Twenty years of evolution in breast cancer intraoperative radiation therapy

• Published in: Physica medica 2013-06, Vol.29, p.e33-e33
• Main Authors: Pastant, A, Fenoglietto, P, Aillères, N, Lemanski, C, Gutovski, M, Dubois, J.B, Azria, D
• Format: Article
• Language: English
• Subjects: Radiology
• ISSN: 1120-1797; 1724-191X
• DOI: 10.1016/j.ejmp.2013.08.105

Introduction Since the first breast cancer Intraoperative Radiation Therapy treatment in October 1992 performed in our institution, this technique never stopped to evolve. Until 2011 a linear accelerator delivering high energy electron beam was used to treat approximately 130 patients. The first treatments with INTRABEAM® system (Carl Zeiss SAS) using low energy X-rays were performed in October 2011. Materials and methods Nighty-four patients have now been treated with INTRABEAM® . For each, the radiation dose required was 20 Gy to the surface of the surgical margin in a single fraction. The Intrabeam® system produces low energy photons from a 50 kV and 40 μA source while preceding irradiation technique used electrons energy of 6 or 9 MeV. The isotropy of the low energy photon beam and the dose rate were measured before each treatment. Sterile applicators with variable diameters from 3 to 5 cm are selected to exactly fit the surgical cavity, thus allowing a homogeneous spherical irradiation. Results With INTRABEAM® , the dose attenuation is rapid (5 Gy at 1 cm from the applicator surface), thereby reducing damage to surrounding healthy tissue. The mobile X-ray source is installed in one of two operating ambulatory surgery and does not require as before the immobilization of a radiotherapy bunker. The time needed to deliver the dose was between 20 and 53 min and depends on the size of the applicator. The total time needed for the room and the staff for the dose delivery step is not more important with Intrabeam® system as before. Conclusion The shift from breast intraoperative radiotherapy using a linear accelerator to Intrabeam® was realized with no major problems in our institution. Using this new system has improved the workflow of radiotherapy and surgery, and thus increases the number of patients that can benefit from this technique.