Intraoperative Radiation Therapy Versus Whole Breast Radiation for Early-Stage Breast Cancer Treatment in Rural Appalachia.

Autor:	Abdelsattar JM; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA., McClain K; School of Medicine, West Virginia University, Morgantown, WV, USA., Afridi FG; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA., Wen S; Department of Biostatistics, West Virginia University, Morgantown, WV, USA., Cai Y; Department of Biostatistics, West Virginia University, Morgantown, WV, USA., Musgrove KA; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA., Bailey K; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA., Shaikh PM; Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA., Jacobson GM; Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA., Marsh W; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA., Lupinacci K; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA., Cowher MS; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA., Jenkins HH; 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2020 Dec; Vol. 86 (12), pp. 1666-1671. Date of Electronic Publication: 2020 Aug 10.
DOI:	10.1177/0003134820940735
Abstrakt:	Background: Intraoperative radiation therapy (IORT) is an alternate accelerated form of radiation following breast-conserving surgery (BCS). Lack of data regarding long-term outcomes has limited adoption. We report our experience with IORT in patients undergoing BCS versus whole breast radiation therapy (WBRT). Methods: Retrospective review of patients undergoing BCS with IORT versus WBRT (2012-2017). Inclusion: low grade, T1-2N0M0, estrogen receptor/progesterone receptor positive, and Her2-negative infiltrating ductal carcinomas. IORT was delivered as a single fraction of radiation (20 Gy) intraoperatively. Outcomes were compared using Fisher's test for discrete variables or Wilcoxon signed-rank test for continuous variables. Kaplan-Meier method was used to estimate disease-free survival (DFS). Results: Fifty-one patients (44%) received IORT, and 66 (56%) received WBRT. There was no difference in age, tumor size, receptor status, or in-breast recurrence (1.9% vs 0%, all P > .05). Length of follow-up was longer in the WBRT group due to time to inception of IORT (mean ± SD: 44 ± 8.1 vs 73 ± 13 months, P < .001). There was no difference in DFS between the 2 groups (HR 2.5; P = .44). IORT patients experienced delay to BCS (mean ± SD: 38 ± 12.7 vs 27 ± 12.2 days, P < .001) likely due to coordination of care. Analysis demonstrated IORT patients would have traveled a mean distance of 20 miles to the closest WBRT center (range 1-70, miles) for a mean travel time of 31 minutes (range 4-90, minutes) per WBRT treatment. Discussion: IORT produces noninferior oncologic outcomes and decreased skin toxicity compared with WBRT. It can be convenient for patients in rural regions with limited health care access.
Databáze:	MEDLINE
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