Outcomes of selective whole breast irradiation following lumpectomy with intraoperative radiation therapy for hormone receptor positive breast cancer

• Published in: The American journal of surgery Vol. 218; no. 4; pp. 749 - 754
• Main Authors: Broman, Kristy, Sun, Weihong, Zhou, Jun-min, Fridley, Brooke, Diaz, Roberto, Laronga, Christine
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2019; Elsevier Limited
• Subjects: Adult; Aged; Background radiation; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer therapies; Carcinoma - pathology; Carcinoma - radiotherapy; Carcinoma - surgery; Criteria; Endocrine therapy; Female; Health risks; Humans; Irradiation; Lumpectomy; Lymphatic system; Mastectomy; Mastectomy, Segmental; Menopause; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Pathology; Patient Selection; Patients; Radiation; Radiation therapy; Radiotherapy, Adjuvant; Retrospective Studies; Risk; Surgery; Treatment Outcome
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.07.011

For low risk breast cancer, the TARGIT-A randomized trial supported lumpectomy with intraoperative radiation therapy (IORT) and selective whole breast radiation (WBXRT). Selection criteria for WBXRT vary. Women with hormone-receptor positive, clinically node-negative breast cancer were categorized retrospectively as suitable for IORT alone or also needing WBXRT by TARGIT-A or expanded TARGIT criteria (TARGIT-MCC). We evaluated local recurrence (LR) by selection criteria and receipt of WBXRT. Among 194 cases followed a median of 44 months, 54 (27.8%) met TARGIT-MCC criteria for WBXRT (34 met TARGIT-A criteria). Thirty patients were recommended and 21 (10.8%) received WBXRT. Of 13 patients with LR, none received WBXRT. LR was 10.5% in patients meeting TARGIT-MCC criteria who did not receive WBXRT versus 0% after WBXRT (p = 0.299). Selective WBXRT may have mitigated LR. Nearly all LR were in patients not recommended WBXRT. Further work should refine criteria for WBXRT after IORT. Prior work among women with early breast cancer supported lumpectomy with intraoperative radiation therapy and selective adjuvant radiation using a risk-adapted approach. An expanded set of criteria for adjuvant radiation appear to further mitigate local recurrence risk. Local recurrence after lumpectomy with IORT could be further minimized by identification of additional high-risk features, as well as greater adherence to adjuvant endocrine therapy. •Breast conserving surgery includes lumpectomy and whole breast radiation (WBXRT).•Intraoperative radiation (IORT) is an evidence-based alternative to adjuvant WBXRT.•Select patients should still undergo WBXRT after IORT based on high risk pathology.•Expanded selection criteria for WBXRT after IORT may improve local recurrence rates, but are insufficient.•Adjuvant endocrine therapy decreases local recurrence after lumpectomy/IORT with selective WBXRT.