M Keshtgar

Targeted intraoperative radiotherapy for breast cancer in patients in whom external beam radiation is not possible.

PURPOSEnExternal beam radiation therapy (EBRT) following wide local excision of the primary tumor is the standard treatment in early breast cancer. In some circumstances this procedure is not possible or is contraindicated or difficult. The purpose of this study was to determine the safety and efficacy of targeted intraoperative radiotherapy (TARGIT) when EBRT is not feasible.nnnMETHODS AND MATERIALSnWe report our experience with TARGIT in three centers (Australia, Germany, and the United Kingdom) between 1999 and 2008. Patients at these centers received a single radiation dose of 20 Gy to the breast tissue in contact with the applicator (or 6 Gy at 1-cm distance), as they could not be given EBRT and were keen to avoid mastectomy.nnnRESULTSnEighty patients were treated with TARGIT. Reasons for using TARGIT were 21 patients had previously received EBRT, and 31 patients had clinical reasons such as systemic lupus erythematosus, motor neuron disease, Parkinsons disease, ankylosing spondylitis, morbid obesity, and cardiovascular or severe respiratory disease. Three of these patients received percutaneous radiotherapy without surgery; 28 patients were included for compelling personal reasons, usually on compassionate grounds. After a median follow-up of 38 months, only two local recurrences were observed, an annual local recurrence rate of 0.75% (95% confidence interval, 0.09%-2.70%).nnnCONCLUSIONSnWhile we await the results of the randomized trial (over 2,000 patients have already been recruited), TARGIT is an acceptable option but only in highly selected cases that cannot be recruited in the trial and in whom EBRT is not feasible/possible.

Quality Assurance and Training of Targeted Intraoperative Radiotherapy: Establishment of the TARGIT Academy

There is growing interest in accelerated partial breast irradiation, which aims to decrease the volume of breast treated and increase the daily fraction size of radiation. Of the available technologies, only two provide partial breast irradiation in the operating room during surgery, namely use of a mobile linear accelerator (http://www.intraopmedical.com/) and the novel technique of targeted intraoperative radiotherapy (TARGIT) using the INTRABEAM® system (Carl Zeiss Surgical, Oberkochen, Germany).