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

Bargalló-Rocha, Juan Enrique; Soto‐Pérez‐de‐Celis, Enrique; Picó-Guzmán, Francisco Javier; Quintero-Rodríguez, Carlos Eduardo; Almog, David; Santiago-Concha, Gabriel; Flores-Balcázar, Christian Haydeé; Corona, J.; Vázquez-Romo, Rafael; Villarreal‐Garza, Cynthia; Mohar, Alejandro

doi:10.1002/jso.24712

Cited by 14 publications

(3 citation statements)

References 22 publications

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“…We have previously shown that almost half of older adults with BC treated in Mexico present with stage III or IV disease and therefore are not candidates for treatment with upfront surgery followed by adjuvant chemotherapy or hormonal treatment [32]. Interestingly, in our study very few older women receiving NACT were treated with breast conservation, which may reflect both local surgical practices and patient barriers for accessing radiotherapy after breast‐conserving surgery, which may lead to the decision to perform mastectomy [33].…”

Section: Discussionmentioning

confidence: 72%

Real-World Outcomes Among Older Mexican Women with Breast Cancer Treated with Neoadjuvant Chemotherapy

et al. 2020

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Background. Older patients with breast cancer treated in high-income countries often present with early-stage disease, leading to a lack of information on the use of neoadjuvant chemotherapy in this population. We analyzed the real-world outcomes of older women with breast cancer treated with neoadjuvant chemotherapy at a single institution in Mexico. Materials and Methods. The study included 2,216 patients treated with neoadjuvant chemotherapy. Regarding achievement of pathologic complete response (defined as no invasive residual tumor in the breast and lymph nodes), 243 patients aged ≥65 years were compared with 1,973 patients aged <65 years. Disease-free survival and overall survival were compared between groups according to pathologic complete response and subtype, defined by hormone receptor and human epidermal growth receptor 2 (HER2) status. Results. Older women were less likely to have a pathologic complete response than their younger counterparts (26.3 vs. 35.3%, p < .001). When response rates by subtype were analyzed, this difference was significant only for women with triple-negative tumors. Achieving less than a pathologic complete response was associated with a greater chance of recurrence, but age was not an independent factor for recurrence for any subtype. Reaching a pathologic complete response was significantly associated with improved survival among older women with breast cancer, with the exception of those with hormone receptor-positive, HER2− disease. Conclusion. Although older women have fewer pathological complete responses, their outcomes after neoadjuvant chemotherapy are comparable to those of younger patients. This is particularly relevant for the treatment of older adults with breast cancer in developing countries, who present in advanced stages and more often need neoadjuvant therapy.

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Section: Discussionmentioning

confidence: 72%

Real-World Outcomes Among Older Mexican Women with Breast Cancer Treated with Neoadjuvant Chemotherapy

et al. 2020

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“…In many countries, patients live a considerable distance from the radiotherapy centre ( 31 , 36 , 37 ) and are more likely to receive a mastectomy than breast conservation ( 38 ). Even in the USA as recently as 2015, patients who lived farther away from the radiation facility (> 9.2 miles/19 min away by road) were 36%–44% more likely to receive a mastectomy than breast conservation ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Global adoption of single-shot targeted intraoperative radiotherapy (TARGIT-IORT) for breast cancer—better for patients, better for healthcare systems

Vaidya

Baum

et al. 2022

Front. Oncol.

