Intraoperative Radiotherapy for Breast Cancer in Elderly Women

To evaluate outcomes and postoperative toxicities after intraoperative radiotherapy (IORT) in elderly women. 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 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® technique. 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%). IORT can be safely given to elderly women, with a good local control rate and without major toxicities. 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.