Outcomes and complications of intraoperative radiotherapy versus external beam radiotherapy for early breast cancer

TL;DR

This study compares intraoperative and external beam radiotherapy for early breast cancer, finding that IORT has fewer radiation side effects and better cosmetic results.

Contribution

The study provides a direct comparison of postoperative and post-radiation complications between IORT and EBRT in early breast cancer patients.

Findings

IORT had more post-operative pain but fewer post-radiation complications like erythema and hyperpigmentation compared to EBRT.

Cosmetic outcomes were significantly better in the IORT group compared to the EBRT group.

There was no significant difference in recurrence-free or overall survival between the two groups.

Abstract

Intraoperative radiotherapy (IORT) is an alternative for external beam radiotherapy (EBRT) for early stage breast cancer (BC). Herein, we compared outcomes, postoperative and post‐radiation complications of IORT and EBRT.

We conducted a cohort study to compare complications of IORT and EBRT in patients. A checklist of the complications of IORT and EBRT, was used to assess and post‐radiation complications and outcomes.

Overall, 264 women (121 in IORT and 143 in EBRT group) with a mean (SD) age of 55 ± 8.6 years analyzed in this study. The IORT group (quadrantectomy + SLNB + IORT) had more severe post‐operative pain compared to the EBRT group (quadrantectomy + SLNB) (OR = 1.929, 95% CI: 1.116–3.332). Other postoperative complications, including edema, erythema, seroma, hematoma, and wound complications were not significantly different between the IORT and EBRT groups.

EBRT was associated with higher rates post‐radiation complications, including erythema (95.8% vs. 21.5%), skin dryness (30.8% vs. 12.4%), pruritus (26.6% vs. 17.4%), hyperpigmentation (48.3% vs. 9.9%), and telangiectasia (1.4% vs. 0.8%). Multivariate analysis showed that erythema, skin dryness and pruritus, and hyperpigmentation were more severe in the EBRT group, while breast induration was higher in the IORT group (OR = 4.109, 95% CI: 2.242–7.531). Excellent, good, and fair cosmetic outcome was seen in 11.2%, 72%, and 16.8% of the patients in the EBRT group and 29.8%, 63.6%, and 6.6% in the IORT group, respectively, suggesting that the cosmetic outcome was significantly better in the IORT group (P < .001). There wasn't statistically significant difference in recurrence‐free survival and overall survival rates between two groups of patients who received either IORT or EBRT (P = .953, P = .56).

IORT is considered to have lower post‐radiation complications and better cosmetic outcomes in breast cancer patients. Therefore, IORT might be used as the treatment of choice in eligible patients.

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