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Micro abstractTargeted intraoperative radiotherapy (TARGIT-IORT) is delivered immediately after lumpectomy for breast cancer. We estimated its impact. At least 44,752 patients with breast cancer were treated with TARGIT-IORT in 260 centres in 35 countries, saving >20 million miles of travel and preventing ~2,000 non–breast cancer deaths. The TARGIT-IORT website (https://targit.org.uk/travel) provides maps and tools to find the nearest centre offering TARGIT-IORT and travel savings.BackgroundTargeted intraoperative radiotherapy (TARGIT-IORT) delivers radiotherapy targeted to the fresh tumour bed exposed immediately after lumpectomy for breast cancer. TARGIT-A trial found TARGIT-IORT to be as effective as whole-breast radiotherapy, with significantly fewer deaths from non–breast cancer causes. This paper documents its worldwide impact and provides interactive tools for clinicians and patients.MethodCentres using TARGIT-IORT provided the date of the first case and the total number of patients. We plotted these data on a customised Google Map. An interactive web-based tool provided directions to the closest centre. Using the data from the TARGIT-A trial, we estimated the total savings in travel miles, carbon footprint, and the number of non–breast cancer deaths that might be prevented.ResultsData from 242 (93%) of the 260 centres treating patients from 35 countries were available. From the first patient treated in 1998 to early 2020, at least 44,752 women with breast cancer have been treated with TARGIT-IORT. The TARGIT-IORT website (https://targit.org.uk/travel) displays the Google Map of centres with number of cases and an interactive tool for patients to find the nearest centre offering TARGIT-IORT and their travel savings. Scaling up to the already treated patients, >20 million miles of travel would have been saved and about 2,000 deaths prevented.ConclusionOne can ascertain the number of patients treated with a novel treatment. These data show how widely TARGIT-IORT has now been adopted and gives an indication of its beneficial worldwide impact on a large number of women with breast cancer.

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“…The international randomized phase III TARGIT-A trial confirmed the oncologic safety of IORT by demonstrating local recurrence rates to be non-inferior to those of standard WBI at 5 years (2, 5, 7). IORT's unique ability to spare the healthy tissue from radiation further decreases the risk of developing high-grade radiation-related toxicity (8–10).…”

Section: Introductionmentioning

confidence: 99%

A Prospective Analysis of Quality of Life and Toxicity Outcomes in Treating Early Breast Cancer With Breast Conservation Therapy and Intraoperative Radiation Therapy

et al. 2018

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Introduction: Intraoperative radiation therapy (IORT) is a minimally invasive radiation option for select patients with early stage breast cancer. This prospective, single institution, pilot study summarizes patient-reported quality of life (QoL) outcomes and clinician-reported toxicity following IORT following breast conservation therapy.Methods: Forty-nine patients were enrolled in a prospective study from 2013 until 2015 to assess QoL and toxicity following breast conservation therapy and IORT. Nine patients did not meet criteria for IORT alone on final pathology and required whole breast irradiation afterwards. These patients were evaluated separately. Validated QoL questionnaires were provided to patients at 1-week, 1-month, and subsequent 6-month intervals for 2 years. Radiation-related toxicity symptoms were evaluated by clinicians at the same time intervals. Likert scale responses were converted to continuous variables to depict patient-reported and clinician-reported outcomes.Results: Outcomes were analyzed as weighted averages of the Likert scale for each symptom. Responses for negative QoL symptoms ranged largely from 0 (none) to 2 (moderate). Responses for positive QoL symptoms ranged largely from 3 (quite a bit) to 4 (very much). Seventy-five percent of patients developed a toxicity; however, 99% of the toxicities were grades 1 and 2. All toxicities demonstrated a downward trend over time, with the exception of breast fibrosis and nodularity, which increased over time. There were no local recurrences upon 2-year follow up.Conclusion: Early stage breast cancer treated with IORT yields favorable QoL outcomes and minimal toxicity profiles with adequate short-term local control.

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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

Abstract: By reducing costs and time needed for patients to receive radiotherapy, IORT could potentially enhance access to breast conservation in resource-limited developing countries.

Cited by 14 publications

References 22 publications

Real-World Outcomes Among Older Mexican Women with Breast Cancer Treated with Neoadjuvant Chemotherapy

Real-World Outcomes Among Older Mexican Women with Breast Cancer Treated with Neoadjuvant Chemotherapy

Global adoption of single-shot targeted intraoperative radiotherapy (TARGIT-IORT) for breast cancer—better for patients, better for healthcare systems

A Prospective Analysis of Quality of Life and Toxicity Outcomes in Treating Early Breast Cancer With Breast Conservation Therapy and Intraoperative Radiation Therapy

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