Abstract
Aim. To compare effect of intraoperative radiotherapy (IORT) and conventional external beam radiation therapy (EBRT) in the combined treatment of breast cancer (BC).
Materials and methods. The study was conducted in the Breast Cancer Unit of the Clinical Oncologic Dispensary No.1 of Krasnodar Territory. The main study group consisted of 104 patients who underwent breast-conserving surgery (BCS) in combination with IORT; the control group included 180 patients after combined treatment of BCS and routine EBRT. Cosmetic results of treatment were analyzed using a Harvard scale (4-point Likert scale), and late toxicity was assessed using the modified for BC LENT-SOMA scale. Statistical analysis was performed using the STATISTICA (v.10. Tibco, USA) analytics software.
Results. The relapse-free survival rate in women that received IORT and EBRT after 36-48 months of follow-up was 95.0% for the treatment group (median time 43±0.8 months) and 97.0% for the control group (median time 45±0.6 months), (p>0.05). Local relapses were diagnosed with almost the same frequency in both groups: 3.8% after IORT and 3.3% after EBRT. There was no significant difference in the cosmetic results of treatment between the groups. However, there was a significant decrease in the rate of skin hyperpigmentation after IORT compared to EBRT.
Conclusion. The use of IORT after BCS can significantly reduce radiation exposure, duration and cost of treatment, which is especially important for older patients, working women and those who live at a considerable distance from the medical unit. There was no statistically significant difference in the frequency of local relapses in the compared groups. The proposed combined method of cancer treatment reduces the incidence of late radiation complications, such as hyperpigmentation and fibrosis, and improves cosmetic results.
References
Мерабишвили В.М. Состояние онкологической помощи в России: рак молочной железы среди женского населения. Заболеваемость, смертность, достоверность учета, детальная локализационная и гистологическая структура (популяционное исследование на уровне федерального округа) Вопросы онкологии 2022;68(3):286-293 [Merabishvili VM. State of the Russian Oncology Service: breast cancer among women. Morbidity and mortality rates, accuracy index, detailed localization and histological structure (Population-based study at the federal district level). Vopr Onkol. 2022;68(3):286-293 (in Russ.)]. doi:10.37469/0507-3758-2022-68-3-286-293.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-41. doi:10.1056/NEJMoa022152.
Трофимова О.П., Кондратьева А.П. Роль лучевой терапии в комплексном лечении больных раком молочной железы В кн.: Клиническая маммология. Современное состояние проблемы. М: ГЭОТАР-Медиа; 2006:291–314 [Trofimova OP, Kondrateva AP. The role of radial therapy in treatment of patients with breast cancer. In: Clinical mammology. Current state of the problem. Moscow: GEOTAR-Media; 2006:291-314 (in Russ.)].
Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087-106. doi:10.1016/S0140-6736(05)67887-7.
Formenti SC, Arslan AA, Pike MC. Re: Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(22):1723. doi:10.1093/jnci/djr406.
Yang H-Y, Tu C-W, Chen C-C, et al. Sole adjuvant intraoperative breast radiotherapy in Taiwan: a single-center experience. Breast Cancer Res. 2021;(23):43. doi:10.1186/s13058-021-01421-y.
Брянцева Ж.В., Новиков С.Н., Канаев С.В. и др. Внутритканевая брахитерапия источниками высокой мощности дозы в лечении больных раком молочной железы. Медицинская физика. 2017;(3):34-40 [Bryantseva JV, Novikov SN, Kanaev SV, et al. High dose rate brachytherapy in treatment of breast cancer patients. Medical physics. 2017;(3):34–40 (in Russ.)].
Vaidya JS, Wenz F, Bulsara M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet: 2014;383(9917):603-13. doi:10.1016/S0140-6736(13)61950-9.
Канаев С.В., Новиков С.Н., Брянцева Ж.В. и др. Сравнительный анализ возможностей внутритканевой брахитерапии источниками высокой мощности дозы и облучения электронами при подведении дополнительной дозы облучения на ложе удаленной опухоли молочной железы. Вопросы онкологии. 2018;64(3):303-309 [Kanaev SV, Novikov SN, Bryantseva JV, et al. Radiation boost after whole-breast irradiation: dosimetric comparison of high dose rate interstitial brachytherapy and irradiation with electrons. Vopr Onkol. 2018;64(3):303-9 (in Russ.)]. doi:10.37469/0507-3758-2018-64-3-303-309.
