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Breast cancer

Targeted intraoperative radiotherapy—one pit stop for breast cancer treatment

Nature Reviews Clinical Oncology volume 11, page 1 (2014)Cite this article

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The current standard of care for women with small breast carcinoma (up to 3.5 cm) is a lumpectomy followed by adjuvant external beam radiotherapy (EBRT) for several weeks after surgery. Despite the length of treatment and its adverse effects, EBRT is considered necessary to decrease local tumour recurrence. Two new studies, one published in The Lancet and the other in The Lancet Oncology, have identified targeted intraoperative radiotherapy as an alternative protocol to treat women with early stage breast cancer. Both studies arise from the staggering reality that many women face mastectomy—despite having a tumour that is suitable for conservative breast surgery—because of the logistical and financial difficulties of a 6-week course of post-operative radiotherapy.

Lead author of one of the studies, Jayant Vaidya, explains how previous findings showed that “breast cancer seems to recur mainly at the site of the original tumour,” which led to the idea of developing an instrument that would deliver radiation to the tumour bed during lumpectomy. Vaidya and colleagues developed a new technique—TARGIT (TARGeted Intraoperative radioTherapy)—and designed a risk-adapted trial to achieve a personalized approach to adjuvant radiotherapy. The TARGIT-A trial, launched in March 2000 and closed in June 2012, accrued a total of 3,451 women aged ≥45 years with invasive ductal carcinoma who were suitable for conservative breast surgery. Patients were randomly assigned to receive TARGIT or EBRT. Patients assigned to the TARGIT group, were subjected to lumpectomy, immediately followed by a single dose of radiation (20 Gy), delivered under the same anesthetic.

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References

  1. Vaidya, J. S. et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 10.1016/S0140-6736(13)61950-9

  2. Veronesi, U. et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 10.1016/S1470-2045(13)70497-2

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Authors
  1. Alessia Errico
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Errico, A. Targeted intraoperative radiotherapy—one pit stop for breast cancer treatment. Nat Rev Clin Oncol 11, 1 (2014). https://doi.org/10.1038/nrclinonc.2013.226

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