The Salzburg concept of intraoperative radiotherapy for breast cancer: Results and considerations

Authors

  • Roland Reitsamer,

    Corresponding author
    1. Breast Center Salzburg, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria
    • Breast Center Salzburg, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
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    • Fax: +43-662-4482-2572

  • Felix Sedlmayer,

    1. Department of Radiotherapy and Radiooncology, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria
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  • Michael Kopp,

    1. Department of Radiotherapy and Radiooncology, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria
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  • Gerhard Kametriser,

    1. Department of Radiotherapy and Radiooncology, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria
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  • Christian Menzel,

    1. Breast Center Salzburg, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria
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  • Heinz Deutschmann,

    1. Department of Radiotherapy and Radiooncology, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria
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  • Olaf Nairz,

    1. Department of Radiotherapy and Radiooncology, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Salzburg, Austria
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  • Wolfgang Hitzl,

    1. Research Office, Biostatistics, Paracelsus Private Medical School Salzburg, Salzburg, Austria
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  • Florentia Peintinger

    1. Department of Gynecology, General Hospital Leoben, Leoben, Austria
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Abstract

Aim of this study is to show that ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery can be reduced by proper surgery and modern radiotherapy techniques. Three hundred and seventy eight women with stage I or II breast cancer had breast conserving surgery and received 51–56.1 Gy of postoperative radiation to the whole breast in 1.7 Gy fractions, but patients received different boost strategies. Group 1 (n = 188) received electron boost radiation of 12 Gy subsequent to the irradiation to the whole breast, group 2 (n = 190) received intraoperative electron boost radiation of 9 Gy directly to the tumor bed, followed by whole breast irradiation. After a median follow up period of 81.0 months in group 1 and a median follow up period of 51.1 months in group 2, 12 IBTRs (6.4%) could be observed in group 1 and no IBTR could be observed in group 2 (0.0%). The 5-year actuarial rates of IBTR were 4.3% (95% CI, 1.9–8.3%) and 0.0% (95% CI, 0.0–1.9%), respectively (p = 0.0018). The 5-year actuarial rates of distant recurrence were 8.6% (95% CI, 4.9–13.5%) and 4.2% (95% CI, 1.8–8.2%), respectively (p = 0.08). The 5 year disease-free survival rates were 90.9% (95% CI, 85.8–94.7%) in group 1 and 95.8% (95% CI, 91.8–98.2%) in group 2 (p = 0.064). Immediate IORT-boost and whole breast irradiation yields excellent local control at 5 years, and was associated with a statistically significant decreased rate of IBTR compared with a similar cohort of patients treated with whole breast irradiation and conventional electron boost. © 2005 Wiley-Liss, Inc.

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