The Value of Intraoperative Radiation Therapy (IORT) in Integrative Breast Cancer Treatment
A single, high-precision radiotherapy treatment shortens treatment duration, reduces side effects, and improves the compliance and quality of life of breast cancer patients in Hong Kong.
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Introduction
Breast cancer is one of the most common cancers among women in Hong Kong, with incidence rates continuing to rise. According to the Hong Kong Cancer Registry (2022), breast cancer accounts for approximately 27% of new female cancer cases, posing a significant public health challenge. Conventional radiotherapy usually follows breast-conserving surgery, requiring several weeks of treatment, which can be a heavy burden on patients’ daily lives and work.
Intraoperative Radiation Therapy (IORT) offers a new option: immediately after tumor excision, a single high-dose of radiation is delivered directly to the tumor bed in the operating room. This approach shortens treatment duration and reduces recurrence risk, providing practical value for Hong Kong where healthcare resources are limited and patients often seek convenience (Vaidya et al., 2014).
Principles of IORT in Breast Cancer Treatment
Treatment Method
IORT typically uses low-energy X-rays (e.g., TARGIT technique) or electron beams, applied immediately to the tumor bed after excision, thereby minimizing exposure to the heart and lungs. This is particularly important for left-sided breast cancers, which are common among Hong Kong women, due to proximity to the heart (Veronesi et al., 2013).
Advantages
- Single-session completion: Unlike the 15–25 sessions of conventional radiotherapy commonly provided in Hong Kong public hospitals, IORT is completed in one procedure.
- Reduced side effects: Less skin erythema, breast deformation, and cardiopulmonary complications.
- Improved compliance: For patients who must travel long distances between hospitals, IORT reduces logistical and occupational burdens, making it especially suitable for residents in community settings.
Clinical Evidence
TARGIT-A Trial
The large international TARGIT-A trial showed that, for low-risk early breast cancer patients, IORT and whole-breast external beam radiotherapy (EBRT) had comparable 5-year recurrence and survival rates (Vaidya et al., 2014).
ELIOT Trial
The ELIOT study demonstrated that electron-beam IORT and EBRT had no significant differences in long-term survival rates, with IORT associated with fewer cardiopulmonary complications (Veronesi et al., 2013).
Hong Kong Clinical Context
Within Hong Kong’s healthcare system, radiotherapy waiting times in public hospitals are relatively long, and patients often need to travel across different Hospital Authority institutions. The one-time nature of IORT reduces strain on both medical resources and patient convenience (Hong Kong Cancer Registry, 2022).
Indications
Based on European and ASTRO/ESTRO recommendations, IORT is most suitable for:
- Age ≥ 50 years
- Tumor ≤ 2 cm
- Hormone receptor-positive
- No lymph node involvement
In Hong Kong, IORT may serve as an alternative for low-risk early breast cancer patients. For high-risk groups such as triple-negative or HER2-positive cases, EBRT remains the standard, with IORT serving only as an adjunct (Correa et al., 2017).
Integrative Medicine Perspective
Immunonutrition Integration
Surgery and radiotherapy may impair immune function. Supplementation with nutrients such as arginine and omega-3 fatty acids has been shown to promote immune recovery and reduce infection and inflammation. Some private medical institutions in Hong Kong already incorporate postoperative nutritional management (Arends et al., 2021).
Psychological Support and Quality of Life
Hong Kong breast cancer patients often experience anxiety due to lengthy treatment courses. IORT reduces the number of hospital visits, thereby lowering psychological stress. When combined with counseling and mindfulness-based stress reduction (MBSR), patient experience can be further improved (Greenlee et al., 2017).
Holistic Care
IORT represents more than just a technology; it is part of Hong Kong’s future move towards multidisciplinary integrative care, bringing together surgical, oncological, nutritional, and psychological expertise for comprehensive patient management.
Limitations and Challenges
- Local recurrence: Some studies report slightly higher recurrence rates compared with EBRT, necessitating careful patient selection.
- High equipment demand: Requires specialized devices, currently available only in selected private oncology centers in Hong Kong.
- Limited long-term data: Insufficient long-term follow-up for high-risk breast cancer groups.
Conclusion
IORT demonstrates clear advantages in breast cancer treatment by offering “single-session completion, precision targeting, and fewer side effects.” It is particularly suitable for Hong Kong breast cancer patients, reducing healthcare burdens and improving compliance. When integrated with immunonutrition, psychological support, and holistic care models, IORT may become a new direction for breast cancer treatment in Hong Kong.
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References
- Arends, J., et al. (2021). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 40(5), 2898–2913.
- Correa, C., et al. (2017). Accelerated partial breast irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Practical Radiation Oncology, 7(2), 73–79.
- Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). (2011). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year survival. Lancet, 378(9804), 1707–1716.
- Greenlee, H., et al. (2017). Clinical practice guidelines on integrative therapies as supportive care in breast cancer. Journal of Clinical Oncology, 35(18), 1962–1981.
- Hong Kong Cancer Registry. (2022). Hong Kong Cancer Statistics 2020. Hospital Authority.
- Vaidya, J. S., et al. (2014). Risk-adapted targeted intraoperative radiotherapy versus whole breast radiotherapy: TARGIT-A trial. Lancet, 383(9917), 603–613.
- Veronesi, U., et al. (2013). Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomized trial. Lancet Oncology, 14(13), 1269–1277.