Intraoperative Radiotherapy for Breast Cancer in Elderly Women

Intraoperative radiotherapy (IORT) with low-energy photons was delivered to 191 women >65 years of age. Only 8 patients had postoperative external beam radiotherapy. 5-year local relapse rate was 1.7%. Postoperative complications were rare, without delay in wound healing, even in older women. Cosmetic result was good or excellent in >90% of the patients. Purpose: To evaluate outcomes and postoperative toxicities after intraoperative radiotherapy (IORT) in elderly women. Population: Women older than 65 years, with infiltrating ductal breast cancer <= 3 cm, expressing estrogen receptor (ER+) without Her2 overexpression, and with negative axillary nodes. Treatment: Treatment consisted of partial mastectomy with a sentinel lymph node biopsy (SLNB) procedure; in case of positive SLNB, IORT was cancelled. IORT consisted in a total dose of 20 Gy in 1 fraction delivered at the surface of the applicator with the Intrabeam (R) technique. Results: IORT was planned to be administered to a total of 225 patients but was cancelled for 34 patients during surgery. Thus 191 patients were analyzed; mean age was 76 years, with 57 patients (30%) >80 years. Despite inclusion criteria, 15 had lobular carcinoma and 7 were triple negative. With a median follow-up of 40 months, we observed only 1 local recurrence, located in the skin over the initial tumor. The 5-year local relapse rate was 1.7%. A wound healing delay ( >15 days) was observed in 21 patients (11%). Sixty-six patients (35%) had postoperative complications, mainly grade 2, resolving within a few days. Two patients needed surgical drainage for local abscesses. Long-term ( >1 year) cosmetic outcome was evaluated in 120 patients and was judged excellent or good in 102 (91%). Conclusion: IORT can be safely given to elderly women, with a good local control rate and without major toxicities. (C) 2021 Elsevier Inc. All rights reserved.