A Novel Approach of INTRABEAM Intraoperative Radiotherapy for Nipple-Sparing Mastectomy With Breast Reconstruction

This study aims to broaden the application of INTRABEAM (Zeiss Meditech, Jena, Germany) intraoperative radiotherapy (IORT) in nipple-sparing mastectomy (NSM) with breast reconstruction for breast cancer. A single dose of 16 Gy was administered in 7 patients receiving IORT. The median radiation time was 13 minutes 14 seconds. No acute radiation injury with symptoms was observed, and the short-term outcomes were good. Background: Despite the advancement and increasing use of breast-conserving surgery, mastectomies, including nipple-sparing mastectomy (NSM), are still carried out in a portion of breast cancer patients. However, the role of NSM is still controversial, mainly because of concern about the oncologic safety of the nipple-areola complex (NAC). INTRABEAM (Carl Zeiss, Oberkochen, Germany) is the most widely used mobile intraoperative radiotherapy (IORT) device to date. This pilot study aims to broaden the application of the INTRABEAM system for breast cancer, investigating the feasibility of INTRABEAM IORT in NSM with breast reconstruction. Patients and Methods: From December 2012 to June 2013, 7 female patients with breast cancer were enrolled in the study. NSM with or without axillary dissection was performed first. After confirming negative retroareolar frozen section results and no poor local bleeding in the NAC, INTRABEAM IORT was carried out with a single dose of 16 Gy, followed by breast reconstruction. The complications and short-term outcomes were assessed. Results: The median radiation time was 13 minutes 14 seconds in the 7 cases. One patient complained of mild pain in the radiation field on the skin in the first 2 weeks. All 7 patients were followed for a median of 7 months. No acute radiation injury with symptoms (heart, lung, or hematologic system), NAC necrosis, local recurrence, or metastasis was observed. Although every patient had reduction in NAC sensitivity, the contours of the breasts (including the NAC) were satisfactory. Conclusions: INTRABEAM IORT may be a feasible and convenient approach for NSM with breast reconstruction in patients with breast cancer.