Operative Technique |

Surgical Technique of Intraoperative Radiotherapy in Conservative Treatment of Limited-Stage Breast Cancer

Mattia Intra, MD; Giovanna Gatti, MD; Alberto Luini, MD; Viviana Galimberti, MD; Paolo Veronesi, MD; Stefano Zurrida, MD; Antonio Frasson, MD; Mario Ciocca, MD; Roberto Orecchia, MD; Umberto Veronesi, MD, PhD
Arch Surg. 2002;137(6):737-740. doi:10.1001/archsurg.137.6.737.
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At the European Institute of Oncology, Milan, Italy, we have focused our interest on the use of intraoperative radiation therapy (IORT) in limited-stage breast cancer that is conservatively treated. A new technique to perform IORT was applied in 185 patients from July 1, 1999, to October 31, 2001. As the surgeon plays a crucial role in this procedure in selecting the patients, performing the breast resection, preparing the gland as a target to receive IORT, delivering the radiation directly to the mammary gland via a dedicated applicator, and, finally, reconstructing the breast, each phase of the surgical technique has been completely standardized and is described herein. The use of IORT in the conservative treatment of breast cancer could allow the course of external fractionated-dose radiation therapy to be completely avoided; IORT dramatically reduces radiation exposure of the skin, lung, and subcutaneous tissues and avoids the irradiation of the contralateral breast, which contributes to a very low incidence of radiation-induced sequelae. In our experience, IORT for limited-stage breast carcinoma is easy to perform and only briefly prolongs the duration of the surgical procedure.

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Figure 1.

The breast mobilization facilitates the exposure of the mammary gland parenchyma to the radiation beam.

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Figure 2.

A lead disk 5 mm thick is placed, as a protective device, between the gland and the pectoral muscle.

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Figure 3.

In correspondence to the breach left by the removal of the quadrant, the gland is sutured to restore its anatomy and thickness.

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Figure 4.

The skin margins are hitched to the nontraumatic hooks of a metallic ring and gently stretched out of the radiation field.

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Figure 5.

The sterile polymethyl methacrylate (Perspex) applicator of the linear accelerator is placed directly in contact with the breast gland to guarantee the coverage of the entire target volume.

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