Breast conserving surgery along with adjuvant radiotherapy is effective in terms of local control and survival for early stage breast cancer (1). External beam radiotherapy (EBRT) following breast conserving surgery has been shown to improve survival by preventing local recurrence, in the Early Breast Cancer Trialists’ Collaborative Group meta-analysis (2). Standard radiotherapy typically requires numerous fractions over a 3−5 week period and is performed weeks or months after surgery or chemotherapy. Partial breast irradiation (PBI) techniques, including intraoperative radiotherapy (IORT), have been investigated in the last decades (3,4). IORT is delivered at the same time as surgery, eliminating the need for numerous hospital visits in some selected cases. IORT for early breast cancer with the Intrabeam® system (Carl Zeiss, Oberkochen, Germany) has been shown to be non-inferior to EBRT in reducing local recurrence in a randomized phase III trial, the Targeted Intraoperative Radiotherapy-A (TARGIT-A) trial (5,6). The Intrabeam® radiotherapy system comprises of a miniature X-ray source that produces low energy photons (50 kV) delivered directly to the tumor bed. After surgical excision of the tumor, a reusable spherical applicator is fixed to the end of the source and placed in the tumor bed in order to obtain a homogeneous dose distribution to the surrounding breast tissues. A purse string suture is used to conform the target breast tissue to the surface of the applicator sphere. The time required for the entire procedure is 20 to 45 min, depending on the diameter of applicator required for a specifc tumor bed. Results from the TARGIT-A trial demonstrated that careful patient selection and IORT can achieve good local control after breast conserving surgery.


Keywords: Intraoperative radiotherapy, IORT, breast cancer, early toxicity, TARGIT-A Trial, HUG experience