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• W2097831221 abstract "Long term follow-up (f/u) of patients (pts) undergoing accelerated partial breast irradiation (APBI) with single-fraction (SF) intraoperative radiation therapy (IORT) following breast conserving surgery is limited. We report our institutional experience with SF IORT in early stage breast cancer with respect to local control and toxicity. Records were reviewed for 64 consecutive pts who received SF IORT from 2002 to 2014 at our institution. Of these, 47 pts were prospectively enrolled in an institutional IRB-approved phase 1-2 study between 2002 and 2008. Eligible pts were ≥40 years with stage 0, I or II breast cancer measuring ≤2.5 cm without nodal involvement and were all screened with breast MRI to exclude multifocal or multicentric disease. Eight of the 47 pts did not fully meet eligibility criteria and declined additional surgery or radiation. The remaining 17 pts were treated per protocol guidelines between 2009 and 2014. IORT was delivered using either a 200 kV orthovoltage source or electrons to 15-21 Gy prescribed to the 90% isodose line. The median age at treatment was 61 years (range: 40-84 years). Median f/u time was 81 months (range 1 - 136 months). Two pts had an ipsilateral breast tumor recurrence (IBTR), one of whom was treated off protocol. A third patient had a nodal micrometastasis and developed an isolated axillary recurrence. All 3 patients had declined further surgery, radiation, and/or systemic therapy. Overall, 52 of 64 pts (81%) received adjuvant systemic therapy consisting of endocrine therapy (n = 49), chemotherapy (n = 5) and/or trastuzumab (n = 1). For pts who met original protocol guidelines, the IBTR rate was 1.6% at 6 years of f/u. On univariate analysis, the following factors emerged as significant predictors of IBTR: age <50 years (p < 0.001), pathologic nodal involvement (p < 0.001), and lack of any adjuvant systemic therapy (p = 0.001). There were 2 cases of isolated distant relapses, which occurred in pts who had also declined adjuvant systemic therapy. Lack of systemic therapy was the only significant predictor of distant relapse (p = 0.01). All 64 pts tolerated IORT well with no evidence of grade III or higher toxicity. APBI using IORT is an inherently desirable option for breast conserving therapy. Our group has an IBTR rate of 1.6% at 6 years of f/u. Lack of systemic therapy emerged as a significant predictor for local, regional, and distant relapse. We conclude that adherence to appropriate clinical guidelines for patient selection and strongly advising adherence to recommendations for additional surgery, radiation, and systemic therapy are critical for successful use of APBI using SF IORT." @default.
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• W2097831221 date "2014-09-01" @default.
• W2097831221 modified "2023-10-14" @default.
• W2097831221 title "Local Recurrence Among Patients With Early-Stage Breast Cancer Treated With Intraoperative Radiation Therapy: The Effect of Systemic Therapy" @default.
• W2097831221 doi "https://doi.org/10.1016/j.ijrobp.2014.05.953" @default.
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