1072-y
[Indexed for MEDLINE]

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