Halima Ahmed, Fane Lauren, Parker Sean, Obi Elizabeth, Fleming-Hall Erica, Gentle Corey, Cherian Sheen, Valente Stephanie, Al-Hilli Zahraa, Tendulkar Rahul, Shah Chirag
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Ann Surg Oncol. 2024 Feb;31(2):931-935. doi: 10.1245/s10434-023-14448-6. Epub 2023 Oct 19.
Increasingly, data have supported the use of partial-breast irradiation (PBI) for low-risk patients after breast-conserving surgery, with techniques allowing for completion of treatment in 1-3 weeks. Intraoperative radiation therapy (IORT) is an alternative to PBI. Our institution had used low-energy photon IORT (TARGIT) for more than a decade. The initial results demonstrated a 2% local recurrence rate with a short follow-up period of 2 years. This report presents updated outcomes during with 5-year follow-up.
A review of an institutional review board (IRB)-approved institutional registry was performed. The review identified 215 patients with early-stage breast cancer (stages 0-IIA) who received IORT. At the time of surgery, IORT was delivered with 20 Gy in a single fraction, with 5.1% (n = 11) of patients receiving additional whole-breast irradiation (WBI).
The mean age at diagnosis was 71 years (range, 49-98 years), and the median follow-up was 5.7 years (interquartile range [IQR], 4.2-7.0 years). Of the 215 patients, 2.8% (n = 6) had ductal carcinoma in situ (DCIS), 90.7% (n = 195) had T1 disease, and 6.5% (n = 14) had T2 disease. Endocrine therapy was prescribed for 79% and chemotherapy for 1.4% of the patients. The 5-year rates were 5.3% for local recurrence, 6.4% for locoregional recurrence, and 2.7% for distant metastases. At 5 years, 93% of the patients were alive.
The 5-year outcomes with TARGIT IORT demonstrated high rates of local recurrence, exceeding those seen with alternative modern approaches. The local recurrence outcomes with IORT are more consistent with studies omitting radiation following breast-conserving surgery, using endocrine therapy alone. Consistent with current guidelines and previous data, TARGIT IORT should not be used as monotherapy outside prospective clinical trials.
越来越多的数据支持对保乳手术后的低风险患者使用部分乳腺照射（PBI），相关技术可在1至3周内完成治疗。术中放疗（IORT）是PBI的一种替代方法。我们机构使用低能量光子IORT（TARGIT）已有十多年。初步结果显示，在2年的短期随访中局部复发率为2%。本报告展示了5年随访期的最新结果。
对机构审查委员会（IRB）批准的机构登记册进行了回顾。该回顾确定了215例接受IORT的早期乳腺癌（0-IIA期）患者。手术时，IORT单次给予20 Gy，5.1%（n = 11）的患者接受了额外的全乳照射（WBI）。
诊断时的平均年龄为71岁（范围49 - 98岁），中位随访时间为5.7年（四分位间距[IQR]，4.2 - 7.0年）。在215例患者中，2.8%（n = 6）为导管原位癌（DCIS），90.7%（n = 195）为T1期疾病，6.5%（n = 14）为T2期疾病。79%的患者接受了内分泌治疗，1.4%的患者接受了化疗。5年局部复发率为5.3%，区域复发率为6.4%，远处转移率为2.7%。5年时，93%的患者存活。
TARGIT IORT的5年结果显示局部复发率较高，超过了其他现代替代方法。IORT的局部复发结果与保乳手术后仅使用内分泌治疗而省略放疗的研究结果更为一致。与当前指南和既往数据一致，在非前瞻性临床试验之外，TARGIT IORT不应作为单一疗法使用。
