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Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure

Published online by Cambridge University Press:  31 August 2018

Hamid Reza Baghani ,
Hajar Moradmand  and
Seyed Mahmoud Reza Aghamiri
Hamid Reza Baghani
Affiliation:
Physics Department, Hakim Sabzevari University, Sabzevar, Iran
Hajar Moradmand
Affiliation:
Radiation Medicine Department, Shahid Beheshti University, Tehran, Iran
Seyed Mahmoud Reza Aghamiri
Affiliation:
Physics Department, Hakim Sabzevari University, Sabzevar, Iran
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Abstract

Background

Breast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied.

Materials and Methods

A computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles.

Results

IORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT.

Conclusion

Although the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.

Keywords

breast cancerclinical outcomesintraoperative radiotherapytreatment modalities
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 1 , March 2019 , pp. 98 - 106
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Baghani HR, Moradmand H, Aghamiri SMR. (2019) Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure. Journal of Radiotherapy in Practice18: 98–106. doi: 10.1017/S146039691800033X

References

1. Onitilo, A A, Engel, J M, Stankowski, R V, Suhail, A R. Survival comparisons for breast conserving surgery and mastectomy revisited: community experience and the role of radiation therapy. Clin Med Res 2015; 13: 65–73.Google Scholar
2. Veronesi, U, Marubini, E, Mariani, L et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 2001; 12: 997–1003.Google Scholar
3. Owen, J R, Ashton, A, Bliss, J M et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol 2006; 7: 467–471.Google Scholar
4. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby, S, McGale, P, Correa, C et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10801 women in 17 randomised trials. Lancet 2011; 378: 1707–1716.Google Scholar
5. Bitter, S M, Heffron-Cartwright, P, Wennerstrom, C, Weatherford, J, Einstein, D, Keiler, L C. WBRT vs. APBI: an interim report of patient satisfaction and outcomes. J Contemp Brachytherapy 2016; 8: 17–22.Google Scholar
6. Njeh, C F, Saunders, M W, Langton, C M. Accelerated partial breast irradiation (APBI): a review of available techniques. Radiat Oncol 2010; 5: 1–28.Google Scholar
7. Ivanov, O, Dickler, A, Lum, B Y, Pellicane, J V, Francescatti, D S. Twelve month follow-up results of a trial utilizing Axxent electronic brachytherapy to deliver intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol 2011; 18: 453–458.Google Scholar
8. Reitsamer, R, Sedlmayer, F, Kopp, M et al. Concepts and techniques of intraoperative radiotherapy (IORT) for breast cancer. Breast Cancer 2008; 15: 40–46.Google Scholar
9. Gunderson, L L, Calvo, F A, Willet, C G. Rationale and historical perspective of Intraoperative irradiation. In Gunderson L L, Willett C G, Harrison L B (eds) Intraoperative irradiation: techniques and results. New York: Humana Press, 2011: 3–26.Google Scholar
10. Silverstein, M J, Fastner, G, Maluta, S et al. Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 1—ELIOT. Ann Surg Oncol 2014; 21: 3787–3792.Google Scholar
11. Esposito, E, Anninga, B, Harris, S et al. Intraoperative radiotherapy in early breast cancer. Br J Surg 2015; 102: 599–610.Google Scholar
12. Beck, C. On external roentgen treatment of internal structures (eventration treatment). NY Med J 1919; 89: 621–622.Google Scholar
13. Abe, M, Fukuda, M, Yamano, K, Matsuda, S, Handa, H. Intra-operative irradiation in abdominal and cerebral tumours. Acta Radiol Ther Phys Bio 1971; 10: 408–416.Google Scholar
14. Trifiletti, D M, Jones, R, Showalter, S L et al. Techniques for intraoperative radiation therapy for early-stage breast carcinoma. Future Oncol 2015; 11: 1047–1058.Google Scholar
