Cargando…

Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center

Introduction: Breast conserving surgery (BCS) followed by postoperative whole breast irradiation (WBI) is the current standard of care for early stage breast cancer patients. Boost to the tumor bed is recommended for patients with a higher risk of local recurrence and may be applied with different t...

Descripción completa

Detalles Bibliográficos
Autores principales: König, Laila, Lang, Kristin, Heil, Jörg, Golatta, Michael, Major, Gerald, Krug, David, Hörner-Rieber, Juliane, Häfner, Matthias F., Koerber, Stefan A., Harrabi, Semi, Bostel, Tilman, Debus, Jürgen, Uhl, Matthias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536702/
https://www.ncbi.nlm.nih.gov/pubmed/31165041
http://dx.doi.org/10.3389/fonc.2019.00384
_version_ 1783421819112390656
author König, Laila
Lang, Kristin
Heil, Jörg
Golatta, Michael
Major, Gerald
Krug, David
Hörner-Rieber, Juliane
Häfner, Matthias F.
Koerber, Stefan A.
Harrabi, Semi
Bostel, Tilman
Debus, Jürgen
Uhl, Matthias
author_facet König, Laila
Lang, Kristin
Heil, Jörg
Golatta, Michael
Major, Gerald
Krug, David
Hörner-Rieber, Juliane
Häfner, Matthias F.
Koerber, Stefan A.
Harrabi, Semi
Bostel, Tilman
Debus, Jürgen
Uhl, Matthias
author_sort König, Laila
collection PubMed
description Introduction: Breast conserving surgery (BCS) followed by postoperative whole breast irradiation (WBI) is the current standard of care for early stage breast cancer patients. Boost to the tumor bed is recommended for patients with a higher risk of local recurrence and may be applied with different techniques. Intraoperative electron radiotherapy (IOERT) offers several advantages compared to other techniques, like direct visualization of the tumor bed, better skin sparing, less inter- and intrafractional motion, but also radiobiological effects may be beneficial. Objective of this retrospective analysis of IOERT as boost in breast cancer patients was to assess acute toxicity and early oncological outcomes. Material and Methods: All patients, who have been irradiated between 11/2014 and 01/2018 with IOERT during BCS were analyzed. IOERT was applied using the mobile linear accelerator Mobetron with a total dose of 10 Gy, prescribed to the 90% isodose. After ensured woundhealing, WBI followed with normofractionated or hypofractionated regimens. Patient reports, including diagnostic examinations and toxicity were analyzed after surgery and 6–8 weeks after WBI. Overall survival, distant progression-free survival, in-breast and contralateral breast local progression-free survival were calculated using the Kaplan-Meier method. Furthermore, recurrence patterns were assessed. Results: In total, 157 patients with a median age of 57 years were evaluated. Postoperative adverse events were mild with seroma and hematoma grade 1–2 in 26% and grade 3 in 0.6% of the patients. Wound infections grade 2–3 occurred in 2.2% and wound dehiscence grade 1–2 in 1.9% of the patients. Six to eight weeks after WBI radiotherapy-dependent acute dermatitis grade 1–2 was most common in 90.9% of the patients. Only 4.6% of the patients suffered from dermatitis grade 3. No grade 4 toxicities were documented after surgery or WBI. 2- and 3-year overall survival and distant progression-free survival, were 97.5 and 93.6, and 0.7 and 2.8%, respectively. In-breast recurrence and contralateral breast cancer rates after 3 years were 1.9 and 2.8%, respectively. Conclusion: IOERT boost during BCS is a safe treatment option with low acute toxicity. Short-term recurrence rates are comparable to previously published data and emphasize, that IOERT as boost is an effective treatment.
format Online
Article
Text
id pubmed-6536702
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-65367022019-06-04 Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center König, Laila Lang, Kristin Heil, Jörg Golatta, Michael Major, Gerald Krug, David Hörner-Rieber, Juliane Häfner, Matthias F. Koerber, Stefan A. Harrabi, Semi Bostel, Tilman Debus, Jürgen Uhl, Matthias Front Oncol Oncology Introduction: Breast conserving surgery (BCS) followed by postoperative whole breast irradiation (WBI) is the current standard of care for early stage breast cancer patients. Boost to the tumor bed is recommended for patients with a higher risk of local recurrence and may be applied with different techniques. Intraoperative electron radiotherapy (IOERT) offers