RESUMO
Breast cancer is the most common cancer pathology in women in the Western world. The median age at diagnosis is 60 years and in the coming decades it is estimated that the number of elderly women affected reaches an important percentage. This aging of the cancer population, associated with its inherent comorbidities and aggravated by the lack of consensus about the most appropriate treatment, make it difficult to administer an effective postoperative treatment in elderly women with a low-risk profile. An exhaustive geriatric evaluation is a sine qua non condition to opt for a specific type of treatment. To date, several options are available such as endocrine therapy (ET) alone, moderate/high hypofractionation and various accelerated partial breast irradiation (APBI) techniques. In this article, we provide information about each of them.
RESUMO
Objetivo. La intraoperative radiotherapy (IORT, «radioterapia intraoperatoria») en pacientes seleccionadas con cáncer de mama permite un tratamiento corto y preciso durante la cirugía conservadora sobre el lecho tumoral in situ. Presentamos nuestra experiencia inicial de IORT con dispositivo Intrabeam®. Pacientes y métodos. Se seleccionaron inicialmente 120 pacientes con cáncer de mama para IORT con Intrabeam® según protocolo TARGIT-A, desde enero de 2013 hasta febrero de 2015. Las indicaciones fueron: candidatas a cirugía conservadora, mayores de 45 años, diagnóstico histológico de carcinoma ductal infiltrante≤3cm hormonodependiente y axila clínica, ecográfica e histológicamente negativa. Resultados. De las pacientes seleccionadas, 34 (28%) no recibieron IORT debido al tamaño de la cavidad quirúrgica (28 casos) o problemas técnicos (6 casos). Finalmente, 86 pacientes (72%) recibieron IORT. La edad media fue de 64 años (DE±8,4). En 22 pacientes (26%) fue preciso administrar radioterapia externa a toda la mama. Trece pacientes (15%) tuvieron complicaciones: 3 casos de seroma que precisaron de más de 3 punciones para resolución (4%), 6 casos de absceso-mastitis (7%), 2 casos de hematoma (2%) y 2 casos de dehiscencia parcial de la herida quirúrgica (2%). No hubo toxicidad grave (grado iii-iv). El resultado estético fue bueno o muy bueno en el 87% de las pacientes (75). Conclusión. La IORT con Intrabeam® es una alternativa segura y bien tolerada frente a la radioterapia externa en pacientes seleccionadas, con un buen resultado estético a corto plazo (AU)
Objective. Intraoperative radiotherapy (IORT) in selected patients with breast cancer allows a short and precise treatment on the tumor bed in situ during conservative surgery. We present our initial experience of IORT with the Intrabeam® device. Patients and methods. From January 2013 to February 2015, 120 patients with breast cancer were pre-selected for IORT with Intrabeam® according to the TARGIT-A protocol. The indications were as follows: candidates for conservative surgery, age older than 45 years, a histological diagnosis of hormone-dependent infiltrating ductal carcinoma≤3cm and absence of axillary involvement on physical, ultrasound and histological examination. Results. Among the selected patients, 34 (28%) did not receive IORT due to the size of the surgical cavity (28 patients) or technical problems (6 patients). Finally, 86 patients (72%) received IORT. The average age was 64 years (SD±8.4). In 22 patients (26%), it was necessary to administer external beam radiotherapy to the whole breast. Thirteen patients (15%) had complications: 3 cases of seroma requiring more than 3 attempts for resolution (4%), 6 cases of abscess-mastitis (7%), 2 cases of hematoma (2%) and 2 cases of partial dehiscence of the surgical wound (2%). There was no severe toxicity (grade iii-iv). The aesthetic result was good or very good in 87% of the patients (n=75). Conclusion. IORT with Intrabeam® is a safe and well tolerated alternative versus external radiotherapy in selected patients and provides a good short-term aesthetic result (AU)
