Skip to main content
SpringerLink
Log in
Book cover

Accelerated Partial Breast Irradiation pp 345–366Cite as

APBI Intraoperative Technique with Electrons

  • Chapter

The rationale for the irradiation of a limited volume of tissue around the surgical bed in place of whole breast irradiation comes from numerous studies that have shown that 80% or more of local relapses after conservative surgery and radiation therapy occur at the original tumor site. Particularly in low-risk patients, a more limited local treatment could be justified. Intraoperative radiotherapy with electrons (IOERT) has the advantages of reducing the radiotherapy course from 5–7 weeks to a single dose given directly in the operating room immediately following tumor resection, and of reducing the course of external radiation treatment needed when IOERT is used as boost. This would overcome some of the constraints that may prevent patients (especially older patients) from having breast-conserving therapy, such as accessibility to a radiotherapy center and the effects of a prolonged treatment course on the patient's social life and financial resources. Moreover, IOERT could minimize some of the potential side effects associated with conventional EBRT because the skin and subcutaneous tissues are not irradiated and the irradiated volumes of lung and heart are significantly reduced. IOERT thus lends itself to implementing the treatment philosophy of partial breast irradiation, but results from the ELIOT randomized Phase III trial are awaited before considering its use as a standard treatment.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Abner AL, Connolly JL, Recht A, et al. (2000) The relation between the presence and extent of lobular carcinoma in situ and the risk of local recurrence for patients with infi ltrating carcinoma of the breast treated with conservative surgery and radiation therapy. Cancer 88:1072–77

    Article  PubMed  CAS  Google Scholar 

  • Arthur D (2003) Accelerated partial breast irradiation: a change in treatment paradigm for early stage breast cancer. J Surg Oncol 84:185–91

    Article  PubMed  Google Scholar 

  • Arthur DW, Koo D, Zwicker RD, et al. (2003) Partial breast brachytherapy after lumpectomy: low-dose-rate and high-dose-rate experience. Int J Radiat Oncol Biol Phys 56:681–9

    PubMed  Google Scholar 

  • Athas WF, Adams-Cameron M, Hunt WC, et al. (2000) Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst 92:269–71

    Article  PubMed  CAS  Google Scholar 

  • Baglan KL, Martinez AA, Frazier RC, et al. (2001) The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 50:1003–11

    Article  PubMed  CAS  Google Scholar 

  • Bartelink H, Horiot JC, Poortmans P, et al. (2001) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345:1378–87

    Article  PubMed  CAS  Google Scholar 

  • Bartelink H, Horiot JC, Poortmans PM, et al. (2007) Impact of a 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 25 (22):3259–65

    Article  PubMed  Google Scholar 

  • Belkacemi Y, Chauvet MP, Giard S, et al. (2003) Partial breast irradiation: high dose rate peropera-tive brachytherapy technique using the MammoSite. Cancer Radiother 7 Suppl 1:129s–36s

    PubMed  CAS  Google Scholar 

  • Bovi J, Qi XS, White J, Li XA, et al. (2007) Comparison of three accelerated partial breast irradiation techniques: treatment effectiveness based upon biological models. Radiother Oncol 84(3):226–32

    Article  PubMed  Google Scholar 

  • Calvo FA, Meirino RM, Orecchia R (2006) Intraoperative radiation therapy. Part 2. Clinical results. Crit Rev Oncol Hematol 59:116–27

    Article  PubMed  Google Scholar 

  • Chen PY, Vicini FA, Benitez P, et al. (2006) Long-term cosmetic results and toxicity after accelerated partial-breast irradiation: a method of radiation delivery by interstitial brachytherapy for the treatment of early-stage breast carcinoma. Cancer 106:991–9

    Article  PubMed  Google Scholar 

  • Ciocca M, Piazzi V, Lazzari R, et al. (2006) Real-time in vivo dosimetry using micro-MOSFET detectors during intraoperative electron beam radiation therapy in early-stage breast cancer. Radiother Oncol 78(2):213–6

    Article  PubMed  CAS  Google Scholar 

  • Clarke M, Collins R, Darby S, et al. (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366:2087–106

    PubMed  CAS  Google Scholar 

  • Du X, Freeman JL, Freeman DH, et al. (1999) Temporal and regional variation in the use of breast-conserving surgery and radiotherapy for older women with early stage breast cancer from 1983 to 1985. J Gerontol A Biol Sci Med Sci 54:474–78

    Google Scholar 

  • Dubois JB, Hay M, Gely S, et al. (1997) IORT in breast carcinomas. Front Radiat Ther Oncol 31:131–137

