Intraoperative radiotherapy in the treatment of breast cancer: a review of the evidence

Abstract

The surgical treatment of early breast cancer has evolved from the removal of the entire breast and surrounding tissues (mastectomy) to the removal of the tumour together with a margin of healthy tissue (lumpectomy). Adjuvant radiotherapy, however, is still mainly given to the whole breast. Furthermore, external beam radiotherapy is often given several months after initial surgery and requires the patient to attend the radiotherapy centre daily for several weeks. A single fraction of radiotherapy given during surgery directly to the tumour bed (intraoperative radiotherapy) avoids these problems. The rationale and level-1 evidence for the safety and efficacy of the technique are reviewed.

Figure 1

(a) The portable X-ray accelerator (Intrabeam). Soft X-rays are produced at the tip of the drift tube. (b) The intrabeam device mounted on the stand. The unit is portable and can be moved into the operating theatre as and when required. (c) Sterile drape and applicator in place, ready for positioning by the surgeon. (d) The applicator has been placed in the tumour bed and a purse-string suture is being applied to ensure conformity of the tissue to the applicator.