Update on intraoperative radiotherapy: new challenges and issues.

Area of Science:

• Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Intraoperative radiotherapy (IORT) has emerged as a potential alternative to standard external beam radiotherapy (EBRT) for early breast cancer treatment.
• Recent trials and meta-analyses suggest IORT is non-inferior to EBRT, with comparable local recurrence rates and improved survival.
• Despite evidence, IORT adoption in clinical practice remains limited due to ongoing scientific debate and clinician hesitancy.

Purpose of the Study:

• To evaluate the efficacy and safety of IORT compared to EBRT for early breast cancer.
• To assess the impact of IORT on local recurrence, survival, and overall mortality.
• To advocate for the integration of IORT into standard clinical practice for selected breast cancer patients.

Main Methods:

• Review of randomized controlled trials (RCTs) and meta-analyses comparing IORT and EBRT.
• Analysis of data from landmark trials such as TARGIT-A and ELIOT.
• Evaluation of different IORT application methods, including tumor bed boost radiotherapy.

Main Results:

• IORT demonstrated non-inferiority to EBRT in treating early breast cancer over the past decade.
• TARGIT-A and ELIOT trials reported low local recurrence rates and good survival outcomes with IORT.
• A recent meta-analysis indicated lower mortality rates in patients treated with partial breast radiotherapy (a form of IORT) compared to EBRT.

Conclusions:

• Current evidence supports IORT as a viable and effective treatment option for early breast cancer.
• IORT offers potential benefits, including reduced mortality, making it ready for wider clinical implementation.
• Well-selected and informed patients should be offered IORT as a treatment choice in current clinical practice.