intra-operative radiation therapy for early stage … · intra-operative radiation therapy for...
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CONFIDENTIAL AND PROPRIETARY © 2012 Sarah Cannon. 1
INTRA-OPERATIVE RADIATION THERAPY
FOR EARLY STAGE BREAST CANCER
IN
DENVER, COLORADO, USA
BARBARA S. SCHWARTZBERG, M.D.
Associate Professor of Surgery - University of Colorado
Sarah Cannon Research Institute at Rose Medical Center
Denver, Colorado
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VIEW FROM MY OFFICE – DENVER, COLORADO
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SEQUENCE OF EVENTS
May 25, 2011 Cancer Committee Presentation
July 15, 2011 AXXENT system purchase
October 31, 2011 IRB approval
November 2, 2011 First IORT case
January 10, 2013 Completed accrual with 51
patients
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XOFT AXXENT SYSTEM OVERVIEW
Balloon
Applicators X-RAY source
Axxent System
Controller
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INCLUSION CRITERIA
1. Women > 40 years old
2. Single lesion
3. Infiltrating ductal carcinoma
4. Cancer < 2.5 cm on preoperative radiographic imaging
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EXCLUSION CRITERIA
1. Multifocal cancer
2. Lymphovascular invasion
3. Extensive intraductal component
4. History of breast cancer and/or radiation
5. Neo-adjuvant therapy
6. Pregnancy or lactation
7. Scleroderma, active lupus, ipsilateral pacemaker
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RADIOGRAPHIC WORKUP
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SLN BIOPSY FOLLOWED BY LUMPECTOMY
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SHIELD PLACEMENT
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BALLOON PLACEMENT
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BALLOON PLACEMENT
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BALLOON DOCKING
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DELIVERY OF ELECTRONIC BRACHYTHERAPY
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PROCEDURE RESULTS
• 51 patients - to OR for IORT
• 1 patient - technical difficulties
• 5 patients - positive intra-operative SLNs
• 3 patients - IORT but positive SLNs on final pathology
• 2 patients - Positive margins
•40 (78%) patients completed IORT per protocol
• Average age - 63.8 years
• Average tumor size - 1.04 cm
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PROCEDURE CHARACTERISTICS
Average total procedure time 1 hour 47 minutes
Average radiation delivery time 512.4 seconds (8.5 mins)
Average balloon size
3 to 4 cm balloon 37 patients
4 to 5 cm balloon 3 patients
Average balloon fill 31.75 ml
Average radiation dose 20 Gy
Average skin-to-balloon distance 1.21 cm
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FOLLOW UP
• 40 patients have completed IORT protocol
• Average follow up - 29 months
• One patient has been diagnosed with a
brain metastases at two years
• 2 patients have died of unrelated
causes
• No evidence of any local recurrences
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IORT - ONE YEAR FOLLOW UP
NORMAL BREAST 1 YEAR POST IORT
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IORT – ONE YEAR MAMMOGRAPHIC FOLLOW UP
SCREENING MAMMOGRAM ONE YEAR POST-OP
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CONCLUSION
Early results of intra-operative radiation
therapy using the Axxent Electronic
Brachytherapy System in the United
States support the use of IORT for
treatment of early stage breast cancer.
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XOFT MULTI - INSTITUTIONAL STUDY
A Safety and Efficacy Study
of Intra-Operative Radiation
Therapy (IORT) Using the Xoft®
Axxent® eBx
™ System at the
Time of Breast Conservation
Surgery for Early Stage Breast
Cancer
“ExBRT”
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