Novel Development in Breast Radiotherapy in Bangladesh: Challenges in Intraoperative Radiotherapy by a Breast Onco-surgeon
Authors: Ali Nafisa
Institution: Labaid Cancer Hospital and Super Speciality Center
Introduction
Intraoperative radiotherapy (IORT) using the Xoft Axxent electronic brachytherapy (eBx) system provides a single-dose radiation treatment option for patients with early breast cancer (EBC) at the time of surgery. This systematic review aims to analyze existing studies on the use of this balloon-based eBx system and evaluate its effectiveness as a standalone treatment modality, particularly focusing on cosmetic outcomes, recurrence rates, and the need for additional external beam radiotherapy (EBRT).
Methods
A systematic search of studies published before February 2021 was conducted in PubMed, Scopus, and Science Direct. Inclusion criteria targeted studies employing a single-fraction 20 Gy IORT treatment using the Xoft Axxent eBx system for EBC patients. Eligible studies were reviewed following PRISMA guidelines. Patient selection criteria, cosmetic outcomes, recurrence rates, and the need for subsequent EBRT were analyzed. These findings were compared to clinical outcomes from 20 Bulgarian patients treated with the same modality.
Results
Out of 1032 studies, 17 met the eligibility criteria. Most studies reported excellent cosmetic outcomes, with low recurrence rates ranging from 1% to 5.8%. However, up to 31% of patients required additional EBRT. In the Bulgarian cohort of 20 patients, cosmetic results were similarly rated as excellent, with 25% requiring EBRT. Over a median follow-up of 39 months, there was one case of local recurrence and one distal recurrence. No randomized controlled trials (RCTs) have been conducted to confirm this approach's long-term effectiveness.
Conclusion
The Xoft Axxent eBx system is a safe and feasible option for IORT in EBC patients, with favorable cosmetic outcomes and low recurrence rates. However, a substantial proportion of patients may still require EBRT. The absence of RCTs limits definitive conclusions regarding its long-term effectiveness.
