Exclusive intraoperative radiotherapy for invasive breast cancer in elderly patients (>70 years): proportion of eligible patients and local recurrence-free survival

BMC Surgery, Nov 2016

Background To estimate the proportion of elderly patients (>70 years) with breast cancer eligible for an Exclusive IntraOperative RadioTherapy (E-IORT) and to evaluate their local recurrence-free survival rate. Methods This retrospective study examining two cohorts focuses on patients over 70 years old: a multi-centric cohort of 1411 elderly patients and a mono-centric cohort of 592 elderly patients. All patients underwent conservative surgery followed by external radiotherapy for T0-T3 N0-N1 invasive breast cancer, between 1980 and 2008. Results Within each cohort two groups were identified according to the inclusion criteria of the RIOP trial (R group) and TARGIT E study (T group). Each group was divided into two sub-groups, patients eligible (E) or non-eligible (nE) for IORT. The population of patients that were eligible in the TARGIT E study but not in the RIOP trial were also studied in both cohorts. The proportion of patients eligible for IORT was calculated, according to the eligibility criteria of each study. A comparison of the 5-year local or locoregional recurrence-free survival rate between eligible vs non-eligible patients was made. In both cohorts, the proportion of patients eligible according to the RIOP trial’s eligibility criteria was 35.4 and 19.3%, and according to the TARGIT E study criteria was 60.9 and 45.3%. The 5-year locoregional recurrence-free survival rate was not significantly different between RE and RnE groups, TE and TnE groups. In both cohorts RE and (TE-RE) groups were not significantly different. Conclusions Our results encourage further necessary studies to define and to extend the eligibility criteria for per operative exclusive radiotherapy.

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Exclusive intraoperative radiotherapy for invasive breast cancer in elderly patients (>70 years): proportion of eligible patients and local recurrence-free survival

Lambaudie et al. BMC Surgery Exclusive intraoperative radiotherapy for invasive breast cancer in elderly patients (>70 years): proportion of eligible patients and local recurrence-free survival Eric Lambaudie 1 3 10 Gilles Houvenaeghel 1 3 10 Amira Ziouèche 1 3 10 Sophie Knight 1 3 François Dravet 0 Jean Remy Garbay 7 Sylvie Giard 6 Hélène Charitansky 5 Monique Cohen 1 3 10 Christelle Faure 4 Delphine Hudry 9 Paul Azuar 8 Richard Villet 2 Pierre Gimbergues 11 Christine Tunon de Lara 12 Agnès Tallet 1 3 10 Marie Bannier 1 3 10 Mathieu Minsat 1 3 10 Michel Resbeut 1 3 10 0 Institut René Gauducheau , Nantes , France 1 CRCM , Marseille , France 2 Hôpital des Diaconesses , Paris , France 3 Institut Paoli Calmettes , 232 Boulevard de Sainte-Marguerite, 13009 Marseille , France 4 Centre Léon Bérard , Lyon , France 5 Centre Claudius Regaud , Toulouse , France 6 Centre Oscar Lambret , Lille , France 7 Institut Gustave Roussy , Villejuif , France 8 Hôpital de Grasse , Grasse , France 9 Centre Georges François Leclerc , Dijon , France 10 Aix Marseille Université , Marseille , France 11 Centre Jean Perrin , Clermont Ferrand , France 12 Institut Bergonié , Bordeaux , France Background: To estimate the proportion of elderly patients (>70 years) with breast cancer eligible for an Exclusive IntraOperative RadioTherapy (E-IORT) and to evaluate their local recurrence-free survival rate. Methods: This retrospective study examining two cohorts focuses on patients over 70 years old: a multi-centric cohort of 1411 elderly patients and a mono-centric cohort of 592 elderly patients. All patients underwent conservative surgery followed by external radiotherapy for T0-T3 N0-N1 invasive breast cancer, between 1980 and 2008. Results: Within each cohort two groups were identified according to the inclusion criteria of the RIOP trial (R group) and TARGIT E study (T group). Each group was divided into two sub-groups, patients eligible (E) or non-eligible (nE) for IORT. The population of patients that were eligible in the TARGIT E study but not in the RIOP trial were also studied in both cohorts. The proportion of patients eligible for IORT was calculated, according to the eligibility criteria of each study. A comparison of the 5-year local or locoregional recurrence-free survival rate between eligible vs non-eligible patients was made. In both cohorts, the proportion of patients eligible according to the RIOP trial's eligibility criteria was 35.4 and 19.3%, and according to the TARGIT E study criteria was 60.9 and 45.3%. The 5-year locoregional recurrence-free survival rate was not significantly different between RE and RnE groups, TE and TnE groups. In both cohorts RE and (TE-RE) groups were not significantly different. Conclusions: Our results encourage further necessary studies to define and to extend the eligibility criteria for per operative exclusive radiotherapy. Breast cancer; Elderly patients; Intraoperative radiotherapy - Summary The objective of this retrospective study was to estimate, in a cohort of 12,025 patients managed conventionally, the proportion of elderly patients (>70 years) eligible for exclusive intra-operative radiotherapy (IORT) and to evaluate local recurrence-free survival rates. The results of this study suggest that up to 50% of patients presenting with a cN0, T0-2 tumor could be eligible for exclusive IORT with expected 7-year local recurrence-free survival rates ranging from 93 to 96%. These results suggest the possible extension of the eligibility criteria for intra-operative exclusive radiotherapy. Background Breast cancer has become the most frequent cancer in both “developed” and “developing” countries (http://globocan.iarc.fr/). Its management represents a major concern for public health at therapeutic and economic levels. Moreover, robust publications have shown that in the case of conservative surgery for an invasive cancer, adjuvant whole-breast irradiation in association with a boost to the tumor bed significantly increases recurrence-free survival, without any difference compared to total mastectomy in terms of overall survival [1]. However, almost 90% of recurrences in the breast are located in the same quadrant [2]. Based on this clinical information, and with the aim of facilitating access to radiotherapy, partial breast irradiation techniques have been developed over the past 20 years; using brachytherapy, external radiotherapy and intraoperative radiotherapy. Organized screening combined with these modern therapeutic approaches enable a less radical and invasive management of patients. As suggested by the results of the Targit A trial, targeted intraoperative radiotherapy appears to be as safe as whole-breast external beam radiotherapy when the radiotherapy is delivered at the time of lumpectomy in selected patients [3]. The potential medico-economic impact must be considered in order to encourage the development of this technique as a second objective. In France, the (...truncated)


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Eric Lambaudie, Gilles Houvenaeghel, Amira Ziouèche, Sophie Knight, François Dravet, Jean Garbay, Sylvie Giard, Hélène Charitansky, Monique Cohen, Christelle Faure, Delphine Hudry, Paul Azuar, Richard Villet, Pierre Gimbergues, Christine de Lara, Agnès Tallet, Marie Bannier, Mathieu Minsat, Michel Resbeut. Exclusive intraoperative radiotherapy for invasive breast cancer in elderly patients (>70 years): proportion of eligible patients and local recurrence-free survival, BMC Surgery, 2016, pp. 74, 16, DOI: 10.1186/s12893-016-0191-9