A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines
Purpose: Intraoperative radiation therapy (IORT) as a form of accelerated partial breast irradiation (APBI) is controversial given the limited evidence to support its efficacy. However, it remains an attractive option for low-risk patients with ductal carcinoma in situ (DCIS), who derive a small abs...
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| Format: | Article |
| Language: | English |
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Elsevier
2019-04-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109418302379 |
| _version_ | 1818151317098463232 |
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| author | Christine Chin, MD Sitara Hirji, BA Maika Onishi, MD Richard Ha, MD Bret Taback, MD David P. Horowitz, MD Eileen P. Connolly, MD, PhD |
| author_facet | Christine Chin, MD Sitara Hirji, BA Maika Onishi, MD Richard Ha, MD Bret Taback, MD David P. Horowitz, MD Eileen P. Connolly, MD, PhD |
| author_sort | Christine Chin, MD |
| collection | DOAJ |
| description | Purpose: Intraoperative radiation therapy (IORT) as a form of accelerated partial breast irradiation (APBI) is controversial given the limited evidence to support its efficacy. However, it remains an attractive option for low-risk patients with ductal carcinoma in situ (DCIS), who derive a small absolute benefit in local control with standard whole breast irradiation (WBI). We examine how the American Society for Therapeutic Radiation Oncology (ASTRO) APBI consensus guidelines (CG) may be applied to the preoperative selection of patients with DCIS for IORT and determine treatment outcomes by CG group. Methods and Materials: We identified patients with biopsy-proven pure DCIS enrolled in an institutional prospective registry IORT database using the Zeiss Intrabeam® device between September 2013 and February 2017. Based on available preoperative clinicopathologic information, patients were deemed suitable, cautionary, or unsuitable for IORT according to the ASTRO CG. Change in CG group based on final pathologic diagnosis was determined, and additional therapy was recommended for unsuitable patients. Outcome in terms of ipsilateral breast tumor recurrence was determined. Results: A total of 61 DCIS lesions in 60 patients were treated with IORT. Preoperatively, 21 patients (35%) were suitable and 36 (59%) were cautionary. Four (6%) were unsuitable because of lesion size but declined WBI. Final pathologic diagnosis changed the CG grouping of 10 patients (16%) because of either occult high-grade disease in 2 (3%) or close/positive margins in 8 (13%). Ultimately 12 patients total were considered unsuitable, of whom 8 (66%) accepted additional WBI after IORT. At a median follow-up of 2.2 years, ipsilateral breast tumor recurrence was identified among 2 suitable, 1 cautionary, and no unsuitable patients. Conclusion: Further investigation is necessary to refine selection of patients with DCIS who may be optimally treated with IORT alone. High acceptance of additional therapy among unsuitable patients resulted in excellent outcomes. The use of biomarkers in addition to traditional clinical and pathologic factors may help to better select patients for IORT. |
| first_indexed | 2024-12-11T13:36:54Z |
| format | Article |
| id | doaj.art-0ea187f41d7245718362990c7f9cb8a9 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-11T13:36:54Z |
| publishDate | 2019-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-0ea187f41d7245718362990c7f9cb8a92022-12-22T01:04:59ZengElsevierAdvances in Radiation Oncology2452-10942019-04-0142253260A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus GuidelinesChristine Chin, MD0Sitara Hirji, BA1Maika Onishi, MD2Richard Ha, MD3Bret Taback, MD4David P. Horowitz, MD5Eileen P. Connolly, MD, PhD6Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New YorkDepartment of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New YorkMedical Oncology, Sutter Health Network, Palo Alto Foundation Medical Group, Sunnyvale, CaliforniaDepartment of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New YorkDepartment of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New YorkDepartment of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New YorkDepartment of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Corresponding author. Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th St, CHONY North B-Level, Room 11, New York, NY 10032.Purpose: Intraoperative radiation therapy (IORT) as a form of accelerated partial breast irradiation (APBI) is controversial given the limited evidence to support its efficacy. However, it remains an attractive option for low-risk patients with ductal carcinoma in situ (DCIS), who derive a small absolute benefit in local control with standard whole breast irradiation (WBI). We examine how the American Society for Therapeutic Radiation Oncology (ASTRO) APBI consensus guidelines (CG) may be applied to the preoperative selection of patients with DCIS for IORT and determine treatment outcomes by CG group. Methods and Materials: We identified patients with biopsy-proven pure DCIS enrolled in an institutional prospective registry IORT database using the Zeiss Intrabeam® device between September 2013 and February 2017. Based on available preoperative clinicopathologic information, patients were deemed suitable, cautionary, or unsuitable for IORT according to the ASTRO CG. Change in CG group based on final pathologic diagnosis was determined, and additional therapy was recommended for unsuitable patients. Outcome in terms of ipsilateral breast tumor recurrence was determined. Results: A total of 61 DCIS lesions in 60 patients were treated with IORT. Preoperatively, 21 patients (35%) were suitable and 36 (59%) were cautionary. Four (6%) were unsuitable because of lesion size but declined WBI. Final pathologic diagnosis changed the CG grouping of 10 patients (16%) because of either occult high-grade disease in 2 (3%) or close/positive margins in 8 (13%). Ultimately 12 patients total were considered unsuitable, of whom 8 (66%) accepted additional WBI after IORT. At a median follow-up of 2.2 years, ipsilateral breast tumor recurrence was identified among 2 suitable, 1 cautionary, and no unsuitable patients. Conclusion: Further investigation is necessary to refine selection of patients with DCIS who may be optimally treated with IORT alone. High acceptance of additional therapy among unsuitable patients resulted in excellent outcomes. The use of biomarkers in addition to traditional clinical and pathologic factors may help to better select patients for IORT.http://www.sciencedirect.com/science/article/pii/S2452109418302379 |
| spellingShingle | Christine Chin, MD Sitara Hirji, BA Maika Onishi, MD Richard Ha, MD Bret Taback, MD David P. Horowitz, MD Eileen P. Connolly, MD, PhD A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines Advances in Radiation Oncology |
| title | A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines |
| title_full | A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines |
| title_fullStr | A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines |
| title_full_unstemmed | A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines |
| title_short | A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines |
| title_sort | single institution experience in the preoperative selection of dcis patients for iort using the astro consensus guidelines |
| url | http://www.sciencedirect.com/science/article/pii/S2452109418302379 |
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