several advantages compared to other techniques, like direct visualization of the tumor bed, better skin sparing, less inter- and intrafractional motion, but also radiobiological effects may be beneficial. Objective of this retrospective analysis of IOERT as boost in breast cancer patients was to assess acute toxicity and early oncological outcomes. Material and Methods: All patients, who have been irradiated between 11/2014 and 01/2018 with IOERT during BCS were analyzed. IOERT was applied using the mobile linear accelerator Mobetron with a total dose of 10 Gy, prescribed to the 90% isodose. After ensured woundhealing, WBI followed with normofractionated or hypofractionated regimens. Patient reports, including diagnostic examinations and toxicity were analyzed after surgery and 6–8 weeks after WBI. Overall survival, distant progression-free survival, in-breast and contralateral breast local progression-free survival were calculated using the Kaplan-Meier method. Furthermore, recurrence patterns were assessed. Results: In total, 157 patients with a median age of 57 years were evaluated. Postoperative adverse events were mild with seroma and hematoma grade 1–2 in 26% and grade 3 in 0.6% of the patients. Wound infections grade 2–3 occurred in 2.2% and wound dehiscence grade 1–2 in 1.9% of the patients. Six to eight weeks after WBI radiotherapy-dependent acute dermatitis grade 1–2 was most common in 90.9% of the patients. Only 4.6% of the patients suffered from dermatitis grade 3. No grade 4 toxicities were documented after surgery or WBI. 2- and 3-year overall survival and distant progression-free survival, were 97.5 and 93.6, and 0.7 and 2.8%, respectively. In-breast recurrence and contralateral breast cancer rates after 3 years were 1.9 and 2.8%, respectively. Conclusion: IOERT boost during BCS is a safe treatment option with low acute toxicity. Short-term recurrence rates are comparable to previously published data and emphasize, that IOERT as boost is an effective treatment. Frontiers Media S.A. 2019-05-21 /pmc/articles/PMC6536702/ /pubmed/31165041 http://dx.doi.org/10.3389/fonc.2019.00384 Text en Copyright © 2019 König, Lang, Heil, Golatta, Major, Krug, Hörner-Rieber, Häfner, Koerber, Harrabi, Bostel, Debus and Uhl. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
König, Laila
Lang, Kristin
Heil, Jörg
Golatta, Michael
Major, Gerald
Krug, David
Hörner-Rieber, Juliane
Häfner, Matthias F.
Koerber, Stefan A.
Harrabi, Semi
Bostel, Tilman
Debus, Jürgen
Uhl, Matthias
Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center
title Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center
title_full Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center
title_fullStr Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center
title_full_unstemmed Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center
title_short Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients—First Clinical Results From a Single Center
title_sort acute toxicity and early oncological outcomes after intraoperative electron radiotherapy (ioert) as boost followed by whole breast irradiation in 157 early stage breast cancer patients—first clinical results from a single center
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536702/
https://www.ncbi.nlm.nih.gov/pubmed/31165041
http://dx.doi.org/10.3389/fonc.2019.00384
work_keys_str_mv AT koniglaila acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT langkristin acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT heiljorg acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT golattamichael acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT majorgerald acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT krugdavid acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT hornerrieberjuliane acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT hafnermatthiasf acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT koerberstefana acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT harrabisemi acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT bosteltilman acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT debusjurgen acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter
AT uhlmatthias acutetoxicityandearlyoncologicaloutcomesafterintraoperativeelectronradiotherapyioertasboostfollowedbywholebreastirradiationin157earlystagebreastcancerpatientsfirstclinicalresultsfromasinglecenter