Чумаченко И.С., Мурашко Р.А., Кешабян А.А. и др. Результаты органосохраняющего лечения рака молочной железы с применением интраоперационной лучевой терапии. Опухоли женской репродуктивной системы. 2021;3(17): 25-32 [Chumachenko IS, Murashko RA, Keshabyan AA, et al. Results of organ-preserving treatment of breast cancer using intraoperative radial therapy. Tumors of female reproductive system. 2021;3(17):25-32 (in Russ.)]. doi:10.17650/1994-4098-2021-17-3-16-23.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341-6. doi:10.1016/0360-3016(95)00060-C.
Wadasadawala T, Sinha S, Verma S, et al. A prospective comparison of subjective and objective assessments of cosmetic outcomes following breast brachytherapy. J Contemp Brachytherapy. 2019;11(3):207-214. doi:10.5114/jcb.2019.85414.
Merie R, Browne L, Cardoso JS, et al. Proposal for a gold standard for cosmetic evaluation after breast conserving therapy: Results from the St George and Wollongong Breast Boost trial. J Med Imaging Radiat Oncol. 2017;61(6):819-825. doi:10.1111/1754-9485.12645.
Халафян А.А. Статистика 6. Математическая статистика с элементами теории вероятностей. М.: Бином 2010; 496 [Khalafayan AA. Statistics 6. Mathematical statistics with elements of probability theory. Moscow: Binom 2010;496 (in Russ.)].
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(5):597-608. doi:10.1016/S1470-2045(21)00080-2.
Kaiser J, Reitsamer R, Kopp P, et al. Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer. Breast Care (Basel). 2018;13(3):162-167. doi:10.1159/000489637.
Harness JK, Davies K, Via C, et al. Meta-Analysis of Local Invasive Breast Cancer Recurrence After Electron Intraoperative Radiotherapy. Ann Surg Oncol. 2018;25(1):137-147. doi:10.1245/s10434-017-6130-x.
Манихас А.Г., Гринев И.А., Оганесян А.С. и др. Обоснование метода комплексного лечения локализованного рака молочной железы с использованием методики интраоперационной лучевой терапии после неоадъювантной системной лекарственной терапии и биопсии сигнальных лимфатических узлов. Вопросы онкологии. 2016;62(6):767-74 [Manikhas AG, Grinev IA, Oganesian AS, et al. Rationale of the method of complex treatment for localized breast cancer with the use of methodology of intraoperative radiation therapy after neoadjuvant systemic drug therapy and sentinel lymph node biopsy. Vopr Onkol. 2016;62(6):767-74 (in Russ.)].
Sun MS, Liu HJ, Liu YH, et al. Intraoperative radiotherapy versus whole-breast external beam radiotherapy, and other factors associated with the prognosis of early breast cancer treated with breast-conserving surgery and radiotherapy: a retrospective study from SEER database. Transl Cancer Res. 2020;9(11):7125-7139. doi:10.21037/tcr-20-2441.
Coombs NJ, Coombs JM, Vaidya UJ, et al. Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT. BMJ Open. 2016;6:e010703. doi:10.1136/bmjopen-2015-010703.
Andersen KG, Gärtner R, Kroman N, et al. Persistent pain after targeted intraoperative radiotherapy (TARGIT) or external breast radiotherapy for breast cancer: a randomized trial. Breast. 2012;21(1):46-9. doi:10.1016/j.breast.2011.07.011.
Welzel G, Boch A, Sperk E, et al. Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A. Radiat Oncol. 2013;8:9. doi:10.1186/1748-717X-8-9.
Sedlmayer F, Reitsamer R, Wenz F, et al. Intraoperative radiotherapy (IORT) as boost in breast cancer. Radiat Oncol. 2017;12(1):23. doi:10.1186/s13014-016-0749-9.
Polgár C, Ott OJ, Hildebrandt G, et al. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(2):259-268. doi:10.1016/S1470-2045(17)30011-6.
Obi E, Tom MC, Manyam BV, et al. Outcomes with intraoperative radiation therapy for early-stage breast cancer. Breast J. 2020;26(3):454-457. doi:10.1111/tbj.13574.
König L, Lang K, Heil J, et al. Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients-First Clinical Results From a Single Center. Front Oncol. 2019;(9):384-394. doi:10.3389/fonc.2019.00384.
Брянцева Ж.В., Акулова И.А., Новиков С.Н. и др. Внутритканевая брахитерапия источниками высокой мощности дозы в лечении больных раком молочной железы. Онкологический журнал: лучевая диагностика, лучевая терапия. 2019;2(4):26-34 [Bryantseva ZV, Akulova IA, Novikov SN, et al. High dose rate brachytherapy in treatment of breast cancer patients. Journal of oncology: diagnostic radiology and radiotherapy. 2019;2(4):26-34 (In Russ.)]. doi:10.37174/2587-7593-2019-2-4-26-34.
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