International Journal of Radiation Oncology * Biology * Physics
Volume 77, Issue 5 , Pages 1309-1314 , 1 August 2010

Intraoperative Radiotherapy as a Boost During Breast-Conserving Surgery Using Low-Kilovoltage X-Rays: The First 5 Years of Experience With a Novel Approach

  • Frederik Wenz, M.D.

      Affiliations

    • Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
    • Corresponding Author InformationReprint requests to: Frederik Wenz, M.D., Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany. Tel: (+49) 621-383-4960; Fax: (+49) 621-383-733496
    • ,
  • Grit Welzel, M.Sc.

      Affiliations

    • Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
    • ,
  • Elena Blank, M.S.

      Affiliations

    • Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
    • ,
  • Brigitte Hermann, M.D.

      Affiliations

    • Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
    • ,
  • Volker Steil, M.Sc.

      Affiliations

    • Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
    • ,
  • Marc Sütterlin, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
    • ,
  • Uta Kraus-Tiefenbacher, M.D.

      Affiliations

    • Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

Received 30 April 2009 ,Revised 19 June 2009 ,Accepted 23 June 2009.

References 

  1. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New Engl J Med. 2002;347:1227–1232
  2. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–1241
  3. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in extent of surgery for early breast cancer on local recurrences and 15-year survival: An overview of the randomised trials. Lancet. 2005;366:2087–2106
  4. Bartelink H, Horiot JC, Poortmans P, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–1387
  5. Bartelink H, Horiot JC, Poortmans PM, et al. Impact of higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25:3259–3265
  6. Poortmans P, Bartelink H, Horiot JC, et al. The influence of the boost technique on local control in breast conserving treatment in the EORTC ‘boost versus no boost’ randomised trial. Radiother Oncol. 2004;72:25–33
  7. Antonini N, Jones H, Horiot JC, et al. Effect of age and radiation dose on local control after breast conserving treatment: EORTC trial 22881-10882. Radiother Oncol. 2007;82:265–271
  8. Benda RK, Yasuda G, Sethi A, et al. Breast boost: Are we missing the target?. Cancer. 2003;97:905–909
  9. Vaidya JS, Tobias JS, Baum M, et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol. 2004;5:165–173
  10. Vaidya J, Tobias JS, Baum M, et al. Targeted intraoperative radiotherapy (TARGIT)—an innovative approach to partial breast irradiation. Semin Radiat Oncol. 2005;15:84–91
  11. Kraus-Tiefenbacher U, Steil V, Bauer L, et al. A novel device for intraoperative radiotherapy (IORT). Onkologie. 2003;26:596–598
  12. Veronesi U, Orrechia R, Luini A, et al. Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: Experience with 590 cases. Ann Surg. 2005;242:101–106
  13. Intra M, Luini A, Gatti G, et al. Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: A lesson learned by over 1000 procedures. Surgery. 2006;140:467–471
  14. Lemanski C, Azria D, Thezenas S, et al. Intraoperative radiotherapy given as a boost for early breast cancer: Long-term clinical and cosmetic results. Int J Radiat Oncol Biol Phys. 2006;64:1410–1415
  15. Ollila DW, Klauber-DeMore N, Tesche LJ, et al. Feasibility of breast preserving therapy with single fraction in situ radiotherapy delivered intraoperatively. Ann Surg Oncol. 2007;14:660–669
  16. Gatzemeier W, Orecchia R, Gatti G, et al. Intraoperative radiotherapy (IORT) in the treatment of breast carcinoma - a new therapeutic alternative within the scope of breast-saving therapy? Current state and future prospects. Report of experiences form the European Institute of Oncology (EIO). Strahlenther Onkol. 2001;177:330–337
  17. Reitsamer R, Sedlmayer F, Kopp M, et al. The Salzburg concept of intraoperative radiotherapy for breast cancer: Results and considerations. Int J Cancer. 2006;118:2882–2887
  18. Beal K, McCormick B, Zelefsky MJ, et al. Single-fraction intraoperative radiotherapy for breast cancer: Early cosmetic results. Int J Radiat Oncol Biol Phys. 2007;69:19–24
  19. Kraus-Tiefenbacher U, Scheda A, Steil V, et al. Intraoperative radiotherapy (IORT) for breast cancer using the INTRABEAM system. Tumori. 2005;91:339–345
