【摘 要】
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Background: Collimator based, single fraction intraoperative radiotherapy (IORT) has recently been explored at a limited number of institutions as a potential replacement for conventional whole breast
【机 构】
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Department of Surgery Stanford University Medical Center USA
【出 处】
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BIT‘s2nd Annual World Cancer Congess-2009 (2009第二届癌症大会)
论文部分内容阅读
Background: Collimator based, single fraction intraoperative radiotherapy (IORT) has recently been explored at a limited number of institutions as a potential replacement for conventional whole breast irradiation following quadrantectomy.Potential benefits include a significantly shorter course of therapy, less utilization of radiation oncology services, and less irradiation of normal structures surrounding the surgical cavity.Concerns include significant short and long term toxicity and inadequate therapeutic effectiveness of the single large dose of irradiation to surgical margins in place of standard fractionation regimens that are typically delivered over 5-6 weeks.Concern has also been expressed regarding delivery of radiation prior to final pathology margin status.Methods: A pilot study using single fraction, intraoperative, collimator based, orthovoltage irradiation immediately following lumpectomy was initiated at Stanford Hospital in 2002.Women ≥ age 40, with invasive ductal cancer or DCIS with T ≥ 2.5, negative margins, negative nodes, and without extensive intraductal carcinoma (EIC), screened with preoperative breast magnetic resonance imaging (MRI) were treated with IORT and followed for feasibility of delivering IORT, radiation related toxicity, ipsilateral recurrence, as well as for distant metastases, and disease specific survival.Results: 45 patients have been treated with complication rates <5% and local recurrence rates <5% at 3.5 years mean follow-up.There are no distant metastases or deaths related to breast cancer.Conclusion: Collimator based, single fraction IORT following lumpectomy appears feasible with minimal early toxicity and acceptable local recurrence rates.Further investigation is warranted to determine if the approach is feasible in a multi-institutional setting.A larger, adequately powered clinical trial will be necessary to demonstrate if single fraction IORT at the time of lumpectomy is as safe and effective as conventional post-operative whole breast irradiation.
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