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Vaidya JS, Bulsara M, Baum M, et al. New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer. Br J Cancer. 2021;125(3):380-389doi: 10.1038/s41416-021-01440-8.
Vaidya, J. S., Bulsara, M., Baum, M., Wenz, F., Massarut, S., Pigorsch, S., Alvarado, M., Douek, M., Saunders, C., Flyger, H., Eiermann, W., Brew-Graves, C., Williams, N. R., Potyka, I., Roberts, N., Bernstein, M., Brown, D., Sperk, E., Laws, S., Sütterlin, M., Corica, T., Lundgren, S., Holmes, D., Vinante, L., Bozza, F., Pazos, M., Blanc-Onfroy, M. L., Gruber, G., Polkowski, W., Dedes, K. J., Niewald, M., Blohmer, J., McReady, D., Hoefer, R., Kelemen, P., Petralia, G., Falzon, M., Joseph, D., & Tobias, J. S. (2021). New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer. British journal of cancer, 125(3), 380-389. https://doi.org/10.1038/s41416-021-01440-8
Vaidya, Jayant S, et al. "New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer." British journal of cancer vol. 125,3 (2021): 380-389. doi: https://doi.org/10.1038/s41416-021-01440-8
Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, Alvarado M, Douek M, Saunders C, Flyger H, Eiermann W, Brew-Graves C, Williams NR, Potyka I, Roberts N, Bernstein M, Brown D, Sperk E, Laws S, Sütterlin M, Corica T, Lundgren S, Holmes D, Vinante L, Bozza F, Pazos M, Blanc-Onfroy ML, Gruber G, Polkowski W, Dedes KJ, Niewald M, Blohmer J, McReady D, Hoefer R, Kelemen P, Petralia G, Falzon M, Joseph D, Tobias JS. New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer. Br J Cancer. 2021 Aug;125(3):380-389. doi: 10.1038/s41416-021-01440-8. Epub 2021 May 25. PMID: 34035435; PMCID: PMC8329051.
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Br J Cancer. 2021 Aug;125(3):380-389. doi: 10.1038/s41416-021-01440-8. Epub 2021 May 25.

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer.

British journal of cancer

Jayant S Vaidya, Max Bulsara, Michael Baum, Frederik Wenz, Samuele Massarut, Steffi Pigorsch, Michael Alvarado, Michael Douek, Christobel Saunders, Henrik Flyger, Wolfgang Eiermann, Chris Brew-Graves, Norman R Williams, Ingrid Potyka, Nicholas Roberts, Marcelle Bernstein, Douglas Brown, Elena Sperk, Siobhan Laws, Marc Sütterlin, Tammy Corica, Steinar Lundgren, Dennis Holmes, Lorenzo Vinante, Fernando Bozza, Montserrat Pazos, Magali Le Blanc-Onfroy, Günther Gruber, Wojciech Polkowski, Konstantin J Dedes, Marcus Niewald, Jens Blohmer, David McReady, Richard Hoefer, Pond Kelemen, Gloria Petralia, Mary Falzon, David Joseph, Jeffrey S Tobias

Affiliations

  1. Division of Surgery and Interventional Science, University College London, London, UK. [email protected].
  2. Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia.
  3. Division of Surgery and Interventional Science, University College London, London, UK.
  4. Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
  5. Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
  6. Department of Radiation Oncology, Red Cross Hospital, Technical University of Munich, Munich, Germany.
  7. Department of Surgery, University of California, San Francisco, CA, USA.
  8. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
  9. School of Surgery, University of Western Australia, Perth, WA, Australia.
  10. Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark.
  11. Department of Gynecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany.
  12. Patient advocate and writer, London, UK.
  13. Department of Surgery, Ninewells Hospital, Dundee, UK.
  14. Department of Surgery, Royal Hampshire County Hospital, Winchester, UK.
  15. Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Berlin, Germany.
  16. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
  17. Department of Oncology, St Olav's University Hospital, & Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
  18. John Wayne Cancer Institute & Helen Rey Breast Cancer Foundation, University of Southern California, Los Angeles, CA, USA.
  19. Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
  20. Department of Surgery, Instituto Oncologico Veneto (IVO) IRCCS, Padoa, Italy.
  21. Department of Radiation Oncology, University Hospital, Ludwig Maximilians Universitat, Munich, Germany.
  22. Oncologie radiothérapeute, Institut de Cancérologie de l'Ouest, Nantes, France.
  23. Brust Zentrum Seefeld, Zurich, Switzerland.
  24. Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland.
  25. Breast Center, Universitätsspital Zürich, Zurich, Switzerland.
  26. Saarland University Medical Center, Homburg, Germany.
  27. Sankt Gertrauden-Krankenhaus, and The Charité-Universitätsmedizin Berlin, Berlin, Germany.
  28. Princess Margaret Cancer Centre, Toronto, Canada.
  29. Sentara Surgery Specialists, Hampton, VA, USA.
  30. Ashikari Breast Center, New York Medical College, New York, NY, USA.
  31. Department of Surgery, University College London Hospitals, London, UK.
  32. Department of Pathology University College London Hospitals, London, UK.
  33. Department of Clinical Oncology, University College London Hospitals, London, UK.

PMID: 34035435 PMCID: PMC8329051 DOI: 10.1038/s41416-021-01440-8

Abstract

BACKGROUND: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses.

METHODS: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT.

RESULTS: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091.

CONCLUSION: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect.

TRIAL REGISTRATION: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).

© 2021. The Author(s).

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