Intraoperative

radiotherapy of the
breast with
INTRABEAM: initial
experience at our
center

Introduction
External RT after breast conservative
surgery is a STANDAR adjuvant
treatment
Reduces local recurrence
Increase the survival
Many session
Specific Center. High rate of abandoned
Oncoplastic surgery. Boost
Long term Complications. Cosmetic results

Introduction (2)
IORT
One session
At the tumor cavity (90% of recurrence)
Better cosmetic result

Introduction (3)
Our initial experience with the IORT,
using Intrabeam system

Materials and Methods

From January 2013 to February 2015, 120 patients
with breast cancer were pre-selected for IORT with
Intrabeam according TARGIT-A protocol
Indications

conservative surgery
older than 45 years
IDC of 3 cm or less in side
positive hormone receptor
negative axilla, either with USS or pathological
methods

Risk - adapted negative histologic

caractheristics at definitive histologic exam
adyuvant external breast radiotherapy

Materials and Methods (2)

Mortality
Complications
Irradiation toxicicity
Recurrence
Cosmetic result
Further treatment

Results

Results (2)

Results (3)

Average age : 64 years (range 46-86)

Average diameter of the applicator : 4 cm (2.5 to 5 cm)
Average operating time : 150 minutes

Results (4)
Reoperation for affected margins or indication
of lymphadenectomy
Re-lumpectomy (widening of the margins)
Mastectomy

Axillary lymphadenectomy

1
4
5
(6%)
1
(1%)

Adyuvant external radiotherapy*

Axillary metastasis
Re-lumpectomy (widening of the margins) and
axillary micrometastasis
* Breast and axilla. Only 1 case with mastectomy and axillary
micrometastasis in sentinel node received axillary radiotherapy alone

21
1
22
(26%
)

Results (5)
Complications
Seroma that required more than 3 attempts for
3 (4%)
resolution
Abscess-mastitis
6 (7%)
Hematoma (without surgical drainage)
2 (2%)
Partial wound dehiscence
2 (2%)
Chronic fistulae
1 (1%)
13
(15%)

Results (6)
Irradiation toxicity
No severe toxicity (grade 3-4)
Only 15 cases (17%) had acute moderate skin
toxicity (grade 2)
21 cases (24%) had mild-moderate chronic skin
induration

No distant/local recurrence,
recurrence no breast
cancer related mortality
Good /very good cosmetic results in 75
patients (87%)

Discussion
TARGIT A study randomized 3,451 patients with
initial breast cancer either to standard external beam
RT (EBRT) or to IORT (TARGIT)
Prepathology and postpathology cohort

Our experience
2/3 patients preselected received IORT
26% received external breast RT 74% completed all
loco-regional treatment at once!
Reoperation for affected margins 6% (7,1% TARGIT-A)
Complications 15% (11,5% TARGIT-A); relapsing
seroma 4%
Good cosmetics results. Zhou et al. Interoperative radiotherapy
of seventy-two cases Asian Pac J Cancer Prev. 2012;13(4):1131-5
90 % IORT group vs 75% EBRT

No mortality, no severe toxicity

Conclusion
IORT with Intrabeam is a safe and
well
tolerated
alternative
versus
external radiotherapy in selected
patients with short-term good cosmesis