{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T21:53:07Z","timestamp":1782251587978,"version":"3.54.5"},"reference-count":37,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Aims: Due to its favorable dose distribution and targeting of the region at highest risk of recurrence due to direct visualization of tumor bed, intraoperative electron radiation therapy (IOERT) is used as part of a breast-conserving treatment approach. The aim of this study was to analyze tumor control and survival, as well as the toxicity profile, and cosmetic outcomes in patients irradiated with an IOERT boost for breast cancer. Materials and Methods: 139 Patients treated at our institution between January 2010 and January 2015 with a single boost dose of 10 Gy to the tumor bed during breast-conserving surgery followed by whole-breast irradiation were retrospectively analyzed. Results: 139 patients were included in this analysis. The median age was 54 years (range 28\u201383 years). The preferred surgical strategy was segmental resection with sentinel lymphonodectomy (66.5%) or axillary dissection (23.1%). Regarding adjuvant radiotherapy, the vast majority received 5 \u00d7 1.8 Gy to 50.4 Gy. At a median follow-up of 33.6 months, recurrence-free and overall survival were 95.5% and 94.9%, respectively. No patient developed an in-field recurrence. Seven patients (5.0%) died during the follow-up period, including two patients due to disease recurrence (non-in-field). High-grade (CTCAE &gt; 2) perioperative adverse events attributable to IOERT included wound healing disorder (N = 1) and hematoma (N = 1). High-grade late adverse events (LENT-SOMA grade III) were reported only in one patient with fat necrosis. Low-grade late adverse events (LENT-SOMA grade I-II) included pain (18.0%), edema (10.5%), fibrosis (21%), telangiectasia (4.5%) and pigmentation change (23.0%). The mean breast retraction assessment score was 1.66 (0\u20136). Both patients and specialists rated the cosmetic result \u201cexcellent\/good\u201d in 84.8% and 87.9%, respectively. Conclusion: Our study reports favorable data on the cosmetic outcome as well as the acute and early long-term tolerability for patients treated with an IOERT boost. Our oncologic control rates are comparable to the previous literature. However, prospective investigations on the role of IOERT in comparison to other boost procedures would be desirable.<\/jats:p>","DOI":"10.3390\/cancers14153636","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T22:03:42Z","timestamp":1658873022000},"page":"3636","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Early Outcome, Cosmetic Result and Tolerability of an IOERT-Boost Prior to Adjuvant Whole-Breast Irradiation"],"prefix":"10.3390","volume":"14","author":[{"given":"Danny","family":"Jazmati","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9112-1024","authenticated-orcid":false,"given":"Edwin","family":"B\u00f6lke","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kati","family":"Halfmann","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2533-0167","authenticated-orcid":false,"given":"B\u00e1lint","family":"Tamaskovics","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugen","family":"Ruckh\u00e4berle","sequence":"additional","affiliation":[{"name":"Department of Gynecology & Obstetrics, Heinrich-Heine University Dusseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Fehm","sequence":"additional","affiliation":[{"name":"Department of Gynecology & Obstetrics, Heinrich-Heine University Dusseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Gynecology & Obstetrics, Heinrich-Heine University Dusseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8811-5416","authenticated-orcid":false,"given":"David","family":"Krug","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Nestle Kr\u00e4mling","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Senology, EVK, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8709-7252","authenticated-orcid":false,"given":"Stefanie","family":"Corradini","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital, LMU Munich, 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried","family":"Budach","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svjetlana","family":"Mohrmann","sequence":"additional","affiliation":[{"name":"Department of Gynecology & Obstetrics, Heinrich-Heine University Dusseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Haussmann","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Matuschek","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.7314\/APJCP.2016.17.S3.43","article-title":"Incidence and Mortality and Epidemiology of Breast Cancer in the World","volume":"17","author":"Ghoncheh","year":"2016","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"682","DOI":"10.6004\/jnccn.2017.0072","article-title":"NCCN Guidelines Update: Evolving Radiation Therapy Recommendations for Breast