Effect Analysis Of Intraoperative Radiotherapy In 73 Patients With Early Breast Cancer

Objective The technique of intraoperative radiotherapy(IORT)has become more and more mature with the development of economy and society,Early-stage breast cancer(BC)with breast-conserving surgery(BSC)and IORT has also become more widespread.However,the prognosis of early-stage breast cancer patients undergoing intraoperative radiotherapy is still different,and the influencing factors are less studied.This study was designed to retrospectively analyze the local recurrence rate,complications,and the cosmetic of intraoperative radiotherapy after breast conserving surgery in patients with early breast cancer.To investigate the relationship between age,tumor size,histological grade,pathological type,radiotherapy dose,applicator size,estrogen(ER)and progesterone(PR)status and clinical efficacy and prognosis,to provide a basis for patients' selection,treatment scheme and prognosis of patients undergoing intraoperative radiotherapy in clinical?Materials /Methods This study is a retrospective approach.Selected from the Department of Breast Surgery,the First Affiliated Hospital of Zhengzhou University,from September 2014 to August 2016,73 patients with early breast cancer who underwent BCS and IORT.The age,tumor location,histopathological features,histological grade,tumor size,ER/PR status,sentinel lymph node status,tumor stage,surgical boundary negative, applicator size,Irradiation dose,start time of surgery,end of follow-up time,endocrine therapy and the protocol,chemotherapy and the program.Follow-up statistics included local recurrence,metastases,death,and wound complications(redness,effusion,fat necrosis).The local recurrence rate(LRR),the incidence of wound complications,and the distant metastasis rate(DM)were evaluated by physical examination and imaging,and the cosmetic effect was evaluated by Harris.Statistical data were collected using SPSS 21.0 statistical software.Counts were expressed as percentages.Kaplan-Meier method was used for univariate analysis.COX multivariate analysis was used to analyze the disease-free survival(DFS)rate and overall survival(OS)of patients undergoing intraoperative radiotherapy for early breast cancer.Results 1?Clinical efficacy of intraoperative radiotherapy for early breast cancer Of the 73 patients,2 patients had positive sentinel lymph nodes during operation,and underwent axillary lymph node dissection.1 patient had bilateral breast masses,and the left intraoperative pathology showed invasive carcinoma and underwent intraoperative radiotherapy,intraoperative pathology showed the right intraoperative was benign lesion,which was not treated.But the postoperative pathology showed the right side was invasive carcinoma,and was removed after 4 cycles of chemotherapy.Two patients underwent external beam irradiation(EBRT).One patient had esophageal cancer and 1 patient had cervical cancer at the sime time and both received regular chemotherapy.The median follow-up time for all patients was 42.6 months.In the follow-up,combined with imaging and pathological biopsy,4 patients had local recurrence(5.5%),including 1 case of ipsilateral supra-condylar metastasis(1.4%),3 cases of tumor bed recurrence(4.1%),no ipsilateral axillary lymph node metastasis and distant metastasis occurred.Three patients died(4.1%).Eight patients developed wound complications(11.0%),including 3 patients with ipsilateral breast and axillary effusion(4.1%),4 patients with incision edema(4.1%),and 2 patients with incisional hematoma and infection.(2.7%).The aesthetic effect of breast after intraoperative radiotherapy was evaluated by Harris,and the excellent rate was 84.9%.2?Analysis of the influence of related risk factors on the efficacy of patients Kaplan-Meier survival analysis was used to analyze the related factors of BCS and IORT of DFS and OS.Find that only age(?2=14.04,P=0.003)statistically positive for association with DFS of the patiens,and Local recurrence and metastasis rate and/or mortality were higher in patients over 70 years old.Multiple factors were then analyzed using the Log rank test,with only applicator diameter(?2=70.38,P<0.05)statistically positive for related to the wound complications,and the larger side may increase the wound complications.The remaining risk factors did not increase the incidence of wound complications in patients.COX multivariate analysis showed that age is an independent risk factor for DFS rate and the risk factors had no significant effect on the OS rate of patients with BCS and IORT.Conclusion 1.IORT may be a safe form of treatment for the selected patients with early breast cancer,and can achieve satisfactory cosmetic results.2.Larger applicator diameters may increase the incidence of wound complications.3.Age is an independent risk factor for DFS in patients undergoing early breast cancer during radiotherapy.