    Article  PubMed  CAS  Google Scholar 

  • Elkinol MM, Sutton H (1959) X-ray damage and recovery in mammalian cells in culture. Nature 184:1293

    Article  Google Scholar 

  • Formenti SC (2005) External-beam partial-breast irradiation. Semin Radiat Oncol 15:92–9

    Article  PubMed  Google Scholar 

  • Formenti SC, Truong MT, Goldberg JD, et al. (2004) Prone accelerated partial breast radiation (p-APBI) after breast conserving surgery; preliminary clinical results and dose volume histogram (DVH) analysis. Int J Radiat Onc Biol Phys 60:493–504

    Article  Google Scholar 

  • Fischer B, Jeong JH, Anderson S, et al. (2002) Twenty-fi ve-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and radiation. N Engl J Med 8:567–75

    Article  Google Scholar 

  • Fischer B, Anderson S, Redmond CK, et al. (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333:1456–61

    Article  Google Scholar 

  • Harpe JL, Jenrette JM, Vanek KN, et al. (2005) Acute complications of MammoSite brachytherapy: a single institution's initial clinical experience. Int J Radiat Oncol Biol Phys 61:169–74

    Google Scholar 

  • Holland R, Veling SH, Mravunac M, et al. (1985) Histologic multifocality of Tis, TI-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56:979–90

    Article  PubMed  CAS  Google Scholar 

  • Holmes DR, Baum M, Joseph D (2007) The TARGIT trial: targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update). Am J Surg 194:507–510

    Article  PubMed  Google Scholar 

  • Intra M, Gatti G, Luini A, et al. (2002) Surgical technique of intraoperative radiotherapy in conservative treatment of limited-stage breast cancer. Arch Surg 137(6):737–40

    Article  PubMed  Google Scholar 

  • Intra M, Luini A, Gatti G, et al. (2006) Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: a lesson learned by over 1000 procedures. Surgery 140(3):467–71

    Article  PubMed  Google Scholar 

  • Ivaldi GB, Leonardi MC, Orecchia R, et al. (2008) Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast-conserving surgery in premenopausal women. Int J Radiat Oncol Biol Phys 72(2):485–93

    PubMed  Google Scholar 

  • Keisch M, Vicini F, Kuske RR, et al. (2003) Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 55(2):289–93

    PubMed  Google Scholar 

  • King TA, Bolton JS, Kuske RR, et al. (2000) Long-term results of e-fi eld brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer. Am J Surg 180:299–304

    Article  PubMed  CAS  Google Scholar 

  • Kozak KR, Smith BL, Adams J, et al. (2006) Accelerated partial-breast irradiation using proton beams: initial clinical experience. Int J Radiat Oncol Biol Phys 66:691–8

    PubMed  Google Scholar 

  • Kuske RR, Winter K, Arthur DW (2004) A phase II trial of brachytherapy alone following lumpectomy for stage I or II breast cancer; initial outcomes of RTOG 9517. Proc Am Soc Clin Oncol 23:18

    Google Scholar 

  • Lea DE (1955) Actions of radiation on living cells. Cambridge University Press, Cambridge

    Google Scholar 

  • Lemanski C, Azria D, Thezenas S, et al. (2006) Intraoperative radiotherapy given as a boost for early breast cancer: long-term clinical and cosmetic results. Int J Radiat Oncol Biol Phys 64(5):1410–1415

    PubMed  Google Scholar 

  • Luini A, Orecchia R, Gatti G, et al. (2005) The pilot trial on intraoperative radiotherapy with electrons (ELIOT): update on the results. Breast Cancer Res Treat 93:55–9

    Article  PubMed  Google Scholar 

  • Merrick HW III, Battle JA, Padgett BJ, et al. (1997) IORT for early breast cancer: a report on long-term results. Front Radiat Ther Oncol 31:126–30

    Article  PubMed  Google Scholar 

  • Meurk ML, Goer DA, Spalek G, et al. (1997) The Mobetron: a new concept for IORT. Front Radiat Ther Oncol 31:65–70

    Article  PubMed  CAS  Google Scholar 

  • Mussari S, Sabino Della Sala W, Busana L, et al. (2006a) Full-dose intraoperative radiotherapy with electrons in breast cancer. First report on late toxicity and cosmetic results from a single-institution experience. Strahlenther Onkol 182 (10):589–95

