TARGIT-R (Retrospective): 5-Year Follow-Up Evaluation of Intraoperative Radiation Therapy (IORT) for Breast Cancer Performed in North America

Valente, Stephanie A.; Tendulkar, Rahul D.; Cherian, Sheen; Shah, Chirag; Ross, Darrel L.; Lottich, S. Chace; Laronga, Christine; Broman, Kristy Kummerow; Donnelly, Eric D.; Bethke, Kevin P.; Shaw, Christina; Lockney, Natalie A.; Pederson, Aaron; Rudolph, Ray; Hasselle, Michael D.; Kelemen, Pond R.; Hermanto, Ulrich; Ashikari, Andrew Y.; Kang, Sung-Jun; Hoefer, Richard; McCready, David R.; Fyles, Anthony; Escallon, Jamie; Rohatgi, Nitin; Graves, Jeannine; Graves, Gregory M.; Willey, Shawna C.; Tousimis, Eleni; Riley, Lee B.; Deb, Nimisha; Tu, Chao; Small, William; Grobmyer, Stephen R.

doi:10.1245/s10434-020-09432-3

Cited by 33 publications

(28 citation statements)

References 36 publications

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“…TARGIT R, a nonrandomized IORT study that included 667 patients from 12 institutions with a median follow-up of 5.1 years, 24 , 25 reported a 5-year local recurrence probability of 8.0% for those who received IORT alone versus 1.7% for those who received IORT plus WBRT; 25.5% of TARGIT R patients received supplemental WBRT. When both groups were combined, the probability of local recurrence for all patients was 6.6%.…”

Section: Discussionmentioning

confidence: 99%

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Recurrence and Survival Rates for 1400 Early Breast Tumors Treated with Intraoperative Radiation Therapy (IORT)

et al. 2022

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Introduction Intraoperative radiotherapy (IORT) permits accurate delivery of radiation therapy directly to the tumor bed. We report local, regional, and distant recurrence data along with overall and breast cancer-specific survival for 1400 tumors treated with x-ray IORT. Methods A total of 1367 patients with 1400 distinct tumors were enrolled in a registry trial. All received breast conservation surgery and low-energy 50 kV x-ray IORT. To be eligible for excision plus IORT as the only local treatment, histopathology had to confirm tumor size ≤30 mm, margins ≥2 mm, negative lymph nodes, and no extensive lymphovascular invasion. Patients who failed any parameters were referred for additional surgery and/or whole breast radiation therapy (WBRT). Results There were 64 ipsilateral local recurrences, 60 were in the IORT only group, 7 axillary recurrences, and 7 distant recurrences. Forty-one local recurrences were within the same quadrant as the index cancer. Twenty-three were in different quadrants. With 62 months of median follow-up, the 5-year Kaplan–Meier probability of any event for all 1400 tumors was 5.27%. For 1175 patients who received IORT only, it was 5.98%. For favorable subtypes, it ranged from 2.41 to 4.31%. Multivariate analysis revealed that biologic subtype luminal A and the addition of WBRT significantly reduced the risk of local recurrence. Conclusions The local, regional, and distant recurrence rates observed were comparable to those reported in the literature for IORT but higher than those reported for standard forms of WBRT, hypofractionated treatment, or APBI. IORT benefits include convenience, decreased exposure to medical environments, and low complication rates.

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Section: Discussionmentioning

confidence: 99%

“…Of our patients, 11.9% received supplemental WBRT compared with 26.8% for TARGIT A (immediate treatment group), 25.5% for TARGIT R, and 5% for ELIOT. 12 – 14 , 25 …”

Section: Discussionmentioning

confidence: 99%

Recurrence and Survival Rates for 1400 Early Breast Tumors Treated with Intraoperative Radiation Therapy (IORT)

et al. 2022

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“…After full-text scrutinization, 35 of them were further omitted for the following reasons: (1) no provision of the 5-year outcomes in 15 potential articles for calculating the weighted average proportion; (2) no application of a 10-16 Gy boost to the patient in 13 potential studies for calculating the weighted average proportion in the WBI cohort; (4) no usage of a single dose of 21 Gy in five potential studies for calculating the weighted average proportion in the IORT cohort; and (5) 2 articles with other reasons. Ultimately, 38 articles with 30,225 early breast cancer patients were involved (9-12, 15-20, 26-53), in which 18 exclusively analyzed the 5-year oncological efficacy in the WBI cohort (15,16,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41), 9 exclusively analyzed that in the IORT cohort (9,12,17,(42)(43)(44)(45)(46)(47), and 11 compared the oncological efficacy between the cohorts (10,11,(18)(19)(20)(48)(49)(50)(51)(52)(53). Three of the 11 studies for the comparative meta-analysis had the available data to calculate the weighted average 5-year oncological efficacy in the non-comparative meta-analysis (10,…”

Section: Literature Searchmentioning

confidence: 99%

“…Six (10,17,18,20,42,46) and 12 (10, 15, 18, 20, 26-30, 33, 36, 40) studies were respectively involved for the analysis of the weighted average 5-year DMFS rates in the IORT cohort and the WBI cohort. Our pooled result showed that the weighted average 5-year DMFS rate in the IORT cohort (96.6% [95% CI, 94.3-98.9%]) outnumbered that in the WBI cohort (94.9% [95% CI, 92.2-97.6%]) (Table 3).…”

Section: Dmfsmentioning

confidence: 99%

Comparison of the Oncological Efficacy Between Intraoperative Radiotherapy With Whole-Breast Irradiation for Early Breast Cancer: A Meta-Analysis

He¹,

Zhou²,

Qi³

et al. 2021

Front. Oncol.

