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Intraoperative radiotherapy (IORT) versus whole-breast external beam radiotherapy (EBRT) in early stage breast cancer: results from SEER database

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

Intraoperative radiotherapy (IORT) has emerged as an alternative to whole-breast external beam radiotherapy (EBRT) for early breast cancer. This study aimed to investigate the risk factors for survival after IORT or whole-breast EBRT in breast cancer patients.

Materials and methods

Breast cancer patients undergoing IORT or whole-breast EBRT were included from the surveillance, epidemiology, and end results database. Risk factors for overall survival (OS) and cancer-specific survival (CSS) were identified by Cox proportional hazards regression analysis.

Results

The IORT and EBRT groups did not differ significantly in OS and CSS. T2 stage (tumor size > 2 cm) was associated with poorer OS (aHR 3.49, 95% CI 1.05–11.62, P = 0.042), whereas ER-positive tumors were associated with better OS (aHR 0.26, 95% CI 0.09–0.76, P = 0.014).

Conclusion

IORT was not inferior than EBRT considering the OS and CSS in the short-term follow-up of early breast cancer. It may be a reasonable alternative to EBRT for early breast cancer in select patients with favorable tumor size and receptor status, given the need for long-term monitoring of local control and radiation toxicity.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29.

    Article  Google Scholar 

  2. Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J. Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg. 2014;149:267–74.

    Article  Google Scholar 

  3. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, 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;347:1233–41.

    Article  Google Scholar 

  4. Akhtari M, Teh BS. Accelerated partial breast irradiation: advances and controversies. Chin J Cancer. 2016;35:31.

    Article  Google Scholar 

  5. Dutta SW, Showalter SL, Showalter TN, Libby B, Trifiletti DM. Intraoperative radiation therapy for breast cancer patients: current perspectives. Breast Cancer. 2017;9:257–63 (Dove Med Press).

    PubMed  Google Scholar 

  6. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. 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. 2005;366:2087–106.

    Article  CAS  Google Scholar 

  7. Voti L, Richardson LC, Reis I, Fleming LE, Mackinnon J, Coebergh JW. The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida. Breast Cancer Res Treat. 2006;95:89–95.

    Article  Google Scholar 

  8. Athas WF, Adams-Cameron M, Hunt WC, Amir-Fazli A, Key CR. Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst. 2000;92:269–71.

    Article  CAS  Google Scholar 

  9. Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.

    Article  Google Scholar 

  10. Harris EER, Small W Jr. Intraoperative radiotherapy for breast cancer. Front Oncol. 2017;7:317.

    Article  Google Scholar 

  11. Abbott AM, Dossett LA, Loftus L, Sun W, Fulp W, Sokol GH, et al. Intraoperative radiotherapy for early breast cancer and age: clinical characteristics and outcomes. Am J Surg. 2015;210:624–8.

    Article  Google Scholar 

  12. Rivera R, Banks A, Casillas-Lopez A, Rashtian A, Lewinsky B, Sheth P, et al. Targeted intraoperative radiotherapy for the management of ductal carcinoma in situ of the breast. Breast J. 2016;22:63–74.

    Article  Google Scholar 

  13. Hanna GG, Kirby AM. Intraoperative radiotherapy in early stage breast cancer: potential indications and evidence to date. Br J Radiol. 2015;88:20140686.

    Article  CAS  Google Scholar 

  14. Zhang L, Zhou Z, Mei X, Yang Z, Ma J, Chen X, et al. Intraoperative radiotherapy versus whole-breast external beam radiotherapy in early-stage breast cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2015;94:e1143.

    Article  Google Scholar 

  15. Deshmukh AA, Shirvani SM, Lal L, Swint JM, Cantor SB, Smith BD, et al. Cost-effectiveness analysis comparing conventional, hypofractionated, and intraoperative radiotherapy for early-stage breast cancer. J Natl Cancer Inst. 2017;109:DJX068.

    Article  Google Scholar 

  16. Alvarado MD, Mohan AJ, Esserman LJ, Park CC, Harrison BL, Howe RJ, et al. Cost-effectiveness analysis of intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol. 2013;20:2873–80.

    Article  Google Scholar 

  17. Shah C, Badiyan S, Khwaja S, Shah H, Chitalia A, Nanavati A, et al. Evaluating radiotherapy options in breast cancer: does intraoperative radiotherapy represent the most cost-efficacious option? Clin Breast Cancer. 2014;14:141–6.

    Article  Google Scholar 

  18. Vaidya JS, Tobias JS, Baum M, Keshtgar M, Joseph D, Wenz F, et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol. 2004;5:165–73.

    Article  Google Scholar 

  19. Pilar A, Gupta M, Ghosh Laskar S, Laskar S. Intraoperative radiotherapy: review of techniques and results. Ecancermedicalscience. 2017;11:750.

    Article  Google Scholar 

  20. Trifiletti DM, Jones R, Showalter SL, Libby BB, Brenin DR, Schroen A, et al. Techniques for intraoperative radiation therapy for early-stage breast carcinoma. Future Oncol. 2015;11:1047–58.

    Article  CAS  Google Scholar 

  21. Kolberg HC, Loevey G, Akpolat-Basci L, Stephanou M, Fasching P, Untch M, et al. Targeted intraoperative radiotherapy tumour bed boost during breast conserving surgery after neoadjuvant chemotherapy in HER2 positive and triple negative breast cancer. Rev Recent Clin Trials. 2017;12:93–100.

    Article  CAS  Google Scholar 

  22. Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14:1269–77.

    Article  Google Scholar 

  23. Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 2014;383:603–13.

    Article  Google Scholar 

  24. Welzel G, Boch A, Sperk E, Hofmann F, Kraus-Tiefenbacher U, Gerhardt A, et al. Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A. Radiat Oncol. 2013;8:9.

    Article  Google Scholar 

  25. Silverstein MJ, Fastner G, Maluta S, Reitsamer R, Goer DA, Vicini F, et al. Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 1–ELIOT. Ann Surg Oncol. 2014;21:3787–92.

    Article  Google Scholar 

  26. Silverstein MJ, Fastner G, Maluta S, Reitsamer R, Goer DA, Vicini F, et al. Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 2–TARGIT. Ann Surg Oncol. 2014;21:3793–9.

    Article  Google Scholar 

  27. Leonardi MC, Maisonneuve P, Mastropasqua MG, Cattani F, Fanetti G, Morra A, et al. Comparison of treatment outcome between invasive lobular and ductal carcinomas in patients receiving partial breast irradiation with intraoperative electrons. Int J Radiat Oncol Biol Phys. 2017;99:173–81.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People’s Republic of China

    Juan Lei

  2. Department of Mathematics, California State University Dominguez Hills, Carson, CA, USA

    Yi Wang

  3. Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China

    Zhuofei Bi

  4. Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China

    Shengneng Xue

  5. Department of Endocrinology and Metabolism, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China

    Bing Ou

  6. Division of Cardiology, Heart and Vascular Center, University of Iowa Hospital and Clinics, Iowa, IA, USA

    Kan Liu

Authors
  1. Juan Lei
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  2. Yi Wang
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  3. Zhuofei Bi
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  4. Shengneng Xue
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Correspondence to Juan Lei.

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Cite this article

Lei, J., Wang, Y., Bi, Z. et al. Intraoperative radiotherapy (IORT) versus whole-breast external beam radiotherapy (EBRT) in early stage breast cancer: results from SEER database. Jpn J Radiol 38, 85–92 (2020). https://doi.org/10.1007/s11604-019-00891-7

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  • DOI: https://doi.org/10.1007/s11604-019-00891-7

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