    Google Scholar 

  • Mussari S, Sabino Della Sala W, et al. (2006b) Full-dose intraoperative radiotherapy with electrons in breast cancer. First report on late toxicity and cosmetic results from a single-institution experience. Strahlenther Onkol 182(10):589–95

    Google Scholar 

  • NSABP B-39, RTOG 0413 (2006) A randomized Phase III study of conventional whole breast irradiation versus partial breast irradiation for women with stage 0, I, or II breast cancer. Clin Adv Hematol Oncol 4:719–21

    Google Scholar 

  • Ollila DW, Klauber-DeMore N, Tesche LJ, et al. (2007) Feasibility of breast preserving therapy with single fraction in situ radiotherapy delivered intraoperatively. Ann Surg Oncol 14(2): 660–9

    Article  PubMed  Google Scholar 

  • Orecchia R, Ciocca M, Lazzari R, et al. (2003) Intraoperative radiation therapy with electrons (ELIOT) in early stage breast cancer. Breast 12:483–90

    Article  PubMed  CAS  Google Scholar 

  • Orecchia R, Ciocca M, Tosi G, et al. (2005) Intraoperative electron beam radiotherapy (ELIOT) to the breast: a need for a quality assurance program. Breast 14:541–6

    Article  PubMed  CAS  Google Scholar 

  • Ott OJ, Hildebrandt G, Potter R, et al. (2007) Accelerated partial breast irradiation with multi-catheter brachytherapy: local control, side effects and cosmetic outcome for 274 patients. Results of the German—Austrian multi-centre trial. Radiother Oncol 82:281–6

    Article  PubMed  Google Scholar 

  • Patel RR, Das RK (2006) Image-guided breast brachytherapy: an alternative to whole-breast radiotherapy. Lancet Oncol 7:407–15

    Article  PubMed  Google Scholar 

  • Perez CA, Brady LW (2008) Principles and practice of radiation oncology. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  • Petit JY, Veronesi U, Luini A, et al. (2005) When mastectomy becomes inevitable: the nipple-sparing approach. Breast 14(6):527–31

    Article  PubMed  CAS  Google Scholar 

  • Petit JY, Veronesi U, Orecchia R, et al. (2006) Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): A new type of mastectomy for breast cancer treatment. Breast Cancer Res Treat 96(1):47–51

    Article  PubMed  Google Scholar 

  • Petit JY, Veronesi U, Rey P, et al. (2009) Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 114(1):97–101

    Article  PubMed  CAS  Google Scholar 

  • Polgár C, Sulyok Z, Fodor J, et al. (2002) Sole brachytherapy of the tumor bed after conservative surgery for T1 breast cancer: fi ve-year results of a phase I–II study and initial fi ndings of a randomized phase III trial. J Surg Oncol 80:121–8

    Article  PubMed  Google Scholar 

  • Polgár C, Major T, Fodor J, et al. (2004) High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: seven-year results of a comparative study. Int J Radiat Oncol Biol Phys 60:1173–81

    PubMed  Google Scholar 

  • Polgár C, Strnad V, Major T (2005) Brachytherapy for partial breast irradiation: the European experience. Semin Radiat Oncol 15:116–22

    Article  PubMed  Google Scholar 

  • Polgár C, Lovey K, Major T, et al. (2006) Partial breast irradiation (PBI) versus whole breast irradiation (WBI) after breast conserving surgery for low risk breast cancer patients: 5-year results of a randomized study. Radiother Oncol 81:S148

    Google Scholar 

  • Poortmans P, Bartelink H, Horiot J, et al. (2004) The infl uence of the boost technique on local control in breast conserving treatment in the EORTC “boost versus no boost” randomized trial. Radiother Oncol 72:25–33

    Article  PubMed  Google Scholar 

  • Read J (1952) The effect of ionizing radiation on broad beam root. Br J Radiol 25:89–154

    Article  PubMed  CAS  Google Scholar 

  • Reitsamer R, Sedlmayer F, Kopp M, et al. (2006) The Salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations. Int J Cancer 118:2882–7

    Article  PubMed  CAS  Google Scholar 

  • Ribeiro GG, Magee B, Swindell R, et al. (1993) The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol 5:278–83

    Article  CAS  Google Scholar 

  • Sanders ME, Scroggins T, Ampil FL, et al. (2007) Accelerated partial breast irradiation in early-stage breast cancer. J Clin Oncol 25:996–1002

    Article  PubMed  Google Scholar 

  • Thames HD, Withers HR, Peters CJ, et al. (1982) Changes in early and late radiation responses with altered dose fractionation. Implications for dose—survival relationships. Int J Radiat Oncol Biol Phys 8:219

