Single-Center Long-Term Follow-Up After Intraoperative Radiotherapy as a Boost During Breast-Conserving Surgery Using Low-Kilovoltage X-Rays
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Intraoperative radiotherapy (IORT) during breast-conserving surgery as a boost followed by whole-breast radiotherapy is increasingly used.
Between February 2002 and December 2008, a total of 197 patients were treated with IORT as a boost (20 Gy, 50 kV x-rays; Intrabeam System, Carl Zeiss Surgical, Oberkochen, Germany) during breast-conserving surgery, followed by whole-breast radiotherapy (46–50 Gy). Systemic therapy was provided according to the St. Gallen consensus. Patients were recalled every 6–12 months for follow-up. Findings were scored according to the LENT-SOMA scale.
Median age was 61.8 (range 30–84) years, and median follow-up was 37 (range 5–91) months. There were T1, T2, and Tx tumors in 129, 67, and 1 patients, respectively, and N0, N1, N2, and N3 disease in 144, 36, 15, and 2 patients, respectively. Until December 2009, 5 local invasive relapses, 1 local ductal carcinoma-in-situ, 1 axillary relapse, 6 secondary cancers, and 11 distant metastases were seen, resulting in a 5-year disease-free survival of 81.0% and an overall survival of 91.3%. Local relapse-free survival (invasive cancers) at 3 and 5 years was 97.0%. After a follow-up of 5 years (n = 58), only 8 patients (13.8%) had chronic skin toxicities, and 2 patients (3.4%) had a marked increase in density (fibrosis III), while 62.0% had no/barely palpable fibrosis 0–I. Other toxicities observed included severe pain (n = 4, 6.9%), retraction (n = 17, 29.3%), edema of the breast (n = 1, 1.7%), and lymphedema in general (n = 2, 3.4%).
After IORT as a tumor bed boost with low-kilovoltage x-rays followed by whole-breast radiotherapy, low local recurrence and chronic toxicity rates were seen after 5-year follow-up.
KeywordsLymphedema Local Relapse Accelerate Partial Breast Irradiation High Single Dose Antihormone Treatment
The project is supported by grant FKZ 01ZP0508 from the “Bundesministerium für Bildung und Forschung.” We thank Mrs. Anette Kipke, Erika Filp and Mrs. Dr. med. Brigitte Hermann, MD for organizational support. Radiobiological research in the laboratory of F.W. is supported by Carl Zeiss Surgery, Oberkochen, Germany.
Conflict of Interest
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