Is IORT ready for roll-out?

Abstract

Two large randomised controlled trials of intraoperative radiotherapy (IORT) in breast-conserving surgery (TARGIT-A and ELIOT) have been published 14 years after their launch. Neither the TARGIT-A trial nor the ELIOT trial results have changed the current clinical practice for the use of IORT. The in-breast local recurrence rate (LRR) after IORT met the pre-specified non-inferiority margins in both trials and was 3.3% in TARGIT-A and 4.4% in the ELIOT trial. In both trials, the pre-specified estimates for local recurrence (LR) with external beam radiation therapy (EBRT) significantly overestimated actual LRR. In the TARGIT-A trial, LR with EBRT was estimated at the outset to be 6%, and in the ELIOT trial, it was estimated to be 3%. Surprisingly, LRR in the EBRT groups has been found to be significantly lower, 1.3% in the EBRT arm of the TARGIT-A and 0.4% in the EBRT arm of the ELIOT trial, respectively. Median follow-up was 2.4 years for the TARGIT-A trial and 5.8 years for the ELIOT trial. However, the initial cohort of patients in the TARGIT-A trial (reported in 2010) now have a median follow-up of 3.8 years and data on LR were available at 5 years follow-up on 35% of patients (18% who received IORT). Although further follow-up will increase confidence with the data, it will also further delay clinical implementation. By carefully weighing the risks and benefits of a single-fraction radiation treatment with patients, IORT should be offered within agreed and strict protocols. Patients deemed at low risk of LR or those deemed suitable for partial breast irradiation, according to the GEC-ESTRO and ASTRO recommendations, could be considered as candidates for IORT. These guidelines apply to all partial breast irradiation techniques, and more specific guidelines for IORT would assist clinicians.

The impact of the use of intraoperative radiotherapy on costs, travel time and distance for women with breast cancer in the Mexico City Metropolitan Area

“…Sixty-nine women treated with BCS and IORT during the selected time period were included in our analysis ( Table 1) Cost analysis for patients living both in the MCMA and outside the MCMA is presented in Although EBRT is the standard of care following BCS, many patients fail to receive it due to difficulties with transportation, and many choose to have a mastectomy to avoid it. 12 In order to address this problem, strategies aimed at shortening adjuvant radiotherapy, including IORT, have been developed. Two randomized clinical trials 13,14 found IORT was not-inferior to EBRT in carefully selected patients with low-risk disease.…”

“…Although EBRT is the standard of care following BCS, many patients fail to receive it due to difficulties with transportation, and many choose to have a mastectomy to avoid it . In order to address this problem, strategies aimed at shortening adjuvant radiotherapy, including IORT, have been developed.…”

Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure

“…Thus, in cases where the shape and position of the tumour bed is not simply accessible to the intended applicator, IOERT is not suitable. Finally, the IOERT facilities are much more expensive than low-kilovolt IORT devices 53 …”

The Role of Intraoperative Radiation Therapy in the Complex Treatment of Breast Cancer: The Current State of the Problem

“…ИОЛТ), представляющая собой воздействие на ложе опухоли радиацией в высоких дозах в качестве «буста» -ударной дозы облучения на область, которая соответствовала расположению опухолевого узла в молочной железе до выполненной резекции[13]. В основе так называемого буста лежит лучевое воздействие на оставшуюся часть молочной железы и регионарные зоны в суммарной очаговой дозе 2 Гр 5 раз в неделю (до 50 Гр на всю железу) и локальное воздействие на ложе резецированной опухоли в размере 10-16 Гр.…”