1School of Medicine, Southeast University, Nanjing 210009, China; 2Research Institute of General Surgery,General Hospital of Eastern Military Command of PLA,Nanjing 210002,China; 3Medical School of Nanjing University, Nanjing 210093, China
Abstract：Objective To compare the survival and prognostic factors of intraoperative radiotherapy (IORT) and postoperative radiotherapy (PORT) in female patients, aged≥50 years, diagnosed with node-negative breast cancer (≤ 3cm in size). Methods Clinical data of eligible early breast cancer patients between 2010 and 2015 were obtained from the SEER database. Patients were divided into the IORT and PORT groups according to the radiotherapy record and propensity score matching (PSM) was subsequently conducted. Kaplan-Meier curve was used to evaluate the overall survival (OS) and breast cancer-specific survival (BCSS) between two groups and Cox proportional hazard regression analysis was used to explore the risk factors of clinical prognosis. Results 7 068 patients were included after PSM. The median follow-up time was 32.0 months. The 5-year OS rates in the IORT and PORT groups were 96.8% and 93.8%, respectively. Univariate Cox analysis showed that radiotherapy, age, histological grade, T stage, estrogen receptor (ER) status and progesterone receptor (PR) status were the independent risk factors for OS, and histological grade, T stage, ER status, PR status and chemotherapy were the independent risk factors for BCSS. Multivariate Cox regression analysis demonstrated that patients who received IORT had better OS than PORT counterparts (P=0.020). Besides, patients aged≥60 years obtained worse OS than those aged<60 years (P=0.003). Patients with T2 stage or ER-negative tumors had worse OS than those with T1 stage tumors (P<0.001) or ER-positive tumors (P=0.001). Patients with grade Ⅲ-Ⅳ tumors achieved worse BCSS (P=0.004). Subgroup analysis showed that IORT yielded better OS for elderly patients (≥60 years), grade Ⅲ-Ⅳ tumors, infiltrating duct carcinoma, T2 stage tumors, ER-positive tumors, PR-positive tumors and patients without chemotherapy. Conclusions IORT may bring benefit for highly selected patients with low risk of recurrence, which is not inferior to PORT in terms of short-term survival. Prospective studies with longer follow-up time are needed to confirm the findings.
Xue Yu,Xu Xiaofan,Chen Yuqiu et al. Survival after intraoperative or postoperative radiotherapy in early breast cancer:an analysis of the SEER database[J]. Chinese Journal of Radiation Oncology, 2021, 30(8): 786-791.
[1] Reintgen C, Reintgen D, Solin LJ. Advances in local-regional treatment for patients with early-stage breast cancer:a review of the field[J]. Clin Breast Cancer, 2010, 10(3):180-187. DOI:10.3816/CBC.2010.n.025. [2] Tuttle TM, Jarosek S, Habermann EB, et al. Omission of radiation therapy after breast-conserving surgery in the United States:a population-based analysis of clinicopathologic factors[J]. Cancer, 2012, 118(8):2004-2013. DOI:10.1002/cncr.26505. [3] Kulcenty K, Piotrowski I, Rucinski M, et al. Surgical wound fluids from patients with breast cancer reveal similarities in the biological response induced by intraoperative radiation therapy and the radiation-induced bystander effect-transcriptomic approach[J]. Int J Mol Sci, 2020, 21(3):1159. DOI:10.3390/ijms21031159. [4] Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT):a randomised controlled equivalence trial[J]. Lancet Oncol, 2013, 14(13):1269-1277. DOI:10.1016/S1470-2045(13)70497-2. [5] Frasson AL, Filho AB, Lichtenfels M, et al. Effect of intraoperative radiotherapy for early breast cancer on 10-year recurrence rates and overall survival[J]. Breast J, 2020, 26(3):427-432. DOI:10.1111/tbj.13502. [6] Lei J, Wang Y, Bi Z, et al. Intraoperative radiotherapy (IORT) versus whole-breast external beam radiotherapy (EBRT) in earlystage breast cancer:results from SEER database[J]. Jpn J Radiol, 2020, 38(1):85-92. DOI:10.1007/s11604-019-00891-7. [7] Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO)[J]. Int