Experience of the usage intraoperative radiation therapy after neoadjuvant systemic drug treatment and sentinel lymph node biopsy in breast cancer patients with clinical stage T2N0M0

Abstract

Relevance. Breast cancer is the leading oncological disease among female population. In some cases, clinical stage T2N0M0 is contraindication to breast-concerving surgery due to a big size of the primary tumor. Mastectomy is an optimal surgery in this situation. However, removal of the breast is a serious psychological trauma for the patient, causing quality of life decrease. Attempting to perform breast-conserving surgery is quite logical. Due to this we investigated a method of complex treatment of breast cancer using intraoperative radiation therapy, sentinel lymph node biopsy and neoadjuvant systemic drug therapy. Goal: the main goal is to improve the results of early breast cancer treatment, through the introduction into clinical practice of the original method of complex treatment. Materials and methods. 101 patients treated in the State clinical oncology department of St. Petersburg in the period from 2014 to 2016 were included in the study. The main inclusion criteria was a clinical stage T2N0M0. All the patients are not the candidates for breast - conserving surgery. In the experience group were patients (n=51) who received treatment on the method studied. 50 patients were randomized to the control group, where the mastectomy was performed. In the experience group late toxicity was evaluated after radiosurgery using modified LENT-SOMA scale. Quality of life was assessed by questionnaire QLQ-C30 in both groups. Results. 49 (96%) patients of the experience group were treated by breast-conserving surgery (lumpectomy with intraoperative radiation) due to clinical and radiological tumor response to neoadjuvant therapy. After systemic therapy 10 (20%) women were performed axillary lymph node dissection. Quality of life in the experience group was significantly higher. Late toxicity was not significant after application of intraoperative and whole breast radiotherapy. Conclusion. The investigated method of a complex treatment of early breast cancer is safe and effective and is able to provide the same control of locoregional recurrence as modified radical mastectomy. However, the proposed method provides a statistically significant better quality of life.

Keywords

• intraoperative radiation therapy
• sentinel lymph node biopsy
• neoadjuvant therapy