Nr Williams

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.

Breast cancer patients treated with intra-operative radiotherapy alone when conventional external beam radiation therapy was not possible

Background: Intra-operative radiotherapy (IORT) with Intrabeam system has been piloted since 1998 and used in the randomised TARGIT International trial since 2000. Some patients are suitable for off-trial therapy, particularly where external beam radiotherapy (EBRT) cannot be offered due to various reasons. Methods: Patients with invasive breast cancer underwent wide local excision followed by IORT (n=75) using the Intrabeam system containing a miniature electron gun and accelerator. Low energy x-rays (50kV) are emitted from the point source, delivering 20Gy to the breast tissue at the surface of the tumour bed using a spherical applicator (Figure 1). The procedure can be performed in an unmodified operating theatre. Patients who were deemed unfit for surgery received interstitial radiotherapy alone using Intrabeam, with only the point source placed at the tumour centre under stereo-guidance under local anaesthetic, and were followed up with serial MRI scans. Results: Over the past 7 years 78 patients have been treated in this way in centres in 3 countries (UK, Germany and Australia). To date there have been no local recurrences. One patient developed a second primary and subsequently died of brain metastases (Table). Conclusions: This cohort adds to the evidence that targeted radiotherapy using Intrabeam (either IORT or interstitial) could offer a safe and effective method of delivering radiotherapy to breast cancer patients in whom EBRT is not an option. Patients who are suitable for either EBRT or IORT can participate in the TARGIT Trial (Figure 2). Table