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• W3176267562 abstract "We would like to thank our colleagues for their interest in the updated ELIOT trial. 1 Orecchia R Veronesi U Maisonneuve P et al. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-centre, randomised, phase 3 equivalence trial. Lancet Oncol. 2021; 22: 597-608 Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar By showing a higher local relapse rate in the accelerated partial breast irradiation group, we do not intend to discourage the use of electron intraoperative radiotherapy (ELIOT)—let alone of accelerated partial breast irradiation in general—but rather to underscore the importance of appropriate patient selection. The ELIOT trial has identified a subgroup of patients with a notably low rate of local recurrence after either accelerated partial breast irradiation or whole-breast irradiation. In well-selected patients, ELIOT has the great advantage of delivering the entire treatment in a single session. For its intrinsic peculiarity, it might represent the best option for some subgroups of patients for whom whole-breast irradiation is challenging (eg, carriers of cardiac implantable electronic devices and patients with serious comorbidities). ELIOT might be considered a niche treatment because it can be safely delivered to a subset of patients eligible for accelerated partial breast irradiation (namely, patients with small luminal A tumours), but is not that the point of any tailored treatment? Across the range of modalities offered by modern radiotherapy, clinicians can select the most appropriate for the individual patient, who can then make an informed choice. By contrast with the situation 20 years ago, when the ELIOT trial started, clinicians can now rely on recommendations based on the correct definition of indications, technical parameters, and procedures. The lesson and the legacy from the ELIOT trial are included in the European guidelines published in 2020. 2 Fastner G Gaisberger C Kaiser J et al. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer. Radiother Oncol. 2020; 149: 150-157 Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar We agree that there is an opportunity to more closely examine the relationship between type of local recurrence and collimator size and other technical factors; an analysis that is underway and will soon be published. Unlike in the first publication of ELIOT, in 2013, we did not want to categorise in-breast reappearances according to the original tumour site. We believe that the true value of any accelerated partial breast irradiation trial lies in the potential for control of the disease across the whole breast. The active control of accelerated partial breast irradiation at the site of the index tumour must be coupled with the dormancy of distant occult tumour foci in properly selected patients, 3 Orecchia R Leonardi MC Partial breast irradiation: targeting volume or breast molecular subtypes?. Breast. 2013; 22: S137-S140 Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar which is the basic rationale behind any accelerated partial breast irradiation treatment. The significant difference in local control at 5 years between suitable and unsuitable groups according to the ASTRO guidelines for accelerated partial breast irradiation 4 Correa C Harris EE Leonardi MC et al. Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Pract Radiat Oncol. 2017; 7: 73-79 Summary Full Text Full Text PDF PubMed Scopus (327) Google Scholar disappear with a longer follow-up. A probable explanation might be that higher-risk tumours have a high tendency to relapse shortly after diagnosis, whereas lower-risk tumours are more indolent under hormonal manipulation. 5 Jatoi I Anderson WF Jeong JH Redmond CK Breast cancer adjuvant therapy: time to consider its time-dependent effects. J Clin Oncol. 2011; 29: 2301-2304 Crossref PubMed Scopus (128) Google Scholar The cessation of hormonal therapy after 5 years might account for the accelerated pace of local relapses in oestrogen receptor-positive tumours in patients considered suitable for accelerated partial breast irradiation according to ASTRO guidelines. The different progression pattern of breast cancer subtypes underlines the value of longer follow-up to assess the effect of treatments. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-centre, randomised, phase 3 equivalence trialThe long-term results of this trial confirmed the higher rate of IBTR in the ELIOT group than in the WBI group, without any differences in overall survival. ELIOT should be offered to selected patients at low-risk of IBTR. Full-Text PDF Partial breast irradiation with intraoperative radiotherapy in the ELIOT trialWe congratulate Roberto Orecchia and colleagues1 for presenting long-term results of partial breast irradiation with electron intraoperative radiotherapy for patients with early breast cancer (the ELIOT trial) in The Lancet Oncology. In this single-centre, randomised phase 3 trial, 1305 women were randomly allocated into two groups to receive a single electron intraoperative radiotherapy dose of 21 Gy or whole-breast irradiation. Higher rates of ipsilateral breast tumour relapse were found in the electron intraoperative radiotherapy group than in the whole-breast irradiation group (15 year recurrence rate: 12·6% vs 2·4%; p<0·0001), without differences in overall survival. Full-Text PDF Partial breast irradiation with intraoperative radiotherapy in the ELIOT trialWe congratulate Roberto Orecchia and colleagues1 for publishing the long-term results of the single-centre, phase 3, randomised, equivalence ELIOT trial, in which 1305 women (aged 48–75 years, with a unicentric tumour ≤2·5 cm in diameter, and node-negative) were randomly assigned to receive a single 21 Gy fraction of electron intraoperative radiotherapy, or whole-breast irradiation over 6 weeks. Higher 15-year rates of local relapse were found in the electron intraoperative radiotherapy group (12·6% vs 2·4%; p<0·0001). Full-Text PDF Partial breast irradiation with intraoperative radiotherapy in the ELIOT trialWe congratulate Roberto Orecchia and colleagues1 for their Article reporting the long-term outcomes of the ELIOT trial, for which the first publication (with 5-year data) took place in 2013.2 Reported risk-stratified cumulative incidences of breast cancer recurrence rates were now based on the renewed American Society for Radiation Oncology criteria for partial breast irradiation.3 For patients defined as cautionary under the American Society for Radiation Oncology criteria (n=182), Orecchia and colleagues1 (table 3) report a 15-year breast cancer recurrence rate of 10% (95% CI 6·3–14·7)—surprisingly lower than the 15-year breast cancer recurrence rate in 223 patients defined as suitable (13·1% [95% CI 8·3–19·1]), which was, in turn, unexpectedly high. Full-Text PDF Partial breast irradiation with intraoperative radiotherapy in the ELIOT trialDescribing the long-term outcomes of the ELIOT trial,1 the authors point out “the possible local side-effects of the [ELIOT] technique (immediate fat necrosis, skin flap-temporary suffering, or late parenchymal fibrosis)”, which is an important detail. Full-Text PDF" @default.
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• W3176267562 title "Partial breast irradiation with intraoperative radiotherapy in the ELIOT trial – Authors' reply" @default.
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