{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T06:41:37Z","timestamp":1782456097304,"version":"3.54.5"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"1178","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The incidence of fat necrosis (FN) is well known (15%-35%) with accelerated partial breast irradiation (APBI) techniques such as brachytherapy and external beam radiation therapy. However, specific data related to intraoperative radiation therapy (IORT) is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted in a single institution with 489 post-menopausal female patients &amp;gt;45-year-old with early-stage invasive breast cancer (T1-2N0M0) who underwent lumpectomy and IORT between March 2016 and June 2023. The median age was 68\u2009years (range, 49-93). WBRT was additionally offered in 36 patients (7.4%) for exhibiting local adverse features. Adjuvant endocrine therapy (consisting of aromatase inhibitors) and chemotherapy were administrated in 384 patients (78.5%) and 12 patients (2.4%), respectively. The incidence and potential predictors of fat necrosis were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median follow-up was 36\u2009months, the 3-year incidence of FN was 63.1% (95% CI, 58.2%-68%). Grade 1, grade 2, and grade 3 FN were present in 278 (57%), 10 patients (2%), and 3 patients (0.6%), respectively. The median FN size was 22\u2009mm (range, 5-50). Adjuvant endocrine therapy but not whole breast radiation therapy was found to be the only independent predictor associated with significantly increased risk of FN (1.77 [95% CI, 1.14-2.76], P\u2009=\u2009.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>IORT carries a higher largely asymptomatic FN incidence. Risk increases with aromatase inhibitors, not with WBRT. Endocrine therapy should not be withheld, and asymptomatic FN should not alter routine surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>Endocrine therapy is associated with increased risk of fat necrosis after lumpectomy and IORT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqaf267","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T13:11:41Z","timestamp":1761570701000},"page":"312-318","source":"Crossref","is-referenced-by-count":2,"title":["Endocrine therapy increases risk of fat necrosis risk after lumpectomy and intraoperative radiation therapy in early-stage breast cancer"],"prefix":"10.1093","volume":"99","author":[{"given":"Christophe","family":"Scherer","sequence":"first","affiliation":[{"name":"Department of Surgery, P\u00f4le Sant\u00e9 R\u00e9publique , Clermont-Ferrand 63100,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivien","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, U2R , Clermont-Ferrand 63100,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Anzellini","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sapienza University, Sant\u2019Andrea Hospital , Rome 00161,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia Falchettto","family":"Osti","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, U2R , Clermont-Ferrand 63100,","place":["France"]},{"name":"Department of Radiation Oncology, Sapienza University, Sant\u2019Andrea Hospital , Rome 00161,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Doridot","sequence":"additional","affiliation":[{"name":"Department of Surgery, P\u00f4le Sant\u00e9 R\u00e9publique , Clermont-Ferrand 63100,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Muracciole","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, CHU La Timone, Assistance Publique de Marseille , Marseille 13385,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Nappa","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, U2R , Clermont-Ferrand 63100,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beno\u00eet","family":"Mesurolle","sequence":"additional","affiliation":[{"name":"Department of Radiology, P\u00f4le Sant\u00e9 R\u00e9publique , Clermont-Ferrand 63100,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5888-8688","authenticated-orcid":false,"given":"Gokoulakrichenane","family":"Loganadane","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Institut Curie , Paris 75005,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"2026022702512565500_tqaf267-B1","doi-asserted-by":"publisher","first-page":"m2836","DOI":"10.1136\/bmj.m2836","article-title":"Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomized clinical trial","volume":"370","author":"Vaidya","year":"2020","journal-title":"BMJ"},{"key":"2026022702512565500_tqaf267-B2","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/s0720-048x(00)00303-x","article-title":"Fat necrosis of the breast: clinical, mammographic and sonographic features","volume":"39","author":"Bilgen","year":"2001","journal-title":"Eur J Radiol"},{"key":"2026022702512565500_tqaf267-B3","doi-asserted-by":"publisher","first-page":"758371","DOI":"10.1155\/2012\/758371","article-title":"Mammographic findings after intraoperative radiotherapy of the breast","volume":"2012","author":"Rivera","year":"2012","journal-title":"Radiol Res Pract"},{"key":"2026022702512565500_tqaf267-B4","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/tbj.12049","article-title":"Are mammographic changes in the tumor bed more pronounced after intraoperative radiotherapy for breast cancer? 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