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. 2022 Dec:177:71-80.
doi: 10.1016/j.radonc.2022.10.025. Epub 2022 Oct 28.

Ten-year results of hypofractionated whole breast radiotherapy and intraoperative electron boost in premenopausal women

Maria Cristina Leonardi  1 , Chiara Fausta Cormio  2 , Samuele Frassoni  3 , Samantha Dicuonzo  4 , Cristiana Fodor  1 , Mattia Intra  5 , Maria Alessia Zerella  1 , Anna Morra  1 , Federica Cattani  6 , Stefania Comi  6 , Nicola Fusco  7 , Mattia Zaffaroni  1 , Viviana Galimberti  5 , Paolo Veronesi  8 , Silvia Dellapasqua  9 , Francesca De Lorenzi  10 , Giovanni Battista Ivaldi  11 , Vincenzo Bagnardi  3 , Roberto Orecchia  12 , Damaris Patricia Rojas  1 , Barbara Alicja Jereczek-Fossa  2
Affiliations

Ten-year results of hypofractionated whole breast radiotherapy and intraoperative electron boost in premenopausal women

Maria Cristina Leonardi et al. Radiother Oncol. 2022 Dec.

Abstract

Aim: To evaluate outcome of intraoperative electron boost (IOERT) and hypofractionated whole breast irradiation (HWBI) for breast cancer (BC) in young women.

Methods and materials: Women aged ≤ 48 with pT1-2 N0-1 BC received 12 Gy IOERT boost during conservative surgery followed by 3-dimensional conformal HWBI in 13 fractions (2.85 Gy/die). Local relapses (LR) and survival (disease-free, DFS; specific, BCSS; overall, OS) were analyzed.

Results: 481 consecutive BC patients, mostly node negative, with median age of 42 were treated between 2004 and 2014. Median tumor size was 1.48 cm and median IOERT collimator was 4 cm. After 25-day mean interval, HWBI was delivered. At a median follow-up of 9.6 years, there were 23 LRs (4.8 %, 9 of which were in the boost region). Ten-year LR cumulative incidence was 4.1 % (95 %CI, 2.5-6.3). Over time, local control rate decreased for Luminal A and HER2 positive with negative hormonal receptors, while remained steady for triple negative. At multivariate analysis, LR predictors included age < 40, extensive intraductal component and the use of 4-cm IOERT collimator size. Ten-year survival outcomes were as follows: DFS 80.0 % (95 % CI, 75.8-83.5), BCSS 97.5 % (95 % CI, 95.5-98.6 %), OS 96.5 % (95 % CI, 94.3-97.9). Luminal B HER2 negative had the worse survival outcomes. Perioperative complications were uncommon (16.4 %), acute toxicity was mild (<2% Grade 3), but moderate/severe fibrosis was described in 40.8 % of the cases. Cosmesis was scored as excellent/good in 86 % of the cases.

Conclusions: ELIOT boost and HWBI achieved an excellent local control at the cost of tumor bed fibrosis. IOERT boost dose lower than 12 Gy is advisable.

Keywords: Boost; Breast cancer; Intraoperative electron radiotherapy; Outcome.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Conflict of Interest Statement Maria Cristina Leonardi, Barbara Alicja Jereczek-Fossa and Samantha Dicuonzo received a speaker honorarium from Accuray Inc. outside the current work. Maria Alessia Zerella had research grant from AIRC under IG 2019 - ID. 23,118 project “Phase I/II clinical trial on single fraction ablative preoperative radiation treatment for early-stage breast cancer”. Mattia Zaffaroni received a research fellowship from AIRC entitled “Radioablation ± hormonotherapy for prostate cancer oligorecurrences (RADIOSA trial): potential of imaging and biology” outside the current study. Silvia Dellapasqua had travel/accommodations expenses paid by Lilly, Novartis, Pfizer, and an Advisory Role for Astra Zeneca. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The remaining authors declare no conflicts of interest.

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