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Inicio Cirugía Española (English Edition) Intraoperative radiotherapy in early breast cancer: Observational comparison wit...
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Vol. 99. Issue 2.
Pages 132-139 (February 2021)
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Vol. 99. Issue 2.
Pages 132-139 (February 2021)
Original article
DOI: 10.1016/j.cireng.2021.01.001
Intraoperative radiotherapy in early breast cancer: Observational comparison with whole breast radiotherapy
Radioterapia intraoperatoria en cáncer de mama precoz: análisis observacional frente a radioterapia externa
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José Ramón Oliver Guilléna,
Corresponding author
jose.oliver.1210@gmail.com

Corresponding author.
, Ernesto Hernando Almudib, Guadalupe Molina Osorioc, Reyes Ibañez Carrerasc, José Antonio Font Gómezd, Isabel Vicente Gómeze, Carmen García Murf, María Carmen Casamayor Francob
a IIS Aragón. S. de Cirugía General y del Ap. Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
b S. de Cirugía General y del Ap. Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
c S. de Oncología Radioterápica, Hospital Universitario Miguel Servet, Zaragoza, Spain
d S. de Radiofísica, Hospital Universitario Miguel Servet, Zaragoza, Spain
e S. de Ginecología, Hospital Universitario Miguel Servet, Zaragoza, Spain
f S. de Radiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Figures (2)
Tables (5)
Table 1. Tumor and patients characteristics (age, comorbidities).
Table 2. Surgical characteristics and adjuvant therapies.
Table 3. Reoperations and complications.
Table 4. Radiodermatitis (RTOG/EORTC grades).
Table 5. Oncological results and mortality.
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Abstract
Introduction

In early breast cancer (EBC), a single dose of intraoperative radiotherapy (IORT) might be an option to standard whole breast radiotherapy (WBRT). However, there is no consensus about its use and clinical results.

Aim

To analyse the morbidity and oncological outcomes of IORT as monotherapy in EBC.

Methods

A single centre observational analytic study was performed. A prospective IORT cohort (2015−17) and a retrospective WBRT cohort (2012−17) were selected following the same criteria: ≥ 45 y.o., invasive ductal carcinoma or variants, radiological tumour size ≤ 3cm, positive oestrogenic receptors, negative HER2, cN0; exclusion criteria: lymphovascular invasion, multicentricity/multifocality, BRCA mutation and neoadjuvant therapy. Clinical, histological, surgical, oncological characteristics and complications were collected.

Results

A total of 425 cases were selected: 217 in IORT cohort and 208 in WBRT cohort. Average age in IORT and WBRT groups was 67±9.5 and 64.8±9.9 y.o. respectively (p=0.01). ASA 3 risk score patients were 17.7% in IORT and 24 cases in WBRT (p=0.027). There were no differences in histological results or tumoral stage. Average follow up was 24.4±8 months in IORT and 50.5±18 months in WBRT (p<0.001). No differences were detected in local recurrence, metastases or mortality. Complications that required reintervention or hospitalization were similar in both groups. A total of 3 and 14 cases developed early severe dermatitis in IORT and WBRT groups respectively (p=0.01).

Conclusion

IORT as monotherapy in selected patients with EBC stands for an alternative option versus WBRT. It seems especially useful in advanced-age patients with severe comorbidities. IORT associates lesser early severe dermatitis.

Keywords:
Breast neoplasm
IORT
Outcome
Radiotherapy
Resumen
Introducción

Una única dosis de radioterapia intraoperatoria (IORT) en cáncer de mama precoz (EBC) puede ser una opción frente a la radioterapia externa estándar (WBRT). Sin embargo, no existe consenso sobre su uso y resultados.

Objetivo

Analizar la morbilidad y resultados oncológicos de la IORT como monoterapia en el tratamiento del EBC.

Métodos

Se realiza un estudio analítico observacional unicéntrico, comparando una cohorte prospectiva IORT (2015-17) con una cohorte retrospectiva WBRT (2012-17). Los criterios de selección aplicados son: ≥ 45 años de edad, carcinoma ductal infiltrante o variantes, tamaño tumoral radiológico ≤ 3cm, receptores estrogénicos positivos, HER2 negativo, cN0; criterios de exclusión: invasión linfovascular, multicentricidad/multifocalidad, mutaciones BRCA y tratamiento neoadyuvante.

Se valoran características clínicas, tumorales, quirúrgicas, oncológicas y complicaciones.

Resultados

Se estudiaron 425 casos: 217 tratados con IORT y 208 con WBRT. La edad media en IORT y WBRT fue 67±9,5 y 64,8±9,9 años, respectivamente (p=0,01). El riesgo ASA 3 en IORT fue 17,7%, frente a 24 casos de WBRT (p=0,027). No hubo diferencias en resultados anatomopatológicos o estadificación. El seguimiento medio de IORT fue 24,4±8 meses, frente a 50,5±18 meses de WBRT (p<0,001). No se hallaron diferencias significativas en recidiva local, metástasis o mortalidad. Las complicaciones que precisaron reintervención u hospitalización resultaron equiparables. La radiodermitis precoz grave se presentó en tres casos IORT frente a 14 casos WBRT (p=0,01).

Conclusiones

La IORT como monoterapia en pacientes seleccionadas con EBC representa una opción alternativa frente a WBRT, especialmente en aquellas con edad avanzada y comorbilidades. Se asocia, además, con menos radiodermitis precoz grave.

Palabras clave:
Cáncer de mama
IORT
Resultados
Radioterapia

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