Intraoperative radiation therapy: is it a standard now?

Area of Science:

• Oncology
• Radiotherapy
• Breast Cancer Treatment

Background:

• Whole breast radiotherapy (WBRT) is the current standard for adjuvant breast cancer treatment.
• Accelerated partial breast irradiation (APBI) is being investigated as a potentially less burdensome alternative.
• Intraoperative radiation therapy (IORT) is an appealing APBI technique due to its speed and convenience.

Purpose of the Study:

• To evaluate the role of APBI as a replacement for WBRT in the adjuvant breast cancer setting.
• To discuss the patient selection criteria and technical aspects of APBI.
• To assess the safety and efficacy of APBI based on current evidence.

Main Methods:

• Review of early findings from Phase II and randomized Phase III trials on APBI.
• Analysis of consensus statements from major oncology societies regarding patient selection.
• Examination of results from non-randomized studies like the ELIOT trial.

Main Results:

• APBI, particularly IORT, is safe and well-tolerated in selected low-risk patients.
• Short follow-up periods in current trials limit definitive conclusions on long-term outcomes.
• The ELIOT study identified potential patient candidates based on 5-year results with 21 Gy dose.

Conclusions:

• APBI should be considered experimental until sufficient long-term data from large randomized trials are available.
• Proper patient selection is crucial for risk-adapted radiotherapy, with tumor and patient features being key.
• Stratification by clinical phenotype, molecular class, and use of preoperative MRI may improve patient eligibility identification for APBI.