Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 3;28(5):3932-3944.
doi: 10.3390/curroncol28050335.

Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System-A Systematic Review and First Bulgarian Experience in Breast Cancer Patients

Desislava Kostova-Lefterova  1 , Mariela Vasileva-Slaveva  2   3 , Svilen Maslyankov  4 , Assia Konsoulova  3   5 , Margarita Atanasova  6 , Tsvetelina Paycheva  7 , Alexandrina Vlahova  8 , Marusya Genadieva-Yordanova  8 , Ginka Prodanova  4 , Zahari Zahariev  9 , Vasil Pavlov  4 , Georgi Todorov  4 , Boris Vasilev  10 , Kostadin Angelov  4 , Tashko Deliyski  11   12 , Ivelina Petrova  11   12 , Desislava Hitova  13 , Ivo Petrov  14
Affiliations

Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System-A Systematic Review and First Bulgarian Experience in Breast Cancer Patients

Desislava Kostova-Lefterova et al. Curr Oncol. .

Abstract

(1) Background: We aimed to analyze currently available studies with intraoperative radiotherapy (IORT) as a choice of treatment where the Xoft Axxent® electronic brachytherapy (eBx) system was used as a single-dose irradiation and an exclusive radiotherapy approach at the time of surgery in patients with early breast cancer (EBC). We also compared the results of the systematic review to the Bulgarian experience. (2) Methods and Materials: We performed a systematic review of the studies published before February 2021, which investigate the application of a single-fraction 20 Gy radiation treatment, delivered at the time of lumpectomy in EBC patients with the Xoft Axxent® eBx System. A systematic search in PubMed, Scopus, and ScienceDirect was performed. The results are reported following the PRISMA guidelines. The criteria on patients' selection for IORT (the additional need for EBRT), cosmetic outcomes, and recurrence rate from the eligible studies are compared to the treatment results in Bulgarian patients. (3) Results: We searched through 1032 results to find 17 eligible studies. There are no published outcomes from randomized trials. When reported, the cosmetic outcomes in most of the studies are defined as excellent. The observed recurrence rate is low (1-5.8%). Still, the number of patients additionally referred to postoperative external breast radiotherapy (EBRT) is up to 31%. Amongst the 20 patients treated in Bulgaria, the cosmetic outcomes are also evaluated as excellent, five of which (25%) are referred for EBRT. Within median follow-up of 39 months, there was one local and one distal recurrence. (4) Conclusions: Current evidence demonstrates the Xoft Axxent® eBx system as a safe and feasible technique for IORT delivery in EBC patients. There are no randomized controlled trials conducted at this time point to prove its long-term effectiveness. Better patient selection and a reimbursement strategy have to be proposed to extend the application of this technique in Bulgaria.

Keywords: Axxent electronic brachytherapy; early breast cancer; electronic brachytherapy; intraoperative radiotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cosmetic results 6 months (a), one year (b) and two years (c) after treatment.
See this image and copyright information in PMC

References

    1. Pilar A., Gupta M., Ghosh Laskar S., Laskar S. Intraoperative radiotherapy: Review of techniques and results. Ecancermedicalscience. 2017;11:750. doi: 10.3332/ecancer.2017.750. - DOI - PMC - PubMed
    1. Rosi A., Viti V. Guidelines for quality assurance in intra-operative radiation therapy. Oncología (Barcelona) 2004;27:7. doi: 10.4321/S0378-48352004000700013. - DOI
    1. Paunesku T., Woloschak G.E. Future Directions of Intraoperative Radiation Therapy: A Brief Review. Front Oncol. 2017;7:300. doi: 10.3389/fonc.2017.00300. - DOI - PMC - PubMed
    1. Herskind C., Ma L., Liu Q., Zhang B., Schneider F., Veldwijk M.R., Wenz F. Biology of high single doses of IORT: RBE, 5 R’s, and other biological aspects. Radiat. Oncol. 2017;12:1–14. doi: 10.1186/s13014-016-0750-3. - DOI - PMC - PubMed
    1. Herskind C., Wenz F. Radiobiological aspects of intraoperative tumour-bed irradiation with low-energy X-rays (LEX-IORT) Transl. Cancer Res. 2014;3:3–17.

Publication types