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Kolberg HC, Uhl V, Massarut S, Holmes D, Liedtke C, Whineray Kelly E, Lövey G, Vaidya JS. Abstract P3-12-22: Targeted intraoperative radiotherapy (TARGIT IORT) during breast conserving surgery for early stage breast cancer in patients with breast augmentation with implants. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Targeted intraoperative radiotherapy (TARGIT) has become a standard option during breast conserving surgery for selected cases of early breast cancer and over 20,000 patients have been treated in over 300 centers around the world. Although a growing number of patients are presenting with implant breast augmentation, no data has been published regarding the safety of TARGIT with implants in situ. TARGIT IORT as a replacement for whole breast irradiation is an important issue in this context because of the high rates of capsular fibrosis following EBRT in such patients.
Methods: We are reporting a case series of 12 patients who received TARGIT during breast conserving surgery for early breast cancer, had undergone breast augmentation with implants before and wanted their implants to stay in situ. Patients were informed that no published data existed and decided on this approach on an individual basis. 3 patients received additional EBRT after TARGIT IORT because of the presence of EIC or LVI. TARGIT IORT was performed using Intrabeam - 50 kV – X-rays delivering 20 Gy prescribed at the surface of the tumor bed during the initial lumpectomy procedure.
Results:Patient characteristics are given in table 1. Follow-up varied from 78 months to 3 months. 11 patients presented with invasive breast cancer, 1 patient with DCIS. There were no procedure related complications and none of the patients have needed their implant removed. 1/12 patients (ID 7) was diagnosed with a local recurrence in a distant quadrant after 36 months of follow-up. In 11/12 patients no breast-cancer-related events occurred.
Patient characteristicsIDER/PR/HER2GradeSentinel NodesTumor Size (mm)Distance Implant to Tumor (mm)EBRT after IORTFollow up time (months)1pos/pos/neg2pN1mi (sn)95No622pos/neg/neg2pN0 (sn)1913Yes543pos/pos/neg3pN0 (sn)0.85Yes324pos/pos/neg2pN0 (sn)611No155pos/pos/neg3pN0 (sn)71Yes146pos/pos/neg1pN0 (sn)515No117pos/pos/neg2pN0 (sn)7not reportedNo378pos/pos/na1 (DCIS)N/A8not reportedNo789pos/pos/neg2pN0 (sn)15not reportedNo1510pos/neg/neg1pN0 (sn)144No4411pos/pos/neg2pN0 (sn)91No1112pos/pos/neg2pN0 (sn)75No3Table 1
Conclusion: This series of patients with TARGIT during breast conserving surgery for early breast cancer after breast augmentation with implants in situ revealed no safety concerns. Our case series gives some confidence in discussing this option with suitable patients. To expand this series, we are gathering details about other cases from the whole TARGIT group worldwide.
Citation Format: Kolberg H-C, Uhl V, Massarut S, Holmes D, Liedtke C, Whineray Kelly E, Lövey G, Vaidya JS. Targeted intraoperative radiotherapy (TARGIT IORT) during breast conserving surgery for early stage breast cancer in patients with breast augmentation with implants [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-22.
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Affiliation(s)
- H-C Kolberg
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - V Uhl
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - S Massarut
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - D Holmes
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - C Liedtke
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - E Whineray Kelly
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - G Lövey
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - JS Vaidya
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
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Sedloev T, Gabrovski I, Usheva S, Kovacheva S, Spiridonova T, Spirdonov J, Jeleva Z, Terziev I, Korukov B, Damyanov D, Lövey G. [Firs Case Report of Intraoperative Radiotherapy (IORT) for Early Breast Cancer in Bulgaria]. Khirurgiia (Mosk) 2016; 82:40-44. [PMID: 29383929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The intraoperative radiotherapy (IORT) is an innovative method for treatment of breast cancer, which can be used as a substitute of postoperative external beam radiotherapy )EBRT), or boost treatment to EBRT (1). Radiobiological advantages of IORT compared to EBRT are higher relative biologic effectiveness of low-dose radiation therapy and the presence of high dose in the tumor bed (where the possibility of remaining vital tumor cells is the highest), as this dose reduces rapidly with the distance from the applicator (2). Important feature of IORT alone is that it can be applied as a single fraction during the surgical intervention and spares 3 to 5 weeks of following radiation therapy. This means less time spent in hospital for the patients and for the radiotherapeutical units - reduced waiting lists and more machine time for other patients. Prolonged operative time as well as the need of additional staff are assumed as relative flaws of IORT (3). The INTRABEAM® system (Carl Zeiss Surgical Gmbh, Oberkochen, Germany) uses a single high dose of low-energy X-rays (mas 50kV), applied to the tumor bed immediately after the surgical excision of the tumor. These rays have high degree of absorption and low penetrating ability. This determines their advantage in comparison to EBRT to protect the surrounding healthy tissues (2). The data from the Targeted Intraoperative radioTherapy (TARGIT-A) and the Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomized controlled equivalence trial show that when following the recommendations of The Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) Breast Cancer Working Group (2009) for an accelerated partial breast irradiation (APBI), IORT can be used as an equivalent of the postoperative radiotherapy (1,4,5,6). The purpose of this article is to show the results of the performed on 15 December 2015 for the first time in Bulgaria breast conserving surgery with intraoperative radiotherapy on a patient with early breast cancer.
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