Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial

Vaidya, JS; Joseph, David; Tobias, Jeffrey; Bulsara, Max; Wenz, Frederik; Saunders, Christobel; Alvarado, Michael; Flyger, Henrik; Massarut, Samuele; Eiermann, W.; Keshtgar, Mohammed; Dewar, John; Kraus-Tiefenbacher, U.; Sütterlin, Marc; Esserman, Laura J.; Holtveg, Helle; Roncadin, M.; Pigorsch, Steffi; Metaxas, M; Falzon, Mary; Matthews, April M.; Corica, Tammy; Williams, Norman; Baum, Michael

doi:10.1016/s0140-6736(10)60837-9

Cited by 670 publications

(619 citation statements)

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“…28 Targeted intraoperative partial-breast RT is another innovative strategy that delivers a single fraction of RT to the tumor site at the time of BCS. 29 Finally, accelerated hypofractionated RT delivered over 3 weeks represents an attractive alternative to whole-breast RT after BCS. In a prospective randomized trial, Whelan et al reported that local recurrence rates at 10 years were not significantly different between accelerated, hypofractionated whole-breast RT and standard RT.…”

Section: Discussionmentioning

confidence: 99%

Omission of radiation therapy after breast‐conserving surgery in the United States

Tuttle

Jarosek

Habermann

et al. 2011

Cancer

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BACKGROUND: Radiation therapy (RT) after breast-conserving surgery (BCS) is associated with a significant reduction in ipsilateral breast tumor recurrence and breast cancer mortality rates in patients with early stage breast cancer. The authors of this report sought to determine which patients with breast cancer do not receive RT after BCS in the United States. METHODS: The Surveillance, Epidemiology, and End Results registry was used to determine the rates of RT after BCS for women with stage I through III breast cancer in the United States from 1992 through 2007. A multivariate analysis was performed to identify independent predictors of omission of RT. RESULTS: In total, 294,254 patients with invasive, nonmetastatic breast cancer were identified who underwent surgery from 1992 through 2007. Most patients (57%) underwent BCS; among those, 21.1% did not receive RT after BCS. The omission of RT increased significantly from 1992 (15.5%) to 2007 (25%). The receipt of RT also decreased significantly for patients with increased cancer stage, age <55 years, high-grade tumors, large tumors, positive or untested lymph node status, African American or Hispanic race, and negative or unknown estrogen receptor status. Significant geographic variation was observed in the rates of RT after BCS. CONCLUSIONS: The omission of RT after BCS was more common in recent years, especially among women who had an increased risk of breast cancer recurrence. This trend represents a serious health care concern because of the potential increased risk of local recurrence and breast cancer mortality.

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Section: Discussionmentioning

confidence: 99%

Omission of radiation therapy after breast‐conserving surgery in the United States

Tuttle

Jarosek

Habermann

et al. 2011

Cancer

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“…IORT means having a single fraction of RT, during the surgery, directly to the tumor bed in a single fraction [65,66]. The chief advantage of IORT is the delivery of radiation precisely to the operative bed at the time of surgery, without any prolonged treatment or additional invasive procedures.…”

Section: Intraoperative Radiotherapy (Iort):-mentioning

confidence: 99%

“…The data for four randomized trials [36,61,65,66] comparing WBI and APBI were partially presented (Table 4); so far the results regarding toxicity and efficacy have been mixed. …”

Section: Apbi: the Future:-mentioning

confidence: 99%

“…So recently, a novel handheld probe has been developed for intra-operative detection of positive margins to reduce re-excision rate and improve IORT technique [73]. The Targeted IORT (TARGIT-A), a randomized controlled has published data on 2,232 patients in whom intra-operative kilovotage (kV) x-rays were used to target 1 cm away from the lumpectomy cavity, compared with WBI with or without a boost [65]. Kilovoltage x-rays are considered to be more radiobiologically effective than the megavoltage x-rays used in traditional external beam RT; different forms of radiotherapy (RT) have invitro differential degrees of effect on such biologic endpoints as tumor cell kill or even damage to normal tissues, such as ribs [74] However, debate remains as to whether the dose prescribed is sufficient to provide tumor eradication ie equivalent to what is provided by WBI or other forms of APBI.…”

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confidence: 99%

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Accelerated Partial-Breast Irradiation: A State of the Art Strategy.

Hamoud¹,

Ghorbel²,

Falfali³

et al. 2017

IJAR

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Breast conservative surgery, partial breast irradiation, whole breast irradiation, , cosmetic results, Brachytherapy Breast-conserving therapy consists of wide local excision (WLE) followed by whole-breast irradiation (WBI).It is already widely accepted as an alternative to mastectomy. It is used for the treatment of patients with early-stage breast cancer. Accelerated partial-breast irradiation (APBI) is a new strategy. It is characterized by being shorter & an alternative radiation technique for a highly selected patients with favorable early-stage breast cancer. The objective of this review article is to analyze different modalities of APBI delivery and discuss the possible benefits and harms associated with this new platform. …………………………………………………………………………………………………….... Introduction:-Breast cancer has the highest incidence among all cancers in female. In early-stage breast cancer (stage ≤ II), the use of breast-conserving therapy (BCT) is a well-established treatment option. It is comparable to total mastectomy with good results as far as rates of local-regional control and overall survival. It enables patients to maintain their breasts with an acceptable cosmetic results [1]. In the initial trials regarding BCT that were done in the 1970s and 1980s, the new strategy typically involved segmental mastectomy with level I & II axillary lymph node dissection, followed by whole-breast irradiation (WBI). Radiation therapy (RT) is given with a dose of 45-50 Gy over the course of 5 weeks, with or without a boost to the tumor bed. WBI is a relatively well-tolerated treatment. This modality has resulted in good long-term cosmetic results, with low rates of treatment-associated morbidity. The Early Breast Cancer Trialists' Collaborative Group in their meta-analysis has demonstrated that the addition of radiation therapy (RT) to breast-conserving surgery has improved not only local-regional control, but also long-term overall survival [2]. In accelerated partial breast irradiation (APBI) a limited volume of breast tissue is irradiated. This includes tumor bed, lumpectomy or wide local excision with safety margins. It is delivered over a short period of time with increasing the fraction dose. Changing the strategy from whole breast irradiation to a small target (only part of the breast) as in APBI needs full investigation & scrutiny not only because of potential changes in local control but also for its possible impact on the overall survival . Aim of This Review:-Despite of the presence of advanced studies, the role, indication and the optimum APBI technique are still yet to be clearly identified. Therefore, in this review, we will try to find an answer for a number of controversial issues for better identification of the following:

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“…PBI with TARGIT-IORT within a risk-adapted approach has the convenience of being completed at the time of lumpectomy, has lower acute and late toxicity [1][2][3] , is preferred by patients 4 5 , improves cosmesis and quality of life 6 7 , is less expensive 8 9 , and reduces environmental and social costs 10 . Common sense would dictate that it should become an accepted treatment option for suitable patients world-wide.…”

mentioning

confidence: 99%