Single-dose intraoperative radiotherapy during lumpectomy for breast cancer: an innovative patient-centred treatment

In the randomised TARGIT-A trial, risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy was non-inferior to whole-breast external beam radiotherapy, for local recurrence. In the long-term, no difference was found in any breast cancer outcome, whereas there were fewer deaths from non-breast-cancer causes. TARGIT-IORT should be included in pre-operative consultations with eligible patients

Global adoption of single-shot targeted intraoperative radiotherapy (TARGIT-IORT) for breast cancer – better for patients, better for health care systems

Introduction: TARGeted Intraoperative radioTherapy (TARGIT-IORT), developed in the late 1990s, delivers radiotherapy targeted to the fresh tumour bed exposed immediately after lumpectomy for breast cancer. Long-term results of the TARGIT-A trial found TARGIT-IORT during lumpectomy to be as effective as whole breast radiotherapy, and led to significantly fewer deaths from non-breast cancer causes. This paper documents its worldwide impact and provides interactive tools for clinicians and patients. / Method: Each centre provided the number of patients treated using TARGIT-IORT. These data were plotted on an interactive ‘My Google Map’. We also created an interactive web-based tool. Using the longterm outcomes from the TARGIT-A trial, we estimated the total savings in travel miles, time, carbon footprint, and the number of deaths from other causes that might be prevented. / Results: Data from 242 (93%) of the 260 centres treating patients from 35 countries were available. The first was treated in 1998 at University College London. As of early 2020, at least 44752 women with breast cancer have been treated with TARGIT-IORT. https://targit.org.uk/travel displays the Google-map of centres with number of cases and the interactive tool that enables patients to find the nearest centre offering TARGIT-IORT and their travel savings. Scaling the main benefits up to the already treated patients, >20 million miles of travel would have been saved, and about 2000 deaths prevented. / Discussion: One can ascertain the number of patients treated with a novel treatment. These data show how widely TARGIT-IORT has now been adopted and gives an indication of its beneficial worldwide impact on a large number of women with breast cancer

Breast Cancer Research and Treatment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44205/1/10549_2004_Article_318268.pd

Intraoperative radiotherapy for breast cancer: powerful evidence to change practice

We believe that the recent News and Views article (Sasieni, P. D. & Sawyer, E. J. Intraoperative radiotherapy for early breast cancer — insufficient evidence to change practice. Nat. Rev. Clin. Oncol. 17, 723–724 (2020))1 about the TARGIT-A trial contains several factual and logical errors. This article overlooks both the long-term positive findings2 and the all-important patient perspective

Cosmesis and breast-related quality of life outcomes following intra-operative radiotherapy for early breast cancer - a sub-study of the TARGIT - a trial

Purpose: The international randomized TARGIT-A trial compared risk-adapted single-dose intra-operative radiotherapy (TARGIT-IORT) to 3-7 weeks of daily conventional external beam radiotherapy (EBRT) in women with early breast cancer treatable with breast conserving surgery. TARGIT-A showed TARGIT-IORT to be non-inferior compared to EBRT in terms of reducing the risk of local cancer recurrence and found no difference in breast cancer survival however its effect on patient reported cosmesis and breast-related quality of life (QOL) have not yet been described. Methods and Materials: Longitudinal cosmesis and QOL data were collected from a sub-set of TARGIT-A participants who received TARGIT-IORT as a separate procedure (post-pathology). Patients completed a cosmetic assessment before radiotherapy and annually thereafter for at least five years. Patients also completed the combined EORTC core questionnaire (QLQ-C30) and Breast Specific Module (BR23) in addition to the Body Image after Breast Cancer Questionnaire (BIABC) at baseline and annually thereafter. The combined EORTC questionnaires were also collected 3, 6, and 9 months after wide local excision (WLE). Results: An Excellent-Good (EG) cosmetic result was scored more often than a Fair-Poor (FP) result for both treatment groups across all time points. TARGIT-IORT patients reported better breast-related QOL than EBRT patients. Statistically and clinically significant differences were seen at month-6 and Year-1, with EBRT patients having moderately worse breast symptoms (a statistically significant difference of more than 10 in a 100 point scale) than TARGIT-IORT patients at these time points. Conclusion: Patients treated with TARGIT-IORT on the TARGIT-A trial have similar self-reported cosmetic outcome but better breast-related QOL outcomes than patients treated with EBRT. This important evidence can facilitate the treatment decision making process for patients who have early breast cancer suitable for breast conserving surgery and inform their clinicians