Breast conservative surgery and whole breast radiotherapy vs breast conservative surgery and IORT: surgical opinion.

Abstract

BACKGROUND\nTo define the possibility of Intraoperative Radiation Therapy (IORT) s application on clinical practice and point out the problems observed by Verona Breast Unit.\n\n\nMETHODS\nAmong AOUI ( Azienda Ospedaliera Universitaria Integrata ) Verona Breast Unit s patients, treated between July 2015 and June 2017, were identified 459 patients undergoing breast conserving surgery for a carcinoma, followed by IORT in 77 cases or by Whole Breast Radiotherapy (WBRT) in 382 cases. The data of WBRT group were analysed considering IORT eligibility criteria to identify a sub-group of candidable patients, for whom we evaluated the diagnostic process that had lead to exclusion from IORT.\n\n\nRESULTS\nIn WBRT group 184 patients (48%) had a ductal NOS infiltrating carcinoma, of which 64 cases (16.8%) were eligible for IORT. Other 79 patients of WBRT group (21%) presented DCIS, of which only 27 were in ASTRO (American Society for Radation Oncology) suitable group for IORT. Considering the results of the pre-operative exams, or rather agobiopsy and MRI scan, 55 patients of 64 (85.9%) resulted unsuitable for IORT, while 9 patients (14.1%) could be eligible.\n\n\nCONCLUSIONS\nIORT major limits are: the restricted eligibility criteria, especially on histology; the need of a complete execution of preoperative exams and the tecnical limits of these exams. ASTRO suitable group, including small diameter, low-grade DCIS, might be used to extend the candidability criteria. A multidisciplinary approach might improve the pre-operative study, so the use of IORT in clinical practice.