Intraoperative radiation therapy in the treatment of breast cancer

Aim

To assess the effectiveness and safety of IORT as a boost or single therapy for the current standard treatment of breast cancer.

Conclusions and results

The results of studies that assess IORT as an alternative to an external-radiation booster dose indicate that this combination does not amount to an increase in terms of effectiveness and overall survival, nor does it entail a significant reduction in terms of safety with respect to conventional external radiation treatment. These results are drawn from studies of little methodological rigour, and there are no clinical trials that would go to confirm them. Administration of a single dose of IORT is associated with an incidence of recurrences and metastasis comparable to that of conventional treatment and, despite showing low toxicity, does not improve the toxicity of conventional treatment to any significant degree. This evidence is based on a single RCT with certain limitations and on observational and descriptive studies, something that considerably reduces the validity of these results. Indeed, the results of the studies included give rise to important doubts regarding the possible replacement of conventional external radiotherapy by intraoperative radiation as the treatment of choice in patients with breast cancer in the initial stages.

Recommendations

Given the poor evidence that is available, is not recommended the incorporation of IORT into the health system. Additional information from the various clinical trials currently underway maybe modify the recommendation on its incorporation. The implementation of IORT, such as boost or as monotherapy, requires the establishment of clear criteria and uniform of selection of patients, the creation of multidisciplinary teams, the design of a suitable protocol for working with strict adherence to the same and of a quality control of each stage of the procedure.
The predictable low frequency of use of this technique, you would recommend its implementation in hospitals specializing in the treatment of cancer and in the shortest number of centers as possible, to minimize the learning curve and ensure the technical prowess of the professionals.

Methods

A systematic review of the literature was conducted, from January 2000 to January 2013, in the following databases: CRD (Health Technology Assessment, Database of Abstracts of Reviews of Effectiveness, NHS Economic Evaluation Database), Cochrane Plus Library, Medline, Embase, ISI Web of Knowledge, CSIC-Índice Médico Español, Clinical Trials Registry, WHO International Clinical Trials Registry Platform and Current Controlled Trials. This process was completed by a general search of quality Internet web pages. Two reviewers, acting independently, selected the papers in accordance with pre-established inclusion and exclusion criteria, with any disagreements being resolved by consensus. Lastly, a manual review was performed of the bibliographic references cited in the papers selected. Data were extracted and summarised in evidence tables. Study quality was assessed using the National Health and Medical Research Council scale.

Further research/reviews required

Further quality studies are needed to allow firm conclusions. It is recommended to investigate the role of IORT as the sole treatment in patients with recurrent disease in which this contraindicated EBRT.

INAHTA Brief issue: 2013/010

Agency: AVALIA-T, Galician Agency for Health Technology Assessment
(Formerly:

Written by

Paula Cantero Muñoz)
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Reference: avalia-t2012/14, http://www.sergas.es/Docs/Avalia-t/avaliat201214RioCaMama.pdf" alt="http://www.sergas.es/Docs/Avalia-t/avaliat201214RioCaMama.pdf">http://www.sergas.es/Docs/Avalia-t/avaliat201214RioCaMama.pdf">Webpage


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