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BackgroundIntraoperative radiotherapy (IORT) and whole-breast irradiation (WBI) are both effective radiotherapeutic interventions for early breast cancer patients undergoing breast-conserving surgery; however, an issue on whether which one can entail the better prognosis is still controversial. Our study aimed to investigate the 5-year oncological efficacy of the IORT cohort and the WBI cohort, respectively, and compare the oncological efficacy between the cohorts.Materials and MethodsWe conducted a computerized retrieval to identify English published articles between 2000 and 2021 in the PubMed, the Web of Science, the Cochrane Library, and APA PsycInfo databases. Screening, data extraction, and quality assessment were performed in duplicate.ResultsA total of 38 studies were eligible, with 30,225 analyzed participants. A non-comparative binary meta-analysis was performed to calculate the weighted average 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) in the two cohorts, respectively. The LRFS, DMFS, and OS (without restriction on the 5-year outcomes) between the two cohorts were further investigated by a comparative binary meta-analysis. The weighted average 5-year LRFS, DMFS, and OS in the IORT cohort were 96.3, 96.6, and 94.1%, respectively, and in the WBI cohort were 98.0, 94.9, and 94.9%, respectively. Our pooled results indicated that the LRFS in the IORT cohort was significantly lower than that in the WBI cohort (pooled odds ratio [OR] = 2.36; 95% confidential interval [CI], 1.66–3.36). Nevertheless, the comparisons of DMFS (pooled OR = 1.00; 95% CI, 0.76–1.31), and OS (pooled OR = 0.95; 95% CI, 0.79–1.14) between the IORT cohort with the WBI cohort were both not statistically significant.ConclusionsDespite the drastically high 5-year oncological efficacy in both cohorts, the LRFS in the IORT cohort is significantly poorer than that in the WBI cohort, and DMFS and OS do not differ between cohorts.

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“…The sole use of IORT as a substitute for WBI was critically questioned. The current data demonstrate a tendency for higher local recurrence rates; therefore, the authors recommend critical patient selection for the use of IORT alone when omitting WBI [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative radiotherapy boost as part of breast-conservation therapy for breast cancer: a single-institution retrospective analysis

et al. 2021

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Background There are currently no data from randomized controlled trials on the use of intraoperative radiotherapy (IORT) as a tumor bed boost as part of a breast-conservation approach for breast cancer. This study retrospectively reviewed the safety and efficacy of IORT as a boost treatment at a tertiary cancer center. Methods From 2015 to 2019, patients underwent breast-conserving surgery with axillary lymph node staging and a single dose of 20 Gy IORT with 50-kV photons, followed by whole-breast irradiation (WBI) and adjuvant systemic therapy (if applicable). Patients were followed for assessment of acute and late toxicities (using the Common Terminology Criteria for Adverse Events version 5.0) at 3–6-month intervals. Outcomes included ipsilateral (IBTR) and contralateral breast progression-free survival (CBE), distant metastasis-free survival (DMFS), and overall survival (OS). Results Median follow-up for the 214 patients was 28 (range 2–59) months. Most patients had T1 disease (n = 124) and were clinically node negative. Only few patients had high-grade and/or triple-negative disease. The vast majority of patients underwent sentinel node biopsy, and 32 (15%) required re-resection for initially positive margins. Finally, all tumor bed margins were clear. Nine (4.2%) and 48 (22.4%) patients underwent neoadjuvant and adjuvant chemotherapy, respectively. WBI was predominantly performed as conventionally fractionated WBI (n = 187, 87.4%), and the median time from BCS to WBI was 54.5 days. IORT was delivered with a single dose of 20 Gy. The median WBI dose was 50 Gy (range 29.4–50.4 Gy). No patients experienced grade 4 events; acute grade 3 toxicities were limited to 17 (8%) cases of radiation dermatitis. Postoperative toxicities were mild. After WBI only one case of late grade ≥ 2 events was reported. There were two recurrences in the tumor bed and one contralateral breast event. Conclusion This investigation provides additional preliminary data supporting the using of IORT in the boost setting and corroborates the existing literature. These encouraging results should be prospectively validated by the eventual publication of randomized studies such as TARGIT‑B.

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TARGIT-R (Retrospective): 5-Year Follow-Up Evaluation of Intraoperative Radiation Therapy (IORT) for Breast Cancer Performed in North America

Cited by 33 publications

References 36 publications

Recurrence and Survival Rates for 1400 Early Breast Tumors Treated with Intraoperative Radiation Therapy (IORT)

Recurrence and Survival Rates for 1400 Early Breast Tumors Treated with Intraoperative Radiation Therapy (IORT)

Comparison of the Oncological Efficacy Between Intraoperative Radiotherapy With Whole-Breast Irradiation for Early Breast Cancer: A Meta-Analysis

Intraoperative radiotherapy boost as part of breast-conservation therapy for breast cancer: a single-institution retrospective analysis

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