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Intraoperative radiotherapy for breast cancer: powerful evidence to change practice

Nature Reviews Clinical Oncology volume 18, pages 187–188 (2021)Cite this article

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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.

Risk-adapted single-dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) is a method of partial breast irradiation (PBI) for early breast cancer. Most patients (80%) receiving TARGIT-IORT2 during their lumpectomy complete their local treatment entirely during this single session, under the same anaesthetic. Supplemental whole breast external beam radiotherapy (WBRT) is only recommended for a minority of patients (20%) if unexpected prespecified tumour-related factors such as invasive lobular cancer and positive margins are found postoperatively. However, most patients with conventional ‘high risk’ features were treated without supplemental WBRT, including four-fifths of those with grade 3 or ER-negative disease, and two-thirds of node-positive cases. By contrast, traditional WBRT or other PBI approaches require up to 30 additional hospital visits — TARGIT-IORT involves far fewer clinic appointments3. Other benefits include fewer toxicities, less pain, better cosmetic results and better quality of life2.

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References

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Acknowledgements

Funding for the TARGIT-A trial was mainly provided by the National Institute for Health Research (NIHR) Health Technology Assessment programme (HTA 07/60/49). J.S.V. and J.S.T. received funding from the UK HTA, NIHR, and Department of Health for some activities related to the TARGIT trials.

Author information

Authors and Affiliations

  1. Division of Surgery and Interventional Science, University College London, London, UK

    Jayant S. Vaidya, Max Bulsara & Michael Baum

  2. Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia

    Max Bulsara

  3. Department of Surgery, University of California, San Francisco, CA, USA

    Michael Alvarado

  4. London, UK

    Marcelle Bernstein

  5. Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy

    Samuele Massarut

  6. School of Surgery, University of Western Australia, Perth, WA, Australia

    Christobel Saunders

  7. University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany

    Elena Sperk

  8. University Medical Center Freiburg, Freiburg, Germany

    Frederik Wenz

  9. Department of Clinical Oncology, University College London Hospitals, London, UK

    Jeffrey S. Tobias

Authors
  1. Jayant S. Vaidya
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  2. Max Bulsara
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  3. Michael Baum
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  4. Michael Alvarado
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  5. Marcelle Bernstein
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  6. Samuele Massarut
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  10. Jeffrey S. Tobias
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Consortia

the TARGIT-A investigators

  • Jayant S. Vaidya
  • , Max Bulsara
  • , Michael Baum
  • , Michael Alvarado
  • , Marcelle Bernstein
  • , Samuele Massarut
  • , Christobel Saunders
  • , Elena Sperk
  • , Frederik Wenz
  •  & Jeffrey S. Tobias

Corresponding author

Correspondence to Jayant S. Vaidya.

Ethics declarations

Competing interests

J.S.V. has received research funding and honoraria from Photoelectron Corp and Carl Zeiss and has received travel support from Carl Zeiss. M. Bulsara has received travel support from Carl Zeiss. M. Baum has served on the scientific advisory board, has acted as a consultant of and received travel support from Carl Zeiss. M.A. has received travel support from Carl Zeiss. M. Bernstein has received travel support from Carl Zeiss. S. M. has received travel support from Carl Zeiss. C.S. has received travel support from Carl Zeiss. E.S. has received honoraria and travel support from Carl Zeiss. F.W. has received research funding and travel support from Carl Zeiss. J.S.T. has received travel support from Carl Zeiss.

Additional information

Related links

Consent: Supported Decision-Making: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/consent/

Decision making and consent: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent

National and International Guidelines include TARGIT-IORT for breast cancer: https://www.targit.org.uk/targit-iort-in-guidelines

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Vaidya, J.S., Bulsara, M., Baum, M. et al. Intraoperative radiotherapy for breast cancer: powerful evidence to change practice. Nat Rev Clin Oncol 18, 187–188 (2021). https://doi.org/10.1038/s41571-021-00471-7

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