Cancer","volume":"15","author":"Salerno","year":"2017","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1002\/1097-0142(19850901)56:5<979::AID-CNCR2820560502>3.0.CO;2-N","article-title":"Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery","volume":"56","author":"Holland","year":"1985","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3259","DOI":"10.1200\/JCO.2007.11.4991","article-title":"Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial","volume":"25","author":"Bartelink","year":"2007","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1200\/JCO.1997.15.3.963","article-title":"Role of a 10-Gy boost in the conservative treatment of early breast cancer: Results of a randomized clinical trial in Lyon, France","volume":"15","author":"Romestaing","year":"1997","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/BF03032380","article-title":"The role of boost irradiation in the conservative treatment of stage I-II breast cancer","volume":"7","author":"Fodor","year":"2001","journal-title":"Pathol. Oncol. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/S1470-2045(14)71156-8","article-title":"Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial","volume":"16","author":"Bartelink","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.ijrobp.2010.07.1996","article-title":"Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery","volume":"81","author":"Vaidya","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S0140-6736(10)60837-9","article-title":"Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): An international, prospective, randomised, non-inferiority phase 3 trial","volume":"376","author":"Vaidya","year":"2010","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"294","DOI":"10.5114\/jcb.2016.61973","article-title":"External beam boost versus interstitial high-dose-rate brachytherapy boost in the adjuvant radiotherapy following breast-conserving therapy in early-stage breast cancer: A dosimetric comparison","volume":"8","author":"Terheyden","year":"2016","journal-title":"J. Contemp. Brachytherapy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.radonc.2015.12.006","article-title":"Recommendations from GEC ESTRO Breast Cancer Working Group (II): Target definition and target delineation for accelerated or boost partial breast irradiation using multicatheter interstitial brachytherapy after breast conserving open cavity surgery","volume":"118","author":"Major","year":"2016","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1159\/000489637","article-title":"Intraoperative Electron Radiotherapy (IOERT) in the Treatment of Primary Breast Cancer","volume":"13","author":"Kaiser","year":"2018","journal-title":"Breast Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13058-021-01424-9","article-title":"IOERT versus external beam electrons for boost radiotherapy in stage I\/II breast cancer: 10-year results of a phase III randomized study","volume":"23","author":"Ciabattoni","year":"2021","journal-title":"Breast Cancer Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1007\/s00066-010-2147-9","article-title":"Radiobiological comparison of hypofractionated accelerated partial-breast irradiation (APBI) and single-dose intraoperative radiotherapy (IORT) with 50-kV X-rays","volume":"186","author":"Herskind","year":"2010","journal-title":"Strahlenther. Onkol. Organ Dtsch. Rontgenges."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.radonc.2020.02.001","article-title":"Toxicity and cosmetic outcome after hypofractionated whole breast irradiation and boost-IOERT in early stage breast cancer (HIOB): First results of a prospective multicenter trial (NCT01343459)","volume":"146","author":"Fastner","year":"2020","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.canlet.2011.08.020","article-title":"Efficacy and safety of intraoperative radiotherapy in breast cancer: A systematic review","volume":"313","year":"2011","journal-title":"Cancer Lett."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.radonc.2020.04.059","article-title":"ESTRO IORT Task Force\/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer","volume":"149","author":"Fastner","year":"2020","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0167-8140(00)00210-3","article-title":"The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC \u2018boost vs. no boost\u2019 trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups","volume":"55","author":"Vrieling","year":"2000","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s00066-019-01473-2","article-title":"Long-term cosmetic outcome after preoperative radio-\/chemotherapy in locally advanced breast cancer patients","volume":"195","author":"Matuschek","year":"2019","journal-title":"Strahlenther. Onkol. Organ Dtsch. Rontgenges."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"716860","DOI":"10.1155\/2014\/716860","article-title":"Cosmetic Outcome Assessment following Breast-Conserving Therapy: A Comparison between BCCT.core Software and Panel Evaluation","volume":"2014","author":"Haloua","year":"2014","journal-title":"Int. J. Breast Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.radonc.2013.05.031","article-title":"IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: Long term results of an ISIORT pooled analysis","volume":"108","author":"Fastner","year":"2013","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00066-007-2013-6","article-title":"IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: Results of an ISIORT pooled analysis","volume":"183","author":"Sedlmayer","year":"2007","journal-title":"Strahlenther. Onkol. Organ Dtsch. Rontgenges."