Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer

BackgroundIntraoperative radiotherapy (IORT) during breast-conserving surgery is increasingly used. We analyzed the influence of the interval between an IORT boost and external beam radiotherapy (EBRT) on late toxicity.MethodsForty-eight patients received 20 Gy IORT (50 kV X-rays (Intrabeam, Carl Zeiss, Oberkochen, Germany) followed by 46–50 Gy EBRT with a median interval of 36 days (14-197). Late toxicity was assessed with the modified LENT SOMA score after a median of 36 months.ResultsTwelve patients developed a higher grade fibrosis (°II–III), three teleangiectases, one a breast edema grade °II, six retractions, four hyperpigmentations and five pain (°II–III). The median interval between IORT and EBRT was significantly shorter in these patients (n = 18) compared to the 30 patients without higher grade toxicity (29.5 days vs. 39.5 days, p = 0.023, Mann–Whitney U-test).ConclusionStarting EBRT about 5–6 weeks after IORT appears to be associated with a decreased risk of chronic late toxicity compared with a shorter interval. The impact on local recurrence of prolonged gaps between IORT and EBRT is not known.