    PubMed  Google Scholar 

  • Vaidya JS, Tobias JS, Baum M, et al. (2004) Intraoperative radiotherapy for breast cancer. Lancet Oncol 5:165–73

    Article  PubMed  Google Scholar 

  • Vaidya JS, Tobias JS, Baum M, et al. (2005) Targeted intraoperative radiotherapy (TARGIT): an innovative approach to partial breast irradiation. Semin Radiat Oncol 15:84–91

    Article  PubMed  Google Scholar 

  • Vaidya JS, Baum M, Tobias JS, et al. (2006) Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost. Int J Radiat Oncol Biol Phys 66(5):1335–8

    PubMed  Google Scholar 

  • Veronesi U, Luini A, Del Vecchio M, et al. (1993) Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Eng J Med 328:1587–91

    Article  CAS  Google Scholar 

  • Veronesi U, Marubini E, Mariani L, et al. (2001a) Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 12:997–1003

    Article  CAS  Google Scholar 

  • Veronesi U, Orecchia R, Luini A, et al. (2001b) A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated. Eur J Cancer 37(17):2178–83

    Article  CAS  Google Scholar 

  • Veronesi U, Cascinelli N, Mariani L, et al. (2002) Twenty-year follow-up of a surgery with radical mastectomy for early breast cancer. N Engl J Med 16:1227–32

    Article  Google Scholar 

  • Veronesi U, Gatti G, Luini A, et al. (2003a) Full-dose intraoperative radiotherapy with electrons during breast conserving surgery. Arch Surg 138:1253–6

    Article  Google Scholar 

  • Veronesi U, Gatti G, Luini A, et al. (2003b) Intraoperatrive radiation therapy for breast cancer: technical notes. The Breast J 9 (2):106–112

    Article  Google Scholar 

  • Veronesi U, Orecchia R, Luini A, et al. (2008) Full dose intraoperative radiotherapy with electrons (ELIOT) during breast conserving surgery: experience with 1246 cases. ecancermedicalscience 2:65

    Google Scholar 

  • Vicini FA, Kestin LL, Edmunson GK, et al. (1999) Dose—volume analysis for quality assurance of interstitial brachytherapy for breast cancer. Int J Radiat Oncol Biol Phys 45:803–10

    PubMed  CAS  Google Scholar 

  • Vicini FA, Kestin L, Chen P, et al. (2003) Limited-fi eld radiation therapy in the management of early stage breast cancer. J Natl Cancer Inst 95:1205–10

    Article  PubMed  Google Scholar 

  • Vicini F, Winter K, Straube W, et al. (2005) A phase I/II trial to evaluate three-dimensional confor-mal radiation therapy confi ned to the region of the lumpectomy cavity for stage I/II breast carcinoma: initial report of feasibility and reproducibility of Radiation Therapy Oncology Group (RTOG) Study 0319. Int J Radiat Oncol Biol Phys 63:1531–7

    Article  PubMed  Google Scholar 

  • Voogd AC, Peterse JL, Crommelin MA, et al. (1999) Histological determinants for different types of local recurrence after breast-conserving therapy of invasive breast cancer. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Eur J Cancer 35:1828–37

    Article  PubMed  CAS  Google Scholar 

  • Walner P, Arthur D, Bartelink H, et al. (2004) Workshop on Partial Breast Irradiation: State of the Art and the Science, Bethesda. J Natl Cancer Inst 96:175–84

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, Milan, 20141, Italy

    Roberto Orecchia, Giovanni B. Ivaldi & Maria C. Leonardi

Authors
  1. Roberto Orecchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni B. Ivaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria C. Leonardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Orecchia .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, Tufts Medical Center, 750 Washington St., Boston, MA, 02111 NEMC 824, USA

    David E. Wazer

  2. Department of Radiation Oncology, Virginia Commonwealth University, 401 College Street, 980058, Richmond, VA, 23928, USA

    Douglas W. Arthur

  3. Department of Radiation Oncology, William Beaumont Hospital, 3601 W. Thirteen Mile Road, Royal Oak, MI, 48072, USA

    Frank A. Vicini

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Orecchia, R., Ivaldi, G.B., Leonardi, M.C. (2009). APBI Intraoperative Technique with Electrons. In: Wazer, D.E., Arthur, D.W., Vicini, F.A. (eds) Accelerated Partial Breast Irradiation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88006-6_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-88006-6_20

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-88005-9

  • Online ISBN: 978-3-540-88006-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation