Barrou Julien, Tallet Agnes, Cohen Monique, Bannier Marie, Buttarelli Max, Gonzague Laurence, Jauffret Camille, Lambaudie Eric, Rua Sandrine, Tyran Margueritte, Varela Leonel, Houvenaeghel Gilles
Institut Paoli Calmette and CRCM, Aix Marseille University, Marseille, France.
Breast J. 2018 Sep;24(5):715-723. doi: 10.1111/tbj.12993. Epub 2018 Jan 22.
The spread of systematic screening and the emergence of oncoplastic techniques allow more breast conservative treatment associating lumpectomy and external beam radiation therapy. In order to furthermore facilitate the patient's treatment, intraoperative radiation therapy (IORT) has been developed. The oncological safety of this technique has been studied, and is considered acceptable. Many questions remain unsolved in regard of the toxicity of this procedure as well as the patient's selection criteria. In this study, we present the first results and complications rate of patients treated by IORT in a single French institution. Between 2012 and 2015, all patients with breast cancer treated in a one-step procedure associating lumpectomy and IORT were retrospectively included in a monocentric cohort. Acute and long-term toxicities were evaluated using CTCAE v4.0 classification. 280 breast cancers were treated using IORT procedure. Additional external beam radiation therapy was requested for 45.7% patients. The acute complications rate was 14.6%, with 5 surgical revisions needed (1.78%). With a median follow up of 911 days, the long-term grade-3 toxicity rate was 1.1%. The only risk factor for local fibrosis was external beam radiation therapy (EBRT) (OR = 1.99; IC95 [1.05-3.81], P = 0.036). Three patients (1.07%) were diagnosed with local recurrence. The results from this cohort confirm the low complication and recurrence rate of IORT procedure. A good selection of patients is necessary in order to lower the EBRT rate and allow therapeutic de-escalation. The classification of tumors into IHC subsets seems a good selection gate. Intraoperative radiation therapy appears to have a low toxicity rate with an acceptable local recurrence risk, and should therefore be considered as an option in the treatment of early breast cancer.
系统筛查的普及和肿瘤整形技术的出现，使得更多的保乳治疗可以将肿块切除术与外照射放疗相结合。为了进一步方便患者治疗，术中放疗（IORT）应运而生。该技术的肿瘤学安全性已得到研究，并被认为是可接受的。然而，关于该手术的毒性以及患者选择标准，仍有许多问题尚未解决。在本研究中，我们展示了法国一家机构中接受IORT治疗的患者的初步结果和并发症发生率。2012年至2015年期间，所有在单一步骤中接受肿块切除术和IORT联合治疗的乳腺癌患者被回顾性纳入一个单中心队列。使用CTCAE v4.0分类评估急性和长期毒性。280例乳腺癌患者接受了IORT手术。45.7%的患者需要额外的外照射放疗。急性并发症发生率为14.6%，其中5例需要手术修复（1.78%）。中位随访911天，长期3级毒性发生率为1.1%。局部纤维化的唯一危险因素是外照射放疗（EBRT）（OR = 1.99；95%置信区间[1.05 - 3.81]，P = 0.036）。3例患者（1.07%）被诊断为局部复发。该队列的结果证实了IORT手术的低并发症和复发率。为了降低EBRT率并实现治疗降级，有必要对患者进行良好的选择。将肿瘤分类为免疫组化亚组似乎是一个很好的选择标准。术中放疗似乎毒性率较低，局部复发风险可接受，因此应被视为早期乳腺癌治疗的一种选择。
