Semra Günay1, Ömür Alan2, Orhan Yalçın1, Aygen Türkmen3, Nihal Dizdar2

1Clinic of Breast and Endocrin Surgery, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey
2Clinic of Oncology, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey
3Clinic of Anesthesiology and Reanimation, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey

Abstract

Objective: To present our experience since November 2013, and case selection criteria for intraoperative boost radiotherapy (IObRT) that significantly reduces the local recurrence rate after breast conserving surgery in patients with breast cancer.
Material and Methods: Patients who were suitable for IObRT were identified within the group of patients who were selected for breast conserving surgery at our breast council. A MOBETRON (mobile linear accelerator for IObRT) was used for IObRt during surgery.
Results: Patients younger than 60 years old with <3 cm invasive ductal cancer in one focus (or two foci within 2 cm), with a histologic grade of 2-3, and a high possibility of local recurrence were admitted for IObRT application. Informed consent was obtained from all participants. Lumpectomy and sentinel lymph node biopsy was performed and advancement flaps were prepared according to the size and inclination of the conus following evaluation of tumor size and surgical margins by pathology. Distance to the thoracic wall was measured, and a radiation oncologist and radiation physicist calculated the required dose. Anesthesia was regulated with slower ventilation frequency, without causing hypoxia. The skin and incision edges were protected, the field was radiated (with 6 MeV electron beam of 10 Gy) and the incision was closed. In our cases, there were no major post-operative surgical or early radiotherapy related complications.
Conclusion: The completion of another stage of local therapy with IObRT during surgery positively effects sequencing of other treatments like chemotherapy (CT), hormonotherapy (HT) and RT, if required. IObRT increases disease free and overall survival, as well as quality of life in breast cancer patients.

Keywords: Breast cancer, boost radiotherapy, intraoperative radiotherapy, local recurrence


 

Ethics Committee Approval

Local Review Board decision is not required due to the retrospective nature of study.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - S.G., Ö.A.; Design - S.G., Ö.A.; Supervision - S.G., Ö.A., O.Y.; Funding - S.G., Ö.A.; Materials - S.G., Ö.A.; Data Collection and/or Processing - S.G.; Analysis and/or Interpretation - S.G., Ö.A., O.Y., A.T., N.D.; Literature Review - S.G., Ö.A.; Writer - S.G., Ö.A.; Critical Review - S.G., Ö.A., O.Y., A.T., N.D.; Other - S.G., Ö.A., A.T. 


Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.