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Comparative Study
. 2005 Jul;242(1):101-6.
doi: 10.1097/01.sla.0000167927.82353.bc.

Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases

Umberto Veronesi  1 , Roberto Orecchia, Alberto Luini, Viviana Galimberti, Giovanna Gatti, Mattia Intra, Paolo Veronesi, Maria Cristina Leonardi, Mario Ciocca, Roberta Lazzari, Pietro Caldarella, Serife Simsek, Luzemira Santos Silva, Daniele Sances
Affiliations
Comparative Study

Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases

Umberto Veronesi et al. Ann Surg. 2005 Jul.

Abstract

Background: Previous studies show that local recurrences after breast-conserving treatment occur in the site of the primary tumor. The need for postoperative radiotherapy on the whole breast is challenged in favor of radiotherapy limited to the area of the breast at high risk of recurrence. The new mobile linear accelerators easily moved close to the operating table to allow the full-dose irradiation during surgery.

Patients and methods: From July 1999 to December 2003, 590 patients affected by unifocal breast carcinoma up to a diameter of 2.5 cm received wide resection of the breast followed by intraoperative radiotherapy with electrons (ELIOT). Most patients received 21 Gy intraoperatively, biologically equivalent to 58 to 60 Gy in standard fractionation. Patients were evaluated 1, 3, 6, and 12 months after surgery, and thereafter every 6 months, to look for early, intermediate, late complications, and other events.

Results: After a follow-up from 4 to 57 months (mean, 24 months; median, 20 months), 19 patients (3.2%) developed breast fibrosis, mild in 18, severe in 1, which resolved within 24 months. Three patients (0.5%) developed local recurrences, 3 patients ipsilateral carcinomas in other quadrants and other 5 patients contralateral breast carcinoma. One patient (0.2%) died of distant metastases.

Conclusions: ELIOT is a safe method for treating conservatively operated breasts, avoids the long period of postoperative radiotherapy, and reduces drastically the cost of radiotherapy. ELIOT reduces radiation to normal tissues and organs. Results on short-term and middle-term toxicity up to 5 years of follow-up are good. Data on local control are encouraging.

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Figures

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FIGURE 1. The linac used for ELIOT.
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FIGURE 2. Thoracic wall protection.
See this image and copyright information in PMC

References

    1. Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol. 2001;12:997–1003. - PubMed
    1. Galimberti V, Veronesi P, Arnone P, et al. Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients. Ann Surg Oncol. 2002;9:924–928. - PubMed
    1. Veronesi U, Gatti G, Luini A, et al. Intraoperative radiotherapy for breast cancer: technical notes. Breast J. 2003;9:106–112. - PubMed
    1. Veronesi U, Orecchia R, Luini A, et al. Focalized intraoperative irradiation after conservative surgery for early-stage breast cancer. Breast. 2001;10:84–89.
    1. Veronesi U, Orecchia R, Luini A, et al. A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer. 2001;37:2178–2183. - PubMed

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