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
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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)