15. Kraus-Tiefenbacher, U, Bauer, L, Scheda, A et al. Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy. BMC Cancer 2007; 7: 1–7.Google Scholar
16. Hanna, G G, Kirby, A M. Intraoperative radiotherapy in early stage breast cancer: potential indications and evidence to date. Br J Radiol 2015; 88: 1–9.Google Scholar
17. Beddar, A S, Biggs, P J, Chang, S et al. Intraoperative radiation therapy using mobile electron linear accelerators: report of AAPM Radiation Therapy Committee Task Group No. 72. Med Phys 2006; 33: 1476–1489.Google Scholar
18. Baghani, H R, Aghamiri, S M R, Mahdavi, S R et al. Dosimetric evaluation of Gafchromic EBT2 film for breast intraoperative electron radiotherapy verification. Phys Medica 2015; 31: 37–42.Google Scholar
19. Reitsamer, R, Sedlmayer, F, Kopp, M et al. The Salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations. Int J Cancer 2006; 118: 2882–2887.Google Scholar
20. Biggs, P, Willett, C G, Rutten, H, Ciocca, M, Gunderson, L L, Calvo, F A. Intraoperative electron beam irradiation: physics and techniques. In Gunderson L L, Willett C G, Harrison L B (eds) Intraoperative irradiation: techniques and results. New York: Humana Press, Springer, 2011: 51–72.Google Scholar
21. Keshtgar, M, Wenz, F. Targeted intraoperative radiotherapy: concept and review of evidence in breast cancer. In Keshtgar M, Pigott K, Wenz F (eds) Targeted intraoperative radiotherapy in oncology. Berlin: Springer-Verlag, 2014: 1–6.Google Scholar
22. Schneider, F, Clausen, S, Thölking, J, Wenz, F, Abo-Madyan, Y. A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report. J Appl Clin Med Phys 2014; 15: 4502.Google Scholar
23. Schneider, F, Fuchs, H, Lorenz, F et al. A novel device for intravaginal electronic brachytherapy. Int J Radiat Oncol Biol Phys 2009; 74: 1298–1305.Google Scholar
24. Vaidya, J S, Tobias, J S, Baum, M et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol 2004; 5: 165–173.Google Scholar
25. Vaidya, J S. APBI with 50 kV Photons: Targeted Intraoperative Radiotherapy (TARGIT). In Wazer D E, Arthur D W, Vicini F (eds) Accelerated partial breast irradiation. Berlin: Springer-Verlag, 2009: 327–343.Google Scholar
26. Herskind, C, Steil, V, Kraus-Tiefenbacher, U, Wenz, F. Radiobiological aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X rays for early-stage breast cancer. Radiat Res 2005; 163: 208–215.Google Scholar
27. Deneve, L J, Hoefer, R A, Harris, E R, Laronga, C. Accelerated partial breast irradiation: A review and description of an early North American surgical experience with the INTRABEAM delivery system. Cancer Control 2012; 19: 295–308.Google Scholar
28. Vaidya, J S, 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: 603–613.Google Scholar
29. Melhus, C S, Rivard, M J, Narth, R. Special brachytherapy modalities. In Venselaar J, Meigooni A S, Baltas D, Hoskin P J (eds) Comprehensive brachytherapy: physical and clinical aspects (imaging in medical diagnosis and therapy. USA: CRC Press, Taylor & Francis, 2012: 397–409.Google Scholar
30. Park, C C, Yom, S S, Podgorsak, M B et al. Electronic brachytherapy working group. American society for therapeutic radiology and oncology (ASTRO) emerging technology committee report on electronic brachytherapy. Int J Radiat Oncol Biol Phys 2010; 76: 963–972.Google Scholar
31. Klepczyk, L C, Keene, K S, De Los Santos, J F. Accelerated partial breast irradiation for early-stage breast cancer: controversies and current indications for use. Curr Treat Options Oncol 2013; 14: 51–65.Google Scholar
32. Dooley, W C, Wurzer, J C, Megahy, M et al. Electronic brachytherapy as adjuvant therapy for early stage breast cancer: a retrospective analysis. Onco Targets Ther 2011; 4: 13–20.Google Scholar
33. Skowronek, J, Hojczyk, M W, Ambrochowicz, K. Brachytherapy in accelerated partial breast irradiation (APBI) – review of treatment methods. J Contemp Brachytherapy 2012; 4: 152–164.Google Scholar
34. Dickler, A, Patel, R R, Wazer, D. Breast brachytherapy devices. Expert Rev Med Devices 2009; 6: 325–333.Google Scholar
