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Long-term cosmetic outcome after intraoperative radiotherapy boost with low-energy X-rays in breast-conserving therapy: a pooled cohort analysis of the TARGIT-BQR and ROKSM trials

Purpose: This study investigates objective long-term cosmetic outcomes in patients with breast cancer after intraoperative radiotherapy applied as a boost (IORT boost) from a pooled international cohort. Methods: A pooled analysis of two prospective studies with IORT boost (low-energy X‑rays, 20Gy;...

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Main Authors: Schimmelfennig, Paulina (Author) , Reuter, Christiane (Author) , Kraus-Tiefenbacher, Uta (Author) , Brück, Viktoria (Author) , Kaiser, Christina (Author) , Keymer, Ralf (Author) , Abo-Madyan, Yasser (Author) , Fleckenstein, Katharina (Author) , Tuschy, Benjamin (Author) , Sütterlin, Marc (Author) , Wenz, Frederik (Author) , Reichardt, Hans (Author) , Fehr, Mathias (Author) , Kuther, Markus (Author) , Büttner, Sylvia (Author) , Sperk, Elena (Author)
Format: Article (Journal)
Language:English
Published: 02 February 2026
In: Strahlentherapie und Onkologie

ISSN:1439-099X
DOI:10.1007/s00066-026-02506-3
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1007/s00066-026-02506-3
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Author Notes:Paulina Schimmelfennig, Christiane Reuter, Uta Kraus-Tiefenbacher, Viktoria Brück, Christina Kaiser, Ralf Keymer, Yasser Abo-Madyan, Katharina Fleckenstein, Benjamin Tuschy, Marc Sütterlin, Frederik Wenz, Hans Reichardt, Mathias Fehr, Markus Kuther, Sylvia Büttner, Elena Sperk
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Summary:Purpose: This study investigates objective long-term cosmetic outcomes in patients with breast cancer after intraoperative radiotherapy applied as a boost (IORT boost) from a pooled international cohort. Methods: A pooled analysis of two prospective studies with IORT boost (low-energy X‑rays, 20Gy; inclusion criteria: 3.5cm maximum tumor size and preoperative indication for a boost according to local criteria) during breast-conserving surgery followed by whole-breast radiotherapy (46–50Gy). The analysis included photos from a subgroup of the prospective phase IV TARGeted Intraoperative radioTherapy (TARGIT) Boost Quality Registry (BQR) study (NCT01440010) with a follow-up of up to 10 years as well as patients from a Swiss study (ROKSM; Spital Thurgau AG; NCT02114086) with a follow-up of 5 years. The pooled analysis included photos from both trials taken at the same timepoints (6 weeks, 6 months, 1 year, 2 years, and 5 years after completion of whole-breast radiotherapy). Cosmetic results were evaluated with the validated BCCT.core software (BCCT.core 2.0, INESC Porto, Portugal) to assess symmetry, color, and scars. A generalized estimating equation (GEE) regression model was used to compare the two cohorts over time. Results: The pooled analysis included 777 cosmetic assessments from 276 patients. Across all follow-ups in the pooled analysis, the majority of cosmetic results were rated as excellent or good (61.9%). Patients from TARGIT-BQR had significantly more excellent or good ratings than patients from ROKSM (p< 0.0001). The proportion of patients receiving “excellent” and “good” ratings remained higher in TARGIT-BQR than in ROKSM at every timepoint during follow-up. Overall, for up to 10 years, the majority of ratings in the whole cohort were “excellent” or “good.” Conclusion: In this international pooled analysis, the cosmetic outcome after IORT boost followed by whole-breast irradiation shows a good esthetic long-term outcome. Further studies should explore factors that influence cosmetic outcomes and consider additional treatment-related parameters.
Item Description:Gesehen am 03.03.2026
Physical Description:Online Resource
ISSN:1439-099X
DOI:10.1007/s00066-026-02506-3

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