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"384","DOI":"10.3389\/fonc.2019.00384","article-title":"Acute Toxicity and Early Oncological Outcomes After Intraoperative Electron Radiotherapy (IOERT) as Boost Followed by Whole Breast Irradiation in 157 Early Stage Breast Cancer Patients-First Clinical Results from a Single Center","volume":"9","author":"Lang","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1023\/A:1011136326943","article-title":"Radiotherapy after breast-conserving surgery in small breast carcinoma: Long-term results of a randomized trial","volume":"12","author":"Veronesi","year":"2001","journal-title":"Ann. Oncol. Off. J. Eur. Soc. Med. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/S0959-8049(02)00116-8","article-title":"Intraoperative radiotherapy given as a boost after breast-conserving surgery in breast cancer patients","volume":"38","author":"Reitsamer","year":"2002","journal-title":"Eur. J. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s00066-006-1559-z","article-title":"Full-dose intraoperative radiotherapy with electrons in breast cancer. First report on late toxicity and cosmetic results from a single-institution experience","volume":"182","author":"Mussari","year":"2006","journal-title":"Strahlenther. Onkol. Organ Dtsch. Rontgenges."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1186\/1748-717X-8-191","article-title":"Electrons for intraoperative radiotherapy in selected breast-cancer patients: Late results of the Montpellier phase II trial","volume":"8","author":"Lemanski","year":"2013","journal-title":"Radiat. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.radonc.2018.06.020","article-title":"Predictors for poor cosmetic outcome in patients with early stage breast cancer treated with breast conserving therapy: Results of the Young boost trial","volume":"128","author":"Brouwers","year":"2018","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.ijrobp.2020.12.005","article-title":"Intensity Modulated Radiation Therapy (IMRT) With Simultaneously Integrated Boost Shortens Treatment Time and Is Noninferior to Conventional Radiation Therapy Followed by Sequential Boost in Adjuvant Breast Cancer Treatment: Results of a Large Randomized Phase III Trial (IMRT-MC2 Trial)","volume":"109","author":"Forster","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.radonc.2020.09.043","article-title":"Postoperative radiotherapy with intensity-modulated radiation therapy versus 3-dimensional conformal radiotherapy in early breast cancer: A randomized clinical trial of KROG 15-03","volume":"154","author":"Choi","year":"2020","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"GS4-05-GS4","DOI":"10.1158\/1538-7445.SABCS18-GS4-05","article-title":"Abstract GS4-05: Dose escalated simultaneous integrated boost radiotherapy for women treated by breast conservation surgery for early breast cancer: 3-year adverse effects in the IMPORT HIGH trial (CRUK\/06\/003)","volume":"79","author":"Coles","year":"2019","journal-title":"Cancer Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.breast.2008.05.009","article-title":"Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer","volume":"17","author":"Wenz","year":"2008","journal-title":"Breast"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S0360-3016(99)00211-4","article-title":"The influence of the boost in breast-conserving therapy on cosmetic outcome in the EORTC \u201cboost versus no boost\u201d trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer","volume":"45","author":"Vrieling","year":"1999","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.radonc.2006.12.008","article-title":"Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy","volume":"82","author":"Donovan","year":"2007","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4038","DOI":"10.1200\/JCO.2013.50.5511","article-title":"Interim cosmetic and toxicity results from RAPID: A randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy","volume":"31","author":"Olivotto","year":"2013","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.ejca.2014.12.013","article-title":"Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial","volume":"51","author":"Livi","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_37","first-page":"121","article-title":"Intensity modulated radiation therapy for breast cancer: Current perspectives","volume":"9","author":"Buwenge","year":"2017","journal-title":"Breast Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/15\/3636\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:57:00Z","timestamp":1760140620000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/15\/3636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,26]]},"references-count":37,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["cancers14153636"],"URL":"https:\/\/doi.org\/10.3390\/cancers14153636","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,26]]}}}