Early-stage breast cancer
Using IORT as a versatile single-dose or boost treatment
[...] TARGIT-IORT is not only an effective but can be in many ways a better treatment for early stage breast cancer patients. Every hospital where breast cancer surgery is performed should offer this form of radiation treatment to their breast cancer patients. [...] It should be considered the new standard of treatment for early stage breast cancer [...]
IORT is a favorable clinical, cost-effective and more sustainable treatment option for global healthcare systems compared to the standard of care
Besides the depicted medical effectiveness IORT also has a very positive societal effect, as it helps to substantially reduce the burden for patients, the overall and real treatment costs compared to EBRT by more than 50% while demonstrating an increased QALY value compared to the current standard of care.11,12 Therefore, it enables care-givers to free-up hospital resources for selected patients to increase the overall patient throughput in the radiotherapy department.
Summarizing, IORT offers a significantly more sustainable radiotherapy option compared to the standard of care due to less waste, use of power and travel times11,13 and demonstrates treatment effectiveness without heterogenity between countries and healthcare systems1, a true value-add for every healthcare provider.
Single dose intra-operative radiotherapy for early stage breast cancer can be a better alternative to conventional whole breast radiotherapy for most patients during primary tumor management.
IORT sustainability effect for eligible breast cancer patients annual, area-wide use in UK
carbon emissions lowered by 1,200 tonnes
(equivalent to 100 hectaes of forest)13
170,000 hours of lifetime saved
(can be used instead for childcare, volunteer work, or paid work for example)13
8 million fewer commuting kilometers
(traveling to clinic)13
These excellent results provide real clinical justification for single intraoperative radiation in suitable patients with early breast cancer. It is now essential to develop the corresponding treatment guidelines as soon as possible.
Vaidya, J. S., et al. (2020). Long-term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. BMJ, 370, m2836. https://doi.org/10.1136/bmj.m2836
Linares-Galiana, I., et al. (2021). Changes in peripheral immune cells after intraoperative radiation therapy in low-risk breast cancer. J Radiat Res. 2021 Jan 1;62(1):110-118. doi: 10.1093/jrr/rraa083.
Fabris, L., et al. (2016). Radiotherapy-induced miR-223 prevents relapse of breast cancer by targeting the EGF pathway. Oncogene 35, 4914–4926 doi:10.1038/onc.2016.23
Belletti, B., et al. (2008). Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res 14(5):1325–32. doi:10.1158/1078-0432.CCR-07-4453
Kolberg, H-C., et al. (2022). Breast preservation after local recurrence of breast cancer: Comparison of length and quality of life (QoL) between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy. Journal of Clinical Oncology 2022 40:16_suppl, e12573-e12573.
Stefanovic, S., et al. (2021). Cardiac serum marker alterations after intraoperative radiotherapy with low-energy x-rays in early breast cancer as an indicator of possible cardiac toxicity. Strahlenther Onkol. 2021 Jan;197(1):39-47. doi: 10.1007/s00066-020-01671-3.
Kolberg, H-C., et al. (2022). Impact of targeted intraoperative (TARGIT-IORT) tumor bed boost during breast conserving surgery for early breast cancer on breast cancer and non-breast cancer associated mortality and morbidity. Cancer Res (2022) 82 (4_Supplement): P3-19-16. https://doi.org/10.1158/1538-7445.SABCS21-P3-19-16
Corica, T., et al. (2018). Cosmetic outcome as rated by patients, doctors, nurses and BCCT. core software assessed over 5 years in a subset of patients in the TARGIT-A Trial. Radiation Oncology (2018) 13:68. https://doi.org/10.1186/s13014-018-0998-x
Keshtgar, M. R., et al. (2013) Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Research and Treatment 140, pages 519–525, doi.org/10.1007/s10549-013-2641-8
Welzel, G., et al. (2013) Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A. Radiation Oncology Journal 8, 9. doi.org/10.1186/1748-717X-8-9
Vaidya, J. S., et al. (2017). Health economics of targeted intraoperative radiotherapy (TARGIT- IORT) for early breast cancer: a cost- effectiveness analysis in the United Kingdom. BMJ Open 7: e014944. doi:10.1136/bmjopen-2016-014944
Monten, C., et al. (2017). Adjuvant breast radiotherapy: How to trade-off cost and effectiveness?. Radiother Oncol, https://doi.org/10.1016/j.radonc.2017.11.005
Coombs, N. J., et al. (2016). Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORTBMJ Open 2016;6:e010703. doi: 10.1136/bmjopen-2015-010703
Vaidya, J. S., et al. (2010). Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet, 376(9735), 91–102. https://doi.org/10.1016/S0140-6736(10)60837-9
Vaidya, J. S., et al. (2011). Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery. International journal of radiation oncology, biology, physics, 81(4), 1091–1097. https://doi.org/10.1016/j.ijrobp.2010.07.1996
Kolberg, H-C., et al. (2017). Targeted intraoperative radiotherapy tumour bed boost during breast conserving surgery after neoadjuvant chemotherapy – a subgroup analysis of hormone receptor-positive HER2-negative breast cancer. Breast Care 12:318–323. DOI:10.1159/000479424.