Treatment choice in early breast cancer patients suitable for breast conservation

Objective To study the feasibility and the advantages of breast-conserving surgery plus intraoperative radiotherapy plus sentinel lymph node biopsy (SLNB) in early breast cancer patients who are suitable for breast conservation. Methods We retrospectively analyzed the clinical data of 136 early breast cancer patients with breast conservation in our hospital from June 2007 to January 2012. Among them, 62 received intraoperative radiotherapy at the dosage of 21 Gy with 9 MeV electrons (intraoperative radiotherapy group), including 41 with axillary lymph node dissection (ALND group) and 21 with SLNB (SLNB group); 74 received conventional postoperative whole-breast radiotherapy at the dosage of 50-60 Gy (5-6 weeks, 25-30 times) after breast-conserving surgery (postoperative radiotherapy group). The duration of operation and wound healing, cost of radiotherapy, and cosmetic results were compared between the intraoperative and postoperative radiotherapy group. The events of radiation injury, recurrence and death were recorded. The function of shoulder joint, edema and abnormal sensation of the affected limb, subcutaneous effusion were recorded in SLNB group and ALND group. The non-parametric test was used for quantitative data and ranked data. Results Compared with postoperative radiotherapy group, the intraoperative radiotherapy group had longer operation time [M(QR):120(15) min vs 90(15)min, P=0.00], more wound healing days [M(QR):13(4) d vs 8(1) d, P=0.00], less cost [M(QR):3500(200)RMB vs 14100(1000)RMB, P=0.00], and slighter radiation injury. No difference in cosmetic results was showed[95.2%(59/162) vs 86.5%(64/74), P=0.09]. There were 2 cases of local recurrences, 2 distant metastases and 1 death in the intraoperative group, while there was 1 local recurrence, 3 distant metastases and no death in the postoperative radiotherapy group. No contralateral breast cancer occurred in two groups. There were 3 cases of shoulder joint dysfunction, 7 edema of affected limb, 10 abnormal sensation of the affected limb, 5 subcutaneous effusion in ALND group, whereas we observed 1 case of shoulder joint dysfunction,1 edema of affected limb of degree I, and 1 subcutaneous effusion in SLNB group. Conclusions The breast-conserving surgery plus intraoperative radiotherapy have the advantages of single fraction irradiation, accurate location and dosage, less cost, better cosmetic results and protection of adjacent organs. Meanwhile the sentinel lymph node biopsy can avoid surgical complications such as shoulder joint dysfunction, limb swelling and abnormal cutaneous sensation, subcutaneous effusion.