10.1245/s10434-006-9152-3
Annals of Surgical Oncology 14:1515-1516 (2007)
© 2007 Society of Surgical Oncology
In Vivo Intraoperative Radiotherapy: A Novel Approach to Radiotherapy for Early Stage Breast Cancer
Karyn B. Stitzenberg,
Nancy Klauber-Demore,
Xiao Sha Chang,
Benjamin F. Calvo,
David W. Ollila,
Lav K. Goyal,
Michael O. Meyers,
Hong Jin Kim,
Joel E. Tepper and
Carolyn I. Sartor
Departments of Surgery and Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
Correspondence: Address correspondence and reprint requests to: Karyn B. Stitzenberg; E-mail: stitz{at}email.unc.edu
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ABSTRACT
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Introduction: Intraoperative radiotherapy (IORT) has the potential to eliminate the access problems associated with standard 6-week post-operative external beam radiotherapy for patients with breast cancer. However, accurate delivery of the IORT dose for breast cancer has been problematic due to difficulty estimating the tumor bed after tumor removal and tissue reapproximation. We are investigating the feasibility of partial breast irradiation using a single fraction of IORT delivered to the tumor in vivo prior to surgical resection.
Methods: In a trial, approved by the University of North Carolina School of Medicine Institutional Review Board, patients 
55 years old with infiltrating ductal carcinoma without an extensive intraductal component with an overall tumor size 
3.0 cm receive a single dose of IORT in place of standard post-operative radiotherapy.
Results: All patients undergo preoperative ultrasonography to define the target volume. In a standard operating room, the tumor is exposed through a standard partial mastectomy incision. IORT is then delivered using a mobile, self-shielded, magnetron-driven X-band linear accelerator (Intraop Corp, Santa Clara, CA, USA). 15 Gy is delivered to the 90% isodose line covering the tumor with a 1 cm margin anterior–posterior and 2 cm margins laterally. After IORT, partial mastectomy is performed in the usual manner.
Conclusions: IORT for breast cancer, delivered to the exposed tumor in vivo, is feasible and allows accurate estimation of the tumor bed. Further follow-up is ongoing to determine the efficacy of this approach.
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ELECTRONIC SUPPLEMENTARY MATERIAL
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Below is the link to the electronic supplementary material. Video File (MPG 97630576 kb)
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FOOTNOTES
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Supplementary material is available in the online version of this article at http://dx.doi.org/10.1245/s10434-006-9152-3 and is accessible for authorized users.
Received for publication August 8, 2005.
Accepted for publication January 4, 2006.
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REFERENCES
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- Athas WF, Adams-Cameron M, Hunt WC, Amir-Fazli A, Key CR. Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst 2000; 92(3):269–71.[Free Full Text]
- Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 1996; 88(11):716–26.[Abstract/Free Full Text]
- Dirbas FM, Jeffrey SS, Goffinet DR. The evolution of accelerated, partial breast irradiation as a potential treatment option for women with newly diagnosed breast cancer considering breast conservation. Cancer Biother Radiopharm 2004; 19(6):673–5.[CrossRef][Medline]
- Mandelblatt JS, Hadley J, Kerner JF, Schulman KA, Gold K, Dunmore-Griffith J, Edge S, Guadagnoli E, Lynch JJ, Meropol NJ, Weeks JC, Winn R. Patterns of breast carcinoma treatment in older women: patient preference and clinical and physical influences. Cancer 2000; 89(3):561–73.[CrossRef][Medline]
- Morrow M, White J, Moughan J, Owen J, Pajack T, Sylvester J, Wilson JF, Winchester D. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol 2001; 19(8):2254–62.[Abstract/Free Full Text]
- Nattinger AB, Hoffmann RG, Kneusel RT, Schapira MM. Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery. Lancet 2000; 356(9236):1148–53.[CrossRef][Medline]
- Nattinger AB, Kneusel RT, Hoffmann RG, Gilligan MA. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst 2001; 93(17):1344–6.[Free Full Text]
- Vaidya JS, Tobias JS, Baum M, Wenz F, Kraus-Tiefenbacher U, D’Souza D, Keshtgar M, Massarut S, Hilaris B, Saunders C, Joseph D. TARGeted intraoperative radiotherapy (TAR-GIT): an innovative approach to partial-breast irradiation. Semin Radiat Oncol 2005; 15(2):84–91.[CrossRef][Medline]
- Veronesi U, Gatti G, Luini A, Intra M, Orecchia R, Borgen P, Zelefsky M, McCormick B, Sacchini V. Intraoperative radiation therapy for breast cancer: technical notes. Breast J 2003; 9(2):106–12.[CrossRef][Medline]
- Veronesi U, Orecchia R, Luini A, Galimberti V, Gatti G, Intra M, Veronesi P, Leonardi MC, Ciocca M, Lazzari R, Caldarella P, Simsek S, Silva LS, Sances D. Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg 2005; 242(1):101–6.[CrossRef][Medline]
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