  20. Kraus-Tiefenbacher U, Scheda A, Bauer L, et al. Intraoperative radiotherapy (IORT) as a boost in patients with early stage breast cancer—acute toxicity. Onkologie. 2006;29:77–82
  21. Kraus-Tiefenbacher U, Bauer L, Scheda A, et al. Long-term toxicity of an intraoperative radiotherapy (IORT) boost using low energy X-rays during breast conserving surgery (BCS). Int J Radiat Oncol Biol Phys. 2006;66:377–381
  22. Wenz F, Welzel G, Keller A, et al. Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer. Breast. 2008;17:617–622
  23. Kraus-Tiefenbacher U, Bauer L, Scheda A, et al. Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer. 2007;7:178
  24. Blank E, Welzel G, Tome O, et al. Elevated risk of late toxicity after a too short interval between intraoperative boost and external beam breast radiotherapy. Geburtsh Frauenheilk. 2008;68:729–733
  25. Vaidya J, Baum M, Tobias JS, et al. Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost. Int J Radiat Oncol Biol Phys. 2006;66:1335–1338
  26. Herskind C, Steil V, Tiefenbacher U, et al. Radiobiologic aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X-rays for early-stage breast cancer. Radiat Res. 2005;163:208–215
  27. Herskind C, Schalla S, Hahn EW, et al. Influence of different dose rates on cell recovery and RBE at different spatial positions during protracted conformal radiotherapy. Radiat Protect Dosim. 2007;122:498–505
  28. Herskind C, Griebel J, Kraus-Tiefenbacher U, et al. Sphere of equivalence—a novel target volume concept for intraoperative radiotherapy using low-energy X rays. Int J Radiat Oncol Biol Phys. 2008;72:1575–1581
  29. Belletti B, Vaidya JS, D'Andrea S, et al. Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res. 2008;14:1325–1332
  30. Kirkpatrick JP, Meyer JJ, Marks LB. The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery. Semin Radiat Oncol. 2008;18:240–243
  31. Flickinger JC, Lunsford LD, Kondziolka D, et al. Radiosurgery and brain tolerance: an analysis of neurodiagnostic imaging changes after gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys. 1992;23:19–26
  32. Nairz O, Deutschmann H, Kopp M, et al. A dosimetric comparison of IORT techniques in limited-stage breast cancer. Strahlenther Onkol. 2006;182:342–348
  33. Harms W, Krempien R, Hensley FW, et al. 5 year results of pulsed dose rate brachytherapy applied as a boost after breast-conserving therapy in patients at high risk for local recurrence from breast cancer. Strahlenther Onkol. 2002;178:607–614
  34. Hoeller U, Tribius S, Kuhlmey A, et al. Increasing the rate of late toxicity by changing the score? A comparison of RTOG/EORTC and LENT/SOMA scores. Int J Radiat Oncol Biol Phys. 2003;55:1013–1018
  35. Lilla C, Ambrosone CB, Kropp S, et al. Predictive factors for late normal tissue complications following radiotherapy for breast cancer. Breast Cancer Res Treat. 2007;106:143–150
  36. Bayerl A, Frank D, Lenz A, et al. Local tumor control and cosmetic outcome following breast conserving surgery and radiation up to a total dose of 56 Gy without boost in breast cancer. Strahlenther Onkol. 2001;177:25–32
  37. Vass S, Bairati I. A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique. Int J Radiat Oncol Biol Phys. 2005;62:1274–1282
  38. Reitsamer R, Fastner G, Menzel C, et al. Results of an ISIORT pooled analysis with Linac-based IORT as boost strategy during breast-conserving surgery in limited-stage breast cancer (Abstr.). Presented at the American Society of Clinical Oncology 2008 Breast Cancer Symposium; September 5–7, 2008; Washington, DC.
  39. Vaidya JS, Baum M, Tobias JS, et al. Efficacy of targeted intraoperative radiotherapy (Targit) boost after breast-conserving surgery: Updated results (Abstr.). Presented at the 44th Annual Meeting of the American Society for Clinical Oncology; May 30–June 3, 2008; Chicago, IL.
  40. Mussari S, della Sala WS, Busana L, et al. Full-dose intraoperative radiotherapy with electrons in breast cancer. Strahlenther Onkol. 2006;182:589–595

 Supported by grants from the Bundesministeriums für Bildung und Forschung and the Dietmar Hopp Stiftung.

 Conflict of interest: Radiobiologic research in the laboratory of F. Wenz is supported by Carl Zeiss Oberkochen.

PII: S0360-3016(09)02798-9

doi: 10.1016/j.ijrobp.2009.06.085

International Journal of Radiation Oncology * Biology * Physics
Volume 77, Issue 5 , Pages 1309-1314 , 1 August 2010

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