Intraoperative Radiotherapy for Breast Cancer: UNI-MED SCIENCE

1. Introduction 12 1.1. References 12 2. The tumor bed in breast cancer - definition and relevance 14 2.1. Definition and relevance 14 2.1.1. References 15 2.2. Rationale for PBI 16 2.2.1. References 17 2.3. Historic and ongoing PBI trials 18 2.3.1. References 20 3. Radiobiological aspects of IORT in breast cancer 22 3.1. Dose response for tumor cells and normal tissue 22 3.2. Basic radiobiological factors 23 3.2.1. The L-Q model 23 3.2.2. Extrapolation to high single doses 24 3.2.3. Biological effects of high single doses 25 3.2.4. Repair during protracted irradiation 26 3.2.5. RBE of 50 kV X-rays from INTRABEAM® 27 3.3. Modelling biological effects of 50 kV X-rays from INTRABEAM® 29 3.3.1. Target volume and risk of recurrence 29 3.3.2. Late normal-tissue reaction 31 3.3.3. IORT as intraoperative boost 31 3.4. Conclusions 32 3.5. References 32 4. Indications for IORT in breast cancer 38 4.1. IORT as a boost 39 4.2. IORT as single treatment (i.e. partial breast irradiation) 39 4.3. References 40 5. IORT with 50 kV X-rays 42 5.1. Physical and technical aspects 42 5.1.1. INTRABEAM® system 42 5.1.2. Quality assurance 43 5.1.3. Workflow 43 5.1.4. Radiation protection 44 5.2. Surgical aspects 46 5.3. Radiotherapeutic aspects of low-KV IORT 49 5.3.1. References 50 5.4. IORT as a boost - clinical results 51 5.4.1. Acute toxicity 51 5.4.2. Late toxicity 53 5.4.3. Postoperative seroma formation 53 5.4.4. Influence of the interval between IORT and WBRT on late toxicity 54 5.4.5. The first five years of experience with a novel approach: Toxicity 55 5.4.6. The first five years of experience with a novel approach: Survival and local control 56 5.4.7. Quality of Life 57 5.4.8. Conclusion 58 5.4.9. References 58 5.5. Intraoperative radiotherapy for breast cancer - The TARGIT trial 59 5.5.1. Preliminary results of the TARGIT trial 62 5.5.2. References 64 5.6. TARGIT-E (lderly) trial 64 5.6.1. Study design 65 5.6.2. References 66 5.7. The history of the development of the INTRABEAM® system 66 5.7.1. References 69 6. IORT with linear accelerators 72 6.1. IOERT methods 72 6.1.1. Target volume and design of an IOERT boost 73 6.2. Treatment concepts: intraoperative boost (BIO-Boost) versus full-dose IOERT 74 6.3. Clinical evidence 74 6.3.1. Boost concept 74 6.3.2. Sole IOERT concept 75 6.3.3. Toxicity / late reactions / cosmesis 75 6.4. IOERT during nipple-sparing mastectomy 76 6.5. Ongoing trials 76 6.6. Summary 76 6.7. References 76 Index 79