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Systematic Review

Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System—A Systematic Review and First Bulgarian Experience in Breast Cancer Patients

1
Department of Medical Diagnostic Activities, Medical University—Pleven, 1 Saint Kliment Ohridski Str., 5800 Pleven, Bulgaria
2
Department of Surgery, University Hospital Acibadem City Clinic Sofia, 66A Tsarigradsko Shose Str., 1784 Sofia, Bulgaria
3
Women for Oncology—Bulgaria, 9000 Varna, Bulgaria
4
Department of Surgery, Alexandrovska University Hospital, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria
5
Department of Medical Oncology, Oncology Complex Center—Burgas, 86 Demokracia Str., 8000 Burgas, Bulgaria
6
Department of Intensive Care, Alexandrovska University Hospital, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria
7
Department of Surgery, Military Medical Academy, 3 Georgi Sofiiski Str., 1431 Sofia, Bulgaria
8
Department of Pathology, Alexandrovska University Hospital, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria
9
Department of Radiotherapy, Uni Hospital, Panagyurishte, 100 Georgi Benkovski Str., 4500 Panagyurishte, Bulgaria
10
Department of Basic Training, University of Telecommunications and Post, 1 Acad. Stephan Mladenov Str., 1700 Sofia, Bulgaria
11
Department of Surgery, Medical University—Pleven, 1 Saint Kliment Ohridski Str., 5800 Pleven, Bulgaria
12
Department of Surgical Oncology, Dr. Georgi Stranski University Hospital—Pleven, 8a Georgi Kochev Str., 5809 Pleven, Bulgaria
13
Department of Radiotherapy, Dr. Georgi Stranski University Hospital—Pleven, 8a Georgi Kochev Str., 5809 Pleven, Bulgaria
14
Department of Medical Physics, Heart and Brain University Hospital, 2 Pierre Curie Str., 5800 Pleven, Bulgaria
*
Author to whom correspondence should be addressed.
The first two authors have equal contribution to the manuscript.
Curr. Oncol. 2021, 28(5), 3932-3944; https://doi.org/10.3390/curroncol28050335
Received: 12 March 2021 / Revised: 21 September 2021 / Accepted: 25 September 2021 / Published: 3 October 2021
(This article belongs to the Section Thoracic Oncology)
(1) Background: We aimed to analyze currently available studies with intraoperative radiotherapy (IORT) as a choice of treatment where the Xoft Axxent® electronic brachytherapy (eBx) system was used as a single-dose irradiation and an exclusive radiotherapy approach at the time of surgery in patients with early breast cancer (EBC). We also compared the results of the systematic review to the Bulgarian experience. (2) Methods and Materials: We performed a systematic review of the studies published before February 2021, which investigate the application of a single-fraction 20 Gy radiation treatment, delivered at the time of lumpectomy in EBC patients with the Xoft Axxent® eBx System. A systematic search in PubMed, Scopus, and ScienceDirect was performed. The results are reported following the PRISMA guidelines. The criteria on patients’ selection for IORT (the additional need for EBRT), cosmetic outcomes, and recurrence rate from the eligible studies are compared to the treatment results in Bulgarian patients. (3) Results: We searched through 1032 results to find 17 eligible studies. There are no published outcomes from randomized trials. When reported, the cosmetic outcomes in most of the studies are defined as excellent. The observed recurrence rate is low (1–5.8%). Still, the number of patients additionally referred to postoperative external breast radiotherapy (EBRT) is up to 31%. Amongst the 20 patients treated in Bulgaria, the cosmetic outcomes are also evaluated as excellent, five of which (25%) are referred for EBRT. Within median follow-up of 39 months, there was one local and one distal recurrence. (4) Conclusions: Current evidence demonstrates the Xoft Axxent® eBx system as a safe and feasible technique for IORT delivery in EBC patients. There are no randomized controlled trials conducted at this time point to prove its long-term effectiveness. Better patient selection and a reimbursement strategy have to be proposed to extend the application of this technique in Bulgaria. View Full-Text
Keywords: early breast cancer; intraoperative radiotherapy; electronic brachytherapy; Axxent electronic brachytherapy early breast cancer; intraoperative radiotherapy; electronic brachytherapy; Axxent electronic brachytherapy
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MDPI and ACS Style

Kostova-Lefterova, D.; Vasileva-Slaveva, M.; Maslyankov, S.; Konsoulova, A.; Atanasova, M.; Paycheva, T.; Vlahova, A.; Genadieva-Yordanova, M.; Prodanova, G.; Zahariev, Z.; Pavlov, V.; Todorov, G.; Vasilev, B.; Angelov, K.; Deliyski, T.; Petrova, I.; Hitova, D.; Petrov, I. Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System—A Systematic Review and First Bulgarian Experience in Breast Cancer Patients. Curr. Oncol. 2021, 28, 3932-3944. https://doi.org/10.3390/curroncol28050335

AMA Style

Kostova-Lefterova D, Vasileva-Slaveva M, Maslyankov S, Konsoulova A, Atanasova M, Paycheva T, Vlahova A, Genadieva-Yordanova M, Prodanova G, Zahariev Z, Pavlov V, Todorov G, Vasilev B, Angelov K, Deliyski T, Petrova I, Hitova D, Petrov I. Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System—A Systematic Review and First Bulgarian Experience in Breast Cancer Patients. Current Oncology. 2021; 28(5):3932-3944. https://doi.org/10.3390/curroncol28050335

Chicago/Turabian Style

Kostova-Lefterova, Desislava, Mariela Vasileva-Slaveva, Svilen Maslyankov, Assia Konsoulova, Margarita Atanasova, Tsvetelina Paycheva, Alexandrina Vlahova, Marusya Genadieva-Yordanova, Ginka Prodanova, Zahari Zahariev, Vasil Pavlov, Georgi Todorov, Boris Vasilev, Kostadin Angelov, Tashko Deliyski, Ivelina Petrova, Desislava Hitova, and Ivo Petrov. 2021. "Intraoperative Radiotherapy with Balloon-Based Electronic Brachytherapy System—A Systematic Review and First Bulgarian Experience in Breast Cancer Patients" Current Oncology 28, no. 5: 3932-3944. https://doi.org/10.3390/curroncol28050335

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