IORT in Breast Cancer Patients

Introduction and Aim: Partial Breast Irradiation (PBI) is an alternative to Whole Breast Irradiation (WBI) used in the treatment of women with early breast cancer. The purposeof this study was to determine the pathological features and outcome of breast cancer patients, treated with IORT. Methods: We retrospectively analyzed the medical records of 71 women with early-stage breast cancer who underwent intraoperative irradiation during breast conserving surgery (BCS) referred to Breast Diseases Research Center affiliated to Shiraz University of Medical Sciences from May 2014 to September 2016. Clinicopathological features and outcome were assessed. SPSS 15.0 statistical software was used for analysis. Results: Mean patient age was 58 years (47-76 years). Mean size of tumor was 1.51 cm. Core Needle Biopsy was performed in 61 (85.9%) and open biopsy was done in 10 (14.08%). Surgical treatment for all patients was breast conservation. Sentinel lymph node biopsy (SLNB) was performed in 68 (97.1%) cases and one patient underwent SLNB and AND. Patients received one dose of 1200 CGY as radical radiation to the tumor bed during surgery. Three cases were bilateral breast cancer (treated with quadranetectomy and SLNB). The pathological report from these patients showed 90% invasive ductal carcinoma. Five cases had lymph node micrometastasis and four cases had lymph node metastasis with 2-7 mm involvement. Lymphovascular invasion was detected in 22/71 patients (37.3%). We identified 60(95%) patients with ER or PR positive tumors. Of 71 subjects, 49(84.5%) were HER-2 negative. The mean follow-up period of patients was 15 months. 50/71(78.1%) and 14/71(21.9%) patients classified in stage I and II, respectively. Complications: There was no surgical site infection in breast or axillary wound. Two patients developed ipsilateral pneumothorax without underlying disease which surgical intervention and thoracostomy tube insertion for eliminating of pneumothorax was performed. The rate of seroma formation was significant in site of quadrantectomy of the initial cases who treated with IORT then after closed drain was inserted for cases with large cavity residue for 24 hours (33 cases). All patients were alive and without local recurrence.Conclusion: IORT in early-stage breast cancers is safe, although it is associated with postoperative adverse events such as seroma. Postoperative complications of IORT are acceptable but it should be mentioned to women during the preoperative counseling