UNICANCER, Institut Paoli-Calmettes, Department of Radiation Oncology, 13009 Marseille, France.
Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France.
Curr Oncol. 2023 Feb 27;30(3):2812-2824. doi: 10.3390/curroncol30030214.
Intraoperative radiotherapy (IORT) is a therapeutic de-escalation option in older women with low-risk early breast cancer (EBC). A qualitative study was implemented to describe EBC physicians' points of view on IORT as a de-escalation option.
Recorded face-to-face and telephone semi-structured interviews were conducted among diverse physicians from seven French comprehensive cancer centers. Interview transcripts were grouped as corpus to construct a typology. Thematic analysis was performed.
Positions toward IORT were contrasted between the 16 participating physicians. Five fully supported IORT as a de-escalation option, four were not in favor, and seven had a more reserved or neutral opinion. Points of divergence concerned treatment efficacy, treatment duration, side effects and sequelae, psychological impact, compliance with adjuvant endocrine therapy, logistical constraints, financial cost, and availability of other techniques of partial breast irradiation. Physicians in favor of IORT emphasized direct benefits for the patient, and those against pointed the lack of specific guidelines, risk of lost opportunity in older women with long life expectancy, and challenges of shared decision making.
Despite national policies to preserve cancer patients' quality of life and increase their participation in medical decision making, therapeutic de-escalation using IORT is not consensual among physicians. Further efforts are needed to promote patient-centered care.
术中放疗（IORT）是低危早期乳腺癌（EBC）老年女性治疗降级的选择。本研究旨在描述 EBC 医师对 IORT 作为降级选择的观点。
在来自法国七个综合癌症中心的 16 名不同医生中进行了记录面对面和电话的半结构化访谈。将访谈记录分组作为语料库构建类型学。进行了主题分析。
16 名参与医生对 IORT 的立场存在差异。5 名医生完全支持 IORT 作为降级选择，4 名医生不支持，7 名医生的观点更为保留或中立。分歧点涉及治疗效果、治疗持续时间、副作用和后遗症、心理影响、对辅助内分泌治疗的依从性、后勤限制、财务成本以及其他部分乳房照射技术的可用性。支持 IORT 的医生强调了对患者的直接益处，而反对者则指出缺乏特定指南、对预期寿命较长的老年女性错失机会的风险，以及共同决策的挑战。
尽管国家政策旨在保护癌症患者的生活质量并增加其在医疗决策中的参与度，但 IORT 的治疗降级在医生中并未达成共识。需要进一步努力促进以患者为中心的护理。
