ABSTRACT
OBJECTIVE: To present our experience since November 2013, and case selection criteria for intraoperative boost radiotherapy (IObRT) that significantly reduces the local recurrence rate after breast conserving surgery in patients with breast cancer. MATERIAL AND METHODS: Patients who were suitable for IObRT were identified within the group of patients who were selected for breast conserving surgery at our breast council. A MOBETRON (mobile linear accelerator for IObRT) was used for IObRt during surgery. RESULTS: Patients younger than 60 years old with <3 cm invasive ductal cancer in one focus (or two foci within 2 cm), with a histologic grade of 2-3, and a high possibility of local recurrence were admitted for IObRT application. Informed consent was obtained from all participants. Lumpectomy and sentinel lymph node biopsy was performed and advancement flaps were prepared according to the size and inclination of the conus following evaluation of tumor size and surgical margins by pathology. Distance to the thoracic wall was measured, and a radiation oncologist and radiation physicist calculated the required dose. Anesthesia was regulated with slower ventilation frequency, without causing hypoxia. The skin and incision edges were protected, the field was radiated (with 6 MeV electron beam of 10 Gy) and the incision was closed. In our cases, there were no major postoperative surgical or early radiotherapy related complications. CONCLUSION: The completion of another stage of local therapy with IObRT during surgery positively effects sequencing of other treatments like chemotherapy, hormonotherapy and radiotherapy, if required. IObRT increases disease free and overall survival, as well as quality of life in breast cancer patients.
ABSTRACT
BACKGROUND AND OBJECTIVES: Optimal management if male breast cancer (MBC) is not clearly established and treatment guidelines are scarce. We evaluated our own results in the treatment of male breast cancer patients with respect to local control (LC), overall survival (OS) and possible prognostic factors for survival. PATIENTS AND METHODS: Thirty-nine patients with MBC were retrospectively studied to evaluate the results in this type of tumor; 94.8% had invasive ductal carcinoma (IDC), 2.6% invasive papillary carcinoma (IPC) and 2.6% invasive lobuler carcinoma (ILC). The distribution according to stage was 12.8%, 46.2%, 30.7% and 10.3% in Stages I, II, III and IV, respectively; 7.7% underwent radiotherapy (RT)+/-hormonotherapy (HT), 22.8% had chemotherapy (CT), 61.8% had chemoradiotherapy (CRT)+/-HT and 7.7% had HT in addition to surgery. RESULTS: The distant metastases rate was 36% and the local recurrence rate was 5%. All the local recurrences and the distant metastases had occurred after the first two years. The 2-year disease free survival (DFS) and OS rates were 87.2% and 89.7%, respectively, and the 5-year DFS and OS rates were 65.8% and 80.1%, respectively. In a univariate analysis for OS, statistical significance was found for lymph node metastases (P=.00001), stage (P=.0098) and age (P=.03), while presence of RT in the treatment modality (P=.6849), and tumor size (P=.4439) demonstrated no significance. The presence of lymph node metastases significantly impaired OS (P=.004) and DFS (P=.014) in the multivariate analysis. CONCLUSION: Postoperative radiotherapy was important in the management of MBC to improve LC resulting in one local failure, but did not improve OS and DFS. The presence of lymph node metastases significantly impaired OS and DFS.
