24041 Department of Surgery, West Virginia University, Morgantown, WV, USA.
School of Medicine, West Virginia University, Morgantown, WV, USA.
Am Surg. 2020 Dec;86(12):1666-1671. doi: 10.1177/0003134820940735. Epub 2020 Aug 10.
Intraoperative radiation therapy (IORT) is an alternate accelerated form of radiation following breast-conserving surgery (BCS). Lack of data regarding long-term outcomes has limited adoption. We report our experience with IORT in patients undergoing BCS versus whole breast radiation therapy (WBRT).
Retrospective review of patients undergoing BCS with IORT versus WBRT (2012-2017). Inclusion: low grade, T1-2N0M0, estrogen receptor/progesterone receptor positive, and Her2-negative infiltrating ductal carcinomas. IORT was delivered as a single fraction of radiation (20 Gy) intraoperatively. Outcomes were compared using Fisher's test for discrete variables or Wilcoxon signed-rank test for continuous variables. Kaplan-Meier method was used to estimate disease-free survival (DFS).
Fifty-one patients (44%) received IORT, and 66 (56%) received WBRT. There was no difference in age, tumor size, receptor status, or in-breast recurrence (1.9% vs 0%, all > .05). Length of follow-up was longer in the WBRT group due to time to inception of IORT (mean ± SD: 44 ± 8.1 vs 73 ± 13 months, < .001). There was no difference in DFS between the 2 groups (HR 2.5; = .44). IORT patients experienced delay to BCS (mean ± SD: 38 ± 12.7 vs 27 ± 12.2 days, < .001) likely due to coordination of care. Analysis demonstrated IORT patients would have traveled a mean distance of 20 miles to the closest WBRT center (range 1-70, miles) for a mean travel time of 31 minutes (range 4-90, minutes) per WBRT treatment.
IORT produces noninferior oncologic outcomes and decreased skin toxicity compared with WBRT. It can be convenient for patients in rural regions with limited health care access.
术中放疗（IORT）是保乳手术后（BCS）的一种替代加速放疗形式。由于缺乏长期结果数据，其应用受到限制。我们报告了 IORT 在接受 BCS 与全乳放疗（WBRT）的患者中的经验。
回顾性分析 2012 年至 2017 年期间接受 BCS 联合 IORT 与 WBRT 的患者。纳入标准：低级别、T1-2N0M0、雌激素受体/孕激素受体阳性、Her2 阴性浸润性导管癌。IORT 术中单次给予 20Gy 剂量的放疗。使用 Fisher 检验比较离散变量，使用 Wilcoxon 符号秩检验比较连续变量。采用 Kaplan-Meier 法估计无病生存（DFS）。
51 例（44%）患者接受 IORT，66 例（56%）患者接受 WBRT。两组患者年龄、肿瘤大小、受体状态或局部复发率（1.9% vs 0%，均 >.05）无差异。由于 IORT 开始时间的不同，WBRT 组的随访时间更长（平均值 ± 标准差：44 ± 8.1 个月 vs 73 ± 13 个月， <.001）。两组患者的 DFS 无差异（HR 2.5； =.44）。IORT 患者接受 BCS 的时间延迟（平均值 ± 标准差：38 ± 12.7 天 vs 27 ± 12.2 天， <.001），这可能是由于治疗协调的原因。分析表明，IORT 患者需要前往最近的 WBRT 中心，平均距离为 20 英里（范围为 1-70 英里），每次 WBRT 治疗的平均旅行时间为 31 分钟（范围为 4-90 分钟）。
IORT 与 WBRT 相比，具有非劣效的肿瘤学结果和较低的皮肤毒性。对于农村地区、医疗资源有限的患者来说较为方便。
