Intraoperative boost radiation effects on early wound complications in breast cancer patients undergoing breast-conserving surgery

Intraoperative boost radiation effects on early wound complications in breast cancer patients undergoing breast-conserving surgery

Background/aim: Intraoperative radiation therapy (IORT) may pose a risk for wound complications. All technical aspects of IORT regarding early wound complications were evaluated. Materials and methods: Ninety-three consecutive patients operated on with the same surgical technique and given (study group) or not given (control group) IORT were included. Wound complications were evaluated in two groups. Results: Forty-three patients were treated with boost dose IORT and 50 patients were treated with breast-conserving surgery without IORT. When both groups were compared in terms of early postoperative complications, there were 11 (25.5%) patients with seroma in the IORT group and 3 patients (6%) in the control group (P = 0.04). While 9 (21%) patients were seen to have surgical site infection (SSI) in the IORT group, there was 1 (2%) SSI in the control group (P = 0.005). There were 15 (35%) patients with delayed wound healing in the IORT group and 4 patients (8%) in the control group (P = 0.006). Conclusion: IORT could have a negative effect on seroma formation, SSI, and delayed healing. It should be kept in mind, however, that in centers with IORT implementation, the complication rate could also increase. Necessary measures for better sterilization in the operating room should be taken, while patient wound healing should be monitored closely

___

  • 1. Fidaner C, Eser SY, Parkin DM. Incidence in Izmir in 1993- 1994: first results from Izmir Cancer Registry. Eur J Cancer 2001; 37: 83-92.
  • 2. Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010; 376: 91-102.
  • 3. Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M. Risk adapted targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 2014; 383: 603-613.
  • 4. Veronesi U, Orecchia R, Luini A, Galimberti V, Zurrida S, Intra M, Veronesi P, Arnone P, Leonardi MC, Ciocca M et al. Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast Cancer Res Treat 2010; 124: 141-151.
  • 5. Veronesi U, Orecchia R, Maisonneuve P, Viale G, Rotmensz N, Sangalli C, Luini A, Veronesi P, Galimberti V, Zurrida S et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013; 14: 1269-1277.
  • 6. Deneve JL, Hoefer RA Jr, Harris EE, Laronga C. Accelerated partial breast irradiation: a review and description of an early North American surgical experience with the intrabeam delivery system. Cancer Control 2012; 19: 295-308.
  • 7. Orecchia R, Veronesi U. Intraoperative electrons. Semin Radiat Oncol 2005; 15: 76-83.
  • 8. Voagd AC, Nielsen M, Peterse JL. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 2001; 19: 1688-1697.
  • 9. Ruano-Ravina A, Cantero-Muñoz P, Eraso Urién A. Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review. Cancer Lett 2011; 313: 15-25.
  • 10. Senthi S, Link E, Chua BH. Cosmetic outcome and seroma formation after breast-conserving surgery with intraoperative radiation therapy boost for early breast cancer. Int J Radiat Oncol Biol Phys 2012; 84: 139-144.
  • 11. Zhou SF, Shi WF, Meng D, Sun CL, Jin JR, Zhao YT. Intraoperative radiotherapy of seventy-two cases of early breast cancer patients during breast-conserving surgery. Asian Pacific Journal of Cancer Prevention 2012; 13: 1131-1135.
  • 12. Belletti B, Vaidya JS, D’Andrea S, Entschladen F, Roncadin M, Lovat F, Berton S, Perin T, Candiani E, Reccanello S et al. Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res 2008; 14: 1325-1332.
  • 13. Baldassarre G, Belleti B, Vaidya JS. Intraoperative radiotherapy (IORT) impairs surgical wound-stimulated breast cancer cell invasion. J Clin Oncol 2007; 25: 211-239.
  • 14. Massarut S, Baldassare G, Belleti B. Intraoperative radiotherapy impairs breast cancer cell motility induced by surgical wound fluid. J Clin Oncol 2006; 24: 106-111.
  • 15. Mahmoud B, El-Tamer B, Marie W, Tracy S. Morbidity and mortality following breast cancer surgery in women national benchmarks for standards of care. Ann Surg 2007; 245: 665- 671.