J Radiat Oncol Biol Phys, 2009, 74(4):987-1001. DOI:10.1016/j.ijrobp.2009.02.031. [8] Shaitelman SF, Lin HY, Smith BD, et al. Practical implications of the publication of consensus guidelines by the american society for radiation oncology:accelerated partial breast irradiation and the national cancer data base[J]. Int J Radiat Oncol Biol Phys, 2016, 94(2):338-348. DOI:10.1016/j.ijrobp.2015.10.059. [9] Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(3):145-164. DOI:10.3322/caac.21601. [10] Coleman R. Clinical benefits of bone targeted agents in early breast cancer[J]. Breast, 2019, 48 s1:S92-S96. DOI:10.1016/S0960-9776(19)31133-6. [11] Mi Y, Lv P, Wang F, et al. Efficacy, late complications, and cosmetic outcomes of targeted intraoperative radiotherapy in breast-conserving surgery for early-stage breast cancer:a single-centre study in China[J]. Jpn J Clin Oncol, 2019, 49(12):1120-1125. DOI:10.1093/jjco/hyz128. [12] Sorrentino L, Fissi S, Meaglia I, et al. One-step intraoperative radiotherapy optimizes conservative treatment of breast cancer with advantages in quality of life and work resumption[J]. Breast, 2018, 39:123-130. DOI:10.1016/j.breast.2018.04.004. [13] Obi E, Tom MC, Manyam BV, et al. Outcomes with intraoperative radiation therapy for early-stage breast cancer[J]. Breast J, 2020, 26(3):454-457. DOI:10.1111/tbj.13574. [14] Kaiser J, Reitsamer R, Kopp P, et al. Intraoperative electron radiotherapy (IOERT) in the treatment of primary breast cancer[J]. Breast Care (Basel), 2018, 13(3):162-167. DOI:10.1159/000489637. [15] Uhlig S, Wuhrer A, Berlit S, et al. Intraoperative radiotherapy for breast cancer treatment efficiently targets the tumor bed preventing breast adipose stromal cell outgrowth[J]. Strahlenther Onkol, 2020, 196(4), 398-404. DOI:10.1007/s00066-020-01586-z. [16] Lemanski C, Bourgier C, Draghici R, et al. Intraoperative partial irradiation for highly selected patients with breast cancer:Results of the INTRAOBS prospective study[J]. Cancer Radiother, 2020, 24(2):114-119. DOI:10.1016/j.canrad.2020.01.007. [17] Vaidya JS, Bulsara M, Baum M, et al. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer:TARGIT-A randomised clinical trial[J]. BMJ, 2020, 370:m2836. DOI:10.1136/bmj.m2836. [18] Leonardi MC, Maisonneuve P, Mastropasqua MG, et al. Accelerated partial breast irradiation with intraoperative electrons:using GEC-ESTRO recommendations as guidance for patient selection[J]. Radiother Oncol, 2013, 106(1):21-27. DOI:10.1016/j.radonc.2012.10.018. [19] Tom MC, Joshi N, Vicini F, et al. The American Brachytherapy Society consensus statement on intraoperative radiation therapy[J]. Brachytherapy, 2019, 18(3):242-257. DOI:10.1016/j.brachy.2019.01.015 [20] Jacobs DHM, Speijer G, Petoukhova AL, et al. Acute toxicity of intraoperative radiotherapy and external beam-accelerated partial breast irradiation in elderly breast cancer patients[J]. Breast Cancer Res Treat, 2018, 169(3):549-559. DOI:10.1007/s10549-018-4712-3. [21] Leonardi MC, Maisonneuve P, Mastropasqua MG, et al. Comparison of treatment outcome between invasive lobular and ductal carcinomas in patients receiving partial breast irradiation with intraoperative electrons[J]. Int J Radiat Oncol Biol Phys, 2017, 99(1):173-181. DOI:10.1016/j.ijrobp.2017.04.033. [22] Kolberg HC, Loevey G, Akpolat-Basci L, et al. Targeted intraoperative radiotherapy tumour bed boost during breast conserving surgery after neoadjuvant chemotherapy in HER2 positive and triple negative breast cancer[J]. Rev Recent Clin Trials, 2017, 12(2):93-100. DOI:10.2174/1574887112666170201142458. [23] Pez M, Keller A, Welzel G, et al. Long-term outcome after intraoperative radiotherapy as a boost in breast cancer[J]. Strahlenther Onkol, 2020, 196(4):349-355. DOI:10.1007/s00066-019-01525-7. [24] Sedlmayer F, Reitsamer R, Wenz F, et al. Intraoperative radiotherapy (IORT) as boost in breast cancer[J]. Radiat Oncol, 2017, 12(1):23. DOI:10.1186/s13014-016-0749-9.
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