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Risk-Adapted Intraoperative Radiation Therapy (IORT) for Breast Cancer: A Novel Analysis
Melvin J Silverstein1,2, Brian Kim3, Kevin Lin3
1Department of Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA. melsilver9@gmail.com.
Annals of Surgical Oncology
|July 18, 2023
Summary
Risk-adapted intraoperative radiation therapy (IORT) is safe for low-risk breast cancer. Adding whole-breast radiation therapy (WBRT) significantly reduces local recurrence rates, though it complicates understanding IORT
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Randomized trials confirm risk-adapted intraoperative radiation therapy (IORT) is a safe alternative to whole-breast radiation therapy (WBRT) for low-risk breast cancer.
- The risk-adapted strategy incorporates additional WBRT for high-risk pathological findings, influencing recurrence rates.
- This strategy may overestimate IORT's standalone efficacy by diluting its impact with WBRT.
Purpose of the Study:
- To evaluate the contribution of IORT with and without additional whole-breast treatment.
- To analyze local recurrence rates based on treatment strategy in breast cancer patients.
Main Methods:
- Analysis of 1600 breast cancers treated with risk-adapted IORT using intention-to-treat and per-protocol methods.
- Local recurrence defined as any ipsilateral breast tumor event.
- Comparison of recurrence rates between patients receiving IORT alone versus IORT with additional WBRT.
Main Results:
- Over a median 63-month follow-up, local recurrence rates differed significantly based on treatment.
- 1393 patients receiving IORT alone had a 5-year local recurrence probability of 5.95% (79 events).
- 207 patients receiving additional WBRT for high-risk pathology had a 5-year local recurrence probability of 0.5% (2 events), p = 0.0009.
Conclusions:
- Whole-breast treatment is an effective and necessary addition to IORT in risk-adapted breast cancer management.
- Increased use of WBRT in risk-adapted protocols complicates the assessment of IORT's independent contribution to local control.
- Further understanding of IORT's standalone efficacy requires careful consideration of concurrent WBRT use.
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