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  • [Ann Surg Oncol.] Redefining Eligibility by Analyzing Canceled Intraoperative Radiotherapy as a Boost for Patients Undergoing Breast-Conserving Treatment.

    연세의대 / 김준원, 이익재*

  • 출처
    Ann Surg Oncol.
  • 등재일
    2019 Dec
  • 저널이슈번호
    26(13):4294-4301. doi: 10.1245/s10434-019-07819-5. Epub 2019 Sep 13.
  • 내용

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    Abstract
    BACKGROUND:
    Intraoperative radiotherapy (IORT) with a 50-kV x-ray is used for a tumor bed boost during breast-conserving surgery. This study evaluated the anatomicosurgical factors associated with cancellation of planned IORT.

    METHODS:
    Patient eligibility for the study included age of 20 years or older, compatibility for lumpectomy, and ductal carcinoma in situ or stages 1-3 invasive carcinoma. All the patients underwent magnetic resonance imaging (MRI) and multidisciplinary team evaluations. Resection margins were assessed by frozen pathology. Pre- and intraoperative variables were compared between the IORT and IORT-cancellation groups.

    RESULTS:
    A total of 434 patients underwent surgeries for IORT between August 2014 and December 2017. For 90 of these patients, IORT was canceled because of repeated positive margins leading to a large cavity or total mastectomy (n = 27), insufficient cavity-skin distance (n = 14), satellite lesions leading to a large cavity or total mastectomy (n = 12), MRI findings of a large primary tumor or uncertain margins leading to a large cavity (n = 6), cavity geometry unsuitable for IORT (n = 6), subareolar tumor extension (n = 6), tumor abutting the pectoralis muscle (n = 3), patient refusal (n = 5), intraoperative confirmation of bilateral breast cancer (n = 3) or benign pathology (n = 3), device malfunction (n = 3), or scheduling difficulty (n = 2). A tumor larger than 2 cm (P = 0.014) and the presence of satellite lesions (P = 0.014) were independent predictors of IORT cancellation.

    CONCLUSIONS:
    Surgical procedures resulting in large cavities were the leading cause of IORT cancellation. Multidisciplinary evaluations using MRI were critical for completion of IORT procedures.

     

     


    Author information

    Kim JW1, Cho Y1, Choi J2, Ahn SG3, Jeong J3, Lee IJ4.
    1
    Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
    2
    Department of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea.
    3
    Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
    4
    Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. ikjae412@yuhs.ac.

  • 편집위원

    IntraBeam을 이용한 유방암의 수술중 방사선치료에서 치료가 취소되는 경우를 분석함으로써 eligibility criteria를 제안한 논문

    2020-01-30 17:15:35

  • 편집위원2

    아직 IORT는 흔하지 않지만 초기 도입비용이 상대적으로 작으며 수술팀과의 공조, 추후 발전 가능성을 고려하면서 관심을 가지게 되었습니다. 본 연구에서는 400여 예정된 IORT중 최소된 케이스를 분석하여 추후, 신환에 대한 IORT 적용시 가이드라인을 제시하고자 하였습니다.

    2020-01-30 17:31:01

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