Feasibility and early toxicity of intraoperative radiotherapy for breast cancer using the papillon + system: First results

• Published in: Clinical and Translational Radiation Oncology
• Main Authors: Marie-Eve Chand-Fouché, Claudine Colnard, Jocelyn Gal, Daniel Lam Cham Kee, Catherine Dejean, Matthieu Gautier, Julien Feuillade, Aurélia Mana, Yves Fouché, Yann Delpech, Magali Dejode, Jean-Pierre Gérard, Emmanuel Barranger
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2023
• Subjects: Papillon+ system; Breast IORT; Brachytherapy; High dose rate; Medical physics. Medical radiology. Nuclear medicine; R895-920; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; RC254-282; South Pole; South pole
• Online Access: https://doi.org/10.1016/j.ctro.2022.10.006; https://doaj.org/article/28ed8f926065458fb47fa824cc6519b8

Background and Purpose: Breast intra operative radiation therapy has been evaluated with different systems delivering 20–21 Gy with treatment times around 30 min. Papillon + TM Contact X-ray machine was designed to produce a 50 kVp beam with a high dose rate ≥ 15 Gy/minute. A pilot study with the first prototype was conducted in Nice. Materials and methods: The inclusion criteria were age ≥ 60 years, unifocal ductal breast adenocarcinoma ≤ 2.5 cm, grade 1–2. Surgical local excision with sentinel node dissection was performed and the applicator was placed in the tumor bed after excision with a prescribed dose of 20 Gy. The main end point of the study was the doses measured with the Gafchromic films; two were located at the skin surface and two in the excision cavity. Secondary endpoints were early toxicity and relapse free survival. Results: Between 10/2018 and 09/2019, 26 patients were included. Mean Gafchromic doses were 18.8 Gy ± 2 Gy at the south pole, 15.6 Gy ± 2.81 Gy at the equator and 2.5 Gy ± 1.67 Gy at the skin. With a median follow-up time of 12 months, no skin or subcutaneous toxicity > grade 2, no local relapse and no metastasis were observed. Conclusion: This is the first phase II study testing the Papillon + tm system for breast IORT with in vivo dosimetry measurements and reassuring clinical data.