Acute toxicity of intraoperative radiotherapy and external beam-accelerated partial breast irradiation in elderly breast cancer patients

• Published in: Breast cancer research and treatment 2018-06, Vol.169 (3), p.549-559
• Main Authors: Jacobs, D. H. M., Speijer, G., Petoukhova, A. L., Roeloffzen, E. M. A., Straver, M., Marinelli, A., Fisscher, U., Zwanenburg, A. G., Merkus, J., Marijnen, C. A. M., Mast, M. E., Koper, P. C. M.
• Format: Article
• Language: English
• Subjects: Acute toxicity; Age Factors; Aged; Aged, 80 and over; Analysis; Brachytherapy; Brachytherapy - adverse effects; Brachytherapy - methods; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer patients; Cancer research; Care and treatment; Clinical Trial; Elderly patients; Electrons; Fatigue; Female; Follow-Up Studies; Geriatrics; Humans; Intraoperative Care - methods; Lumpectomy; Mastectomy; Mastectomy, Segmental; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Pain; Patient Reported Outcome Measures; Radiation; Radiation therapy; Radiotherapy, Adjuvant; Surgery; Toxicity; Treatment Outcome; Tumors
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-018-4712-3

Background and purpose We investigated the acute toxicity of accelerated partial breast irradiation using external beam (EB-APBI) or intraoperative radiotherapy (IORT) techniques in elderly breast cancer patients. Materials and methods Women ≥ 60 years with unifocal breast tumors of ≤ 30 mm were eligible for this prospective multi-center cohort study. IORT was applied with electrons following lumpectomy (23.3 Gy). EB-APBI was delivered using 3D-CRT or IMRT in 10 daily fractions of 3.85 Gy within 6 weeks after surgery. Acute toxicity was scored using the CTCAE v3.0 at 3 months after treatment. Patient-reported symptoms were analyzed using visual analogue scales (VAS) for pain and fatigue (scale 0–10), and single items from the EORTC QLQ-C30 and Breast Cancer questionnaires. Results In total, 267 (IORT) and 206 (EB-APBI) patients were available for toxicity analysis. More patients experienced ≥ grade 2 CTCAE acute toxicity in the IORT group (10.4% IORT and 4.9% EB-APBI; p  = 0.03); grade 3 toxicity was low (3.3% IORT and 1.5% EB-APBI; ns); and no grade 4 toxicity occurred. EB-APBI patients experienced less fatigue direct postoperatively (EORTC p