35. Mehta, V K, Algan, O, Griem, K L et al. Experience with an electronic brachytherapy technique for intracavitary accelerated partial breast irradiation. Am J Clin Oncol 2010; 33: 327–335.Google Scholar
36. Hepel, J T, Hiatt, J R, Cardarelli, G A, Wazer, D E. Modeling study for optimization of skin dose for partial breast irradiation using Xoft/Axxent electronic brachytherapy applicator. Brachytherapy 2010; 9: 81–85.Google Scholar
37. Orecchia, R, Ciocca, M, Lazzari, R et al. Intraoperative radiation therapy with electrons (ELIOT) in early-stage breast cancer. Breast 2003; 12: 483–490.Google Scholar
38. Mills, M D, Fajardo, L C, Wilson, D L, Daves, J L, Spanos, W J. Commissioning of a mobile electron accelerator for intraoperative radiotherapy. J Appl Clin Med Phys 2001; 2: 121–130.Google Scholar
39. Beddar, A S. Stability of a mobile electron linear accelerator system for intraoperative radiation therapy. Med Phys 2005; 32: 3128–3131.Google Scholar
40. Ronsivalle, C, Picardi, L, Iacoboni, V et al. Technical features and experimental characterization of the IORT-1 system, a new IORT dedicated accelerator. Nucl Instrum methods A 2006; 562: 1042–1045.Google Scholar
41. Hosseini Aghdam, M R, Baghani, H R, Mahdavi, S R, Aghamiri, S M R, Akbari, M E. Monte Carlo study on effective source to surface distance for electron beams from a mobile dedicated IORT accelerator. J Radiother Pract 2017; 16: 29–37.Google Scholar
42. Robatjazi, M, Mahdavi, S R, Takavar, A, Baghani, H R. Application of Gafchromic EBT2 film for intraoperative radiation therapy quality assurance. Phys Medica 2015; 31: 314–319.Google Scholar
43. Baghani, H R, Aghamiri, S M R, Mahdavi, S R, Akbari, M E, Mirzaei, H R. Comparing the dosimetric characteristics of the electron beam from dedicated intraoperative and conventional radiotherapy accelerators. J Appl Clin Med Phys 2015; 16: 1–11.Google Scholar
44. Heidarloo, N, Baghani, H R, Aghamiri, S M R, Mahdavi, S R. Evaluating the photon contamination of beam shaper applicator using Monte Carlo simulation. J Mazandaran Univ Med Sci 2017; 26: 212–217.Google Scholar
45. Heidarloo, N, Baghani, H R, Aghamiri, S M R, Mahdavi, S R, Akbari, M E. Commissioning of beam shaper applicator for conformal intraoperative electron radiotherapy. Appl Radiat Isot 2017; 123: 69–81.Google Scholar
46. Rocco, N, Rispoli, C, Iannone, L et al. Intraoperative radiation therapy with electrons in breast cancer conservative treatment: Our experience. Int J Surg 2014; 12: S75–S78.Google Scholar
47. Beddar, A, Krishnan, S. Intraoperative radiotherapy using a mobile electron Linac: A retroperitoneal sarcoma case. J Appl Clin Med Phys 2005; 6: 95–107.Google Scholar
48. Robatjazi, M, Baghani, H R, Mahdavi, S R, Felici, G. Evaluation of dosimetric properties of shielding disk used in intraoperative electron radiotherapy: A Monte Carlo study. Appl Radiat Isot 2018; 139: 107–113.Google Scholar
49. Forouzannia, A, Harness, J K, Carpenter, M M et al. Intra-operative electron radiotherapy (IOERT) boost as a component of adjuvant radiation for breast cancer in the community setting. Am Surg 2012; 78: 1071–1074.Google Scholar
50. Fastner, G, Sedlmayer, F, Merz, F et al. IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: long term results of an ISIORT pooled analysis. Radiother Oncol 2013; 108: 279–286.Google Scholar
51. Veronesi, U, Orecchia, R, Maisonneuve, P et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013; 14: 1269–1277.Google Scholar
52. Rahimzade Yekta, Z, Mahdavi, S R, Baghani, H R et al. In vivo dosimetry using radiochromic films (EBT-2) during intraoperative radiotherapy. J Radiother Pract 2016; 15: 378–384.Google Scholar
53. Esposito, E, Anninga, B, Honey, I et al. Is IORT ready for roll-out? Ecancermedicalscience 2015; 9: 1–8.Google Scholar
54. Silverstein, M J, Fastner, G, Maluta, S et al. Intraoperative radiation therapy: a critical analysis of the ELIOT and TARGIT trials. Part 2—TARGIT. Ann Surg Oncol 2014; 21: 3793–3799.Google Scholar