Long-Term Outcomes Using Electron IOERT APBI for Early Stage Breast Cancer: The Verona University Hospital Experience


      Methods and Materials

      From July 2006 to December 2015, 295 patients suitable for breast-conserving therapy entered a single-arm phase II study and were treated with IOERT as radical treatment. Inclusion criteria were age >50, postmenopausal status, cT1N0M0 stage, grade G1-G2, positive estrogen receptor status; unicentric and unifocal disease, histologically proven invasive ductal carcinoma no previous breast irradiation, good performance status.


      With a median follow-up of 7.1 years (95% CI, 6.5;7.4) 6 women (2.0%) experienced a true local recurrence (reappearance of the tumour in the same quadrant). Five-year overall survival and local recurrence-free survival were 96% (95% CI, 92.9;97.8) and 94.9% (95% CI, 91.6;97.0) respectively.


      Our trial suggests that, in highly selected early stage breast cancers, a single-dose IOERT can be safely delivered with excellent results and very low long-term recurrence rates.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • NSABP B-39
        RTOG 0413: a randomized phase III study of conventional whole breast irradiation versus partial breast irradiation for women with stage 0, I, or II breast cancer.
        Clin Adv Hematol Oncol. 2006; 4 (PMID:17111558): 719-721
        • Vaidya JS
        • Joseph DJ
        • Tobias JS
        • et al.
        Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, noninferiority phase 3 trial.
        Lancet. 2010; 376 (PMID20570343DOI): 91-102
        • Orecchia R
        • Ciocca M
        • Lazzari R
        • et al.
        Intraoperative radiation therapy with electrons (ELIOT) in early-stage breast cancer.
        Breast. 2003; 12 (PMID:14659125 DOI): 483-490
        • Meattini I.
        • et al.
        Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer: long-term results of the randomized phase III APBI-IMRT-Florence Trial.
        J Clin Oncol. 2020; (JCO2000650)
        • Vaidya J.S.
        • et al.
        Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial.
        BMJ. 2020; 370 (m2836)
        • Veronesi U.
        • et al.
        Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial.
        Lancet Oncol. 2013; 14: 1269-1277
        • Vaidya J.S.
        • et al.
        Effect of delayed targeted intraoperative radiotherapy vs whole-breast radiotherapy on local recurrence and survival: long-term results from the TARGIT-a randomized clinical trial in early breast cancer.
        JAMA Oncol. 2020; 6e200249
        • Vaidya J.S.
        • Bulsara M.
        • Baum M.
        Targeted intraoperative radiotherapy for early breast cancer- Reply.
        JAMA Oncol. 2020;
        • Vicini F.A.
        • et al.
        Long-term primary results of accelerated partial breast irradiation acer breast- conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial.
        Lancet. 2019; 394 (doi: 10.1016s0140-6736(19)32514-0): 2155-2164
        • Whelan T.J.
        • et al.
        External beam accelerated partial breast irradiation versus whole breast irradiation acer breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial.
        The Lancet. 2019; 394: 2165-2172
        • Strnad V.
        • et al.
        5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost acer breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial.
        Lancet. 2016; 387: 229-238
        • Coles C.E.
        • et al.
        Partial-breast radiotherapy acer breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non- inferiority trial.
        Lancet. 2017; 390: 1048-1060
      1. Ontario Clinical Oncology Group (OCOG), Canadian Institutes of Health Research (CIHR), Canadian Breast Cancer Research Alliance. RAPID: randomized trial of accelerated partial breast irradiation; 2008. Available at: Accessed March 31, 2012.

        • Roberto Orecchia
        • et al.
        Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-centre, randomised, phase 3 equivalence trial.
        Lancet Oncol. 2021; 22 (10.1016/S1470-2045(21)00080-2. Epub 2021 Apr 9.PMID:33845035DOI:10.1016/S1470-2045(21)00080-2): 597-608
        • Esposito E
        • Anninga B
        • Harris S
        • et al.
        Intraoperative radiotherapy in early breast cancer.
        Br J Surg. 2015; 102 (PMID:25787293DOI): 599-610
        • Veronesi U
        • Luini A
        • Del Vecchio M
        • et al.
        Radiotherapy after breast-preserving surgery in women with localized cancer of the breast.
        N Engl J Med. 1993; 328 (PMID:8387637): 1587-1591
        • Fisher ER
        • Anderson S
        • Redmond C
        • et al.
        Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP protocol B-06.
        Semin Surg Oncol. 1992; 8 (PMID:1496227): 161-166
        • Vaidya' JS
        • Vyas' JJ
        • Chinoy2 RF
        • Merchant3 N
        OP Sharma3 and I Mittra'. Multicentricity of breast cancer: whole-organ analysis and clinical implications.
        Br J Cancer. 1996; 74 (O (C) 1996 Stockton Press All rights reserved 0007-0920/96 S12.00): 820-824
      2. M Baum, JS Vaidya I Mittra. Multicentricity and recurrence of breast cancer. Published: January 18, 1997 DOI: 10.1016/S0140-6736(05)60950-6

        • Holland R
        • Veling SH
        • Mravunac M
        • et al.
        Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery.
        Cancer. 1985; 56 (PMID:2990668.DOI:10.1002/1097-0142(19850901)56:5<979::aid-cncr2820560502>;2-n): 979-990
        • Bartelink H
        • Horiot JC
        • Poortmans PM
        • et al.
        Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial.
        J Clin Oncol. 2007; 25 (PMID:17577015DOI): 3259-3265
        • Polga´r C
        • Van Limbergen E
        • Po¨tter R
        • et al.
        GEC-ESTRO breast cancer working group. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Europe´en de Curiethe´rapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009).
        Radiother Oncol. 2010; 94 ( 264-273
        • Smith BD
        • Arthur DW
        • Buchholz TA
        • et al.
        Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO).
        Int J Radiat Oncol Biol Phys. 2009; 74 (PMID:19545784DOI)9871001
        • Veronesi U
        • Orecchia R
        • Luini A
        • et al.
        Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases.
        Ann Surg. 2005; 242 (PMID:15973107 doi:): 101-106
        • Veronesi U
        • Orecchia R
        • Luini A
        • et al.
        Intraoperative radiotherapy during breast conserving surgery: a study of 1822 cases treated with electrons.
        Breast Cancer Res Treat. 2010; 124 (PMID:20711810DOI): 141-151
        • Kimple RJ
        • Klauber-DeMore N
        • Kuzmiak CM
        • et al.
        Local control following single-dose intraoperative radiotherapy prior to surgical excision of early.
        Ann Surg Oncol. 2011; 18 (PMID: 21061074): 939-945
        • Maluta S
        • Dall'Oglio S
        • Marciai N
        • et al.
        Accelerated partial breast irradiation using only intraoperative electron radiation therapy in early stage breast cancer.
        Int J Radiat Oncol Biol Phys. 2012; 84 (PMID: 22543201 DOI): e145-e152
      3. JS Vaidya, M Bulsara, M Baum et al. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. al PMID:32816842 2020;370:m2836. doi: 10.1136/bmj.m2836.

        • Hickey BE
        • Lehman M
        • Franci DP
        • See AM
        Partial breast irradiation for early breast cancer.
        Rev. 2016; 7 (10.1002/14651858.CD007077.pub3.pmid:27425375)CD007077
        • Jobsen JJ
        • van der Palen J
        • Ong F
        • et al.
        The value of a positive margin for invasive carcinoma in breast-conservative treatment in relation to local recurrence is limited to young women only.
        Int J Radiat Oncol Biol Phys. 2003; 57: 724-731